Psychiatric disorders in the nursing home: A selective review of studies related to clinical care

Rovner, Barry W.; Katz, Ira R.

doi:10.1002/gps.930080112

Cited by 71 publications

(44 citation statements)

References 97 publications

(49 reference statements)

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“…Indeed, there is evidence that Blacks in nursing homes have poorer physical health and worse cognitive functioning than Whites (Belgrave & Bradsher, 1994;Engle & Graney, 1995;Stegbauer et al, 1995). There exists extensive literature concerning both the over-and underuse of various medications in nursing homes (Kim & Rovner, 1995;Rovner et al, 1990Rovner et al, , 1991Rovner & Katz, 1992;Samuels & Katz, 1995). Little is known about medication usage in predominantly Black nursing homes, although possible differences between Blacks and Whites, such as culture, patient symptoms, and type of patient, may result in differences in prescribing habits.…”

Section: Vol 38 No 3 1998 353mentioning

confidence: 99%

“…However, Class and colleagues also found that five of nine Black patients with a primary mood disorder were not receiving antidepressant medication. Clearly, additional studies are needed with large minority samples, particularly for those persons witn a diagnosis of dementia because of the high comorbidity of dementia with depression and other neuropsychiatric disorders (Rovner & Katz, 1992).…”

Section: Vol 38 No 3 1998 353mentioning

confidence: 99%

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Interracial and Intraracial Differences in Neuropsychiatric Symptoms, Sociodemography, and Treatment Among Nursing Home Patients With

Cohen¹,

Hyland²,

Magai

1998

The Gerontologist

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Using an adaptation of George's (1989) social antecedent model of psychopathology, this article examines interracial and intraracial differences in neuropsychiatric symptoms, sociodemography, and treatment among nursing home patients with dementia. The final sample consisted of 164 U.S.-born African Americans, 54 African Caribbeans, and 68 Caucasians. Although there were appreciable interracial differences in sociodemographics, there were minimal clinical differences. This finding may reflect both racial differences in pathways to institutionalization and the homogenization of clinical characteristics created by new governmental standards for nursing homes. There were no substantial differences between African Americans and African Caribbeans. Use of medication to treat neuropsychiatric symptoms was low, and may have reflected difficulties in diagnosis and concerns about the abuse of medications.

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Section: Vol 38 No 3 1998 353mentioning

confidence: 99%

Section: Vol 38 No 3 1998 353mentioning

confidence: 99%

Interracial and Intraracial Differences in Neuropsychiatric Symptoms, Sociodemography, and Treatment Among Nursing Home Patients With

Cohen¹,

Hyland²,

Magai

1998

The Gerontologist

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“…This may have captured some people without a formal mental illness, including those with cognitive impairment attributable to other causes and people with subthreshold depression. However, mild depressive symptoms are often clinically significant, 168,169 and feedback from practitioners suggested the study did accurately identify those older people with mental health problems who commonly present to social services. An unavoidable weakness of the sampling process was that it only captured those older care home entrants known to social or specialist mental health services.…”

Section: Methodological Considerations/lessons For Future Studiesmentioning

confidence: 99%

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Challis

Tucker

Wilberforce

et al. 2014

Programme Grants for Applied Research

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BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…In residents of nursing homes the incidence of mental disorders has been estimated to be 80% or higher [1]. Cognitive impairments, primarily the dementias, are the most prevalent, but major depressive disorders and depressive symptoms have been documented to be 13-48% in both American and European facilities [2,3].…”

Section: Introductionmentioning

confidence: 99%

Memory Awareness in Nursing Home Residents

McDougall

1998

Gerontology

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Background: Health care providers often believe that individuals with cognitive disturbance are unaware of their deficits. The term unawareness was first used to describe hemiplegia following right hemisphere stroke but has since been applied to unawareness of any neurological or neuropsychological deficit. Clinicians usually rely on their subjective observations to evaluate the patient’s awareness of deficits, and few investigators have systematically evaluated this important clinical phenomenon. Objective: The aim of this study was to compare cognition, depression, health, and metamemory (capacity, change, locus, and strategy) in four groups of nursing home residents: the cognitively impaired (29%), depressed (18%), mixed with both cognitive impairment and depression (32%), and controls (21%). Methods: Subjects were 106 residents of six nursing homes between the ages of 79 and 87 with a mean age of 84.18 (SD = 10.01) years, and an average of six comorbid medical conditions. Cognitive function was measured with the Mini Mental State (MMSE); depression with the Geriatric Depression, and metamemory with the Metamemory in Adulthood scales. Anyone scoring <15 on the MMSE was excluded. Subjects included 31 with cognitive impairment, 19 depressed, 34 mixed, and 22 controls. Results: In this sample, 61% were cognitively impaired; however, only 12 had a diagnosis in their records indicating cognitive disturbance. Forty-three percent were depressed. The correlations between depression and capacity (r = –0.38), change (r = –0.50), and locus (r = –0.25) were significant. The controls were significantly younger than the cognitively impaired group. The controls also had higher perceived health status scores than either the cognitively impaired or the depressed group. However, the mixed group’s perceived health status scores were significantly higher than the depressed group’s scores. Conclusion: The metamemory components of capacity and change were able to differentiate the cognitively impaired from the mixed group. Information on the etiology of cognitive impairment was not available since residents’ charts in the six nursing homes provided inadequate documentation and incomplete diagnostic histories. Therefore, quantitative methods for examining memory awareness and the affective state of elderly patients is important for clinicians in order to make informed treatment decisions.

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Psychiatric disorders in the nursing home: A selective review of studies related to clinical care

Cited by 71 publications

References 97 publications

Interracial and Intraracial Differences in Neuropsychiatric Symptoms, Sociodemography, and Treatment Among Nursing Home Patients With

Interracial and Intraracial Differences in Neuropsychiatric Symptoms, Sociodemography, and Treatment Among Nursing Home Patients With

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Memory Awareness in Nursing Home Residents

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