No Longer Undertreated? Depression Diagnosis and Antidepressant Therapy in Elderly Long-Stay Nursing Home Residents, 1999 to 2007

Authors

  • Dorothy Gaboda PhD,

    1. From the Center for *State Health Policy and Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey.
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  • Judith Lucas EdD,

    1. From the Center for *State Health Policy and Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey.
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  • Michele Siegel PhD,

    1. From the Center for *State Health Policy and Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey.
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  • Ece Kalay BA,

    1. From the Center for *State Health Policy and Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey.
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  • Stephen Crystal PhD

    1. From the Center for *State Health Policy and Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey.
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  • Presented at Gerontological Association of America Symposium, Psychotropic Drug Use in the Frail Elderly: Issues and Challenges, Atlanta, Georgia, November 19, 2009.

Address correspondence to Dorothy Gaboda, Center for State Health Policy, Rutgers University, 112 Paterson Street, 5th Floor, New Brunswick, NJ 08901. E-mail: dgaboda@ifh.rutgers.edu

Abstract

OBJECTIVES: To examine the evolution of depression identification and use of antidepressants in elderly long-stay nursing home residents from 1999 through 2007 and the associated sociodemographic and facility characteristics.

DESIGN: Annual cross-sectional analysis of merged resident assessment data from the Minimum Data Set (MDS) and facility characteristics from the Online Survey Certification and Reporting data.

SETTING: Nursing homes in eight states (5,445 facilities).

PARTICIPANTS: Long-stay nursing home residents aged 65 and older (2,564,687 assessments).

MEASUREMENTS: Physician-documented depression diagnoses recorded in the MDS were used to identify residents with depression; antidepressant use was measured using MDS information about residents' receipt of an antidepressant in the 7 days before assessment.

RESULTS: Diagnosis of depression and antidepressant therapy in residents diagnosed increased at a rapid rate. By 2007, 51.8% of residents were diagnosed with depression, 82.8% of whom received an antidepressant. Adjusted odds of treatment were higher for younger residents, whites, and those with moderate impairment of cognitive function.

CONCLUSION: This study demonstrates striking increases in depression diagnosis and treatment with antidepressant medications, but disparities persist without clear evidence about underlying mechanisms. More research is needed to assess effectiveness of antidepressant prescribing.

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