title: Current prevalence of dementia, depression and behavioural problems in the older adult care home sector: the South East London Care Home Survey.
abstract: BACKGROUND
  a large and increasing number of older people in the UK are living in care homes. Dementia is a frequent reason underlying admission and determining care needs, but prevalence data are becoming increasingly outdated and reliant on brief screening instruments.
  
  
  OBJECTIVE
  to describe the prevalence and severity of dementia, depression, behavioural problems and relevant medication use in a representative sample of residential and nursing care home residents.
  
  
  METHODS
  a survey conducted in 15 randomly selected South East London care homes. Consensus clinical dementia diagnoses were made from multi-source information, and the Clinical Dementia Rating (CDR) Scale applied. Depression was ascertained using the Cornell Depression in Dementia Scale and psychological/behavioural problems using the Neuropsychiatric Inventory (NPI).
  
  
  METHODS
  three hundred and one residents with a mean (SD) age of 83.5 (9.8) and 65.8% female were included.
  
  
  RESULTS
  dementia (CDR 1-3) prevalence was 75.1% overall, 55.8% in residential homes, 91.0% in residential elderly mentally infirm care and 77.0% in nursing homes. Depression prevalences were 26.5, 22.0 and 29.6%, respectively, and mean (95% CI) NPI severity scores 3.99 (3.47-4.50), 6.34 (5.29-7.39) and 6.10 (5.50-6.70) with 87.3% of the sample exhibiting at least one NPI symptom. Antidepressants were prescribed in 25.6, 25.0 and 41.3%, respectively, and antipsychotics in 7.0, 34.1 and 19.1%.
  
  
  CONCLUSIONS
  dementia is substantially more common in care homes than recorded diagnoses would suggest, but studies using brief screening instruments may overestimate prevalence. High prevalences of depressive and/or behavioural symptoms and psychotropic use suggest significant unmet need.
authors.affiliation: Psychological Medicine, King's College London (Institute of Psychiatry), London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Stewart
authors.affiliation: Psychological Medicine, King's College London (Institute of Psychiatry), London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.affiliation: Health Service and Population Research Department, King's College London (Institute of Psychiatry), London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Dewey
authors.affiliation: King's College London, Guys Campus, London, UK.
authors.forename: Clive
authors.initials: C
authors.lastname: Ballard
authors.affiliation: Psychological Medicine, King's College London (Institute of Psychiatry), London, UK.
authors.forename: Jatinder
authors.initials: J
authors.lastname: Bisla
authors.affiliation: Psychological Medicine, King's College London (Institute of Psychiatry), London, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Calem
authors.affiliation: South London and Maudsley NHS Foundation Trust, MHOA&D CAG, London, UK.
authors.forename: Viola
authors.initials: V
authors.lastname: Fahmy
authors.affiliation: Care Home Project Team, St Christopher's Hospice, London, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Hockley
authors.affiliation: Care Home Project Team, St Christopher's Hospice, London, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Kinley
authors.affiliation: South London and Maudsley NHS Foundation Trust, MHOA&D CAG, London, UK.
authors.forename: Hywel
authors.initials: H
authors.lastname: Pearce
authors.affiliation: South London and Maudsley NHS Foundation Trust, MHOA&D CAG, London, UK.
authors.forename: Anoop
authors.initials: A
authors.lastname: Saraf
authors.affiliation: Health Service and Population Research Department, King's College London (Institute of Psychiatry), London, UK.
authors.forename: Aysha
authors.initials: A
authors.lastname: Begum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003625:Data Collection; D003704:Dementia / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007361:Intelligence Tests; D008131:London / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D015995:Prevalence; D012112:Residential Facilities / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D014150:Antipsychotic Agents
keywords: mental health; nursing homes; older people; residential EMI; residential homes