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Depression common in seniors' facilities, study finds

The rate of depression in care facilities cannot be directly blamed on seniors? living conditions, doctors say.

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A startling 44 per cent of the quarter-million seniors living in residential-care facilities are suffering from clinical depression, a new study shows.

Researchers found that 26 per cent of residents of nursing homes, personal care homes and long-term care facilities have been diagnosed with depression and another 18 per cent have clear symptoms but no documented diagnosis of depression.

"This study sheds light on the size of this problem," Nancy White, manager of home and continuing care development at the Canadian Institute for Health Information. "But I think the larger message is that we shouldn't accept depression as normal in residential care. It is an illness that can be treated."

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In fact, the data show that two-thirds of seniors who had a diagnosis of depression showed few symptoms, suggesting that they were being treated effectively.

On the other hand, those who had symptoms of depression and were not being treated were three times more likely to suffer from a bevy of problems, including poor sleep, isolation, loss of appetite and difficulty communicating.

"In seniors, depression tends to manifest itself with a lot of physical symptoms like this, not necessarily with tears and sadness," said Marie-France Tourigny-Rivard, an Ottawa psychiatrist who chairs the seniors' advisory committee of the Mental Health Commission of Canada.

She said the new data point to a need to take the issue of depression - and mental health generally - more seriously in seniors, especially those in institutional care. She cautioned, however, against jumping to the conclusion that large numbers of residents are depressed because of their living conditions. "You can't assume that living in a nursing home causes depression," she said.

"Rather, we need to understand that the factors that lead people to live in a residential care setting - physical illness, dementia, loss of a spouse, reduced mobility, etc. - are the same ones that can trigger depression," Dr. Tourigny-Rivard said.

She said there are two common misperceptions that result in seniors being grossly under-diagnosed and under-treated for depression: 1) the belief that aging is, in itself, depressing and; 2) the notion that that older adults with mental-health problems - whether they have long-term issues or are newly diagnosed - cannot recover.

Dr. Tourigny-Rivard stressed, however, that depression is treatable regardless of a person's age, with medication, psychotherapy and peer support.

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The study, which involved 50,000 seniors in Nova Scotia, Ontario, Manitoba, Saskatchewan and Yukon, is one of the largest and most detailed ever conducted in the residential care setting. All the participants underwent the same standard test for depression, using an assessment tool called RAI-MDS 2.0. The approach has already been adopted by eight provinces and territories.

"This is going to make it a lot easier to collect information, to compare it and to determine if interventions work," Ms. White said.

Ultimately, data will be available right down to the individual nursing home level and, theoretically, it could be published for public consumption if the provinces so choose.

Nationwide, there are an estimated 250,000 seniors living in institutional-care settings. The data suggest that more than 100,000 of them are suffering from clinical depression.

The number of people living in nursing homes and similar institutions is expected to soar as Baby Boomers hit their senior years. People over the age of 65 currently make up 12 per cent of the population; that number is projected to grow to 20 per cent by the year 2020.

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About the Author
Public health reporter

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.André has received much acclaim for his writing. More

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