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Comprehensive assessment of depression and behavioral problems in long-term care

Published online by Cambridge University Press:  15 September 2010

Raymond T. C. M. Koopmans*
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Alzheimer Centre Nijmegen, Radboud University Nijmegen, Medical Centre, The Netherlands
Sytse U. Zuidema
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Alzheimer Centre Nijmegen, Radboud University Nijmegen, Medical Centre, The Netherlands
Roeslan Leontjevas
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Alzheimer Centre Nijmegen, Radboud University Nijmegen, Medical Centre, The Netherlands
Debby L. Gerritsen
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Alzheimer Centre Nijmegen, Radboud University Nijmegen, Medical Centre, The Netherlands
*
Correspondence should be addressed to: Prof. Dr. Raymond T.C.M. Koopmans, Radboud University Nijmegen, Medical Center, Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, P.O. Box 9101, code 117 ELG, 6500 HB Nijmegen, The Netherlands. Phone: +31243655307. Email: [email protected].

Abstract

Background: The IPA Taskforce on Mental Health Issues in Long-Term Care Homes seeks to improve mental health care in long-term care (LTC) homes. The aim of this paper is to provide recommendations on comprehensive assessment of depression and behavioral problems in order to further stimulate countries and professionals to enhance their quality of care.

Methods: Existing guidelines on comprehensive assessment of depression or behavioral problems in nursing home (NH) patients or patients residing in LTC homes were collected and a literature review was carried out to search for recent evidence.

Results: Five guidelines from several countries all over the world and two additional papers were included in this paper as a starting point for the recommendations. Comprehensive assessment of depression in LTC homes consists of a two-step screening procedure: an investigation to identify factors that influence the symptoms, followed by a formal diagnosis of depression according to DSM-IV-TR or the Provisional Diagnostic Criteria for Depression in Alzheimer Disease in cases of dementia. Comprehensive assessment of behavioral problems encompasses three steps: description and clarification of the behavior, additional investigation, and assessment of probable causes of the behavior. The procedure starts in the case of moderate behavioral problems.

Conclusion: The recommendations given in this paper provide a useful guide to professional workers in the LTC sector, but clinical judgment and the consideration of the unique aspects of individual residents and their situations is necessary for an optimal assessment of depression and behavioral problems. The recommendations should not be rigidly applied and implementation will differ from country to country.

Type
Focus on mental health issues in long-term-care homes
Copyright
Copyright © International Psychogeriatric Association 2010

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References

Alexandrowicz, R., Weiss, M., Marquart, B. and Wancata, J. (2008). [The validity of a two-step-screening procedure for depression.] Psychiatrische Praxis, 35, 294301 (in German).CrossRefGoogle ScholarPubMed
Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271284.CrossRefGoogle ScholarPubMed
Allen, R. S. et al. (2003). The Revised Memory and Behavior Problems Checklist – Nursing Home: instrument development and measurement of burden among certified nursing assistants. Psychology and Aging, 18, 886895.Google Scholar
Barca, M. L., Engedal, K., Laks, J. and Selbaek, G. (2010). A 12 months follow-up study of depression among nursing-home patients in Norway. Journal of Affective Disorders, 120, 141148.CrossRefGoogle ScholarPubMed
Bartholomeyczik, S. et al. (2006). Rahmenempfelungen zum Umgang mit herausforderndem Verhalten bei Menschen mit Demenz in der stationären Altenhilfe. Bundesministerium für Gesundheit.Google Scholar
Brodaty, H., Draper, B. M. and Low, L. F. (2003). Behavioural and psychological symptoms of dementia: a seven-tiered model of service delivery. Medical Journal of Australia, 178, 231234.CrossRefGoogle ScholarPubMed
Burrows, A. B., Morris, J. N., Simon, S. E., Hirdes, J. P. and Phillips, C. (2000). Development of a minimum data set-based depression rating scale for use in nursing homes. Age and Ageing, 29, 165172.CrossRefGoogle ScholarPubMed
Chochinov, H. M., Wilson, K. G., Enns, M. and Lander, S. (1997). “Are you depressed?” Screening for depression in the terminally ill. American Journal of Psychiatry, 154, 674676.Google ScholarPubMed
Cohen-Mansfield, J. (1986). Agitated behaviors in the elderly. II. Preliminary results in the cognitively deteriorated. Journal of the American Geriatrics Society, 34, 722727.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. and Billig, N. (1986). Agitated behaviors in the elderly. I. A conceptual review. Journal of the American Geriatrics Society, 34, 711721.CrossRefGoogle Scholar
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48 (Suppl. 6), S1016.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.CrossRefGoogle ScholarPubMed
Davison, T. E., McCabe, M. P., Mellor, D., Ski, C., George, K. and Moore, K. A. (2007). The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment. Aging and Mental Health, 11, 8288.CrossRefGoogle ScholarPubMed
de Jonghe, J. F. and Kat, M. G. (1996). Factor structure and validity of the Dutch version of the Cohen-Mansfield Agitation Inventory (CMAI-D). Journal of the American Geriatrics Society, 44, 888889.CrossRefGoogle ScholarPubMed
de Vugt, M. E., Riedijk, S. R., Aalten, P., Tibben, A., van Swieten, J. C. and Verhey, F. R. (2006). Impact of behavioural problems on spousal caregivers: a comparison between Alzheimer's disease and frontotemporal dementia. Dementia and Geriatric Cognitive Disorders, 22, 3541.CrossRefGoogle ScholarPubMed
Demyttenaere, K., Hemels, M. E., Hudry, J. and Annemans, L. (2005). A cost-effectiveness model of escitalopram, citalopram, and venlafaxine as first-line treatment for major depressive disorder in Belgium. Clinical Therapeutics, 27, 111124.CrossRefGoogle ScholarPubMed
Evers, M. M., Samuels, S. C., Lantz, M., Khan, K., Brickman, A. M. and Marin, D. B. (2002). The prevalence, diagnosis and treatment of depression in dementia patients in chronic care facilities in the last six months of life. International Journal of Geriatric Psychiatry, 17, 464472.CrossRefGoogle ScholarPubMed
Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Maclean, J. R. and Beers, M. H. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a U.S. consensus panel of experts. Archives of Internal Medicine, 163, 27162724.CrossRefGoogle Scholar
Finkel, S. I., Lyons, J. S. and Anderson, R. L. (1993). A brief agitation rating scale (BARS) for nursing home elderly. Journal of the American Geriatrics Society, 41, 5052.CrossRefGoogle ScholarPubMed
Gaugler, J. E., Yu, F., Krichbaum, K. and Wyman, J. F. (2009). Predictors of nursing home admission for persons with dementia. Medical Care, 47, 191198.CrossRefGoogle ScholarPubMed
Gerritsen, D. L. et al. (2007). [The GDS-8; a short, client- and user-friendly shortened version of the Geriatric Depression Scale for nursing homes]. Tijdschrift voor Gerontologie en Geriatrie, 38, 298304 (in Dutch).Google Scholar
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. Gerontologist, 45 (Special issue 1), 5055.CrossRefGoogle ScholarPubMed
Hammond, M. F., O'Keeffe, S. T. and Barer, D. H. (2000). Development and validation of a brief observer-rated screening scale for depression in elderly medical patients. Age and Ageing, 29, 511515.CrossRefGoogle ScholarPubMed
Hoe, J., Hancock, G., Livingston, G. and Orrell, M. (2006). Quality of life of people with dementia in residential care homes. British Journal of Psychiatry, 188, 460464.CrossRefGoogle ScholarPubMed
Iverson, G. L., Hopp, G. A., DeWolfe, K. and Solomons, K. (2002). Measuring change in psychiatric symptoms using the Neuropsychiatric Inventory – Nursing Home version. International Journal of Geriatric Psychiatry, 17, 438443.CrossRefGoogle ScholarPubMed
Jongenelis, K. et al. (2003). [Depression among older nursing home patients: a review]. Tijdschrift voor Gerontologie en Geriatrie, 34, 5259.Google ScholarPubMed
Jongenelis, K., Pot, A. M., Eisses, A. M., Beekman, A. T., Kluiter, H. and Ribbe, M. W. (2004). Prevalence and risk indicators of depression in elderly nursing home patients: the AGED study. Journal of Affective Disorders, 83, 135142.CrossRefGoogle Scholar
Jongenelis, K. et al. (2007). Construction and validation of a patient- and user-friendly nursing home version of the Geriatric Depression Scale. International Journal of Geriatric Psychiatry, 22, 837842.CrossRefGoogle ScholarPubMed
Kaufer, D. I. et al. (2000). Validation of the NPI-Q: a brief clinical form of the Neuropsychiatric Inventory. Journal of Neuropsychiatry and Clinical Neurosciences, 12, 233239.Google Scholar
Kaup, B. A. et al. (2007). Depression and its relationship to function and medical status, by dementia status, in nursing home admissions. American Journal of Geriatric Psychiatry, 15, 438442.CrossRefGoogle ScholarPubMed
Kok, R. M., Pot, A. M. and Fisher, E. (2008). Mutlidisciplinary Guideline Depression, Addendum Elderly. Utrecht: Trimbos Institute.Google Scholar
Koss, E. (1997). Assessing patterns of agitation in Alzheimer's disease patients with the Cohen-Mansfield Agitation Inventory. The Alzheimer's disease cooperative Study. Alzheimer Disease and Associated Disorders, 11 (Suppl. 2), S4550.CrossRefGoogle ScholarPubMed
Lange, R. T., Hopp, G. A. and Kang, N. (2004). Psychometric properties and factor structure of the Neuropsychiatric Inventory – Nursing Home version in an elderly neuropsychiatric population. International Journal of Geriatric Psychiatry, 19, 440448.CrossRefGoogle Scholar
Mayer, L. S. et al. (2006). Comparison of three rating scales as outcome measures for treatment trials of depression in Alzheimer disease: findings from DIADS. International Journal of Geriatric Psychiatry, 21, 930936.CrossRefGoogle ScholarPubMed
Miller, R. J., Snowdon, J. and Vaughan, R. (1995). The use of the Cohen-Mansfield Agitation Inventory in the assessment of behavioral disorders in nursing homes. Journal of the American Geriatrics Society, 43, 546549.Google Scholar
Mitchell, A. J. and Coyne, J. C. (2007). Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis of 22 studies. British Journal of General Practice, 57, 144151.Google ScholarPubMed
Moniz-Cook, E. et al. (2008). A European consensus on outcome measures for psychosocial intervention research in dementia care. Aging and Mental Health, 12, 1429.CrossRefGoogle ScholarPubMed
Muller-Thomsen, T., Arlt, S., Mann, U., Mass, R. and Ganzer, S. (2005). Detecting depression in Alzheimer's disease: evaluation of four different scales. Archives of Clinical Neuropsychology, 20, 271276.CrossRefGoogle ScholarPubMed
Nakajima, G. A. and Wenger, N. S. (2007). Quality indicators for the care of depression in vulnerable elders. Journal of the American Geriatrics Society, 55 (Suppl. 2), S302311.Google Scholar
National Guidelines for Seniors' Mental Health. (2006). The Assessment and Treatment of Mental Health Issues in Long Term Care Homes. Focus on Mood and Behaviour Symptoms. Toronto: Canadian Coalition for Seniors' Mental Health.Google Scholar
Olin, J. T. et al. (2002). Provisional diagnostic criteria for depression of Alzheimer disease. American Journal of Geriatric Psychiatry, 10, 125128.CrossRefGoogle ScholarPubMed
Reisberg, B., Borenstein, J., Salob, S. P., Ferris, S. H., Franssen, E. and Georgotas, A. (1987). Behavioral symptoms in Alzheimer's disease: phenomenology and treatment. Journal of Clinical Psychiatry, 48 (Suppl.), 915.Google ScholarPubMed
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, 843849.Google Scholar
Selbaek, G., Kirkevold, O., Sommer, O. H. and Engedal, K. (2008). The reliability and validity of the Norwegian version of the Neuropsychiatric Inventory – Nursing Home version (NPI-NH). International Psychogeriatrics, 20, 375382.CrossRefGoogle ScholarPubMed
Shah, A., Evans, H. and Parkash, N. (1998). Evaluation of three aggression/agitation behaviour rating scales for use on an acute admission and assessment psychogeriatric ward. International Journal of Geriatric Psychiatry, 13, 415420.3.0.CO;2-A>CrossRefGoogle Scholar
Shin, I., Carter, M., Masterman, D., Fairbanks, L. and Cummings, J. (2005). Neuropsychiatric symptoms and quality of life in Alzheimer disease. American Journal of Geriatric Psychiatry, 13, 469474.CrossRefGoogle ScholarPubMed
Smalbrugge, M., Jongenelis, L., Pot, A. M., Eefsting, J. A., Ribbe, M. W. and Beekman, A. T. (2006a). Incidence and outcome of depressive symptoms in nursing home patients in the Netherlands. American Journal of Geriatric Psychiatry, 14, 10691076.CrossRefGoogle ScholarPubMed
Smalbrugge, M., Pot, A. M., Jongenelis, L., Gundy, C. M., Beekman, A. T. and Eefsting, J. A. (2006b). The impact of depression and anxiety on well being, disability and use of health care services in nursing home patients. International Journal of Geriatric Psychiatry, 21, 325332.Google Scholar
Smalbrugge, M., Jongenelis, L., Pot, A. M., Beekman, A. T. and Eefsting, J. A. (2008a). Screening for depression and assessing change in severity of depression. Is the Geriatric Depression Scale (30-, 15- and 8-item versions) useful for both purposes in nursing home patients? Aging and Mental Health, 12, 244248.CrossRefGoogle ScholarPubMed
Smalbrugge, M. et al. (2008b). Guideline Problem Behavior: Utrecht: NVVA.Google Scholar
Snowden, M., Sato, K. and Roy-Byrne, P. (2003). Assessment and treatment of nursing home residents with depression or behavioral symptoms associated with dementia: a review of the literature. Journal of the American Geriatrics Society, 51, 13051317.Google Scholar
Snowdon, J. and Fleming, R. (2008). Recognising depression in residential facilities: an Australian challenge. International Journal of Geriatric Psychiatry, 23, 295300.CrossRefGoogle ScholarPubMed
Streim, J. E., Oslin, D., Katz, I. R. and Parmelee, P. A. (1997). Lessons from geriatric psychiatry in the long-term care setting. Psychiatric Quarterly, 68, 281307.Google Scholar
Sutcliffe, C. et al. (2000). A new version of the Geriatric Depression Scale for nursing and residential home populations: the Geriatric Depression Scale (Residential) (GDS-12R). International Psychogeriatrics, 12, 173181.CrossRefGoogle ScholarPubMed
Teri, L., Truax, P., Logsdon, R., Uomoto, J., Zarit, S. and Vitaliano, P. P. (1992). Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. Psychology of Aging, 7, 622631.CrossRefGoogle ScholarPubMed
Verkaik, R., Francke, A. L., van Meijel, B., Ribbe, M. W. and Bensing, J. M. (2009). Comorbid depression in dementia on psychogeriatric nursing home wards: which symptoms are prominent? American Journal of Geriatric Psychiatry, 17, 565573.CrossRefGoogle ScholarPubMed
Vida, S., des Rosiers, P., Carrier, L. and Gauthier, S. (1994). Prevalence of depression in Alzheimer's disease and validity of research diagnostic criteria. Journal of Geriatric Psychiatry and Neurology, 7, 238244.CrossRefGoogle ScholarPubMed
Wood, S. et al. (2000). The use of the Neuropsychiatric Inventory in nursing home residents: characterization and measurement. American Journal of Geriatric Psychiatry, 8, 7583.CrossRefGoogle ScholarPubMed
Zuidema, S. U., Derksen, E., Verhey, F. R. and Koopmans, R. T. (2007a). Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. International Journal of Geriatric Psychiatry, 22, 632638.CrossRefGoogle Scholar
Zuidema, S. U., Koopmans, R. T. C. M. and Verhey, F. R. J. (2007b). Prevalence and predictors of neuropsychiatric symptoms in cognitively impaired nursing home patients. Journal of Geriatric Psychiatry and Neurology, 22, 632638.CrossRefGoogle Scholar
Zuidema, S. U. et al. (2010). Assessing neuropsychiatric symptoms in nursing home patients with dementia: reliability of reliable change of index of the Neuropsychiatric Inventory and the Cohen-Mansfield Agitation Inventory. International Journal of Geriatric Psychiatry. Epublished ahead of print, 5 August.Google Scholar