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


CONCLUSIONS
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.
Koopmans
Raymond T C M
RT
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. R.Koopmans@elg.umcn.nl
Zuidema
Sytse U
SU
Leontjevas
Roeslan
R
Gerritsen
Debby L
DL
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D001526:Behavioral Symptoms / Q000175:diagnosis* / Q000209:etiology; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000209:etiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D015577:Geriatric Assessment / Q000379:methods*; D017408:Guidelines as Topic; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care; D009735:Nursing Homes; D011787:Quality of Health Care