Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
CNS Drugs
Published in: CNS Drugs 8/2007

01-08-2007 | Therapy in Practice

Depression in Nursing Homes

Ensuring Adequate Treatment

Authors: Dr Robert H. Llewellyn-Jones, John Snowdon

Published in: CNS Drugs | Issue 8/2007

Login to get access

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. Demoralisation (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.
Literature
1.
Gillis LS, Elk R, Trichard L, et al. The admission of the elderly to places of care: a socio-psychiatric community survey. Psychol Med 1982; 12(1): 159–68PubMedCrossRef
2.
Ames D. Depression among elderly residents of local-authority residential homes: its nature and the efficacy of intervention. Br J Psychiatry 1990; 156: 667–75PubMedCrossRef
3.
Lavizzo-Mourey R, Mezey M, Taylor L. Completeness of admissions of residents assessments in teaching nursing homes. J Am Geriatr Soc 1991; 39(7): 676–82PubMed
4.
Bagley H, Cordingley L, Burns A, et al. Recognition of depression by staff in nursing and residential homes. J Clin Nurs 2000; 9(3): 445–50PubMedCrossRef
5.
Rovner BW, German PS, Brant LJ, et al. Depression and mortality in nursing homes. JAMA 1991; 265(8): 993–6PubMedCrossRef
6.
7.
Riedel-Heller S, Matschinger H, Schork A, et al. The utilization of antidepressants in community-dwelling and institutionalized elderly: results from a representative survey in Germany. Pharmacopsychiatry 2001; 34(1): 6–12PubMedCrossRef
8.
Brown M, Lapane K, Luisi A. The management of depression in older nursing home residents. J Am Geriatr Soc 2002; 50(1): 69–76PubMedCrossRef
9.
Arthur A, Matthews R, Jagger C, et al. Factors associated with antidepressant treatment in residential care: changes between 1990 and 1997. Int J Geriatr Psychiatry 2002; 17(1): 54–60PubMedCrossRef
10.
NIH Consensus Development Panel on Depression in Late Life. Diagnosis and treatment of depression in late life. JAMA 1992; 268(8): 1018–24CrossRef
11.
Unützer J, Simon G, Belin TR, et al. Care for depression in HMO patients aged 65 and older. J Am Geriatr Soc 2000; 48(8): 871–8PubMed
12.
Teresi J, Abrams R, Holmes D, et al. Prevalence of depression and depression recognition in nursing homes. Soc Psychiatry Psychiatr Epidemiol 2001; 36(12): 613–20PubMedCrossRef
13.
Phillips CJ, Henderson AS. The prevalence of depression among Australian nursing home residents: results using draft ICD-10 and DSM-III-R criteria. Psychol Med 1991; 21: 739–48PubMedCrossRef
14.
Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res 1975; 12: 189–98CrossRef
15.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed, revised. Washington, DC: American Psychiatric Association, 1987
16.
Rovner BW, Katz IR. Psychiatric disorders in the nursing home: a selected review of studies related to clinical care. Int J Geriatr Psychiatry 1993; 8: 75–87CrossRef
17.
Borson S, Fletcher PM. Mood disorders. In: Reichman WE, Katz PR, editors. Psychiatric care in the nursing home. Oxford: Oxford University Press, 1996: 67–93
18.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association, 1980
19.
Katz IR, Parmelee PA. Overview. In: Rubinstein RL, Lawton MP, editors. Depression in long term and residential care: advances in research and treatment. New York: Springer, 1997: 1–25
20.
Smalbrugge M, Pot AM, Jongenelis L, et al. The impact of depression and anxiety on well being, disability and use of health care services in nursing home patients. Int J Geriatr Psychiatry 2006; 21(4): 325–32PubMedCrossRef
21.
Snowdon J, Burgess E, Vaughan R, et al. Use of antidepressants, and the prevalence of depression and cognitive impairment in Sydney nursing homes. Int J Geriatr Psychiatry 1996; 11(7): 599–606CrossRef
22.
Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression scale: a preliminary report. J Psychiatr Res 1983; 17: 37–49CrossRef
23.
Almeida OP, Almeida SA. Short versions of the Geriatric Depression Scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry 1999; 14: 858–65PubMedCrossRef
24.
Chow ESL, Kong BMK, Wong MTP, et al. The prevalence of depressive symptoms among elderly Chinese private nursing home residents in Hong Kong. Int J Geriatr Psychiatry 2004; 19: 734–40PubMedCrossRef
25.
Tsai Y-F, Chung JWY, Wong TKS, et al. Comparison of the prevalence and risk factors for depressive symptoms among elderly nursing home residents in Taiwan and Hong Kong. Int J Geriatr Psychiatry 2005; 20(4): 315–21PubMedCrossRef
26.
Alexopoulos GS, Abrams RC, Young RC, et al. Use of the Cornell scale in non-demented patients. J Am Geriatr Soc 1988; 36: 230–6PubMed
27.
Payne JL, Sheppard J-M, Steinberg M, et al. Incidence, prevalence, and outcomes of depression in residents of a long-term care facility with dementia. Int J Geriatr Psychiatry 2002; 17: 247–53PubMedCrossRef
28.
Evers MM, Samuels SC, Lantz M, et al. The prevalence, diagnosis and treatment of depression in dementia patients in chronic care facilities in the last six months of life. Int J Geriatr Psychiatry 2002; 17: 464–72PubMedCrossRef
29.
Raskind MA. The clinical interface of depression and dementia. J Clin Psychiatry 1998; 59Suppl. 10: 9–12PubMed
30.
Newman SC. Prevalence of depression in vascular dementia and Alzheimer’s disease in a population sample. J Affect Disord 1999; 52: 169–76PubMedCrossRef
31.
Kales HC, Chen P, Blow FC, et al. Rates of clinical depression diagnosis, functional impairment, and nursing home placement in coexisting dementia and depression. Am J Geriatr Psychiatry 2005; 13: 441–9PubMed
32.
Jongenelis K, Pot AM, Eisses AMH, et al. Prevalence and risk indicators of depression in elderly nursing home patients: the AGED study. J Affect Disord 2004; 83: 135–42PubMedCrossRef
33.
Jones RN, Marcantonio ER, Rabinowitz T. Prevalence and correlates of recognized depression in US nursing homes. J Am Geriatr Soc 2003; 51: 1404–9PubMedCrossRef
34.
Weyerer S, Hafner H, Mann AH, et al. Prevalence and course of depression among elderly residential home admissions in Mannheim and Camden, London. Int Psychogeriatr 1995; 7(4): 479–93PubMedCrossRef
35.
Ames D, Ashby D, Mann AH, et al. Psychiatric illness in elderly residents of part III homes in one London borough: prognosis and review. Age Ageing 1988; 17: 249–56PubMedCrossRef
36.
Parmelee PA, Katz IR, Lawton MP. Incidence of depression in long-term care settings. J Gerontology 1992; 47(6): M189–96CrossRef
37.
Cole M, Bellavance F. The prognosis of depression in old age. Am J Geriatr Psychiatry 1997; 5(1): 4–14PubMed
38.
Birkett DP. Psychiatry in the nursing home. 2nd ed. New York: Haworth, 2001
39.
Kaldy J, Tarnove L. A clinical practice guideline approach to treating depression in long-term care. J Am Med Dir Assoc 2002; 3: 103–10CrossRef
40.
Cohen CI. Hyland K, Kimhy D. The utility of mandatory depression screening of dementia patients in nursing homes. Am J Psychiatry 2003; 160: 2012–7PubMedCrossRef
41.
American Geriatrics Society and American Association for Geriatric Psychiatry. Consensus statement on improving the quality of mental health care in US nursing homes: management of depression and behavioural symptoms associated with dementia. J Am Geriatr Soc 2003; 51: 1287–98CrossRef
42.
Snowdon J, Lane F. Use of the geriatric depression scale by nurses. Aging Ment Health 1999; 3(3): 227–33CrossRef
43.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994
44.
Blazer DG. Epidemiology of late-life depression. In: Schneider LS, Reynolds CF, Lebowitz BD, et al., editors. Diagnosis and treatment of depression in late life: results of the NIH consensus development conference. Washington, DC: American Psychiatric Press, 1994: 9–19
45.
Hybels CF, Blazer DG, Pieper CF. Toward a threshold for subthreshold depression: an analysis of correlates of depression by severity of symptoms using data from an elderly community sample. Gerontologist 2001; 41: 357–65PubMedCrossRef
46.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed, text revision. Washington, DC: American Psychiatric Association, 2000
47.
Kissane D. Demoralisation: a useful conceptualisation of existential distress in the elderly. Australas J Ageing 2001; 20: 110–1CrossRef
48.
Eisses AMH, Kluiter H, Jongenelis K, et al. Risk indicators of depression in residential homes. Int J Geriatr Psychiatry 2004; 19: 634–40PubMedCrossRef
49.
Snowden M, Sato K, Roy-Byrne P. Assessment and treatment of nursing home residents with depression or behavioural symptoms associated with dementia: a review of the literature. J Am Geriatr Soc 2003; 51: 1305–17PubMedCrossRef
50.
Rosen J, Rogers JC, Martin RS, et al. Control-relevant intervention in the treatment of minor and major depression in a long-term care facility. Am J Geriatr Psychiatry 1997; 5(3): 247–57PubMedCrossRef
51.
Rattenbury C, Stones MJ. A controlled evaluation of reminiscence and current topics discussion groups in a nursing home context. Gerontologist 1989; 29(6): 768–71PubMedCrossRef
52.
Rokke P, Tomhave J, Jocic Z. Self-managment therapy and educational group therapy for depressed elders. Cognit Ther Res 2000; 24(1): 99–119CrossRef
53.
Arean PA, Perri MG, Nezu AM, et al. Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults. J Consult Clin Psychology 1993; 61(6): 1003–10CrossRef
54.
Jones E, Beck-Little R. The use of reminiscence therapy for the treatment of depression in rural-dwelling older adults. Issues Ment Health Nurs 2002; 23(3): 279–90PubMedCrossRef
55.
Fernandez-Ballesteros R, Izal M, Diaz P, et al. Training of conversational skills with institutionalized elderly: a preliminary study. Percept Mot Skills 1988; 66(3): 923–6PubMedCrossRef
56.
Miller M, Cornes C, Frank E, et al. Interpersonal psychotherapy for late-life depression: past, present, and future. J Psychother Pract Res 2001; 10(4): 231–8PubMed
57.
Arean P, Cook B. Psychotherapy and combined psychotherapy/ pharmacotherapy for late life depression. Biol Psychiatry 2002; 52(3): 293–303PubMedCrossRef
58.
Morris RG, Morris LW. Cognitive and behavioural approaches with the depressed elderly. Int J Geriatr Psychiatry 1991; 6: 407–13CrossRef
59.
Koder D-A, Brodaty H, Anstey KJ. Cognitive therapy for depression in the elderly. Int J Geriatr Psychiatry 1996; 11(2): 97–107CrossRef
60.
Dunn A, Trivedi M, O’Neal H. Physical activity dose-response effects on outcomes of depression and anxiety. Med Sci Sports Exerc 2001; 33(6 Suppl.): S587–97PubMed
61.
Brosse AL, Sheets ES, Lett HS, et al. Exercise and the treatment of clinical depression in adults: recent findings and future directions. Sports Med 2002; 32(12): 741–60PubMedCrossRef
62.
Singh NA, Clements KM, Fiatarone Singh MA. The efficacy of exercise as a long term antidepressant in elderly subjects: a randomized, controlled trial. J Gerontol A Biol Sci Med Sci 2001; 56A(8): M497–504CrossRef
63.
Mather A, Rodriguez C, Guthrie M, et al. Effects of exercise on depressive symptoms in older adults with poorly responsive depressive disorder. Br J Psychiatry 2002; 180: 411–5PubMedCrossRef
64.
McMurdo MET, Rennie L. A controlled trial of exercise by residents of old people’s homes. Age Ageing 1993; 22(1): 11–5PubMedCrossRef
65.
Karel M, Hinrichsen G. Treatment of depression in late life: psychotherapeutic interventions. Clin Psychol Rev 2000; 20(6): 707–29PubMedCrossRef
66.
Snowdon J, Day S, Baker W. Audits of medication use in Sydney nursing homes. Age Ageing 2006; 35: 403–8PubMedCrossRef
67.
Datto CJ, Oslin DW, Streim JE, et al. Pharmacologie treatment of depression in nursing home residents: a mental health services perspective. J Geriatr Psychiatry Neurol 2002; 15: 141–6PubMed
68.
Harrington C, Tompkins C, Curtis M, et al. Psychotropic drug use in long-term care facilities: a review of the literature. Gerontologist 1992; 32: 822–33PubMedCrossRef
69.
Ruths S, Straand J, Nygaard HA. Psychotropic drug use in nursing homes: diagnostic indications and variations between institutions. Eur J Clin Pharmacol 2001; 57: 523–8PubMedCrossRef
70.
Lapane KL. Second-generation issues in the management of depression in nursing homes [letter]. J Am Geriatr Soc 2002; 50: 2101CrossRef
71.
Brodaty H, Draper BM, Millar J, et al. Randomized controlled trial of different models of care for nursing home residents with dementia complicated by depression or psychosis. J Clin Psychiatry 2003; 64: 63–72PubMedCrossRef
72.
Parker G, Hadzi-Pavlovic D. Melancholia: a disorder of movement and mood. Cambridge: Cambridge University Press, 1996CrossRef
73.
Parker G, Malhi G. Are atypical antipsychotic drugs also atypical antidepressants? Aust N Z J Psychiatry 2001; 35: 631–8PubMedCrossRef
74.
Parker G, Mitchell P, Wilhelm K, et al. Are the newer antidepressant drugs as effective as established physical treatments? Results from an Australian clinical panel review. Aust N Z J Psychiatry 1999; 33: 874–81PubMedCrossRef
75.
Parker G, Roy K, Wilhelm K, et al. Assessing the comparative effectiveness of antidepressant therapies: a prospective clinical practice study. J Clin Psychiatry 2001; 62: 117–25PubMedCrossRef
76.
Katona C, Livingston G. Drug treatment in old age psychiatry. London: Martin Dunitz, 2003
77.
Migliorelli R, Teson A, Sabe L, et al. Prevalence and correlates of dysthymia and major depression among patients with Alzheimer’s disease. Am J Psychiatry 1995; 152: 337–44
78.
Trappler B, Cohen CI. Use of SSRIs in “very old” depressed nursing home residents. Am J Geriatr Psychiatry 1998; 6: 83–9PubMed
79.
Chiu E, Ames D, Draper B, et al. Depressive disorders in the elderly: a review. In: Maj M, Sartorius N, editors. Depressive disorders. Chichester: Wiley, 1999: 313–400CrossRef
80.
Evans ME. Depression in elderly physically ill inpatients: a twelve-month prospective study. Int J Geriatr Psychiatry 1993; 8: 587–92CrossRef
81.
Katz IR, Simpson GM, Curlik SM, et al. Pharmacologie treatment of major depression for elderly patients in residential care settings. J Clin Psychiatry 1990; 51(7 Suppl.): 41–7PubMed
82.
Streim JE, Oslin DW, Katz IR, et al. Drug treatment of depression in frail elderly nursing home residents. Am J Geriatr Psychiatry 2000; 8: 150–9PubMed
83.
Oslin DW, Streim JE, Katz IR, et al. Heuristic comparison of sertraline with nortriptyline for the treatment of depression in frail elderly patients. Am J Geriatr Psychiatry 2000; 8: 140–9
84.
Magai C, Kennedy G, Cohen CI, et al. A controlled clinical trial of sertraline in the treatment of depression in nursing home patients with late-stage Alzheimer’s disease. Am J Geriatr Psychiatry 2000; 8: 66–74PubMedCrossRef
85.
Rosen J, Mulsant BH, Pollock BG. Sertraline in the treatment of minor depression in nursing home residents: a pilot study. Int J Geriatr Psychiatry 2000; 15: 177–80PubMedCrossRef
86.
Burrows AB, Salzman C, Satlin A, et al. A randomized, placebo-controlled trial of paroxetine in nursing home residents with non-major depression. Depress Anxiety 2002; 15: 102–10PubMedCrossRef
87.
Oslin DW, Ten Have TR, Streim JE, et al. Probing the safety of medications in the frail elderly: evidence from a randomised clinical trial of sertraline and venlafaxine in depressed nursing home residents. J Clin Psychiatry 2003; 64: 875–82PubMedCrossRef
88.
89.
Roose SP, Nelson JC, Salzman C, et al. Open-label study of mirtazapine orally disintegrating tablets in depressed patients in the nursing home. Curr Med Res Opin 2003; 19: 737–46PubMedCrossRef
90.
Llewellyn-Jones RH, Baikie KA, Smithers H, et al. Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial. BMJ 1999; 319: 676–82PubMedCrossRef
91.
Cuijpers P, Van Lammeren P. Secondary prevention of depressive symptoms in elderly inhabitants of residential homes. Int J Geriatr Psychiatry 2001; 16: 702–8PubMedCrossRef
92.
Bell M, Goss A. Recognition, assessment and treatment of depression in geriatric nursing home residents. Clin Excell Nurse Pract 2001; 5(1): 26–36PubMed
93.
Ryden M, Snyder M, Gross C, et al. Value-added outcomes: the use of advanced practice nurses in long-term care facilities. Gerontologist 2000; 40(6): 654–62PubMedCrossRef
94.
McCurren C, Dowe D, Rattle D, et al. Depression among nursing home elders: testing an intervention strategy. Appl Nurs Res 1999; 12(4): 185–95PubMedCrossRef
95.
Moxon S, Lyne K, Sinclair I, et al. Mental health in residential homes: a role for care staff. Ageing Soc 2001; 21(1): 71–93CrossRef
96.
Soon JA, Levine M. Screening for depression in patients in long term care facilities: a randomised controlled trial of physician response. J Am Geriatr Soc 2002; 50(6): 1092–9PubMedCrossRef
97.
Snowdon J. Mental health in nursing homes: perspectives on the use of medication. Drugs Aging 1993; 3: 122–30PubMedCrossRef
Metadata
Title
Depression in Nursing Homes
Ensuring Adequate Treatment
Authors
Dr Robert H. Llewellyn-Jones
John Snowdon
Publication date
01-08-2007
Publisher
Springer International Publishing
Published in
CNS Drugs / Issue 8/2007
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI
https://doi.org/10.2165/00023210-200721080-00002

Other articles of this Issue 8/2007

CNS Drugs 8/2007 Go to the issue

Therapy in Practice

Epidemiology, Diagnosis and Management of Mixed Mania

Review Article

CNS Aspergillosis

Review Article

Medical Management of Levodopa-Associated Motor Complications in Patients with Parkinson’s Disease

Adis Spotlight

Spotlight on Quetiapine in Bipolar Depression

Review Article

Osteoporosis, Schizophrenia and Antipsychotics

Correspondence

Baclofen as a Craving-Suppressing Agent