Role of symptom presentation in the diagnosis and treatment of the depressed elderly : a closer look at anhedonia and dysphoria / Leah D. Clyburn. --

Abstract

The main objective of this study was to examine how symptom presentation relative to anhedonia and dysphoria influences diagnosis and treatment patterns documented on the Minimum Data Set for long-term care. It was hypothesized that diagnosis and treatment for depression would be more likely when dysphoria was present. Two samples were included in the present study. The first sample was comprised of 162 residents from three nursing homes and a Veterans’ Care facility in Ontario, with an average age of 82.92 (SD=6.86). The second sample consisted of 1477 nursing home residents aged 65 years and over (average age=83.69, SD=7.93) from 22 facilities across Ontario. The prevalence of identified depression in each sample was 30% and 16%, respectively. A large majority of the residents identified as depressed in each sample (on average, 75%) were receiving antidepressants. The results of logistic regression analyses applied to the data indicated that a diagnosis of depression was more likely if the resident was female, of younger age, had less cognitive impairment, and clinically significant levels of dysphoria. These results lend some support to the assertion that long-term care residents presenting with anhedonia in the absence of dysphoria, or “depression without sadness”, may be particularly vulnerable to the under-recognition of depression. Further logistic regression analyses of the larger sample revealed that antidepressant treatment was more likely if the resident was younger, had less cognitive impairment, and had clinically significant levels of anhedonia, dysphoria, or both. The findings indicated that most identified depression was treated, but also suggest that certain subgroups may be at risk for the underrecognition of depression. Participants : Nursing home residents from 3 nursing homes in Thunder Bay, Northwestern Ontario and a Veteran's Care facility in London, Ontario.