Depression in Nursing Homes

Abstract

Studies have shown a high prevalence of depressive disorders among nursing home residents around the world. Various losses in old age may precipitate depression, and physical illness and disability are major factors that contribute to the development and persistence of depressive disorders. Demoralization (existential distress) is common. Recognition of what a nursing home resident has lost is often a key to developing plans for management. The prognosis for recovery from depression is worse for patients who face an ongoing distressing situation or physical condition. For ongoing loss-related distress, including sadness about loss of health, it is important for patients to ventilate feelings, and to either re-acquire what is lost or to grieve and then adapt to the new situation. For major depression with melancholia, psychotic depression and bipolar disorders, biological treatments are of prime importance. Non-melancholic major depression is best treated with a combination of antidepressants and psychosocial therapies, the latter being particularly indicated when the depression has been precipitated by stressful and depressing events or situations. Psychosocial and environmental interventions are important in all types of depression and may prove more effective than the use of antidepressants for milder disorders. There has been a welcome increase in the recognition of depression in nursing homes and in the prescription of newer antidepressants, but the published evidence to date does not allow definitive recommendations regarding which antidepressants to use in this setting. Outcome research is needed to assess antidepressant efficacy and to better plan multifaceted treatment strategies for depressions of varying types and aetiologies among nursing home residents.

Antidepressant Prescribing Patterns in the Nursing Home: Second-Generation Issues Revisited

“…22–24 However, it has been shown that antidepressant drug treatment is less effective 25,26 and less well tolerated 27,28 in cognitively impaired older adults, which may partly explain the presence of depressive symptoms despite the use of antidepressants in some of the nursing home residents in our sample. Furthermore, research specifically evaluating the efficacy and safety of these drugs in elderly nursing home patients is lacking, 24,29 and this may have serious and potentially dangerous implications for the well-being of nursing home residents, especially in the context of polypharmacy, combination antidepressant therapy, and cognitive co-morbidity.…”

Aging leads to prolonged duration of inflammation-induced depression-like behavior caused by Bacillus Calmette-Guérin

“…This issue is exacerbated in aged subjects with low socioeconomic status (Koster et al, 2006). Similarly, symptoms of depression increase if the elderly become frail or disabled and moves from the community into a long-term health care facility (Llewellyn-Jones and Snowdon, 2007; Simonsick et al, 1998). Effective preventive strategies are needed for the aging world population (Madhusoodanan et al, 2010), but this problem is compounded by the lack of fundamental knowledge about the biological cause of prolonged depression in the aged (Tiemeier, 2003).…”

Act In case of Depression: The evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study Protocol

“…The review of Bharucha et al [15] of 'talk therapies' for depression in long-term care presents evidence for an improvement in depressive symptoms after reminiscence/life review therapy. Moreover, there is evidence for the effectiveness of multifaceted interventions in residential care [16-18] and in nursing homes [19,20]. …”