Identification of depressive disorder among older people in care homes – a feasibility study

Abstract

Background: Depression is common among older people but more common among those living in care homes. Depression is not easily detected among older adults because of the presentation, and the tendency for older people not to complain of depression, particularly those living in care homes. In general, care home staff have limited training in recognising depression. Depression is undertreated and residents may not receive a therapeutic dose of antidepressant. The true prevalence of depression among care home residents is uncertain. Method: This feasibility study aimed to explore the level of depression among older people in care homes by comparing the outcome of an assessment by care home staff with the outcome of a diagnostic clinical interview, using ICD-10 criteria and the 30-item Geriatric Depression Scale (GDS), conducted by a psychiatrist. Results: In all, 47 older people from four care homes were interviewed by a psychiatrist. Of them, 39.1% (18/46) of residents were prescribed an antidepressant and were no longer depressed; 8.7% (4/46) were prescribed an antidepressant and remained depressed; and 6.5% (3/46) of residents assessed as being depressed, had not been prescribed an antidepressant. That is, 54% (25/46) of residents had been or were currently depressed. Using ICD-10 criteria, the sensitivity of the GDS at a threshold of 10 and 11 was 100%. In total, 89.4% of residents received a correct diagnosis (presence or absence of depression) using the GDS at the 11 threshold. Summary: The prevalence of depression in these homes was 54%. Of the residents with depression, 72% (18/25) were managed with an antidepressant and 28% (7/25) were receiving ineffective or no treatment. The 30-item GDS can provide more useful information than a home care staff assessment for identifying depression. More research should explore the value of training home care staff to administer the 30-item GDS to optimise the management of depression in older people in care homes.

Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings

“…An increasing body of work has developed interventions for care home residents that have focused on specific processes such as assessment, targeted interventions and protocol-based care. Objectives include comprehensive assessment, 110 depression, [111][112][113] dementia, 114 falls prevention, 115 nutrition, 39,[116][117][118] recovery from stroke, 119 medication management, 120 end-of-life care, [121][122][123] tissue viability, 124 oral hygiene 125 and occupational therapy. 126,127 Most of these interventions were multicomponent, but had in common the detailed assessment of residents' functional abilities and the teaching of new skills to care home staff to improve residents' health and well-being.…”

Depression in Cognitive Impairment

“…The lifetime prevalence of major depressive disorder has been recently estimated at 14.4 % [1]. One estimate puts the prevalence of depression in those living in nursing homes at 54 % [2]. The lifetime prevalence of all-cause dementia among individuals aged 71 or older has been estimated at 13.9 %, which comprises about 3.4 million individuals in the United States [3].…”

Effective health care for older people living and dying in care homes: a realist review

“…An increasing body of work has developed interventions for care home residents that have focused on specific processes such as assessment, targeted interventions and protocol-based care. Examples include comprehensive assessment [ 44 ], depression [ 45 – 47 ], dementia [ 7 ], falls prevention [ 48 ], nutrition [ 49 – 52 ], recovery from stroke [ 53 ], medication [ 54 ], end of life care [ 55 – 57 ], tissue viability [ 58 ], oral hygiene [ 59 ], and occupational therapy interventions [ 60 , 61 ]. Most of these interventions were multicomponent but had in common the detailed assessment of residents’ functional abilities and the teaching of new skills to care home staff to improve residents’ health and wellbeing.…”