Studies have found that depression is common among nursing home residents. A systematic review estimated the median prevalence of major depressive disorder was 10%, while the median prevalence of depressive symptoms was 29% (Seitz et al., Reference Seitz, Purandare and Conn2010).
Antidepressants have been shown to be effective for older care home residents (Mottram et al., Reference Mottram, Wilson and Strobl2006). The rate of prescribing in care homes showed a steady increase from 1990s to this decade. In Leicestershire, UK, 11% of nursing home residents were receiving antidepressants in 1990, and the rate rose to 19% by 1997 (Arthur et al., Reference Arthur, Mathews, Jagger and Lindesay2002). Borson et al. (Reference Borson, Scanlan, Doane and Gray2002) reported that in nursing facilities in the US 59% of the elderly on antidepressants received SSRIs.
Studies have shown that prescribing is often in inadequate doses (Snowdon et al., Reference Snowdon, Burgess, Vaughan and Miller1996). A review of the literature revealed limited information on adequacy of dose of antidepressants in the elderly. Our study investigates how widely antidepressants are prescribed in care homes and whether they are prescribed at adequate doses.
The study population consisted of all care home residents in the county of Suffolk, UK. All nursing homes in Suffolk were identified and included in the study. We wrote to all nursing home managers asking if they could provide medication sheets of residents. Anonymity of patients was maintained. Use of adequate dose in this group was assumed as 50% of recommended adult dose taken from various consensus guidelines.
Data was gathered from care home residents of all 44 care homes. In all 618/1450 (43%) of residents from 39 care homes out of 40 were prescribed an antidepressant. Also, 67 (4.6%) residents were on two antidepressants. Prescribing rates varied between 0-76% across care homes. Of these, 68% were “adequate dose.” Fifteen different antidepressants from different classes, namely SSRIs tricyclic antidepressants, typical antipsychotic, NaSSA, and SNRIs were used in these patients. SSRI was the most common antidepressant prescribed (23.7%). The three most common antidepressants were Citalopram, Mirtazapine, and Amitriptyline with a mean dose of 18.6mg, 28.4mg, and 24mg, respectively. There was a significantly high SSRI prescribing rate (Chi-square 235.69 p < .00001). SSRIs were more likely to be prescribed in adequate dose than other groups (Chi square 15.86 p < .001).
In summary, the study found that SSRIs were more likely to be prescribed at “adequate doses” but did not examine the reason for antidepressants prescription. There was an overall high prescription rate of antidepressants (43%). The findings are consistent with other studies (Arthur et al., Reference Arthur, Mathews, Jagger and Lindesay2002, Borson et al., Reference Borson, Scanlan, Doane and Gray2002; Snowdon et al., Reference Snowdon, Burgess, Vaughan and Miller1996) showing increased prescribing of antidepressants in care homes. There was a wide variability in prescribing rates between facilities.
Acknowledgments
The authors wish to thank all staff members at the care homes for their collaboration. We are grateful to Claire, research assistant, for help on collection and collation of data.
