Abstract
BackgroundLate-life depression is common among older adults living in nursing homes (NHs). Over the last 30 years there has been an increase in the rates of prescription of antidepressant medications across all ages, with the largest rise reported in older adults. This study aimed to describe the pattern of antidepressant medication use among NH residents from 7 European countries and Israel and to examine patient and facilities characteristics that may account for it.MethodsWe conducted a cross-sectional analysis of data from the SHELTER study, an observational longitudinal cohort study that collected comprehensive resident data using the interRAI Long-Term Care Facility instrument in 7 European Countries and Israel.Descriptive statistics were used to examine sample characteristics. Potential correlates of antidepressant medication use were identified using multiple logistic regression modeling.ResultsAmong 4023 residents entering the study, 32% had depressive symptoms and nearly half of these individuals used antidepressants. Antidepressant medication use varied by country, with a prevalence in the overall sample of 35.6% (n = 1431). Among antidepressant users, 59.9% were receiving selective serotonin reuptake inhibitors (SSRI). The strongest correlates of antidepressant use included reported diagnosis of anxiety, depression, bipolar disorder, pain, falls and high level of social engagement. Age over 85 years, living in facilities located in rural areas and a diagnosis of schizophrenia reduced the likelihood of being prescribed with an antidepressant.ConclusionsA large proportion of residents in European long-term care facilities receive antidepressant medications. The decision to prescribe antidepressants to NH residents seems to be influenced by both patient and facility characteristics. Future longitudinal studies should evaluate the efficacy and safety of antidepressant use in NHs thus providing evidence for recommendations for clinical practice.
Highlights
Late-life depression is common among older adults living in nursing homes (NHs)
Prescription of antidepressant medications has significantly increased from 21.9% in 1996 to 47.5% in 2006 in US NHs [8] despite concerns related to their safety and appropriateness of psychotropic medications in this population
Previous studies have documented that prescription rates of psychotropic medications in NHs may be influenced by facility factors including the presence of a professional geriatrician [13]
Summary
Late-life depression is common among older adults living in nursing homes (NHs). The prevalence of depression varies in different settings from 10% among community-dwelling elderly [5] individuals to as much as 35% among nursing home (NH) residents [6]. Such high prevalence among institutionalized individuals has been related to the high rates of physical comorbidity coupled with factors such as family disconnection, reduced social engagement or environmental changes that are likely to characterize this population [7]. Previous studies have documented that prescription rates of psychotropic medications in NHs may be influenced by facility factors including the presence of a professional geriatrician [13]
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