Original study
Prevalence and Treatment of Diagnosed Depression among Elderly Nursing Home Residents in Ohio

https://doi.org/10.1016/j.jamda.2007.07.010Get rights and content

Objectives

To examine the prevalence and treatment of diagnosed depression among elderly nursing home residents and determine the resident and facility characteristics associated with diagnosis and treatment.

Design, Setting, and Participants

Documented depression, pharmacotherapy, psychotherapy, sociodemographics, and medical characteristics were obtained from Ohio’s Minimum Data Set for 76 735 residents in 921 nursing homes. The data were merged with Online Survey Certification and Reporting System data to study the impact of facility characteristics. Chi-squared statistics were used to test group differences in depression diagnosis and treatment. Multiple logistic regressions were used to examine the prevalence of diagnosed depression, and among those diagnosed, of receiving any treatment.

Results

There were 48% of residents who had an active depression diagnosis; among those diagnosed, 23% received no treatment; 74% received antidepressants; 0.5% received psychotherapy; and 2% received both. African Americans, the severely cognitively impaired, and those in government facilities were less likely to be diagnosed. Residents aged 85 and older, African Americans, individuals with severe mental illness, those with severe ADL or cognitive impairment, and individuals living in a facility with 4 or more deficiencies were less likely to receive treatment.

Conclusion

Significant disparities exist both in diagnosis and treatment of depression among elderly residents. Disadvantaged groups such as African Americans and residents with physical and cognitive impairments are less likely to be diagnosed and treated. Our results indicate that work needs to be done in the nursing home environment to improve the quality of depression care for all residents.

Section snippets

Data

In this study, the 2000 Ohio Long-term Care MDS was used as the source of NH resident information. These data were merged with the OSCAR data to obtain nursing home facility characteristics. The research protocol was approved by Rutgers, the State University of New Jersey’s Institutional Review Board. The MDS is a nationally standardized 350-item summary screening and assessment tool designed to collect data on nursing home residents including their physical, psychological, and psychosocial

Results

The characteristics of Ohio elderly nursing home residents in 2000 are presented in the first 2 columns of Table 1. Most were female (75%), white (89%), and widowed (64%). Physical comorbidity was prevalent, with 90% having at least 1 chronic physical illness. Over 75% were dependent in ADL activities, and 81% had at least some cognitive impairment. The model resident lived in a for-profit (74%) facility in an urban area (78%) with 100 to 199 (62%) residents.

Discussion

In this paper, we described patterns of identification of depression (diagnosis) and its treatment among long-stay nursing home residents aged 65 and older. We also determined characteristics of residents and facilities that predict whether a resident received a depression diagnosis and subsequent treatment.

Our results indicate that the oldest-old are approximately a third less likely than those age 65 to 75 to be diagnosed; those with very severe cognitive impairment are a third less likely to

Conclusion

Despite these limitations, our findings tend to dispel the longstanding belief that depression is substantially underdiagnosed and undertreated among NH residents. Our findings indicate a very substantial rate both of depression identification and of antidepressant treatment for depression among NH residents, perhaps as a result of general increases in awareness of depression among the elderly, and of the positive potential of available treatments. However, many questions are left unanswered.

References (51)

  • H.G. Koenig et al.

    Epidemiology of geriatric affective disorders

    Clin Geriatr Med

    (1992)
  • B.A. Wright

    Weight loss and weight gain in a nursing home: A prospective study

    Geriatr Nurs

    (1993)
  • J. Snowdon et al.

    A study of depression in nursing homes

    J Psychiatr Res

    (1986)
  • C. Katona

    Managing depression and anxiety in the elderly patient

    Eur Neuropsychopharmacol

    (2000)
  • D.G. Blazer

    Depression in late life: review and commentary

    J Gerontol A Biol Sci Med Sci

    (2003)
  • The American Geriatrics Society and American Association for Geriatric Psychiatry recommendations for policies in support of quality mental health care in U.S. nursing homes

    J Am Geriatr Soc

    (2003)
  • Consensus statement on improving the quality of mental health care in U.S. nursing homes: management of depression and behavioral symptoms associated with dementia

    J Am Geriatr Soc

    (2003)
  • J.E. Morley et al.

    Nutritional issues in nursing home care

    Ann Intern Med

    (1995)
  • R.N. Jones et al.

    Prevalence and correlates of recognized depression in U.S. nursing homes

    J Am Geriatr Soc

    (2003)
  • M.N. Brown et al.

    The management of depression in older nursing home residents

    J Am Geriatr Soc

    (2002)
  • Diagnosis and treatment of depression in late life

    JAMA

    (1992)
  • P.A. Parmelee et al.

    Incidence of depression in long-term care settings

    J Gerontol

    (1992)
  • B.W. Rovner et al.

    Depression and mortality in nursing homes

    JAMA

    (1991)
  • J.F. Schnelle et al.

    Measurement sensitivity and the Minimum Data Set depression quality indicator

    Gerontologist

    (2001)
  • J. Teresi et al.

    Prevalence of depression and depression recognition in nursing homes

    Soc Psychiatry Psychiatr Epidemiol

    (2001)
  • I.R. Katz et al.

    Association of antidepressants and other medications with mortality in the residential-care elderly

    J Geriatr Psychiatry Neurol

    (1994)
  • B.W. Rovner

    Depression and increased risk of mortality in the nursing home patient

    Am J Med

    (1993)
  • B.J. Burns et al.

    Mental health service use by the elderly in nursing homes

    Am J Public Health

    (1993)
  • D.G. Shea et al.

    Determinants of the use of specialist mental health services by nursing home residents

    Health Serv Res

    (1994)
  • M.A. Smyer et al.

    The provision and use of mental health services in nursing homes: results from the National Medical Expenditure Survey

    Am J Public Health

    (1994)
  • L.L. Heston et al.

    Inadequate treatment of depressed nursing home elderly

    J Am Geriatr Soc

    (1992)
  • C.J. Datto et al.

    Pharmacologic treatment of depression in nursing home residents: A mental health services perspective

    J Geriatr Psychiatry Neurol

    (2002)
  • D. Weintraub et al.

    Second-generation issues in the management of depression in nursing homes

    J Am Geriatr Soc

    (2002)
  • S. Crystal et al.

    Diagnosis and treatment of depression in the elderly Medicare population: Predictors, disparities, and trends

    J Am Geriatr Soc

    (2003)
  • D.K. Miller et al.

    Clinically relevant levels of depressive symptoms in community-dwelling middle-aged African Americans

    J Am Geriatr Soc

    (2004)
  • Cited by (0)

    Funded by National Institute of Mental Health Grant 1-RO1 MH076206 and AHRQ Grant R24-HS011825.

    View full text