Long-term care rife with depression

One of the largest studies of the 65-and-over crowd in long-term care homes in Canada has found that 44 per cent have been diagnosed with depression or suffer from symptoms.

TORONTO — One of the largest studies of the 65-and-over crowd in long-term care homes in Canada has found that 44 per cent have been diagnosed with depression or suffer from symptoms.

Many of those who are diagnosed receive treatment and no longer show signs of being down in the dumps, while 18 per cent have symptoms but no documented diagnosis — suggesting that many more sad seniors could be helped, experts say.

“It would certainly suggest that there’s room for improvement when it comes to detecting people who could benefit from treatment,” said Nancy White, manager of home and continuing care development at the Canadian Institute for Health Information, which released the report Thursday.

“What we see is that the people who have symptoms but no diagnosis suffer a lot of very problematic side-effects of the depression — loss of sleep, poor quality of life — and those people could likely benefit from treatment.”

Research covered the 2008-09 fiscal year and findings were arrived at through a study of nearly 50,000 residents of residential facilities offering 24-hour care in Nova Scotia, Ontario, Manitoba, Saskatchewan and the Yukon.

The study used a relatively new assessment tool, called RAI-MDS 2.0, that includes a look at health, nutrition, hearing, communication and cognitive skills, as well as input from nurses, and even kitchen and cleaning staff who interact with residents, White said.

“They have team meetings where they actually say ‘Now, what’s your impression of how Mrs. Smith is doing?’ and ‘What are you seeing?’ . . .

“One of the stories I’ve heard was of a woman who was in a home and when they started doing the assessments, the cleaning staff came to the nurse and said, ‘Well, Mrs. So-and-So cries in her room every afternoon.”’

“Nobody knew that, except the cleaning lady.”

Dr. Marie-France Rivard, chairman of the seniors’ advisory committee of the Mental Health Commission of Canada, said depression is under-diagnosed and undertreated.

“Most people think that, well, you know, if you’re in a nursing home you have too many health problems and if I had to be in a nursing home, I would be depressed too — there’s probably nothing that we can do,” she said. “And we want to change that because we know that treatment of depression will help.”

Treating a chronically sad long-term care resident will also make family members feel better, and help caregivers who might have to deal with irritability or aggressive, defensive behaviour that’s sometimes exhibited by depressed people, she said.

Rivard said the RAI-MDS 2.0 assessment tool, being rolled out in eight jurisdictions across Canada, can help establish what type of depression the senior has, and help guide the treatment.

Dr. David Hogan, who’s in the division of geriatric medicine at the University of Calgary, said depression is known to be common in long-term care patients, and is often unrecognized and frequently inadequately treated.

“But diagnosing it can be challenging in residents suffering from a dementia with a lot of other medical conditions,” he said in an email.

“Depressive symptoms don’t necessarily equal a diagnosis of a clinical depression and the presence of a depression (doesn’t) necessarily mean that people should be placed on an antidepressant. It’s a complex issue.”

Drugs aren’t the only recourse. However, White said the study found that only a small number of people receive psychotherapy. Those with a diagnosis of depression are more likely to receive it.

“We also looked at, for example, recreation therapy to see whether these people were getting non-specialized therapy, in other words pet therapy and music therapy and those kinds of things, and the numbers were very small for those kind of therapies.”

Depression could be caused by brain disease such as Alzheimer’s or stroke, a genetic predisposition, psychological trauma earlier in life, recent bereavement, a loss of health or independence, she said.

White related the story of an elderly woman who was admitted to a nursing home in the Yukon as a palliative care patient, expected to die within a few months.

“The staff did the RAI assessment on this lady, and it flagged that she was at risk for depression. They did a little more investigation, they instituted some treatment with this lady and within a short period of time she was engaging in activities in the home,” White said.

“She participated in pet therapy, she started baking lemon cakes for the staff and for families, and was a really enthusiastic resident of that home for another full two years before she died. Yet when she was admitted everybody thought she was dying. She was depressed.”