The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment

Psychometric properties of the Depressive Symptom Assessment for Older Adults in individuals with moderate or severe dementia

Many older adults with moderate or severe dementia also have depression, but identifying depressive symptoms in these individuals can be challenging. The Depressive Symptom Assessment for Older Adults (DSA), a newly developed instrument designed to evaluate older adults for depression, regardless of their cognitive status, facilitates longitudinal evaluation. This investigation examined the psychometric properties of the DSA in older adults (n = 68) with moderate or severe dementia. Internal consistency for the overall instrument and three of the six subscales, inter-rater reliability, and concurrent validity were established. Preliminary factor analysis yielded two strong factors; however, the other four factors were conceptually unclear. Although the DSA performed well statistically, the instrument may have over-identified depressive symptoms related to disagreeable behavior and lethargy and may have under-identified other depressive symptoms.

Professional carers' knowledge and response to depression among their aged-care clients: the care recipients' perspective

Depression is an under-diagnosed disorder among the elderly, even in those who are in receipt of aged-care services. One factor associated with this under diagnosis has been identified as a reluctance amongst the elderly to discuss their mood and emotions with their medical practitioners. The current study focused on why depression is not recognised and acted on by those providing residential or home-based care to older people. We interviewed 15 elderly people residing in high-level or low-level aged-care facilities, and three elderly people who were receiving personal care in their homes. All participants had been identified by their care agencies as depressed. Participants reported their perceptions of their personal carers' knowledge and practices in managing the residents' depression. Although the participants described their carers in positive terms, they were critical of their knowledge and skills in recognising depression, and indicated that the communication between personal carers and care recipients about depressive symptomatology was seriously flawed. Training for personal carers in these areas, and efforts to change organisational culture are recommended.

Treatment of depression in low-level residential care facilities for the elderly

BACKGROUND

The rate of recognition and treatment of depressed older people in nursing homes is low. Data from the low-level residential care population have not been reported. This study aimed to collect information about the treatment of depression among older persons living in low-level residential care (hostels).

METHOD

The participants comprised 300 elderly residents from ten low-level residential care facilities from various suburbs in metropolitan Melbourne. The participants were interviewed by a trained clinical psychologist to determine the presence or absence of major or minor depressive disorder using the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). Each participant was also administered the Standardized Mini-mental State Examination (SMMSE) to determine level of cognitive function. The clinical psychologist then reviewed all cases in consultation with a geropsychiatrist experienced in the diagnosis of depression among older people, prior to assigning a diagnosis of depression.

RESULTS

An important finding in this study was the low treatment for currently depressed residents, with less than half of those in the sample who were depressed receiving treatment. However, 61 of the 96 residents out of the sample of 300 who were on antidepressants were not currently depressed.

CONCLUSION

There is an under recognition and under treatment of currently depressed older people in low-level residential care facilities (hostels) just as has been reported in studies in nursing homes. However, there are high numbers receiving antidepressants who are not currently depressed.