Skip to main content Accessibility help
×
×
Home

Depression and use of antidepressants in Swedish nursing homes: a 12-month follow-up study

  • Patrik Midlöv (a1), Martin Andersson (a1), Carl Johan Östgren (a2) and Sigvard Mölstad (a1)
Abstract
Background:

The prescription of antidepressants in nursing homes has increased markedly since the introduction of SSRIs, while at the same time depressive symptoms often go unrecognized and untreated. The aim of this study was to examine whether depression among residents in nursing homes is treated adequately.

Methods:

A sample of 429 participants from 11 Swedish nursing homes was selected and was assessed with the Cornell Scale for Depression in Dementia (CSDD) and using medical records and drug prescription data. For 256 participants a follow-up assessment was performed after 12 months.

Results:

The prevalence of depression, according to medical records, was 9.1%, and the prevalence of CSDD score of ≥8 was 7.5%. Depression persisted in more than 50% of cases at the 12-month follow-up. Antidepressants were prescribed to 33% of the participants without a depression diagnosis or with a CSDD score of <8. 46.2% of all participants were prescribed antidepressants. 14% of the participants without a depression diagnosis or with a CSDD score of <8 had psychotropic polypharmacy. 15.2% of all participants had psychotropic polypharmacy, which persisted at the 12-month follow-up in three-quarters of cases.

Conclusion:

The prescription of antidepressants in frail elderly individuals is extensive and may be without clear indication. The clinical implication is that there is a need for systematic drug reviews at nursing homes, paying special attention to the subjects which are on antidepressants.

Copyright
Corresponding author
Correspondence should be addressed to: Patrik Midlöv, Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Jan Waldenströms gata 35, Skåne University Hospital, 205 02 Malmö, Sweden, Phone: +4640 391363; Fax: +4640 391370. Email: patrik.midlov@med.lu.se.
References
Hide All
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271284.
Banerjee, S. et al. (2011). Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet, 378, 403411.
Barca, M. L., Engedal, K. and Selbaek, G. (2010). A reliability and validity study of the cornell scale among elderly inpatients, using various clinical criteria. Dementia and Geriatric Cognitive Disorders, 29, 438447.
Bergdahl, E. et al. (2005). Depression among the oldest old: the Umea 85+ study. International Psychogeriatrics, 17, 557575.
Bergh, S., Selbaek, G. and Engedal, K. (2012). Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double blind, randomised, parallel group, placebo controlled trial. British Medical Journal, 344, e1566.
Coupland, C., Dhiman, P., Morriss, R., Arthur, A., Barton, G. and Hippisley-Cox, J. (2011). Antidepressant use and risk of adverse outcomes in older people: population based cohort study. British Medical Journal, 343, d4551.
Fastbom, J. and Schmidt, I. (2004). Shortages in the treatment of depression of the elderly in nursing homes in Stockholm. Diagnosis is based on flimsy ground, follow up performed early. Lakartidningen, 101, 3683–3684, 36863688.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Hughes, L. D., McMurdo, M. E. and Guthrie, B. (2013). Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing, 42, 6269.
Iden, K. R., Hjorleifsson, S. and Ruths, S. (2011). Treatment decisions on antidepressants in nursing homes: a qualitative study. Scandinavian Journal of Primary Health Care, 29, 252256.
Lindstrom, K., Ekedahl, A., Carlsten, A., Martensson, J. and Molstad, S. (2007). Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced? Scandinavian Journal of Primary Health Care, 25, 38.
Lustenberger, I., Schupbach, B., von Gunten, A. and Mosimann, U. (2011). Psychotropic medication use in Swiss nursing homes. Swiss Medical Weekly, 141, w13254.
Lyketsos, C. G. et al. (2003). Treating depression in Alzheimer disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Archives of General Psychiatry, 60, 737746.
Mann, E., Kopke, S., Haastert, B., Pitkala, K. and Meyer, G. (2009). Psychotropic medication use among nursing home residents in Austria: a cross-sectional study. BMC Geriatrics, 9, 18.
Mottram, P. G., Wilson, K. and Strobl, J. J. (2006). Antidepressants for depressed elderly. Cochrane Database of Systematic Reviews, CD003491.
Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V. and Ustun, B. (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet, 370, 851858.
NICE (2009). Depression: The Treatment and Management of Depression in Adults. London: National Institute for Health and Clinical Excellence (NICE).
NICE (2011). Generalised Anxiety Disorder and Panic Disorder (with or Without Agoraphobia) in Adults. London: National Institute for Health and Clinical Excellence (NICE).
Schreiner, A. S., Hayakawa, H., Morimoto, T. and Kakuma, T. (2003). Screening for late life depression: cut-off scores for the Geriatric Depression Scale and the Cornell Scale for Depression in Dementia among Japanese subjects. International Journal of Geriatric Psychiatry, 18, 498505.
Seitz, D., Purandare, N. and Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22, 10251039.
Shah, S., Schoenbachler, B., Streim, J. and Meeks, S. (2012). Antidepressant prescribing patterns in the nursing home: second-generation issues revisited. Journal of the American Medical Directors Association, 13, 406 e413–e408.
Snowdon, J. (2010). Depression in nursing homes. International Psychogeriatrics, 22, 11431148.
Swedish Council on Health Technology Assessment (SBU). (2012). Diagnosis and monitoring of mood disorders – a systematic review. Stockholm.
The National Board of Health and Welfare (2010). Indicators for evaluation of the quality of drug use by elderly. Stockholm.
Weitoft, G. R., Ericsson, O. and Fastbom, J. (2012). Prescription drugs: Health in Sweden: The National Public Health Report 2012. Chapter 18. Scandinavian Journal of Public Health, 40, 293304.
WHO Collaborating Centre for Drug Statistics Methodology. (2013). Anatomical Therapeutic Chemical (ATC) Classification Index. Oslo: World Health Organisation.
Wilson, K., Mottram, P. G. and Vassilas, C. (2008). Psychotherapeutic treatments for older depressed people. Cochrane Database of Systematic Reviews, CD004853.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed