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Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review

Published online by Cambridge University Press:  04 June 2010

Dallas Seitz ,
Nitin Purandare  and
David Conn
Dallas Seitz
Affiliation:
Department of Psychiatry, Baycrest Centre, Toronto, Ontario, Canada Kunin-Lunenfeld Applied Research Unit, Baycrest Centre, Toronto, Ontario, Canada Women's College Research Institute, Toronto, Ontario, Canada
Nitin Purandare
Affiliation:
Manchester Academic Health Science Centre, Manchester, U.K.
David Conn*
Affiliation:
Department of Psychiatry, Baycrest Centre, Toronto, Ontario, Canada
*
Correspondence should be addressed to: Dr. David Conn, Department of Psychiatry, Baycrest Centre, 3560 Bathurst Street, Toronto, ON, M6A 2E1, Canada. Phone: +1 (416) 785-2500 ext: 2747; Fax: +1 (416) 785-2540. Email: [email protected].
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Abstract

Background: The population of older adults in long-term care (LTC) is expected to increase considerably in the near future. An understanding of the prevalence of psychiatric disorders in LTC will help in planning mental health services for this population. This study reviews the prevalence of common psychiatric disorders in LTC populations.

Methods: We searched electronic databases for studies on the prevalence of major psychiatric disorders in LTC using medical subject headings and key words. We only included studies using validated measures for diagnosing psychiatric disorders or psychiatric symptoms. Our review focused on the following psychiatric disorders: dementia, behavioral and psychological symptoms of dementia (BPSD), major depression, depressive symptoms, bipolar disorder, anxiety disorders, schizophrenia, and alcohol use disorders. We also determined the prevalence of psychiatric disorders in the U.S. LTC population using data from the 2004 National Nursing Home Survey (NNHS).

Results: A total of 74 studies examining the prevalence of psychiatric disorders and psychological symptoms in LTC populations were identified including 30 studies on the prevalence of dementia, 9 studies on behavioral symptoms in dementia, and 26 studies on depression. Most studies involved few LTC facilities and were conducted in developed countries. Dementia had a median prevalence (58%) in studies while the prevalence of BPSD was 78% among individuals with dementia. The median prevalence of major depressive disorder was 10% while the median prevalence of depressive symptoms was 29% among LTC residents. There were few studies on other psychiatric disorders. Results from the 2004 NNHS were consistent with those in the published literature.

Conclusions: Dementia, depression and anxiety disorders are the most common psychiatric disorders among older adults in LTC. Many psychiatric disorders appear to be more prevalent in LTC settings when compared to those observed in community-dwelling older adults. Policy-makers and clinicians should be aware of the common psychiatric disorders in LTC and further research into effective prevention and treatments are required for this growing population.

Keywords

epidemiologylong-term carenursing homepsychiatric disordersmental disorderspsychological symptoms
Type
Focus on mental health issues in long-term-care homes
Information
International Psychogeriatrics , Volume 22 , Special Issue 7: Focus on mental health issues in long-term-care homes , November 2010 , pp. 1025 - 1039
Copyright
Copyright © International Psychogeriatric Association 2010

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References

Achterberg, W., Pot, A. M., Kerkstra, A. and Ribbe, M. (2006). Depressive symptoms in newly admitted nursing home residents. International Journal of Geriatric Psychiatry, 21, 1156–1162.CrossRefGoogle ScholarPubMed
Adolfsson, R., Gottfries, C., Nystrom, L. and Winbald, B. (1981). Prevalence of dementia disorders in institutionalized Swedish old people: the work load imposed by caring for these patients. Acta Psychiatrica Scandinavica, 63, 225–244.Google Scholar
Alvarado-Esquivel, C. et al. (2004). Prevalence of dementia and Alzheimer's disease in elders of nursing homes and a senior center of Durango City, Mexico. BMC Psychiatry, 4, 3.Google Scholar
Andersson, M. and Gottfries, C. (1992). Dementia syndromes in nursing home patients. International Psychogeriatrics, 4, 241–252.Google Scholar
Anstey, K. J., von Sanden, C., Sargent-Cox, K. and Luszcz, M. A. (2007). Prevalence and risk factors for depression in a longitudinal population-based study including individuals in the community and residential care. American Journal of Geriatric Psychiatry, 15, 497–505.Google Scholar
Arias-Merino, E. et al. (2003). Correlates of cognitive impairment in elderly residents of long term care institutions in the metropolitan area of Guadalajara, Mexico. Journal of Nutrition, Health and Aging, 7, 97–101.Google Scholar
Baiyewu, O., Adeyemi, J. D. and Ogunniyi, A. (1997). Psychiatric disorders in Nigerian nursing home residents. International Journal of Geriatric Psychiatry, 12, 1146–1150.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Balestreri, L., Grossberg, A. and Grossberg, G. T. (2000). Behavioral and psychological symptoms of dementia as a risk factor for nursing home placement. International Psychogeriatrics, 12, 59–62.CrossRefGoogle Scholar
Beekman, A. T. et al. (1998). Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam. International Journal of Geriatric Psychiatry, 13, 717–726.3.0.CO;2-M>CrossRefGoogle ScholarPubMed
Bernstein, A. B. and Remsburg, R. E. (2007). Estimated prevalence of people with cognitive impairment: results from nationally representative community and institutional surveys. The Gerontologist, 47, 350–354.Google Scholar
Brodaty, H. et al. (2001). Psychosis, depression and behavioural disturbances in Sydney nursing home residents: prevalence and predictors. International Journal of Geriatric Psychiatry, 16, 504–512.Google Scholar
Buhr, G. T., Kuchibhatla, M., Clipp, E. C., Buhr, G. T., Kuchibhatla, M. and Clipp, E. C. (2006). Caregivers’ reasons for nursing home placement: clues for improving discussions with families prior to the transition. Gerontologist, 46, 52–61.Google Scholar
Burrows, A. B., Salzman, C., Satlin, A., Noble, K., Pollock, B. G. and Gersh, T. (2002). A randomized, placebo-controlled trial of paroxetine in nursing home residents with non-major depression. Depression and Anxiety, 15, 102–110.CrossRefGoogle ScholarPubMed
Butler, R., Fonseka, S., Barclay, L., Sembhi, S. and Wells, S. (1998). The mental health of nursing home residents: a New Zealand study. Aging and Mental Health, 2, 49–52.Google Scholar
Cacchione, P. Z., Culp, K., Laing, J. and Tripp-Reimer, T. (2003). Clinical profile of acute confusion in the long-term care setting. Clinical Nursing Research, 12, 145–158.Google Scholar
Canadian Study of Health and Aging Study Group (1994). Canadian study of health and aging: study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899–913.Google Scholar
Carswell-Opzoomer, A., Puxty, J., Teaffe, M. and Walop, W. (1993). Dementia in long-term care facilities: a survey of the Ottawa-Carleton Region. Canadian Journal on Aging, 12, 360–372.Google Scholar
Chahine, L., Bijlsma, A., Hospers, A. and Chemali, Z. (2007). Dementia and depression among nursing home residents in Lebanon: a pilot study. International Journal of Geriatric Psychiatry, 22, 283–285.CrossRefGoogle ScholarPubMed
Chandler, J. D. and Chandler, J. E. (1988). The prevalence of neuropsychiatric disorders in a nursing home population. Journal of Geriatric Psychiatry and Neurology, 1, 71–76.CrossRefGoogle Scholar
Chen, T-F. et al. (2007). Institution type-dependent high prevalence of dementia in long-term care units. Neuroepidemiology, 28, 142–149.CrossRefGoogle ScholarPubMed
Cheok, A., Snowdon, J., Miller, R. and Vaughan, R. (1996). The prevalence of anxiety disorders in nursing homes. International Journal of Geriatric Psychiatry, 11, 405–410.3.0.CO;2-O>CrossRefGoogle Scholar
Chow, E. S. L. et al. (2004). The prevalence of depressive symptoms among elderly Chinese private nursing home residents in Hong Kong. International Journal of Geriatric Psychiatry, 19, 734–740.CrossRefGoogle ScholarPubMed
Clark, W. S., Street, J. S., Feldmen, P. D. and Breier, A. (2001). The effects of olanzapine in reducing the emergence of psychosis among nursing home patients with Alzheimer's disease. Journal of Clinical Psychiatry, 62, 34–40.Google Scholar
Class, C., Unverzagt, F. W., Gao, S., Hall, K. S., Baiyewa, O. and Hendrie, H. C. (1996). Psychiatric disorders in African American nursing home residents. American Journal of Psychiatry, 153, 677–681.Google Scholar
Cohen, C. I. et al. (2000). Schizophrenia and older adults. An overview: directions for research and policy. American Journal of Geriatric Psychiatry, 8, 19–28.CrossRefGoogle ScholarPubMed
Conn, D. K., Ferguson, I., Mandelman, K. and Ward, C. (1999). Psychotropic drug utilization in long-term-care facilities for the elderly in Ontario, Canada. International Psychogeriatrics, 11, 223–233.CrossRefGoogle ScholarPubMed
Coughlin, T. A., McBride, T. D. and Liu, K. (1990). Determinants of transitory and permanent nursing home admissions. Medical Care, 29, 616–631.CrossRefGoogle Scholar
Donnelly, C., Compton, S., Devaney, N., Kirk, S. and McGuigan, M. (1989). The elderly in long-term care: I. Prevalence of dementia and levels of dependency. International Journal of Geriatric Psychiatry, 4, 299–304.Google Scholar
Engedal, K. and Haugen, P. K. (1993). The prevalence of dementia in a sample of elderly Norwegians. International Journal of Geriatric Psychiatry, 8, 565–570.Google Scholar
Feldman, H., Clarfield, A., Brodsky, J., King, Y. and Dwolatzky, T. (2006). An estimate of the prevalence of dementia among residents of long-term care geriatric institutions in the Jerusalem area. International Psychogeriatrics, 18, 643–652.Google Scholar
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet 366, 2112–2117.Google Scholar
Frank, L., Kleinman, L., Ciesla, G., Rupnow, M. F. and Brodaty, H. (2004). The effect of risperidone on nursing burden associated with caring for patients with dementia. Journal of the American Geriatrics Society, 52, 1449–1455.CrossRefGoogle ScholarPubMed
German, P. S. et al. (1992). The role of mental morbidity in the nursing home experience. Gerontologist, 32, 152–158.Google Scholar
Gill, S. S. et al. (2004). Representation of patients with dementia in clinical trials of donepezil. Canadian Journal of Clinical Pharmacology, 11, e274–285.Google Scholar
Gill, S. S. et al. (2005). Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study. BMJ, 330, 445.CrossRefGoogle ScholarPubMed
Green, M. F. (2006). Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. Journal of Clinical Psychiatry, 67, 3–8.Google ScholarPubMed
Gruber-Baldini, A. L., Zimmerman, S., Boustani, M., Watson, L. C., Williams, C. S. and Reed, P. S. (2005). Characteristics associated with depression in long-term care residents with dementia. The Gerontologist, 45, 50–55.Google Scholar
Harris, Y. (2007). Depression as a risk factor for nursing home admission among older individuals. Journal of the American Medical Directors Association, 8, 14–20.CrossRefGoogle ScholarPubMed
Hosia-Randell, H. and Pitkälä, K. (2005). Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland. Drugs and Aging, 22, 793–800.CrossRefGoogle ScholarPubMed
Jagger, C., Lindesay, J., Jagger, C. and Lindesay, J. (1997). Residential care for elderly people: the prevalence of cognitive impairment and behavioural problems. Age and Ageing, 26, 475–480.Google Scholar
Jones, R. N., Marcantonio, E. R. and Rabinowitz, T. (2003). Prevalence and correlates of recognized depression in U.S. nursing homes. Journal of the American Geriatrics Society, 51, 1404–1409.Google Scholar
Jongenelis, K., Pot, A., Eisses, A., Beekman, A., Kluiter, H. and Ribbe, M. (2004). Prevalence and risk indicators of depression in elderly nursing home patients: the AGED study. Journal of Affective Disorders, 83, 135–142.Google Scholar
Joseph, C. L., Ganzini, L. and Atkinson, R. M. (1995). Screening for alcohol use disorders in the nursing home. Journal of the American Geriatrics Society, 43, 368–373.Google Scholar
Katz, I. R., Lesher, E., Kleban, M., Jethanandani, V. and Parmelee, P. (1989). Clinical features of depression in the nursing home. International Psychogeriatrics, 1, 5–15.Google Scholar
Katz, I. R., Simpson, G. M., Curlik, S. M., Parmelee, P. A. and Muhly, C. (1990). Pharmacologic treatment of major depression for elderly patients in residential care settings. Journal of Clinical Psychiatry, 51, 41–48.Google ScholarPubMed
Kirk, S., Donnelly, M. E. and Compton, S. A. (1991). A profile of residents of old people's homes. Ulster Medical Journal, 60, 154–158.Google ScholarPubMed
Lakdawalla, D., Goldman, D. P., Bhattacharya, J., Hurd, M. D., Joyce, G. F. and Panis, C. W. A. (2003). Forcasting the nursing home population. Medical Care, 41, 8–20.CrossRefGoogle Scholar
Lin, L-C., Wang, T-G., Chen, M-Y., Wu, S-C. and Portwood, M. J. (2005). Depressive symptoms in long-term care residents in Taiwan. Journal of Advance Nursing, 51, 30–37.CrossRefGoogle ScholarPubMed
Lin, P-C., Wang, H-H. and Huang, H-T. (2007). Depressive symptoms among older residents at nursing homes in Taiwan. Journal of Clinical Nursing, 16, 1719–1725.CrossRefGoogle ScholarPubMed
Lindesay, J., Briggs, K. and Murphy, E. (1989). The Guy's/Age Concern survey. prevalence rates of cognitive impairment, depression and anxiety in an urban community. British Journal of Psychiatry, 155, 317–329.Google Scholar
Luppa, M., Luck, T., Brahler, E., Konig, H. H. and Riedel-Heller, S. G. (1998). Prediction of institutionalization in dementia. Dementia and Geriatric Cognitive Disorders, 26, 65–78.Google Scholar
Macdonald, A. J. et al. (2002). Dementia and use of psychotropic medication in non-‘Elderly Mentally Infirm’ nursing homes in South East England. Age and Ageing, 31, 58–64.Google Scholar
Magai, C., Kennedy, G., Cohen, C. I. and Gomberg, D. (2000). A controlled clinical trial of sertraline in the treatment of depression in nursing home patients with late-stage Alzheimer's disease. American Journal of Geriatric Psychiatry, 8, 66–74.Google Scholar
Magaziner, J. et al. (2000). The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: diagnosis by expert panel. The Gerontologist, 40, 663–672.Google Scholar
Margallo-Lana, M. et al. (2001). Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments. International Journal of Geriatric Psychiatry, 16, 39–44.Google Scholar
Matthews, F. E. and Dening, T. (2002). Prevalence of dementia in institutional care. Lancet, 360, 225–226.Google Scholar
McCarthy, J. F., Blow, F. C. and Kales, H. C. (2004). Disruptive behaviors in veterans affairs nursing home residents: how different are residents with serious mental illness? Journal of the American Geriatrics Society, 52, 2031–2038.CrossRefGoogle ScholarPubMed
McSweeney, K. and O'Connor, D. W. (2008). Depression among newly admitted Australian nursing home residents. International Psychogeriatrics, 20, 724–737.CrossRefGoogle ScholarPubMed
Mechanic, D. and McAlpine, D. D. (2000). Use of nursing homes in the care of persons with severe mental illness: 1985–1995. Psychiatric Services, 51, 354–358.CrossRefGoogle Scholar
Molaschi, M., Ponzetto, M., Ferrario, E., Scarafiotti, C. and Fabris, F. (1995). Health and functional status in elderly patients living in nursing homes. Archives of Gerontology and Geriatrics, 21, 267–276.CrossRefGoogle ScholarPubMed
National Center for Health Statistics (1989). Vital and Health Statistics: Nursing Home Utilization by Current Residents: United States, 1985. Hyattsville, MD: U.S. Department of Health and Human Services.Google Scholar
Nihtila, E. K., Martikainen, P. T., Koskinen, S. V., Reunanen, A. R., Noro, A. M. and Hakkinen, U. T. (2008). Chronic conditions and the risk of long-term institutionalization among older people. European Journal of Public Health, 18, 77–84.Google Scholar
Oslin, D. W., Streim, J. E., Parmelee, P., Boyce, A. A. and Katz, I. R. (1997). Alcohol abuse: a source of reversible functional disability among residents of a VA nursing home. International Journal of Geriatric Psychiatry, 12, 825–832.3.0.CO;2-6>CrossRefGoogle ScholarPubMed
Oslin, D. W. et al. (2000). Heuristic comparison of sertraline with nortriptyline for the treatment of depression in frail elderly patients. American Journal of Geriatric Psychiatry, 8, 141–149.Google Scholar
Parmelee, P. A., Katz, I. R. and Lawton, M. (1989). Depression among institutionalized aged: assessment and prevalence estimation. Journals of Gerontology, 44, M22–M29.Google Scholar
Parmelee, P. A., Katz, I. R. and Lawton, M. (1992). Incidence of depression in long-term care settings. Journals of Gerontology, 47, M189–M196.CrossRefGoogle ScholarPubMed
Parmelee, P. A., Katz, I. R. and Lawton, M. (1993). Anxiety and its association with depression among institutionalized elderly. American Journal of Geriatric Psychiatry, 1, 46–58.Google Scholar
Payne, J. L. et al. (2002). Incidence, prevalence, and outcomes of depression in residents of a long-term care facility with dementia. International Journal of Geriatric Psychiatry, 17, 247–253.Google Scholar
Pitkälä, K. H., Laurila, J. V., Strandberg, T. E. and Tilvis, R. S. (2004). Behavioral symptoms and the administration of psychotropic drugs to aged patients with dementia in nursing homes and in acute geriatric wards. International Psychogeriatrics, 16, 61–74.CrossRefGoogle ScholarPubMed
Purandare, N., Burns, A., Challis, D. and Morris, J. (2004). Perceived mental health needs and adequacy of service provision to older people in care homes in the U.K.: a national survey. International Journal of Geriatric Psychiatry, 19, 549–553.Google Scholar
Regier, D. A. et al. (1993). One-month prevalence of mental disorders in the United States and sociodemographic characteristics: the Epidemiologic Catchment Area study. Acta Psychiatrica Scandinavica, 88, 35–47.CrossRefGoogle ScholarPubMed
Reichman, W. E. et al. (1998). Psychiatric consultation in the nursing home: a survey of six states. American Journal of Geriatric Psychiatry, 6, 320–327.Google ScholarPubMed
Robbins, L. N. and Regier, D. A. (1991). Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press.Google Scholar
Robertson, D., Rockwood, K. and Stolee, P. (1989). The prevalence of cognitive impairment in an elderly Canadian population. Acta Psychiatrica Scandinavica, 80, 303–309.Google Scholar
Roose, S. P. et al. (2003). Open-label study of mirtazapine orally disintegrating tablets in depressed patients in the nursing home. Current Medical Research and Opinion, 19, 737–746.Google Scholar
Rovner, B. W. et al. (1986). Prevalence of mental illness in a community nursing home. American Journal of Psychiatry, 143, 1446–1449.Google Scholar
Rovner, B. W., German, P. S., Brant, L. J., Clark, R., Burton, L. and Folstein, M. F. (1991). Depression and mortality in nursing homes. JAMA, 265, 993–996.Google Scholar
Rozzini, R., Boffelli, S., Franzoni, S., Frisoni, G. B. and Trarucchi, M. (1996). Prevalence and predictors of depressive symptoms in a nursing home. International Journal of Geriatric Psychiatry, 11, 629–634.3.0.CO;2-X>CrossRefGoogle Scholar
Sandman, P. and Wallblom, A. (1996). Characteristics of the demented living in different settings in Sweden. Acta Neurologica Scandinavica, 94 (Suppl.), 96–100.Google Scholar
Seitz, D. P., Gruneir, A., Conn, D. K. and Rochon, P. A. (2009). Cholinesterase inhibitor use in U.S. nursing homes: results from the National Nursing Home Survey. Journal of the American Geriatrics Society, 57, 2269–2274.Google Scholar
Selbaek, G., Kirkevold, O. and Engedal, K. (2007). The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. International Journal of Geriatric Psychiatry, 22, 843–849.Google Scholar
Selbaek, G., Kirkevold, O. and Engedal, K. (2008). The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes–A 12-month follow-up study. American Journal of Geriatric Psychiatry 16, 528–536.Google Scholar
Serby, M., Chou, J. C. and Franssen, E. H. (1987). Dementia in an American–Chinese nursing home population. American Journal of Psychiatry, 144, 811–812.Google Scholar
Smalbrugge, M., Jongenelis, L., Pot, A. M., Beekman, A. T. and Eefsting, J. A. (2005a). Comorbidity of depression and anxiety in nursing home patients. International Journal of Geriatric Psychiatry, 20, 218–226.CrossRefGoogle ScholarPubMed
Smalbrugge, M., Pot, A., Jongenelis, K., Beekman, A. and Eefsting, J. (2005b). Prevalence and correlates of anxiety among nursing home patients. Journal of Affective Disorders, 88, 145–153.Google Scholar
Smalbrugge, M., Jongenelis, L., Pot, A. M., Eefsting, J. A., Ribbe, M. W. and Beekman, A. T. (2006). Incidence and outcome of depressive symptoms in nursing home patients in the Netherlands. American Journal of Geriatric Psychiatry 14, 1069–1076.CrossRefGoogle ScholarPubMed
Snowdon, J. (1986). Dementia, depression and life satisfaction in nursing homes. International Journal of Geriatric Psychiatry, 1, 85–91.Google Scholar
Snowdon, J. and Donnelly, N. (1986). A study of depression in nursing homes. Journal of Psychiatric Research, 20, 327–333.Google Scholar
Snowdon, J., Day, S. and Baker, W. (2006). Current use of psychotropic medication in nursing homes. International Psychogeriatrics, 18, 241–250.CrossRefGoogle ScholarPubMed
Statistics Canada (2006). Residential Care Facilities Survey (CANSIM table 107-5501). http://www.statcan.gc.ca/start-debut-eng.htmlGoogle Scholar
Steffens, D. C. et al. (2000). Prevalence of depression and its treatment in an elderly population: the Cache County Study. Archives of General Psychiatry, 57, 601–607.Google Scholar
Street, J. S. et al. (2000). Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer disease in nursing care facilities: a double-blind, randomized, placebo-controlled trial. The HGEU Study Group. Archives of General Psychiatry, 57, 968–976.Google Scholar
Streim, J. E. et al. (2000). Drug treatment of depression in frail elderly nursing home residents. American Journal of Geriatric Psychiatry, 8, 150–159.Google Scholar
Streim, J. E. et al. (2008). A randomized, double-blind, placebo-controlled study of aripiprazole for the treatment of psychosis in nursing home patients with Alzheimer disease. American Journal of Geriatric Psychiatry, 16, 537–550.Google Scholar
Sutcliffe, C. et al. (2007). Depressed mood, cognitive impairment, and survival in older people admitted to care homes in England. American Journal of Geriatric Psychiatry, 15, 708–715.CrossRefGoogle ScholarPubMed
Tariot, P. N. et al. (2001). A randomized, double-blind, placebo-controlled study of the efficacy and safety of donepezil in patients with Alzheimer's disease in the nursing home setting. Journal of the American Geriatrics Society 49, 1590–1599.Google Scholar
Tariot, P. N., Podgorski, C. A., Blazina, L. and Leibovici, A. (1993). Mental disorders in the nursing home: another perspective. American Journal of Psychiatry, 150, 1063–1069.Google Scholar
Teitelbaum, L., Ginsburg, M. L., Hopkins, R. W., Teitelbaum, L., Ginsburg, M. L. and Hopkins, R. W. (1991). Cognitive and behavioural impairment among elderly people in institutions providing different levels of care. Canadian Medical Association Journal, 144, 169–73.Google Scholar
Teresi, J., Abrams, R., Holmes, D., Ramirez, M. and Eimicke, J. (2001). Prevalence of depression and depression recognition in nursing homes. Social Psychiatry and Psychiatric Epidemiology, 36, 613–620.Google Scholar
Testad, I., Aasland, A. and Aarsland, D. (2007). Prevalence and correlates of disruptive behavior in patients in Norwegian nursing homes. International Journal of Geriatric Psychiatry 22, 916–921.CrossRefGoogle ScholarPubMed
Tsai, Y-F., Chung, J. W., Wong, T. K. and Huang, C-M. (2005). Comparison of the prevalence and risk factors for depressive symptoms among elderly nursing home residents in Taiwan and Hong Kong. International Journal of Geriatric Psychiatry, 20, 315–321.Google Scholar
Tschanz, J. T. et al. (2004). Dementia: the leading predictor of death in a defined elderly population: the Cache County Study. Neurology, 62, 1156–1162.Google Scholar
U.S. Census Bureau (2001). An Aging World. Available at: http://www.census.gov/prod/2001pubs/p95-01-1.pdf; last accessed 20 May 2010.Google Scholar
U.S. Department of Health and Human Services. (2009). www.hhs.govGoogle Scholar
Unützer, J. et al. (2003). Depression treatment in a sample of 1,801 depressed older adults in primary care. Journal of the American Geriatrics Society, 51, 505–514.Google Scholar
van den Berg, J., Spijker, J., Van Limbeek, J., Van Tilburg, W., and van Alem, L. (1995). The psychopathology of residents of homes for the elderly in Amsterdam. Tijdschrift voor Gerontologie en Geriatrie, 26, 65–70.Google Scholar
Wagner, A. W., Teri, L., Orr-Rainey, N., Wagner, A. W., Teri, L. and Orr-Rainey, N. (1995). Behavior problems among dementia residents in special care units: changes over time. Journal of the American Geriatrics Society, 43, 784–787.Google Scholar
Walker, S. et al. (1995). Differential clinical characteristics of older Black and White nursing home residents. American Journal of Geriatric Psychiatry, 3, 229–238.CrossRefGoogle ScholarPubMed
Wancata, J., Benda, N., Meise, U. and Windhaber, J. (2003). Non-cognitive symptoms of dementia in nursing homes: frequency, course and consequences. Social Psychiatry and Psychiatric Epidemiology, 38, 637–643.Google Scholar
Weintraub, D., Streim, J. E., Datto, C. J., Katz, I. R., DiFilippo, S. D. and Oslin, D. W. (2003). Effect of increasing the dose and duration of sertraline trial in the treatment of depressed nursing home residents. Journal of Geriatric Psychiatry and Neurology, 16, 109–111.Google Scholar
Weyerer, S., Hafner, H., Mann, A. H., Ames, D. and Graham, N. (1995). Prevalence and course of depression among elderly residential home admissions in Mannheim and Camden, London. International Psychogeriatrics, 7, 479–493.CrossRefGoogle ScholarPubMed
Wittenberg, R., Comas-Herrera, A., Pickard, L. and Hancock, R. (2004). Future Demand for Long-term Care in the U.K. Joseph Rowntree Foundation. York: York Publishing Services.Google Scholar
World Health Organization (2009). Teaching Geriatrics in Medical Education II. Department of Ageing and Life Course and IFMSA. Geneva: World Health Organization. Available at: http://www.who.int/ageing/projects/TeGeMe_II.pdf; last accessed 20 May 2010.Google Scholar
Zuidema, S., Koopmans, R. and Verhey, F. (2007a). Prevalence and predictors of neuropsychiatric symptoms in cognitively impaired nursing home patients. Journal of Geriatric Psychiatry and Neurology, 20, 41–49.Google Scholar
Zuidema, S. U., Derksen, E., Verhey, F. R. and Koopmans, R. T. (2007b). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632–638.Google Scholar