Pattern of Use of Antidepressants in Long-Term Care Facilities for the Elderly

Abstract

Despite some evidence that neuroleptic medication is overused or misused in long-term care facilities for the elderly, there has been virtually no attention paid to the pattern of use of antidepressants in these facilities. All patients in long-term care in a geriatric hospital and a home for the aged who were receiving antidepressants were identified; 10.5% of the patients in the hospital and 12.7% in the home for the aged were receiving an antidepressant. The rate of use of antidepressants on the different units ranged from 0% to 26.8%. The most commonly prescribed antidepressant was doxepin followed by nortriptyline. The mean dose of antidepressant was 34.8 mg. Although depression was the most common reason for the prescription of an antidepressant (69% of patients receiving one), other reasons included pain, agitation, aggression, and insomnia. Patients had been receiving antidepressants for up to 10 years, with a mean duration of 32 months. The majority of patients (60%) had a history of depression predating their institutional admission. Patients receiving antidepressants were compared to a group not receiving antidepressants, who were matched for age, sex, unit, and attending physician. Patients receiving antidepressants were more likely to have a history of stroke (33.8% versus 16.9%). There was no significant difference between the two groups regarding the prevalence of dementia, Parkinson's disease, thyroid disease, malignant tumor, congestive heart failure, or diabetes mellitus. Prospective studies are required to determine the efficacy of antidepressants in this population and to identify factors that can predict a positive response to treatment. (J Geriatr Psychiatry Neurol 1992;5:228–232).

Get full access to this article

View all access options for this article.

References

1. Katz IR , Lesher E , Kleban M , et al: Clinical features of depression in the nursing home. Int Psychogeriatr 1989; 1:5–15.

2. Rovner BW , Kafonek S , Filipp L , et al: Prevalence of mental illness in a nursing home. Am J Psychiatry 1986; 143:1446–1449.

3. Snowdon J , Donnelly N : A study of depression in nursing homes. J Psychol Res 1986; 20:327–333.

4. Sadavoy J , Smith I , Conn DK , et al: Depression in geriatric patients with chronic medical illness. Int J Geriatr Psychiatry 1990; 5:187–192.

5. Robinson RG , Starr LB , Kubos KL , et al: A two year longitudinal study of post-stroke mood disorders: Findings during the initial evaluation. Stroke 1983; 14:736–741.

6. Mayeaux R , Williams J , Stern Y , et al: Depression in Parkinson's disease. Adv Neurol 1984; 40:241–250.

7. Larson E , Reifler B , Sumi S , et al: Diagnostic evaluation of 200 elderly outpatients with suspected dementia. Gerontology 1985; 40:536–543.

8. Burns BJ , Larson DB , Golstrom ID , et al: Mental disorder among nursing home patients: Preliminary finds from the National Nursing Home Survey pretest. Int J Geriatr Psychiatry 1988; 3:27–35.

9. Glasscote RM , Beigel A , Butterfield A , et al: Old Folks at Homes: A Field Study of Nursing and Board-and-Care Homes. Washington, DC, Joint Information Services of the American Psychiatric Association and the National Association for Mental Health, 1976.

10.

10. Prien RF : Problems and practices in geriatric psychopharmacology. Psychosomatics 1980; 21:213–223.

11.

11. Ray WA , Federspiel CF , Schaffner W : A study of antipsychotic drug use in nursing homes; Epidemiologic evidence suggesting misuse. Am J Public Health 1980; 70:485–491.

12.

12. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed revised. Washington, DC, American Psychiatric Association, 1987.

13.

13. Pinner E , Rich CL : Effects of trazodone on aggressive behavior in seven patients with organic mental disorders. Am J Psychiatry 1988; 145:1295–1296.