Depression in nursing home residents often unrecognized

Depression in nursing home residents often unrecognized

November 10, 2010

MU researchers find non-mood changes related to depression in elderly

Depression affects approximately 30 to 40 percent of nursing home residents, but it often goes unrecognized, according to American Geriatrics Society, which can lead to lower quality of life or even suicide. Now, researchers at the University of Missouri have found a series of indicators, other than changes in mood that are associated with the development of depression in nursing home residents.

“Prompt diagnosis and treatment of depression is essential to improve the quality of life for nursing home residents,” said Lorraine Phillips, assistant professor in the Sinclair School of Nursing. “Many elderly people develop certain clinical characteristics at the same time they develop depression. Understanding these changes is essential to quickly and accurately diagnosing depression in nursing home residents.”

Changes in characteristics that Phillips found to be associated with the development of depression include increased verbal aggression, urinary incontinence, increased pain, weight loss, changes in care needs, reduced cognitive ability and decline in performance of daily living activities.

“Depression is currently diagnosed using several methods that emphasize mood symptoms including interviewing and self-reporting of depression symptoms,” Phillips said. “However, since elderly depression may appear with non-mood symptoms, these characteristics identified in this study can help diagnose depression that may be overlooked by traditional screening methods.”

Phillips found that residents with increased verbal aggression were 69 percent more likely to be diagnosed with depression than those who had not shown these changes. Decreases in activities of daily living, such as feeding or dressing one’s self, also were associated with increased depression diagnosis. The research indicates that men and women in nursing homes are equally likely to develop depression. This contrasts with the overall population, where women are more likely than men to experience depression.

To study these changes, MU researchers analyzed data on more than 14,000 nursing home residents aged 65 and older who were not diagnosed with depression at the beginning of the study. Researchers analyzed changes in various clinical factors, other than mood changes, to discover which changes were associated with the development of depression during a three-month interval of time. The data was collected from the Missouri Minimum Data Set, a federally mandated process for clinical assessment of all residents in Medicare- or Medicaid-certified nursing homes.

Depression in nursing homes: prevalence, recognition, and treatment.

Depression in nursing homes: prevalence, recognition, and treatment
Int J Psychiatry Med. 2009;39(4):345-58.
Kramer D1Allgaier AKFejtkova SMergl RHegerl U.



Depression is very common in people above 65 years living in long-term care. However, little is known about how well depression is recognized and how adequately it is treated. Therefore, the present study aimed at assessing accuracy of the unaided clinical diagnosis of the attending physicians, and the medical treatment situation in nursing home residents.



A random sample of 97 residents of 10 nursing homes in Munich was examined with the Section A “Affective Syndrome” of the Structured Clinical Interview (SCID) for DSM-IV to detect depression. Information concerning clinical diagnosis and medication was obtained from the subjects’ medical records.



14.4% suffered acutely from major depression, 14.4% suffered from minor depression, and 18.6% were diagnosed as depressive according to the physician and nursing records. In total, 27.8% received antidepressants. Merely 42.9% of the subjects with acute major depression were diagnosed by their attending physicians as depressive, and only half of them received an antidepressant; 17.5% received antidepressants without a diagnosis of depression in their physician and nursing records. In accordance with the guidelines, 73.3% of the antidepressants prescribed were SSRIs or newer antidepressants. Only 20.0% were tricyclic antidepressants.



Findings show that depression is relatively frequent in residents of nursing homes. Moreover, it is insufficiently recognized by physicians and is even more seldom adequately treated. Also, a significant proportion of residents receive antidepressants without a documented associated indication. Therefore, the recognition and guideline-based treatment of depression should be improved in this high-risk group.

Treating depression in nursing homes: practice guidelines in the real world

Treating depression in nursing homes: practice guidelines in the real world
The Journal of the American Osteopathic Association, October 2003, Vol. 103, 465-469.
D Wagenaar; CC Colenda; M Kreft; J Sawade; J Gardiner; E Poverejan


Depression in nursing home residents is a common phenomenon, though there is a wide range in the severity of this disorder as experienced by elderly adults in the United States. Treating older patients for depression is costly in both human and financial terms. The authors review guidelines and recommendations for the diagnosis of depression and medical treatment of depressed elderly adults from the 1993 Clinical Practice Guidelines for Depression in Primary Care by the US Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality), making note also of similar guidelines provided by the American Medical Directors Association in 1996 and those provided by the American Psychiatric Association in 2000. In November 1999, the authors used a Delphi survey to gather data from pre-screened panelists (N = 10) to have the panel review and clarify the importance and feasibility of each “A” rated item in the US Agency for Health Care Policy and Research guidelines. This research allows health care providers to evaluate the importance and feasibility of items related to the delivery of mental health services for the elderly in nursing homes.