Depression in a Long‐Term Care Facility: Clinical Features and Discordance Between Nursing Assessment and Patient Interviews

Burrows, Adam B.; Satlin, Andrew; Salzman, Carl; Nobel, Kenneth; Lipsitz, Lewis A.

doi:10.1111/j.1532-5415.1995.tb07011.x

Cited by 64 publications

(43 citation statements)

References 35 publications

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“…21.7% had significantly high levels of negative affect as indicated by MADRS scores of 6 18. This prevalence level of depression is similar to that seen in other populations of older people in institutions [1][2][3][4] . Prevalence of anxiety symptoms is, however, also high and this has not been previously noted.…”

Section: Mood and Nursing In Residential Home Residentssupporting

confidence: 64%

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Effect of Micronutrient Supplementation on Mood in Nursing Home Residents

et al. 2008

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One third of older people in nursing and/or residential homes have significant symptoms of depression. In younger people, deficiencies in selenium, vitamin C and folate are associated with depression. This study examines the association between micronutrient status and mood before and after supplementation. The objective was to determine whether the administration of selenium, vitamin C and folate improved mood in frail elderly nursing home residents. Mood was assessed using the Hospital Anxiety and Depression rating scale (HAD), and Montgomery-Åsberg Depression Rating Scale (MADRS). Micronutrient supplementation was provided for 8 weeks in a double-blinded randomised controlled trial. Significant symptoms of depression (29%) and anxiety (24%) were found at baseline. 67% of patients had low serum concentrations of vitamin C, but no-one was below the reference range for selenium. Depression was significantly associated with selenium levels, but not with folate or vitamin C levels. No individual with a HAD depression score of ≧8, had selenium levels >1.2 µM. In those patients with higher HAD depression scores, there was a significant reduction in the score and a significant increase in serum selenium levels after 8 weeks of micronutrient supplementation. Placebo group scores were unchanged. This small study concluded that depression was associated with low levels of selenium in frail older individuals. Following 8 weeks of micronutrient supplementation, there was a significant increase in selenium levels and improved symptoms of depression occurred in a subgroup.

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Section: Mood and Nursing In Residential Home Residentssupporting

confidence: 64%

“…Older people have a high prevalence of depression, with up to one third or more of those living in residential or nursing home, having significant symptoms [1][2][3][4] . The prevalence of depression in nursing or residential homes is at least twice that seen in the general population [5,6] .…”

Section: Introductionmentioning

confidence: 99%

Effect of Micronutrient Supplementation on Mood in Nursing Home Residents

et al. 2008

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“…As we have noted in previous work [Burrows, 1995], information about symptoms of depression provided by caregivers may correlate poorly with information provided by frail, disabled, and cognitively impaired very old nursing home residents. Discordance may result from patients revealing either greater or fewer symptoms than that which is described by a nurse caregiver.…”

Section: Discussionmentioning

confidence: 81%

A randomized, placebo-controlled trial of paroxetine in nursing home residents with non-major depression

et al. 2002

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Depression is common across a broad spectrum of severity among nursing home residents. Previous research has demonstrated the effectiveness of antidepressants in nursing home residents with major depression, but it is not known whether antidepressants are helpful in residents with less severe forms of depression. We conducted a randomized double-blind placebo-controlled 8-week trial comparing paroxetine and placebo in very old nursing home residents with non-major depression. The main outcome measure was the primary nurse's Clinical Impression of Change (CGI-C). Additional outcome measures were improvement on the interview-derived Hamilton Depression Rating Scale (HDRS) and Cornell Scale for Depression (CS) scores. Twenty-four subjects with a mean age of 87.9 were enrolled and twenty subjects completed the trial. Placebo response was high, and when all subjects were considered, there were no differences in improvement between the paroxetine and placebo groups. Two subjects that received paroxetine developed delirium, and subjects that received paroxetine were more likely to experience a decrease in Mini Mental State Exam scores (P =.03). There were no differences in serum anticholinergic activity between groups. In a subgroup analysis of 15 subjects with higher baseline HDRS and CS scores, there was a trend toward greater improvement in the paroxetine group in an outcome measure that combined the CGI-C and interview-based measures (P =.06). Paroxetine is not clearly superior to placebo in this small study of very old nursing home residents with non-major depression, and there is a risk of adverse cognitive effects. Because of the high placebo response and the trend towards improvement in the more severely ill patients, it is possible that a larger study would have demonstrated a significant therapeutic effect for paroxetine as compared with placebo. The study also illustrates the discordance between patient and caregiver ratings, and the difficulties in studying very elderly patients with mood disorders.

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“…There is a poor relationship between resident and nurse CSDD ratings (Burrows, 1995). Brühl and colleagues (2007) found the GDS detected 50% more depression than did nurses.…”

Section: Under-detectionmentioning

confidence: 99%