Inadequate Treatment of Depressed Nursing Home Elderly

OBJECTIVE: To determine the prevalence of antidepressant drug treatment among nursing home elderly with major depression. DESIGN: Survey early and late in nursing home stay. SETTING: Sixty Medicaid/Medicare-certified skilled nursing homes. PARTICIPANTS: Admission cohort of 5,752 residents age 65 or older in 1976 through 1983. MEASURES: Chart review by nurse-abstractors of physicians' diagnoses, drug used, and alertness rating. Diagnosis of depression equivalent to DSM-III-R major depression. RESULTS: Of 868 persons with a diagnosis of depression in the medical record, only 10% were treated with antidepressant drugs. More received neuroleptics and benzodiazepines than received antidepressants, but most (52%) received no psychoactive drug at all. A subset of 258 depressed persons had positive notations in their records supporting a mental status rating of "alert and oriented." Of that subset, only 15% received antidepressants. When followed from admission to discharge or end of study the prevalence rate of antidepressant drug treatment increased by 4%. CONCLUSIONS: In the late 1970's and early 1980's, even when the primary care physician made and recorded a diagnosis of depression, most such nursing home residents remained untreated, incorrectly treated, or inadequately treated.