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Depression in nursing homes

Published online by Cambridge University Press:  03 August 2010

John Snowdon
John Snowdon*
Affiliation:
Sydney Medical School and Concord Hospital, Sydney, Australia
*
Correspondence should be addressed to: Clinical Professor John Snowdon, Sydney Medical School, Jara Unit, Concord Hospital, Sydney, NSW 2139, Australia. Phone: +61-2-97675000; Fax: +61-2-97678951. Email: jsnowdon@mail.usyd.edu.au.
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Abstract

Background: Although studies have shown the prevalence of depression in nursing homes to be high, under-recognition of depression in these facilities is widespread. Use of screening tests to enhance detection of depressive symptoms has been recommended.

Methods: This paper aims to provoke discussion about optimal management of depression in nursing homes. The utility of the Cornell Scale for Depression in Dementia (CSDD) is considered. CSDD data relating to residents assessed in 2008–2009 were collected from three Sydney nursing homes.

Results: CSDD scores were available from 162 residents, though raters stated they were unable to score participants on at least one item in 47 cases. Scores of 13 or more were recorded for 23% of residents in these facilities, but in most of these cases little was documented in case files to show that the results had been discussed by staff, or that they led to interventions, or that follow-up testing was arranged.

Conclusions: Results of CSDD testing should prompt care staff (including doctors) to consider causation of depression in cases where residents are identified as possibly depressed. In particular, there needs to be discussion of how to help residents to cope with disability, losses, and feelings of powerlessness. Research is needed, examining factors that might predict response to antidepressants, and what else helps. Accreditation of nursing homes could be made to depend partly on evidence that staff regularly search for, and (if found) ensure appropriate responses to, depression.

Keywords

screeningCornell Scalecausative factorsdiagnosisnursing staff
Type
Review Article
Information
International Psychogeriatrics , Volume 22 , Special Issue 7: Focus on mental health issues in long-term-care homes , November 2010 , pp. 1143 - 1148
Copyright
Copyright © International Psychogeriatric Association 2010

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References

Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271–284.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: American Psychiatric Press.Google Scholar
American Geriatrics Society and American Association for Geriatric Psychiatry (2003). The American Geriatrics Society and American Association for Geriatric Psychiatry recommendations for policies in support of quality mental health care in U.S. nursing homes. Journal of the American Geriatrics Society, 51, 1299–1304.CrossRefGoogle Scholar
Bagley, H. et al. (2000). Recognition of depression by staff in nursing and residential homes. Journal of Clinical Nursing, 9, 445–450.CrossRefGoogle ScholarPubMed
Bains, J., Birks, J. and Dening, T. (2002). Antidepressants for treating depression in dementia. The Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD003944. doi: 10.1002/14651858.CD003944CrossRefGoogle Scholar
Barca, M. L., Selbaek, G., Laks, J. and Engedal, K. (2008). The pattern of depressive symptoms and factor analysis of the Cornell Scale among patients in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 23, 1058–1065.CrossRefGoogle ScholarPubMed
Barca, M. L., Selbaek, G., Laks, J. and Engedal, K. (2009). Factors associated with depression in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 24, 417–425.CrossRefGoogle ScholarPubMed
Bharucha, A. J., Dew, M. A., Miller, M. D., Borson, S. and Reynolds, C. (2006). Psychotherapy in long-term care: a review. Journal of the American Medical Directors Association, 7, 568–580.CrossRefGoogle ScholarPubMed
Blanchard, M., Serfaty, M., Duckett, S. and Flatley, M. (2009). Adapting services for a changing society: a reintegrative model for Old Age Psychiatry (based on a model proposed by Knight and Emanuel, 2007). International Journal of Geriatric Psychiatry, 24, 202–206.CrossRefGoogle Scholar
Blazer, D. G. (1994). Epidemiology of late-life depression. In Schneider, L. S., Reynolds, C. F., Lebowitz, B. D. and Friedhoff, A. J. (eds.), Diagnosis and Treatment of Depression in Late Life (pp.9–19). Washington, DC: American Psychiatric Press.Google Scholar
Borson, S. and Fletcher, P. M. (1996). Mood disorders. In Reichman, W. E. and Katz, P. R. (eds.), Psychiatric Care in the Nursing Home (pp. 67–93). Oxford: Oxford University Press.Google Scholar
Boyle, V. L., Roychoudbury, C., Beniak, R., Cohn, L., Bayer, A. and Katz, I. (2004). Recognition and management of depression in skilled-nursing and long-term care settings: evolving targets for quality improvement. American Journal of Geriatric Psychiatry, 12, 288–295.CrossRefGoogle ScholarPubMed
Burrows, A. B., Morris, J. N., Simon, S. E., Hirdes, J. P. and Phillips, C. (1995). Development of a Minimum Data Set-based depression rating scale for use in nursing homes. Age and Ageing, 29, 165–172.CrossRefGoogle Scholar
Cohen, C. I., Hyland, K. and Kimhy, D. (2003). The utility of mandatory depression screening of dementia patients in nursing homes. American Journal of Psychiatry, 160, 2012–2017.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 44, 2308–2314.CrossRefGoogle Scholar
Dening, T. and Bains, J. (2004). Mental health services for residents of care homes. Age and Ageing, 33, 1–2.CrossRefGoogle ScholarPubMed
Gruber-Baldini, A. L., Zimmerman, S., Boustani, M., Watson, L. C., Williams, C. S. and Reed, P. S. (2005). Characteristics associated with depression in long-term care residents with dementia. Gerontologist, 45 (special issue 1), 50–55.CrossRefGoogle ScholarPubMed
Jang, Y., Haley, W. E., Small, B. J. and Mortimer, J. A. (2002). The role of mastery and social resources in the association between disability and depression in later life. Gerontologist, 42, 807–813.CrossRefGoogle ScholarPubMed
Kurlowicz, L. H., Evans, L. K., Strumpf, N. E. and Maislin, G. (2002). A psychometric evaluation of the Cornell Scale for Depression in Dementia in a frail, nursing home population. American Journal of Geriatric Psychiatry, 10, 600–608.CrossRefGoogle Scholar
Nelson, J. C., Holden, K., Roose, S., Salzman, C., Hollander, S. B. and Betzel, J. V. (2007). Are there predictors of outcome in depressed elderly nursing home residents during treatment with mirtazapine orally disintegrating tablets? International Journal of Geriatric Psychiatry, 22, 999–1003.CrossRefGoogle ScholarPubMed
Olin, J. T., Katz, I. R., Meyers, B. S., Schneider, L. S. and Lebowitz, B. D. (2002). Provisional diagnostic criteria for Depression of Alzheimer Disease. American Journal of Geriatric Psychiatry, 10, 129–141.CrossRefGoogle ScholarPubMed
Payne, J. L. et al. (2002). Incidence, prevalence, and outcomes of depression in residents of a long-term care facility with dementia. International Journal of Geriatric Psychiatry, 17, 247–253.CrossRefGoogle ScholarPubMed
Pollock, B. G. (2008). Are antidepressants “unnecessary medications” or is this a case of overzealous regulation? Geriatric Psychiatry News, November/December, 2.Google Scholar
Scocco, P., Rapattoni, M. and Fantoni, G. (2006). Nursing home institutionalization: a source of eustress or distress for the elderly? International Journal of Geriatric Psychiatry, 21, 281–287.CrossRefGoogle ScholarPubMed
Smalbrugge, M. S., Jongenelis, L., Pot, A. M., Efsting, J. A., Ribbe, M. W. and Beekman, A. T. F. (2006). Incidence and outcome of depressive symptoms in nursing home patients in the Netherlands. American Journal of Geriatric Psychiatry, 14, 1069–1076.CrossRefGoogle ScholarPubMed
Snowdon, J. (2009). Depression in long-term care facilities: recognition and intervention. Presentation at the International Psychogeriatric Association congress in Montreal. International Psychogeriatrics, 21 (Suppl. 2), S24.Google Scholar
Snowdon, J. and Fleming, R. (2008). Recognising depression in residential facilities: an Australian challenge. International Journal of Geriatric Psychiatry, 23, 295–300.CrossRefGoogle ScholarPubMed
Snowdon, J., Rosengren, D., Daniel, F. and Suyasa, M. (2010). Australia's use of the Cornell Scale to screen for depression in nursing homes. Australasian Journal on Ageing. In press.Google Scholar
Teresi, J., Abrams, R., Holmes, D., Ramirez, M. and Eimicke, J. (2001). Prevalence of depression and depression recognition in nursing homes. Social Psychiatry and Psychiatric Epidemiology, 36, 613–620.CrossRefGoogle ScholarPubMed
Thompson, S., Herrmann, N., Rapoport, M. J. and Lanctôt, K. L. (2007). Efficacy and safety of antidepressants for treatment of depression in Alzheimer's disease: a meta-analysis. Canadian Journal of Psychiatry, 52, 248–255.CrossRefGoogle Scholar
Trappler, B. and Cohen, C. I. (1998). Use of SSRIs in “very old” depressed nursing home residents. American Journal of Geriatric Psychiatry, 6, 83–89.CrossRefGoogle ScholarPubMed