The prevalence, diagnosis and treatment of depression in dementia patients in chronic care facilities in the last six months of life.
OBJECTIVE
To assess the prevalence, diagnosis and treatment of depression among dementia patients and normal controls in chronic care facilities in the last six months of life.


METHODS
We reviewed perimortal data concerning dementia severity, depressive symptoms and diagnoses, and medication use for 279 dementia patients and 24 normal controls brought to autopsy through an Alzheimer's Disease Resource Center.


RESULTS
Major depression was highly prevalent among both dementia patients and normal controls in chronic care facilities in the last six months of life. This depression was under-diagnosed by physicians. Documentation of depressive symptoms by medical support staff has improved over time. However, physician diagnosis of depression has not improved. Recognition of depression was significantly lower for patients with severe dementia. Depression was under-treated in both dementia patients and normal controls, although treatment rates may be increasing. Anxiolytics and hypnotics were often used in lieu of, or in addition to, antidepressant therapy.


CONCLUSIONS
Major depression was highly prevalent in both dementia patients and normal controls, indicating that depression is an important issue for the elderly in the last six months of life irrespective of cognitive status. Under-diagnosis of depression may be an important clinical issue. As physician diagnosis of depression has not improved with time, further physician training and/or awareness initiatives may be warranted. Depression, a treatable cause of excess morbidity and mortality, was undertreated in all groups studied. However, treatment rates may be improving. The prevalent use of anxiolytics and hypnotics for depressed patients is problematic.
Evers
Martin M
MM
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
Samuels
Steven C
SC
Lantz
Melinda
M
Khan
Khalid
K
Brickman
Adam M
AM
Marin
Deborah B
DB
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003704:Dementia / Q000150:complications*; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006707:Homes for the Aged / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data; D015995:Prevalence; D011787:Quality of Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000928:Antidepressive Agents