Concordance of Self- and Informant-Rated Depressive Symptoms in Nursing Home Residents with Dementia: Cross-Sectional Findings

Abstract

Background: Depression is highly prevalent in nursing home residents living with moderate to severe dementia. However, assessing depressive symptoms in residents with dementia can be challenging and may vary by rater perspective. We aimed to investigate the concordance of, and factors associated with self- and informant-rated depressive symptoms in nursing home residents with dementia.Methods: Cross-sectional data was collected from N=162 nursing home residents with dementia (age: 53-100; 74% women). Self-ratings were assessed with the Geriatric Depression Scale, while the Subscale D of the Neuropsychiatric Inventory was used for informant-ratings. Cohen’s Kappa was calculated to determine concordance of both measures and of each with antidepressant medication. Associations with sociodemographic variables, self- and informant-rated quality of life, dementia stage, neuropsychiatric symptoms, functional status and antidepressant medication were analysed with multivariate linear mixed models.Results: Concordance between self- and informant-rated depressive symptoms was minimal (Cohen’s Kappa=.22, p=.02). Self-reported depression was negatively associated with self-rated quality of life (β=-.37; 95%CI: -.48 to .26, p<.001), informant-rated quality of life (β=-.31; 95%CI: -51 to .10, p=.003) and functional status (β=-.15; 95%CI: -.27 to .03, p=.02), whilst informant-rated depression revealed negative associations with informant-rated quality of life (β=-.32; 95%CI: -.54 to .11, p=.003) and dementia stage (β=-.27; 95%CI: -.50 to .03, p=.028). No concordance was found with antidepressant medication.Conclusions: In line with our expectations, low agreement and unique association patterns were found for both measures. These findings indicate that both instruments address different aspects of depression und underline the need for comprehensive approaches when it comes to detecting signs of clinically relevant depressive symptoms in dementia. Trial registration: The trial was registered with the ISRCTN registry (Trial registration number: ISRCTN98947160)