BACKGROUND: Depression has a substantial negative impact on quality of life. Underdiagnosis and undertreatment of depression are major problems in nursing home residents. OBJECTIVES: This study sought to determine the prevalence of depression among older adults in nursing homes in rural Iowa using the Geriatric Depression Scale (GDS), Minimum Data Set (MDS), and primary care provider (PCP) depression diagnosis. DESIGN: This is a secondary analysis of data collected from 279 randomly selected residents of nursing homes in rural Iowa. RESULTS: The prevalence of depression based on the GDS (score of 6 or greater) was 37.3%, the MDS was 21.3%, and the PCP depression diagnosis was 39.1%. CONCLUSION: There was only chance agreement in identifying depression among the measures. The overall prevalence of depression (as indicated by a positive depression marker in any group)was 67.1%, suggesting depression continues to be a problematic clinical and quality of life issue in rural nursing homes. J Am Psychiatr Nurses Assoc, 2005; 11(5), 269-275. DOI:10.1177/1078390305281345
Keywords: depression; older adult; long-term care; minimum data set
The 1986 Institute of Medicine (IOM) report on the quality of care in nursing homes identified underdiagnosis and undertreatment of depression as major problems. Prior to the IOM report, only 10% of nursing home residents with depression were receiving treatment (Heston et al., 1992). By 1998, the Health Care Financing Administration reported that 25% of all nursing home residents were receiving antidepressants. Amore recent study by Datto et al. (2002) showed that 45.5% of nursing home residents were receiving antidepressants. The latter two reports suggest progress in the identification and treatment of depression. However, the study reported here indicates a continued need to assess, diagnose, and treat affective changes among nursing home residents. The purpose of this article is to report the prevalence of depression and discuss the variation in depression measures among elders in rural Iowa nursing homes. In addition, the prevalence of depression among women and men was determined along with a comparison of how measures vary in detection of depression.
Nursing homes typically do not have a mental health professional on staff,and depression in elders is poorly understood among health care generalists. Psychiatric nurses can be instrumental in identifying depression in nursing home residents. When interfacing with nursing home staff through admission and discharge of elders from in-patient or community-based agencies, psychiatric nurses can provide education on the importance of identification and prompt treatment of depression symptoms. The high suicide rate among elders is an ongoing issue that may in part be addressed by early detection and treatment of depression. Psychiatric nurses can help by identifying older adults at highest risk.
Impact of Depression
Depression in elders may occur as an affective response to illness, an adjustment to long-term placement, or as a clinical disorder. Previous studies have shown diverse prevalence rates of depression in nursing homes that varied depending on the assessment method or definition of depression. Rates range from 12.6% to 44% (Jones, Marcantonio, & Rabinowitz, 2003; Rovner et al., 1991). Teresi, Abrams, Holmes, Ramirez,...