Senior Investigator: Professor Marita McCabe¹
Principal Investigators: Professor Kuruvilla George², Associate Professor Kate Moore¹, Associate Professor David Mellor¹, Dr Chantal Ski¹
Research Staff: Dr Tanya Davison¹, Ms Katie Miles¹, Ms Sarah Philips¹, Dr Fiona J. Bailey¹,
¹ School of Psychology, Deakin University
² MBBS, Eastern Health Aged Psychiatry
beyondblue Victorian Centre of Excellence
Project completion year
Depression is a serious, widespread, yet treatable medical condition that affects the health and quality of life of older people living in residential care.
The research comprised a series of three studies:
- The first study determined the prevalence of depression among 300 elderly low-level care residents, with and without cognitive impairment.
- The second study aimed to determine the levels of consumer satisfaction with health care services by examining the perspectives of residents who had received treatment for depression.
- Finally, five depression-screening instruments were examined to evaluate their validity as screening tools for depression among residents with normal and impaired cognitive function.
Eighteen per cent of residents had Major Depressive Disorder and 10 per cent had Minor Depressive Disorder. In addition, 20.3 per cent of the sample were not currently depressed, but were receiving an antidepressant medication. These high figures suggest that depression is a significant issue in residential care facilities.
Depression was not associated with gender, age, or how recently the person had been admitted to the residential facility. However, residents with cognitive impairment were at a slightly increased risk of depression. More than half of the residents with depression had not been recognised as depressed by their general practitioner, or prescribed antidepressant medication.
- Residents with depression demonstrated a poor understanding of their illness, and a low awareness of treatment.
- Less than one quarter of residents prescribed an antidepressant medication reported awareness of this treatment.
- An extremely small number of residents had received treatment from specialist mental health services, and psychological interventions were not accessed by the group.
- Residents tended to report general satisfaction with their health service provider, although affective symptoms of depression were not routinely checked.
- While many residents appreciated the caring manner of their general practitioner, they acknowledged that they typically received only short consultations which focused on physical ailments.
- Older persons appeared to hold low expectations of receiving quality care from health services.
Researchers have called for routine screening for depression in residential care to improve the detection of depression. However, there is no consensus regarding which instrument would be most appropriate for residents with normal cognitive function and moderate levels of cognitive impairment.
The current research found that all five instruments were valid indicators of Major Depressive Disorder, detecting between 89 per cent and 94 per cent of cases.
Most depression instruments were slightly less sensitive to major depression among residents with moderate cognitive impairment, most notably the Geriatric Depression Scale-15 (Sheikh & Yesavage, 1986).
A small number of residents were unable to complete self-rated instruments; however the Cornell Scale for Depression in Dementia (Alexopoulos, Abrams, Young, & Shamoian, 1988a) was appropriate for participants with moderate cognitive impairment.
Implications for Policy and Practice
High numbers of Australians are currently residing in low-level care facilities, with little understanding of the development of depressive illness or knowledge of the treatment options they can access.
Further research is required to understand depression among people residing in low-level care facilities. This research would suggest that older persons receive a low rate of enquiry into symptoms of depression during the short consultations provided by their general practitioner, which is likely to contribute to the low rate of recognition, and may impede treatment progress.
Education for general practitioners in the management of depression among older persons in residential care may improve consumer perspectives of treatment for depression.
While the general practitioner has a small amount of time available with an individual resident, they are likely to rely on nursing staff to provide observations of each resident, to aid in the detection and monitoring of depressive symptoms. Nursing staff are a potentially valuable source of information about the mental state of aged care residents, and it is suggested that the use of routine interviews with nursing staff by general practitioners has the potential to improve outcomes for residents with depression.
Following on from this project, the team has undertaken further research to develop a depression-training program specifically designed for staff working in residential and community aged care settings. With the support of a funding grant from beyondblue a pilot program of this training program has been implemented among aged care staff.
About the Senior Researcher
Professor McCabe is a Professor in the School of Psychology. She is an active researcher and supervises higher degree students. She is committed to collaborative work ventures in aged care and has extensive experience in team building, training and mentoring. Professor McCabe and her team of researchers from Deakin University have worked collaboratively on a number of past projects funded by beyondblue, ARC and NHMRC
Alexopoulos, G. S., Abrams, R. C., Young, R. C., & Shamoian, C. A. (1988a). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271-284.
Shiekh, J., & Yesavage, J. (1986). Geriatric Depression Scale: Recent findings and development of a short version. In T. Brink (Ed.), Clinical gerontology: A guide to assessment and intervention. New York: Howarth Press.