title: Inadequate treatment of depressed nursing home elderly.
abstract: OBJECTIVE
  To determine the prevalence of antidepressant drug treatment among nursing home elderly with major depression.
  
  
  METHODS
  Survey early and late in nursing home stay.
  
  
  METHODS
  Sixty Medicaid/Medicare-certified skilled nursing homes.
  
  
  METHODS
  Admission cohort of 5,752 residents age 65 or older in 1976 through 1983.
  
  
  METHODS
  Chart review by nurse-abstractors of physicians' diagnoses, drug used, and alertness rating. Diagnosis of depression equivalent to DSM-III-R major depression.
  
  
  RESULTS
  Of 868 persons with a diagnosis of depression in the medical record, only 10% were treated with antidepressant drugs. More received neuroleptics and benzodiazepines than received antidepressants, but most (52%) received no psychoactive drug at all. A subset of 258 depressed persons had positive notations in their records supporting a mental status rating of "alert and oriented." Of that subset, only 15% received antidepressants. When followed from admission to discharge or end of study the prevalence rate of antidepressant drug treatment increased by 4%.
  
  
  CONCLUSIONS
  In the late 1970's and early 1980's, even when the primary care physician made and recorded a diagnosis of depression, most such nursing home residents remained untreated, incorrectly treated, or inadequately treated.
authors.affiliation: Institute for Mental Illness Training and Research, University of Washington.
authors.forename: L L
authors.initials: LL
authors.lastname: Heston
authors.forename: J
authors.initials: J
authors.lastname: Garrard
authors.forename: L
authors.initials: L
authors.lastname: Makris
authors.forename: R L
authors.initials: RL
authors.lastname: Kane
authors.forename: S
authors.initials: S
authors.lastname: Cooper
authors.forename: T
authors.initials: T
authors.lastname: Dunham
authors.forename: D
authors.initials: D
authors.lastname: Zelterman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D004363:Drug Utilization; D006801:Humans; D008485:Medical Audit; D008499:Medical Records; D008609:Mental Status Schedule; D015205:Northwestern United States / Q000453:epidemiology; D009735:Nursing Homes; D009949:Orientation; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D015995:Prevalence; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D015206:Southwestern United States / Q000453:epidemiology
chemical_list: D011619:Psychotropic Drugs