Inadequate Treatment of Depressed Nursing Home Elderly

To determine the prevalence of antidepressant drug treatment among nursing home elderly with major depression. Survey early and late in nursing home stay. Sixty Medicaid/Medicare‐certified skilled nursing homes. Admission cohort of 5,752 residents age 65 or older in 1976 through 1983. Chart review by nurse‐abstractors of physicians' diagnoses, drug used, and alertness rating. Diagnosis of depression equivalent to DSM‐III‐R major depression. Of 868 persons with a diagnosis of depression in the medical record, only 10% were treated with antidepressant drugs. More received neuroleptics and benzodiazepines than received antidepressants, but most (52%) received no psychoactive drug at all. A subset of 258 depressed persons had positive notations in their records supporting a mental status rating of “alert and oriented.” Of that subset, only 15% received antidepressants. When followed from admission to discharge or end of study the prevalence rate of antidepressant drug treatment increased by 4%. In the late 1970's and early 1980's, even when the primary care physician made and recorded a diagnosis of depression, most such nursing home residents remained untreated, incorrectly treated, or inadequately treated.