title: Depression in assisted living is common and related to physical burden.
abstract: OBJECTIVE
  The objective of this study was to obtain a direct estimate of the prevalence of depression, its associated factors, and rates of treatment among residents of assisted living (AL) facilities in central Maryland.
  
  
  METHODS
  One hundred ninety-six AL residents were recruited from 22 (10 large and 12 small) randomly selected AL facilities in the city of Baltimore and seven Maryland counties. Chart review, staff and family history, comprehensive in-person resident evaluation, and the Cornell Scale for Depression in Dementia (CSDD) were administered by an experienced team of geriatric psychiatry clinicians. Those scoring >7 on the CSDD, a cut point repeatedly associated with poor outcomes, were considered clinically depressed.
  
  
  RESULTS
  Participants had an average age of 86 years, most were female and widowed, and 68% met consensus criteria for dementia. Twenty-four percent (47 of 196) of the sample was depressed. In bivariate analyses, depression was significantly related to medical comorbidity, need for activities of daily living (ADLs) assistance, more days spent in bed, and less participation in organized activities. After controlling for pertinent covariates in a regression model, only need for ADL assistance remained significantly associated with depression. Forty-three percent of those currently depressed were receiving antidepressants and were more likely to receive them if they lived in a large AL facility. Sixty percent of depressed residents had no regular source of psychiatric care.
  
  
  CONCLUSIONS
  In the first clinical study implemented by geriatric psychiatry professionals in AL, depression was found to be common, undertreated, and related to physical burden. AL is a rapidly growing segment of long-term care and represents an important setting in which to find and treat serious depression.
authors.affiliation: Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Lea C
authors.initials: LC
authors.lastname: Watson
authors.forename: Susan
authors.initials: S
authors.lastname: Lehmann
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mayer
authors.forename: Quincy
authors.initials: Q
authors.lastname: Samus
authors.forename: Alva
authors.initials: A
authors.lastname: Baker
authors.forename: Jason
authors.initials: J
authors.lastname: Brandt
authors.forename: Cynthia
authors.initials: C
authors.lastname: Steele
authors.forename: Peter
authors.initials: P
authors.lastname: Rabins
authors.forename: Adam
authors.initials: A
authors.lastname: Rosenblatt
authors.forename: Constantine
authors.initials: C
authors.lastname: Lyketsos
mesh_terms: D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000706:statistics & numerical data*; D017281:Cost of Illness; D003704:Dementia / Q000453:epidemiology; D003710:Demography; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008605:Mental Health Services / Q000458:organization & administration; D015995:Prevalence; D012720:Severity of Illness Index