Together the results provide the basis for the following recommendations for clinical practice:
• Make systematic diagnostics to distinguish sadness from depression in need of treatment
• Cornell is a validated scale that is easy to use
• Support the patient's own coping strategies
• Avoid antidepressants in mild and moderate depression
• Follow up medical treatment
About the project
This is Kristina Riis Iden’s PhD project. On April 29th 2015 Iden defended her PhD thesis "Depression in nursing homes - underdiagnosis and overtreatment" at the University of Bergen. Link to BORA
The aim of the project was to develop new knowledge about depression in frail old nursing home patients to enable doctors to provide optimal care to these patients. Depression is prevalent among nursing home patients and can lead to reduced quality of life, increased morbidity and premature death. Sadness is a key symptom of depression, but it is also a common human experience. We have conducted three empirical studies with qualitative and quantitative methods, all published as articles.
The PhD thesis highlighted the following issues:
- Treatment decisions on antidepressants
Focus group interviews with nursing home doctors and nurses suggest it may be difficult to distinguish between sadness and depression, but systematic diagnosis work is scarce. Treatment is usually medications (antidepressants) while environmental measures are rarely used. The initiative to start drug treatment often came from the nursing group.
- Depression in newly admitted patients
Depression was diagnosed in every fourth patient newly admitted to a nursing home, while depression diagnosis was documented in patient records in only half of these. Antidepressants were prescribed to many patients but only half received these drugs for depression.
- Patients’ perceptions of sadness
We conducted semi-structured interviews of long-term care patients with no dementia on their thoughts about sadness. Different loss experiences, addiction, poor care and loneliness were common causes of sadness. Patients had different coping strategies, which come to terms with malfunctions, see themselves in a wider perspective and participate in religious activities.
Researchers: Kristina Riis Iden and Sabine Ruths
Stèfan Hjørleifsson (Department of Global Public Health and Primary Care, University of Bergen)
Knut Engedal (Norwegian National Advisory Unit on Ageing and Health)
Funding: General Practice Research