More than 600,000 elderly Americans live in assisted-living facilities (ALFs), with that number growing by 15 to 20 percent each year. Unfortunately, little research has been done on how living in these facilities affects residents' emotional and mental well-being. The few existing studies suggest that elderly persons in residential care are prone to depression, and that this depression has an adverse effect on health. Hoping to shed light on the factors influencing psychological well-being among elderly living in ALFs, Dr. Sherry Cummings, University of Tennessee, Nashville, interviewed 57 residents of an assisted living facility in the southeastern United States. The interview questions measured a range of variables, including depression, life satisfaction, functional status, perceived health, perceived social support, and participation in activities. Although the majority of residents reported reasonable satisfaction with their lives, a significant minority--nearly 20%--of residents reported dissatisfaction and exhibited symptoms of depression.

Examining the variables, Dr. Cummings found that increased functional impairment, poor health, female gender, and perceived lack of social support were linked to higher rates of depression. However, social support emerged as the most significant variable. When residents reported high levels of social support, gender as well as functional impairment and other health measures were no longer significantly linked to depression.

Implications for Social Work
Although the study was small and limited to well-educated, white older adults, it suggests that efforts to improve social support in ALFs could help reduce rates of depression among residents. This includes not only providing activities for residents, but also encouraging relationship-building among residents and between residents and staff.

In addition, the high prevalence of depression among ALF residents highlights a need for more mental health services. Social workers employed at the policy level should advocate for the incorporation of mental health screening and treatment into state ALF regulations. Currently, very few ALFs screen residents for mental health problems besides dementia, and only 16 states require that information about emotional and mental health be included in training programs for ALF staff.

Social workers employed by ALFs can help improve care by developing training programs for staff, screening new residents for depression, encouraging residents to form social ties, and linking residents with local mental health services. Finally, social workers active in clinical research should conduct further investigations into the factors affecting the psychological well-being of ALF residents to provide policymakers and ALF corporations with additional data on which to base policy decisions.