Today's nursing homes are much improved from years past, with larger rooms, visits from pets, even gardens. Still, for many elderly people, the move to a nursing home represents the end of the road and a loss of independence. It's a place you go to die.

Such thoughts can lead to depression, ranging from mild to chronic, which affects approximately 40% of nursing home residents, according to the American Geriatrics Society. Despite its prevalence, few elders in nursing homes will openly admit that they are depressed. That means in many cases, the family must look for the warning signs, which can be subtle: Dad isn't quite as chatty and social as he once was. Mom just picks at her meals.

So depression often goes undiagnosed and untreated — or treated as a "normal" part of aging. Because the signs of depression can mirror the signs of dementia, especially problems with focusing and concentrating, diagnosing depression in an older adult can be difficult.

Kenneth M. Sakauye, a geriatric psychiatrist at UT Medical Group in Memphis, Tenn., says getting to the root cause of depression is key. "Depression can have a biological cause or a psychological cause," Dr. Sakauye told While medication or therapy or both could be prescribed for any patient with depression, knowing the cause can lead to more effective treatment.

For example, Dr. Sakauye says that after a stroke, 50% of people develop depression. He explained that brain changes caused by Alzheimer's, such as decreased blood flow, can result in a sort of vascular depression. If the cause is a biological factor like this, medication may be more effective than therapy because it treats the chemical imbalance.

On the other hand, if depression is mild and caused by psychological factors, such as lack of socialization and stimulation, therapy could be more helpful. "Elderly patients often say the best times of their lives are over," Dr. Sakauye explains. "They were forced to move from home. They feel as if they don't have anything left to live for."

These people can benefit from talking to a professional therapist as well as lifestyle changes such as socialization, stimulation, exercise and bright lights.

Involving the family in therapy sessions can be helpful. "It's up to the patient," Dr. Sakauye says. "Most won't come in without their family."

But what role should family play: active participant or passive listener? "They are there as observers," he says. "It's not traditional family therapy. The family is in a support role."

Dr. Sakauye typically engages the family at the end of the session, and recommends they only speak when asked during sessions. Afterward, the family can help implement the therapy plan, such as reminding the elder of assignments, like joining a group at the nursing home, or taking a walk outside every day.

Here are other ways for caregivers to help their depressed loved ones, according to Dr. Sakauye :

Encourage social interaction. Being around others with similar interests and life experiences is therapeutic. Nursing homes provide plenty of opportunities for friendships and personal connections.

Browse Our Free Senior Care Guides

Help your loved one find a hobby. Boredom and lack of purpose in life can contribute to depression. A hobby like gardening or playing cards is stimulating, keeps the brain active and encourages interactions with like-minded people. Most nursing homes have a daily calendar of activities for a variety of interests and ability levels.

Talk openly. Your loved one may want to talk, but may not know how to start the conversation. Bring up emotional topics and open the door for sharing feelings, but don't force it. Let your parent know it's okay to talk to someone else besides you if it's more comfortable, such as a therapist, a nurse with whom a special bond has been formed or a neighbor who has become a trusted friend.

Enhance the environment. Making your loved one's room feel like home can improve mood. Add personal touches like plants, favorite keepsakes, comfortable furniture and family photos – whatever makes the space feel like home.

Encourage exercise. Even mild exercise like walking has psychological benefits. Suggest activities based on your loved one's physical abilities. Even elders who can't exercise due to physical limitations can go outside and benefit from the fresh air and light.

Make sure all medications are taken as instructed. Even if your loved one starts to feel better, make sure he or she takes all prescribed medications until the doctor gives the okay to stop.

Advocate for your loved one. Request that the nursing home staff conduct regular check-ups and care plans to address your loved one's depression.