title: The management of depression in older nursing home residents.
abstract: OBJECTIVE
  Depression remains underrecognized and undertreated in older people. We estimated the prevalence of depression in older nursing home (NH) residents and described its pharmacological management.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Residents in 1,492 NHs in five states (Kansas, Maine, Mississippi, New York, South Dakota).
  
  
  METHODS
  Forty-two thousand nine hundred one residents aged 65 and older with depression documented as an active clinical condition on the Minimum Data Set (MDS) assessment.
  
  
  METHODS
  Data were from the Systematic Assessment of Geriatric drug use via Epidemiology database. We grouped antidepressant medications by class: tricyclic antidepressants (TCAs), tetracyclics, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors, and others. Logistic regression models revealed predictors of receipt of any antidepressant and, among those treated, predictors of receipt of an SSRI.
  
  
  RESULTS
  Eleven percent of the residents were identified as depressed on the MDS. Of these, 55% received antidepressant therapy. Of depressed residents receiving antidepressant therapy, 32% received doses less than the manufacturers' recommended minimum effective dose for treating depression, with residents on TCAs more likely to receive less than the recommended dose for treating depression. The oldest-old (> or = 85 years) (odds ratio (OR) = 0.93, 95% confidence interval (CI) = 0.88-0.98), black residents (OR = 0.83, 95% CI = 0.75-0.92), and those with severe cognitive impairment (OR = 0.69, 95% CI = 0.64-0.75) were the least likely to receive an antidepressant. In those treated, cardiovascular diseases were associated with an increased likelihood of SSRI use. Despite control for comorbid conditions, women were less likely than men to receive an SSRI (OR = 0.77, 95% CI = 0.72-0.82).
  
  
  CONCLUSIONS
  Although depression is a treatable illness, the majority of NH residents may be inadequately treated.
authors.affiliation: College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA.
authors.forename: Mary N
authors.initials: MN
authors.lastname: Brown
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lapane
authors.forename: Andrea F
authors.initials: AF
authors.lastname: Luisi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy* / Q000453:epidemiology; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009735:Nursing Homes; D015995:Prevalence; D014481:United States / Q000453:epidemiology
chemical_list: D000928:Antidepressive Agents