Recognition, assessment and treatment of depression in geriatric nursing home residents

Depression is the most common, treatable psychiatric disorder found in elderly nursing home residents. Approximately 1.5 million people older than the age of 65 currently reside in nursing homes, and this number is projected to increase substantially with the aging of the U.S. population. Estimates for major depression range from 12% to 22% and 16% to 30% for minor depression, yet the majority of cases remain either unrecognized or untreated. Untreated depression is associated with increased morbidity, mortality, functional impairment, and decreased quality of life for residents. Risk factors for depression include physical illness and disability, polypharmacy, nursing home placement, and environmental factors. The clinical features of depression are often uncharacteristic of the mood changes noted in younger individuals, including somatic symptoms, eating disorders, anxiety, aggression, and cognitive and functional impairment. The on-site nurse practitioner in the nursing home has a pivotal role as a member of the interdisciplinary care team in assessing and managing depression collaboratively with the nursing home staff. Treatment modalities include antidepressant therapy, psychiatric evaluation, psychotherapy, and electroconvulsive therapy. Improving the nursing home environment maybe a key factor in preventing and treating depression in elders.