Mental health services for residents of care homes

Mental health services for residents of care homesIn the UK, about 200,000 older people are resident in care homes, either nursing or residential.We know a lot about the epidemiology of mental health needs in this population and about the medical and mental health services that they receive.Less is known about what may be effective interventions in meeting those needs, and least of all as to how specialist mental health services should organise themselves to provide such interventions in actual practice. EpidemiologyCare home residents constitute a highly dependent population.Irrespective of whether homes cater speciWcally for people with dementia or not, recent studies suggest that over half the residents have some degree of dementia [1, 2].It can be argued that dementia care is the main business of residential care [3].Depression is also common in care homes.However, given the high prevalence of dementia and the difWculties in assessing mood in people with severe dementia, it is difWcult to be conWdent of its exact prevalence.A number of studies have estimated the prevalence of depression in non-demented residents, with Wgures around 40% being typical [4, 5].Most of these individuals have pervasive depressive symptoms rather than major depressive disorder [6], but such symptoms are often persistent over years or until the death of the individual [7].We know much less about risk factors for depression in residential homes than we do about depression in the community.Several factors, such as lack of family support, presence of physical disability (especially pain and visual problems) and restricted personal autonomy (such as access to a toilet or to the outside) may be important (Beekman, personal communication).Depressed mood may be an important factor underlying aggressive behaviour in residents with dementia [8], but the presence of depression does not seem to be associated with increased mortality among care home residents [9].Current evidence suggests that residents of care homes receive inferior standards of both general medical and mental health care [10].Depression is often both under detected and under treated in care home residents [11][12][13].For residents with dementia, there is concern regarding excessive prescribing of antipsychotic drugs [14] and the general quality of care they receive [15].In nursing homes, staff assessments of the presence of organic brain disorders may be inaccurate [16], and there may be perverse incentives not to identify the presence of dementia, as this may require a more expensive placement [17].