Antidepressant Treatment of Depression in Rural Nursing Home Residents

Abstract

Under-diagnosis and under-treatment of depression are major problems in nursing home residents. The purpose of this study was to determine antidepressant use among nursing home residents who were diagnosed with depression using three different methods: (1) the Geriatric Depression Scale, (2) Minimum Data Set, and (3) primary care provider assessments. As one would expect, the odds of being treated with an antidepressant were about eight times higher for those diagnosed as depressed by the primary care provider compared to the Geriatric Depression Scale or the Minimum Data Set. Men were less likely to be diagnosed and treated with antidepressants by their primary care provider than women. Depression detected by nurses through the Minimum Data Set was treated at a lower rate with antidepressants, which generates issues related to interprofessional communication, nursing staff communication, and the need for geropsychiatric role models in nursing homes.

Psychotropic Medication Use Among Older Adults: What All Nurses Need to Know

“…Voyer and Martin (2003) contended that antidepressant drugs are underprescribed for older adults due to a lack of recognition of depressive symptoms by health care providers. In a study of 320 randomly selected Iowa nursing home residents (Kerber, Dyck, Culp, & Buckwalter, 2008), the odds of being treated for depression were eight times greater for those who were diagnosed by a primary care provider versus those diagnosed with either the Geriatric Depression Scale (Yesavage et al, 1982-1983) or the Minimum Data Set. These results provide further evidence that depression in older adults is often unrecognized and untreated.…”

“…Although psychotropic medications are frequently prescribed to manage behavioral disturbances and psychiatric symptoms, it is imperative that a comprehensive nursing assessment be conducted to identify other potential causes of disruptive behavior, such as delirium, pain, fatigue, hunger, incontinence, and infection. Nonpharmacological interventions, such as reminiscence, activity therapy, and pet therapy, should be thoroughly explored (Kerber et al, 2008). When psychotropic medications are administered, the lowest dosage possible should be used, usually one third to one half the usual dosage of younger individuals, with slow titration upward (Carr, 2005).…”

Directions for Effectiveness Research to Improve Health Services for Late-Life Depression in the United States

“…These settings may include nursing homes (31, 52, 61, 69, 74–77), medical inpatient units (78), or community settings such as senior centers, adult day health, day treatment programs, rehabilitation services and assisted living facilities (16, 52, 69, 74, 79). Research within the nursing home setting could look at risks / benefits and appropriate use of antidepressant treatment in nursing home populations (31, 61, 76) while also focusing on psychosocial interventions and training more mental health providers in nursing home settings (61).…”

How Do Regulated Nurse Professionals in Alberta Assess Geriatric Depression in Residential Care Facilities?

“…Indeed, some scholars suggest that direct care nurse professionals, in general, are well-positioned to perform depression screening because they interact with patients and should be able to observe symptoms on a daily basis (Clibbens & Rylatt, 2008;Koopmans et al, 2010;Kurlowicz & NICHE Faculty, 1997). Other studies however, found that nurse professionals experience considerable difficulty identifying depression in residents (Bagley et al, 2000;Kerber, Dyck, Culp, & Buckwalter, 2008;Mitchell & Kakkadasam, 2011;Teresi et al, 2001) due to a lack of familiarity with the residents (Kohler et al, 2005), ageist attitudes (Choi et al, 2009), and inadequate training of staff in geriatric mental health (Davison et al, 2007).…”

“…Importantly though, any designated discipline among those suitable for the assessment role (e.g., nurse professionals, social workers, psychologists, physicians, etc.) requires proper geriatric mental health and counselling education to be effective (Bagley et al, 2000;Clibbens & Rylatt, 2008;Kerber et al, 2008;Mitchell & Kakkadasam, 2011;Koopmans et al, 2010;Teresi et al 2001).…”