Depression in Nursing Home Residents: Prevalent and Serious

Some evidence supports a multidisciplinary approach to helping residents without dementia.

Clinical depression affects 15% to 25% of nursing home residents and is associated with earlier mortality, but evidence is lacking to support interventions that might relieve or prevent depression in this setting. In two studies, investigators assessed the effects of particular interventions on prevalence of depression in nursing home residents.

In a study from the Netherlands, researchers implemented a structured multidisciplinary care program (structured screening and diagnosis; treatment by nurses, activity therapists, psychologists, and physicians; and monitoring of treatment effects) in 33 nursing home units (16 dementia units and 17 general units) with almost 800 residents (mean age, 80). Implementation led to a small but significant decrease in prevalence of depression (compared with prevalence before implementation) in general units, but had no effect in dementia units. Quality of life (assessed by resident interviews) improved in both general and dementia units.

U.K. investigators randomized 78 nursing homes (with 900 residents; mean age, 86) to provide depression-awareness staff training alone or combined with an intervention to encourage more physical activity among residents, including twice-weekly exercise sessions. After 12 months, prevalence of depressive symptoms did not differ significantly between intervention and control groups, regardless of whether residents were depressed at baseline.

Comment: The authors and editorialists lament the inadequate attention paid to depression in many nursing homes, as well as the sparse and conflicting literature on the effectiveness of interventions. Research is complicated by variations in facilities, study samples, and interventions, and by the effects of concomitant dementia. The Dutch study suggests that a structured multidisciplinary program of assessment and treatment might be a good place to start; however, more information is needed on the program's benefits and costs.

— Bruce Soloway, MD

Published in Journal Watch General Medicine May 23, 2013