- Email: [email protected]
Depression in long-term care facilities
Abstracts / Journal of Affective Disorders 107 (2008) S21–S52
participation in the treatment process and understanding of what is being done for their health. doi:10.1016/j.jad.2007.12.201
10.3 Working together – The larger societal picture A. Mustapha Centre for Mental Health and European Depression Association, UK It is often said that the only way to separate mind and body is with an axe. This is equally true when it comes to the mental health community and wider society. Everyone plays a role in the causes, prevention and treatment of mental illness whether they realise and accept the responsibility or not. With a minority of patients actually making it through the doctor's door for diagnosis and treatment we must ensure that every signpost on the patient journey points in the right direction. A practical, personal and where possible evidencebased guide to working together whilst avoiding the pitfalls, the topics covered will include: –Seizing the knowledge ‘high ground’ –Doctors and patient organisations working with media to get the right message out –Providing trained and knowledgeable patient representatives –Linking arms for equality with physical illness –Enhancing the importance of psychiatry within national medical communities –Attacking the prejudices within medical/academic communities –Advocating for better systems, better funding doi:10.1016/j.jad.2007.12.202
S43
tions. The prevalence of depressive disorders is higher in residential care facilities than among older people living at home, but this is partly because the disabilities that made institutional care necessary are causative or maintaining factors in relation to depression. In many parts of the world (Africa, for example), availability of residential care is limited or non-existent, and families bear the burden of caring for people with chronic illnesses. Depression is under-recognised, and its symptoms and those of dementia are commonly regarded as untreatable consequences of ageing. However, health administrators in developing countries may well perceive that in such cases family and community care are preferable to care in institutions, where learned helplessness and increasing dependence may be factors leading to suicidality. There is variability between and within countries in the availability of specialist mental health services and psychiatrically trained staff to assess, intervene in, and provide education about mental disorders of older people in long-term care facilities. There is a need to examine outcomes in relation to collaborative care, antidepressant use and other measures aimed at treating or preventing mood disorders in such facilities. During this symposium, findings and guidance from literature reviews will be presented concerning identification and treatment of late-life depression (particularly in long-term care facilities), and suicidal behaviour in nursing homes. Discussion will focus on how to provide long-term care to older people with disabilities in ways that optimise their mental health and maintain or restore self-esteem. doi:10.1016/j.jad.2007.12.203
11.1 Depression in long-term care facilities J. Snowdon University of Sydney, Australia
Symposium 11 IPA symposium Late-life depression and long-term care Symposium Leader: J. Snowdon University of Sydney, Australia 11 (overview) There is a world-wide need for improved mental health services for older people in long-term care situa-
Introduction: The prevalence of depression in nursing homes in various countries is known to be high. How well is it recognised and treated? Methods: Recent literature was examined in order to explore how effective and efficient are long-term care facility (LTCF) staff in identifying depression among residents, and how identified cases are then treated. The International Psychogeriatric Association's Task Force on provision of mental health services in residential care facilities provided opportunities to review differences
S44
Abstracts / Journal of Affective Disorders 107 (2008) S21–S52
between and within countries in ways of dealing with depression. Information was available about recent initiatives to optimise management of depression in Australian LTCFs. Results: LTCFs are now widespread in developed countries, but mental health services to intervene in cases of depression are not necessarily available or sought for residents who would benefit. There has been a welcome improvement in recognition of depression in nursing homes. Outcome research is needed to assess antidepressant efficacy and to better plan multifaceted treatment strategies for depression of varying types and aetiologies among LTCF residents. Discussion: Health planners in developing countries may well want to recommend community and family provision of long-term care services rather than institutional care for older people unable to care for themselves, and to consider how best to maintain their self-esteem and quality of life (and thus minimise demoralisation). They can learn from suboptimal developments elsewhere, but also note what has worked well.
depression, significant physical illnesses causing disability, or other mental health problems, such as dementia. Management guidelines for depression in the elderly suggest that: Initial treatment should be continued for at least 6 weeks before considering switching antidepressant due to lack of efficacy. Antidepressant treatment should be continued for a minimum of 12 months. The results of an audit of three care homes will be presented where residents are divided into two groups – those receiving antidepressant treatment and those not. For those on antidepressants, concordance with treatment guidelines will be reviewed. For residents not on antidepressants, results of screening for depression will be presented.
doi:10.1016/j.jad.2007.12.204
A. Grek Mount Sinai Hospital, Canada, University of Toronto, Canada
11.2 Depression in residential care: A UK primary care perspective
Moving to and living in a nursing home are difficult experiences, likely traumatic and depressing for many people already struggling with ill health, pain, dependency, and limited social and material resources. In the face of such suffering, a wish for death may be understandable. Depression is known to be more common in nursing homes, and suicide to be associated with depression, physical illness, and social isolation. A PubMed search of the literature (using search terms for suicide or self-injurious behavior in conjunction with those for nursing homes, homes for the aged and assisted living facilities) uncovered 89 articles relevant to the subject published since 1966. This presentation will summarize this literature. Suicide may be more common in nursing homes than in the community even though residents are supervised and have reduced access to the means of suicide. The studies to date – surveys and an uncontrolled psychological autopsy study – suggest that depression is the major risk factor for nursing-home suicide. Active self-injurious behavior is also remarkably common in nursing homes, but it appears to be a feature of dementia rather than of depression. It is sometimes associated with aimless repetitive behavior and aggression. Studies suggest an association with restraint, sedation and unfavorable elements in the physical
J. Rasmussen Moat House Clinic, UK Studies have shown that a significant percentage of elderly in care homes or who are hospitalised suffer from major depression. Depressive signs and symptoms are also frequently associated with chronic, painful or serious physical illness and cardiovascular disease all of which are common in patients in residential care. There is strong evidence that the presence of depression is associated with increased morbidity and mortality. A diagnosis of depression in residential care may be missed due to atypical presentation; e.g., agitation, predominant anxiety, pseudodementia or masking by neurological illnesses such as Parkinson's disease where the clinical features of depression overlap the motor features of PD. The National Institute of Clinical Excellence (NICE) guidelines for depression in the UK state: Screening should be undertaken in primary care (community and residential) and general hospital settings for depression in high-risk groups; e.g., past history of
doi:10.1016/j.jad.2007.12.205
11.3 Self-harm and suicide in nursing homes
participation in the treatment process and understanding of what is being done for their health. doi:10.1016/j.jad.2007.12.201
10.3 Working together – The larger societal picture A. Mustapha Centre for Mental Health and European Depression Association, UK It is often said that the only way to separate mind and body is with an axe. This is equally true when it comes to the mental health community and wider society. Everyone plays a role in the causes, prevention and treatment of mental illness whether they realise and accept the responsibility or not. With a minority of patients actually making it through the doctor's door for diagnosis and treatment we must ensure that every signpost on the patient journey points in the right direction. A practical, personal and where possible evidencebased guide to working together whilst avoiding the pitfalls, the topics covered will include: –Seizing the knowledge ‘high ground’ –Doctors and patient organisations working with media to get the right message out –Providing trained and knowledgeable patient representatives –Linking arms for equality with physical illness –Enhancing the importance of psychiatry within national medical communities –Attacking the prejudices within medical/academic communities –Advocating for better systems, better funding doi:10.1016/j.jad.2007.12.202
S43
tions. The prevalence of depressive disorders is higher in residential care facilities than among older people living at home, but this is partly because the disabilities that made institutional care necessary are causative or maintaining factors in relation to depression. In many parts of the world (Africa, for example), availability of residential care is limited or non-existent, and families bear the burden of caring for people with chronic illnesses. Depression is under-recognised, and its symptoms and those of dementia are commonly regarded as untreatable consequences of ageing. However, health administrators in developing countries may well perceive that in such cases family and community care are preferable to care in institutions, where learned helplessness and increasing dependence may be factors leading to suicidality. There is variability between and within countries in the availability of specialist mental health services and psychiatrically trained staff to assess, intervene in, and provide education about mental disorders of older people in long-term care facilities. There is a need to examine outcomes in relation to collaborative care, antidepressant use and other measures aimed at treating or preventing mood disorders in such facilities. During this symposium, findings and guidance from literature reviews will be presented concerning identification and treatment of late-life depression (particularly in long-term care facilities), and suicidal behaviour in nursing homes. Discussion will focus on how to provide long-term care to older people with disabilities in ways that optimise their mental health and maintain or restore self-esteem. doi:10.1016/j.jad.2007.12.203
11.1 Depression in long-term care facilities J. Snowdon University of Sydney, Australia
Symposium 11 IPA symposium Late-life depression and long-term care Symposium Leader: J. Snowdon University of Sydney, Australia 11 (overview) There is a world-wide need for improved mental health services for older people in long-term care situa-
Introduction: The prevalence of depression in nursing homes in various countries is known to be high. How well is it recognised and treated? Methods: Recent literature was examined in order to explore how effective and efficient are long-term care facility (LTCF) staff in identifying depression among residents, and how identified cases are then treated. The International Psychogeriatric Association's Task Force on provision of mental health services in residential care facilities provided opportunities to review differences
S44
Abstracts / Journal of Affective Disorders 107 (2008) S21–S52
between and within countries in ways of dealing with depression. Information was available about recent initiatives to optimise management of depression in Australian LTCFs. Results: LTCFs are now widespread in developed countries, but mental health services to intervene in cases of depression are not necessarily available or sought for residents who would benefit. There has been a welcome improvement in recognition of depression in nursing homes. Outcome research is needed to assess antidepressant efficacy and to better plan multifaceted treatment strategies for depression of varying types and aetiologies among LTCF residents. Discussion: Health planners in developing countries may well want to recommend community and family provision of long-term care services rather than institutional care for older people unable to care for themselves, and to consider how best to maintain their self-esteem and quality of life (and thus minimise demoralisation). They can learn from suboptimal developments elsewhere, but also note what has worked well.
depression, significant physical illnesses causing disability, or other mental health problems, such as dementia. Management guidelines for depression in the elderly suggest that: Initial treatment should be continued for at least 6 weeks before considering switching antidepressant due to lack of efficacy. Antidepressant treatment should be continued for a minimum of 12 months. The results of an audit of three care homes will be presented where residents are divided into two groups – those receiving antidepressant treatment and those not. For those on antidepressants, concordance with treatment guidelines will be reviewed. For residents not on antidepressants, results of screening for depression will be presented.
doi:10.1016/j.jad.2007.12.204
A. Grek Mount Sinai Hospital, Canada, University of Toronto, Canada
11.2 Depression in residential care: A UK primary care perspective
Moving to and living in a nursing home are difficult experiences, likely traumatic and depressing for many people already struggling with ill health, pain, dependency, and limited social and material resources. In the face of such suffering, a wish for death may be understandable. Depression is known to be more common in nursing homes, and suicide to be associated with depression, physical illness, and social isolation. A PubMed search of the literature (using search terms for suicide or self-injurious behavior in conjunction with those for nursing homes, homes for the aged and assisted living facilities) uncovered 89 articles relevant to the subject published since 1966. This presentation will summarize this literature. Suicide may be more common in nursing homes than in the community even though residents are supervised and have reduced access to the means of suicide. The studies to date – surveys and an uncontrolled psychological autopsy study – suggest that depression is the major risk factor for nursing-home suicide. Active self-injurious behavior is also remarkably common in nursing homes, but it appears to be a feature of dementia rather than of depression. It is sometimes associated with aimless repetitive behavior and aggression. Studies suggest an association with restraint, sedation and unfavorable elements in the physical
J. Rasmussen Moat House Clinic, UK Studies have shown that a significant percentage of elderly in care homes or who are hospitalised suffer from major depression. Depressive signs and symptoms are also frequently associated with chronic, painful or serious physical illness and cardiovascular disease all of which are common in patients in residential care. There is strong evidence that the presence of depression is associated with increased morbidity and mortality. A diagnosis of depression in residential care may be missed due to atypical presentation; e.g., agitation, predominant anxiety, pseudodementia or masking by neurological illnesses such as Parkinson's disease where the clinical features of depression overlap the motor features of PD. The National Institute of Clinical Excellence (NICE) guidelines for depression in the UK state: Screening should be undertaken in primary care (community and residential) and general hospital settings for depression in high-risk groups; e.g., past history of
doi:10.1016/j.jad.2007.12.205
11.3 Self-harm and suicide in nursing homes