Detection of depression in elderly care home residents

Dr Eisses et al (2005) showed how the training of care home staff can help in detecting depression among elderly care home residents. In view of the high prevalence of depression in this group, these results are to be welcomed. However, I would like to raise a few points about the relevance of this report to care homes in England.

First, 8 out of 23 homes (35%) declined to participate, citing lack of interest or feeling that it was too much work. This matches my own experience as a consultant old age psychiatrist dedicated to providing support to care homes with nursing. I would welcome any suggestions on how to engage homes in training to improve the detection of depression in this vulnerable population.

Second, I was impressed by the stability of the workforce, who had spent on average 9.5 years in the participating homes (the shortest period being 10 months). This is considerably longer than is found within some care homes in England, particularly in the large cities. It may be that training would be less effective when staff tend to have a higher rate of turnover.

Finally, I note that the study excluded residents with dementia who scored less than 15 out of 30 on the Mini-Mental State Examination. This decision is understandable as the scale used, the Geriatric Depression Scale (GDS), is difficult to administer to this group. However, I wonder about the effect on the staff. Training staff to exclude these residents from an assessment of depression could send a false signal that these individuals are somehow immune to depression - which most certainly is not the case. Also this approach probably could not apply in care homes with nursing in England. Whereas in the homes studied the prevalence of dementia was only some 9% of the population, dementia in care homes with nursing is high, with ‘non-EMI’ (elderly mental illness) care homes with nursing having a prevalence of dementia as high as 75% (Macdonald & Carpenter, 2003). We use the Cornell Scale for Depression in Dementia (Alexopoulos et al, 1988) for those people with dementia who can not respond to the questions of the GDS.