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Successful ECT in long-term care residents
M H Zisselman1, K G Kelly, T Cutillo-Schmitter
1Temple University Department of Psychiatry, Temple Continuing Care Center, Philadelphia, PA 19141, USA.
Journal of the American Medical Directors Association
|June 19, 2003
Summary
Electroconvulsive therapy (ECT) is a safe and effective treatment for major depression in long-term care (LTC) residents, even those with medical comorbidities. Most patients showed improvement after ECT, highlighting its utility when medications fail.
Area of Science:
- Geriatric Psychiatry
- Neuroscience
- Clinical Medicine
Background:
- Depression is highly prevalent in long-term care (LTC) residents, contributing to increased mortality and morbidity.
- Treatment resistance or intolerance to antidepressants is common in this population.
- Electroconvulsive therapy (ECT) is a known effective treatment for older adults but is understudied in LTC settings.
Purpose of the Study:
- To evaluate the safety and efficacy of Electroconvulsive therapy (ECT) in long-term care (LTC) residents.
- To assess treatment outcomes and complications of ECT in a medically comorbid LTC population.
Main Methods:
- Retrospective chart review of LTC residents who underwent ECT at an academic facility over three years.
- Data collected included demographics, medical comorbidity (Cumulative Illness Rating Scale for Geriatrics - CIRS-G), psychiatric diagnosis, prior medication trials, and cognitive function (Mini-Mental State Examination - MMSE).
- ECT treatment details (number, stimuli type) and outcomes (Clinical Global Impression of Change - CGI) were analyzed.
Main Results:
- Thirteen LTC residents (mean age 81) with major depression, often with psychotic features, received ECT.
- All patients had significant medical comorbidities (mean CIRS-G 19.7) and had failed multiple psychotropic medications.
- 69% of patients showed clinical improvement (CGI), with transient complications like cognitive decline, headache, or delirium, all fully reversible.
Conclusions:
- Electroconvulsive therapy (ECT) is a safe and effective treatment for major depression in medically complex long-term care residents.
- ECT offers a viable therapeutic option for treatment-resistant depression in this vulnerable population.
- Close monitoring for delirium is crucial during and after ECT in LTC residents to manage potential confusion.
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