Mandatory depression screening can significantly increase the proportion of depressed dementia patients receiving antidepressants, lead to dose adjustments, diminish potential ethnic biases in treatment, and affect the depressive symptoms of treated individuals.

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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The authors compared 218 black and 68 white nursing home patients with dementia for differences in the prevalence, recognition, and treatment of depression. There were no racial differences in depressive symptoms, but whites were significantly more likely to receive a diagnosis of "possible depression" and there were few racial differences in clinical, social, or demographic factors associated with depression. Depression was often unrecognized and undertreated in both racial groups; several depression instruments developed for use in dementia had good reliability and validity among blacks; and there were no significant differences in depressive symptoms or diagnosis between U.S.-born and Caribbean-born black patients. The absence of any appreciable interracial or intraracial differences in depression symptoms or diagnoses may reflect uniformity in nursing home selection criteria or lessening of mood differences that may have existed before admission.

This article describes and evaluates the Buddy Program, which uses a natural helping network model to enhance the well-being of persons in nursing homes. Thirty-six nondemented patients ("buddies") and 33 persons with dementia completed the 6-month study that involved an educational program for the buddies and regular meetings between buddy-dementia patient pairs. Over the 6 months, compared to a matched control group, the dementia patients showed no advantage on any of the seven outcome measures and actually had significantly more depressive symptoms and greater nursing home dissatisfaction. The nondementia buddies showed no differences from the controls on any of the outcome measures. The results suggest that natural helping network models may not be easily imported into nursing home settings.