Friday, October 9, 2015

Depression and Dementia

In a recent study researchers found that depressive symptoms were more than twice as common among assisted living residents with mild or moderate dementia than among those without dementia. Depressed residents often do not have positive outcomes and are greater risk of discharge to nursing homes and death. Chronic depression can lead to loss of appetite and weight loss, lethargy, and a host of other premature health complications. Findings of the study document the high prevalence of depressive symptomatology among those with dementia. About 54% of the depressed and 33% of the non-depressed participants were taking antidepressant medication.1 Sixty-two of the participants of the study were depressed had no formal mental health treatment. Depression was more common among participants with severe dementia, behavioral symptoms and those with pain. The study also found that over half of the depressed participants were undetected by staff.
These results indicate a strong need to properly assess residents for depression. Seeking interventions for those suffering who are undiagnosed and corrective actions for those currently treated for depression who may not be depressed can derail potential problems. Identifying these at-risk residents and advising attending physicians and family members may help operators to avert unnecessary mental health triggered discharges, while improving the quality of life for each individual.
The Cornell Scale for Depression in Dementia (CSDD) was developed in response to a need in the industry for a diagnostic tool to quantify incidence of depression in elderly populations with dementia2. This simple 19 question tool enables operators to identify at-risk residents who are suffering from depression and are undiagnosed so that they might be treated, and also identify those who may be already prescribed antidepressants who may not in fact be depressed. This way attending physicians may be offered a nationally recognized diagnostic tool to use to evaluate and prescribe for their patients, rather than relying upon sporadic observations from caregivers and family members.
Using the Cornell Scale for Depression in Dementia (CSDD) operators can create a team consisting of nurses aides, LPNs and/or RNs familiar with the residents to review their collective impressions of each resident, evaluate and identify any depressive characteristics in each of the 19 symptomatic areas. This information can then be tallied and charted to evaluate risk potential. Medication dose, frequency and indication information is also collected to help evaluate the adequacy of any current treatments in place.
Upon collection of the pertinent data, the resident's physician or a consultant Psychologist or Neuropsychologist reviews this information and evaluates the appropriate treatment options for each individual, including perhaps a multidisciplinary review if appropriate. The involvement of mental health professionals in the assessment and treatment of depression in assisted living was found in the study to be alarmingly low. Less than 50% of the depressed participants were receiving any professional help.
Among the key domains of care, depression was the quality-of-life domain with the lowest perceived treatment success1. Perhaps the main reason for this is that such a high percentage of residents are undiagnosed, or inappropriately treated. Empowered with the survey results, management can develop treatment protocols for each resident now properly diagnosed, and train staff on the recognition of depression symptoms and how to effectively deal with them. Further, involvement from mental health professionals can contribute significantly to resident wellness.
The process is very simple and can be fun and enlightening with potential to positively impact the lives of the residents and contribute significantly to their overall quality of life and well-being.
1. Baldini-Gruber, Ann, Zimmerman, Sheryl, Boustani, Malaz, Watson, Lea, Williams, Christianna, Reed, Peter. Characteristics Associated with Depression in Long-Term Care Residents with Dementia. The Gerontologist. Vol. 45, October 2005, Page 50-55.
2. Alexopoulos, G.S., Abrams, R.C., Young, R.C., & Shamoian, C.A. Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 1988, Page 271-284.