Are care homes depressing for people with dementia?

Depression has long been reported to be common in care home residents (Mann et al., 1984). A higher prevalence of depression in care home residents than among community elderly (Beekman et al., 1999) has been reported, while longitudinal studies have suggested a high incidence of depression in older care home residents (Scocco et al., 2006). The latter study showed a typical flaw of research of this type, the cohort being identified after entry to the care home. We still do not know whether care homes are in themselves depressing; that is, is the move to a care home associated with new or worsened depressed mood? We report a pilot study which recruited older people meeting ICD-10 criteria for dementia who were about to be admitted to a care home setting. The aims of the study were: (1) to establish the feasibility of recruiting and researching older people with dementia both before and after a move to a care home and (2) to establish whether moving to a care home is associated with a deterioration in depressed mood for people with dementia. Patients were identified from current caseloads of liaison, community and inpatient psychiatric services for older people. Those with probable dementia who were identified by key workers as likely to move to a care home were approached and recruited to the study. If subjects were unable to give informed consent, carer assent was obtained. The study had full local ethics committee approval. Those agreeing to the study were interviewed by a trained research psychiatrist or psychologist before and after a move to a care home. Each had probable ICD-10 dementia as rated by study psychiatrist. On each occasion, a simple rating of the extent to which physical illness interfered with the persons’ life (‘a lot’, ‘a little’, ‘not at all’) was rated. The main rating scales administered were the depression and cognition subscales of the Psychogeriatric Assessment Scale (PAS; Jorm et al., 1995). This short scale provides a reliable continuous measure of cognition and depression, suitable for measuring change. Twenty-four subjects were approached and 21 (87.5%) agreed to the study. Two subjects moved back home after the first interview while one moved 200 km to residential care and was not followed up. Eighteen subjects were thus interviewed on two occasions. Of the 18, ten were interviewed in a general hospital ward, four in intermediate care, two in a psychiatric hospital ward, one in a day centre and one during a respite residential care admission. All 18 were subsequently interviewed in their new care home a mean of 9.33 weeks (SD 4.60) later. The mean time from admission to follow up interview was 4.8 weeks (SD 1.62). Ten subjects were by then in ordinary residential care, seven in specialist dementia residential care and one in a specialist dementia nursing home. Physical symptom ratings were unchanged preto post-move. Results of main outcomes are shown in Table 1. There was no change in level of cognitive impairment. PAS depression scores fell slightly but this did not reach statistical significance. These results must be interpreted with caution. Numbers were small and measures of physical morbidity were rudimentary. Participants were selected, being people with dementia known to psychiatric services. The experience of people without dementia may be very different, while those known to psychiatric services are also atypical. Further, the care homes may be atypical, though the 12 homes where our participants moved represented a spread of home types. Ceiling effects cannot explain findings as the PAS depression scores are in the mild-moderate range. We believe the results are of note in that: (1) they show that research involving recruiting cohorts before the move to a care home is feasible and (2) they tend to INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY