Use of antidepressants, and the prevalence of depression and cognitive impairment in Sydney nursing homes

Abstract

In 1993, a survey was conducted in 46 of the 47 nursing homes in a health district of Sydney. Medication cards and notes of all residents (N = 2414) were studied. Subjects who were willing and able to answer questions were interviewed by research assistants (senior nurses). Using the Mini‐Mental State Examination and Mental Status Questionnaire, about 80% were found to be cognitively impaired. Of 874 subjects assessed with the Geriatric Depression Scale (GDS), 30.4% scored in the clearly depressed range (14 or more) of whom 27.4% were taking antidepressants. From a subsample of 26 with GDS scores of 14+, the psychiatrist concluded that only one‐third would fulfil DSM‐III‐R criteria for major depression, with or without dementia. The dosages of antidepressants used in these nursing homes were relatively low. Of residents taking a tricyclic or mianserin, 48% were taking less than 30 mg daily, even though in 72% of cases their doctors stated the primary reason they were having this medication was to treat or prevent recurrence of depression. Opinions and evidence concerning the efficacy of such low dosage are conflicting. There is a need for further research, including correlation of efficacy with blood levels of antidepressants.

Urban environment, physical inactivity and unhealthy dietary habits correlate to depression among elderly living in eastern Mediterranean islands: The MEDIS (MEDiterranean ISlands elderly) study

“…The prevalence of major depression varies from 0.86% in a Canadian community (23) to 42% among US nursing home residents (24), and clinically depressive-symptom cases from 7.2% in the US (25) to 48% in Italy (26) in corresponding settings. Some of the variation in the prevalence rates in these studies is rooted in the use of different methods of assessment, such as the use of clinical interviews by experienced clinicians or the use of structured diagnostic interviews by trained nonprofessionals or/and the use of different scales estimating depression.…”

Do older Australians truly have low rates of anxiety and depression? A critique of the 1997 National Survey of Mental Health and Wellbeing

“…The Composite International Diagnostic Interview is too complex an instrument to apply in nursing homes where 80% of residents are cognitively impaired [26]. While the decision to exclude aged residential facilities was reasonable, the implications have not been properly grasped.…”

“…In studies of nursing homes in Canberra, Hobart, Melbourne and Sydney, roughly 10% of assessable nursing home residents met ICD or DSM criteria for depressive psychosis or major depression [14,24–26] and 4% in Sydney had either generalized anxiety disorder or panic disorder [27]. Rates of major depression were even higher in six similar US and UK studies (range 6–30%, mean 21%) [28].…”

Conference presentations: developing nursing knowledge by disseminating research findings

“…On the other hand, the presenter may want to take a much broader view and move beyond their specialty area to describe their specialist skills and knowledge to a broader audience. This is particularly pertinent for psychiatric nurses, given the increased incidence of mental health problems becoming evident in general health care (Arie 2001, Birleson et al 2000, McMahon et al 2001, Mott and Kingsley 1999, Sharrock and Happell 2000, Snowdon et al 1996. Psychiatric nurses with a keen interest in improving the physical health care of users experiencing mental health problems might find it highly relevant to present at non-mental health specialist events.…”