Improving Treatment for Depression in the Nursing Home Population: Integrating the Model of the Depression Care Manager

Changes to psychotropic medications in the six months after admission to nursing homes in Melbourne, Australia

“…In theory, nursing homes provide an ideal venue for mental health care. Residents are always available; they interact constantly with staff; treatment compliance is virtually assured, and adverse effects can be monitored closely (Carlson and Snowden, 2007). Evidence-based protocols for antidepressant use in aged primary care patients can be readily adapted to residential settings and guidelines for antipsychotic use are easily accessed (Mulsant et al, 2001;International Psychogeriatric Association, 2003).…”

“…While pharmacists' reviews of current medications help curb over-prescribing, they cannot address under-prescribing, most notably of antidepressants. One solution might be appoint a mental health nursing specialist or "champion" to screen new residents, gather information, liaise with primary care physicians, promote pharmacological and psychosocial care pathways, engage residents in activity programs, make referrals to aged psychiatry services and educate staff (Carlson and Snowden, 2007). Such positions exist already in the fields of wound care and diabetes and warrant careful study.…”

Depression in older people living in residential homes

“…Antidepressants are the most common treatment for depressed residents (Brown et al ., 2002; Carlson and Snowden, 2007). There is evidence that antidepressants are effective for treating depression, in particular, major depression in care home residents (Rovner and Katz, 1993; Snowden et al ., 2003).…”

“…It is important to note that many of these approaches were delivered in a group format (Bharucha et al ., 2006). Group therapy is a more practical and cost-effective strategy in the residential home environment (Carlson and Snowden, 2007). Individual psychotherapy is not available in most residential care homes (Snowden et al ., 2003) due to a shortage of trained psychotherapists, cost, and, in many countries, a lack of any tradition of psychotherapists working in residential care homes.…”

Mental health service delivery in long-term care homes

“…Nursing homes have been encouraged to appoint one of their own staff, such as a registered nurse, to train as a depression care manager (Carlson and Snowden, 2007). As in collaborative care trials within primary care settings, the responsibilities of the position could include regular screening for depression, as well as education of staff, families and patients about depression, development of treatment plans and monitoring treatment response.…”