The incidence of depression and its risk factors in Dutch nursing homes and residential care homes

OBJECTIVE: Although it is known that depression is highly prevalent in institutionalized older adults, little is known about its incidence and risk factors in nursing homes and residential care homes. The aim of this study was to investigate and compare the incidence and associated risk factors for depression in Dutch nursing homes and residential care homes. DESIGN: Data on depression were extracted from the Vrije Universiteit naturalistic cohort on routine care monitoring with the Minimum Data Set of the Resident Assessment Instrument. PARTICIPANTS: A total of 1,324 residents in six nursing homes and 1,723 residents in 23 residential care homes with an average follow-up of 1.2 years. MEASUREMENTS: Depression was defined as a clinical diagnosis according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and the use of antidepressants. Residents with prevalent depression at baseline were excluded. RESULTS: The incidence rate was 13.6 per 100 person years in the nursing homes and 10.2 per 100 person years in the residential care homes. The independent risk factors for in-home depression for residents in nursing homes included dementia (OR: 1.7; 95{\%} CI: 1.02-2.95) and a score of 3 or more on the Depression Rating Scale (odds ratio [OR]: 2.1; 95{\%} confidence interval [CI]: 1.23-3.70). A protective effect was seen on the use of a hearing aid (OR: 0.3; 95{\%} CI: 0.12-0.80). In the residential care homes, being male (OR: 2.1; 95{\%} CI: 1.27-3.30), having cancer (OR: 2.9; 95{\%} CI: 1.64-4.95), and a score of 2 or higher on the Cognitive Performance Scale (OR: 1.5; 95{\%} CI: 1.05-2.22) increased the risk to develop depression. Age greater than 85 years (OR: 0.5; 95{\%} CI: 0.31-0.67) and hearing impairment (OR: 0.8; 95{\%} CI: 0.60-1.00) appeared to be protective. CONCLUSIONS: The incidence rate for depression in residents of Dutch nursing homes and residential care homes was high and the associated risk factors found may have important implications for staff