Good News and Bad News: Depressive Symptoms Decline and Undertreatment Increases With Age in Home Care and Institutional Settings

Objectives: Examination of prevalence of depressive symptoms among older persons in home care (HC) and complex continuing care (CCC) hospitals/units, factors associated with depressive symptoms in those settings, and rate of antidepressant use among older persons with depressive symptoms. Design: Observational study using data from interRAI assessments used in normal clinical practice. Logistic regression models were used to identify factors associated with depressive symptoms in the frail elderly and treatment approaches were described. Settings: Fourteen HC agencies and 134 CCC hospitals/units in Ontario, Canada. Participants: Older persons (N = 191,9871) aged 65 years and older, including 114,497 persons from HC and 77,490 persons from CCC. Measurement: Data were collected using Resident Assessment Instrument 2.0 (RAI 2.0) (1996-2004) in CCC and Resident Assessment Instrument for Home Care (RAI-HC) (2003-2004) in HC. Results: Prevalence of depressive symptoms among older HC enrollees was lower (12.0%) than in CCC (23.6%). It decreased significantly with age in HC (to about 6% in those older than 95 years) but there were not substantial age differences in CCC. Common factors associated with depressive symptoms in both types of care were cognitive impairment, instability of health, daily pain, disability in activities of daily living; however, advanced age lost its protective effect in CCC. Less than half of the persons in HC and CCC with depressive symptoms were treated with antidepressants and their use decreased with age. Conclusions: Undertreatment of depressive symptoms among older persons remains a serious problem. Learning more about factors associated with depressive symptoms among the oldest old might improve detection and treatment of depression. (Am J Geriatr Psychiatry 2012; 20:1045-1056)