Depression in nursing home residents in Malta

Abstract

Depression is a very common cause of disability in older persons and is significantly associated with being placed in a nursing home. Published studies have shown that the incidence of depression is higher than that in the community and can range from 35% to 80%. The main hypothesis was to verify if depression was widespread but unrecognised in older nursing home residents in Malta. Also, management in those residents identified as being depressed was assessed as well as any significant associations with this condition. Limitations of the study included the exclusion of residents with dementia and those with communication problems. Tools used included the ODS for depression, Barthel index for AD Ls and MMSE for cognitive status. 150 subjects living in two nursing homes were included in this study. 67.3% (P-value <0.01) were found to be depressed. This was higher than in other countries. 12% of the total population had major depression while 55.3% had minor depression. Only 40% of those diagnosed with depression in this study had been so diagnosed prior to the study. Significant associations included low Barthel scores (therefore being dependent in ADLs), loneliness, being currently in pain, being asked directly if one was depressed, having high scores in the ODS, having a low level of satisfaction in the nursing home, having a high number of medical co-morbidities, having had a fracture in the past, being on an antidepressant, being already diagnosed (past history) with depression, taking several medications, being widowed and suffering from OA (P-values <0.05). Multivariate analysis found significant associations between several variables including depression, pain, dependency, taking numerous medications and suffering from multiple medical conditions. These associations were similar to those found in published studies. The study also showed that those residents already diagnosed with depression were being treated inappropriately with low prescription levels of anti-depressants (40.6%). Besides, the psychological approach to treatment was non-existent. In conclusion depression in elderly homes in Malta is highly prevalent but under-diagnosed. Several significant associations with this pathology were noted. In those residents who were already diagnosed the treatment was inappropriate with low prescription levels of the correct medications. There was also a lack of the multidisciplinary approach to treatment. Recommendations include increasing staff education on this pathology, routine screening for depression on nursing home admission, reducing risk factors such as pain, appropriate treatment, regular auditing and further research on this subject.