Underdiagnosis and undertreatment of depression in nursing home residents

BackgroundDepression in nursing home residents decreases their quality of life and is related to behavioral symptoms of dementia. Diagnosing depression in patients with advanced cognitive impairment may be challenging. The purpose of this study was to find out how well depression is diagnosed and treated in Dutch nursing homes in relation with age and dementia severity.MethodsThis cross-sectional study evaluated diagnoses and treatment of depression in nursing home residents using Minimum Data Set (MDS) information. Clinical and MDS-based diagnoses of depression were compared in 1851 residents of eight Dutch nursing homes and their medication use was analyzed.ResultsA clinical diagnosis of depression was present in 14.4% of residents while 42.5% had an MDS diagnosis. This difference was mainly due to an increasing discrepancy between clinical and MDS diagnoses with increasing stage of cognitive impairment. Antidepressants were used only in 33.9% of residents with an MDS diagnosis of severe depression and were given less often to older subject with depression diagnosis. Symptoms of depression were present even in residents treated with antidepressants. Antipsychotics were given to 220 subjects and antianxiety medications to 100 subjects who were diagnosed with depression but were not treated with antidepressants.ConclusionsDepression is underdiagnosed and undertreated, especially in nursing home residents with cognitive impairment. Some residents seem to be treated for depression with antipsychotics and antianxiety medications. More attention paid to recognition and treatment of depression can be expected to improve quality of life of many nursing home residents.