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MDS Update:
What
does the Prevalence of Depression Quality Indicator really mean?
mmmmmmmmmmmmmmmmmmmmm
The
role of the MDS and Quality Indicator reports in the nursing home
survey process and the implications of these data for nursing homes
and practitioners were previously presented in the March/April ACT
Newsletter. Research
recently published in The Gerontologist suggests the
prevalence of the depression quality indicator might be more
reflective of measurement processes than of actual prevalence of
depression in nursing facilities (Schnelle, Wood, Schnelle, &
Simmons, 2001). Researchers
compared prevalence rates of depression using independent interview
assessments of residents by research staff using the Geriatric
Depression Scale and MDS assessments on 16 MDS mood items (Section
E1: Indicators of
Depression, Anxiety, and Sad Mood) documented by nursing staff at
two California nursing facilities.
One of the nursing facilities selected for this study was
flagged on a nationally mandated quality indicator report as having
an unusually low prevalence rate of depression symptoms (which
placed them in the 1st percentile compared with all other
California nursing facilities), while the second facility was
flagged as having an unusually high prevalence rate of depression
symptoms on the same report (placing them within the 70th
percentile compared to other California nursing facilities).
Research
findings (determined by research staff interview assessments)
indicated that the percentage of residents to have probable
depression, 49% vs. 55%, were not significantly different in the two
nursing facilities despite rather large differences in prevalence of
Depression on the QI reports, 1% vs. 12%.
The staff in the facility flagged on the QI report as having
a high depression prevalence rate identified significantly more
residents who also had scores indicative of probable depression on
the resident interviews for follow-up mood assessments than did the
home with a low QI prevalence rate (78% vs. 25%, respectively).
It is notable that even in the facility that had a high
depression prevalence rate on the QI report, prevalence of
depression was underestimated by the MDS when compared to
identification of depression by research staff interview
assessments. The
researchers concluded that the prevalence of the depression quality
indicator might be more reflective of measurement processes than
depression outcomes. The nursing home with the higher depression prevalence rate
was a university-affiliated facility with extensive on-site mental
health services provided by the university while the low-prevalence
facility did not have an in-house mental health staff and referred
all residents with psychiatric problems to off-site mental health
resources. Researchers
concluded that MDS data may be more influenced by the ability of
nursing facility staff to detect symptoms than by actual prevalence
rate.
Implications
for Nursing Facilities and Residents-
While
it is unclear how survey staff or providers will interpret the
prevalence data of depression QI derived from the MDS, it is clear
that in this study, the higher-QI prevalence site should not be
regarded as having a more serious problem with depression outcomes
than the low- QI prevalence site.
The researchers, in fact, suggested that the opposite
conclusion seems more defensible.
The researchers suggested that the low-prevalence site should
be targeted for an intervention project to improve their ability to
detect mood symptoms that may be indicative of depression.
Availability of on-site mental health providers can assist
facility staff in becoming more aware of mood symptoms.
Previous research has suggested that depression symptoms are
frequently under-detected in long-term care residents, perhaps
because these symptoms are often erroneously regarded as a normal
part of aging (Katz, Streim, & Parmelee, 1994).
Implications
for Mental Health Providers- It
is essential that mental health providers in long-term care
facilities educate and sensitize nursing staff to signs and symptoms
of depression in nursing home residents.
Since MDS data are the bases for development of resident care
plans, enhancing the ability of nursing facility staff to correctly
identify MDS mood symptoms can result in providing greater access to
treatment for residents in need of mental health services.
Katz,
I.R., Streim, J., and Paremelee, P.
1994. Prevention
of depression, recurrences, and complications in late life.
Preventive Medicine 23:743-750.
Schnelle,
J.F., Wood, S., Schnelle, E.R., and Simmons, S.F.
2001. Measurement
sensitivity and the minimum data set depression quality indicator.
The Gerontologist 41:401-405.
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Research Updates
Social
Anxiety and Depression in Teens.
(Reuters
Health) Although shyness and anxiety in social situations is normal
for many teenagers, for a small portion of young people it is not
just a phase they will “grow out of”.
Per research results, adolescents whose symptoms are severe
enough to be classified as Social Anxiety Disorder appear to be at
increased risk for later development of major depression (Stein, et.
al. published in the Archives of General Psychiatry).
At the beginning of the study, about 7% of participants aged
14-24 had experienced social anxiety disorder at some point in their
lives, 14% had experienced depressive disorder, and about 2.5% had
both conditions at the same time.
Compared to peers with no emotional disorders, young people
with either Social Anxiety Disorder or depression at the beginning
of the study were about three times as likely to develop depressive
disorder over the follow-up period, which lasted over 4 years.
Those who had had the combination of Social Anxiety Disorder
and depression were more than eight times more likely to have
depressive disorder during follow-up.
Stein and colleagues conclude that the findings support the
idea that intervening early with young people who show signs of
Social Anxiety Disorder may help prevent the development of major
depression, especially those who show some signs of depression as
well.
Stein,
M. B., et. al. Archives
of General Psychiatry. 2001;
58:251-256.
Treating
Teenagers with ADHD. (APA).
In a NIMH supported research project, methylphenidate
(Ritalin) in combination with a behavior modification intervention
was found to improve the performance of adolescents diagnosed with
ADHD on a range of academic measures, including note-taking, daily
assignments, and quiz scores, without causing major side effects. When administered as part of intensive behavior change
interventions, methylphenidate significantly boosted the quality of
students’ schoolwork compared to placebo.
About 80% of adolescents showed improved academic performance
while taking some dose of stimulant medication.
Important individual differences in response to the drug were
found and increasing the dosage did not necessarily improve student
performance – in fact some students’ performance deteriorated
when their dosages of methylphenidate increased.
Evans,
S.W., et. al. Dose-response effects of methylphenidate
on ecologically valid measures of academic performance and classroom
behavior in adolescents with ADHD.
Experimental and Clinical Psychopharmacology. 2001;
Vol. 9, No. 2.
Rapid
Cognitive Decline in Alzheimer’s Patients with Hallucinations.
(Reuters
Health). Hallucinations,
but not delusions, are significantly related to cognitive decline in
patients with Alzheimer’s disease.
Wilson, et. al. studied 410 patients with Alzheimer’s
disease over a 4-year period. At
baseline, hallucinations were present in 41% of patients; delusions
were present in 55% of patients.
The average cognitive decline per year in patients with
hallucinations was found to be 47% higher than that in patients
without hallucinations. Researchers
concluded that, “knowledge of whether or not auditory or visual
hallucinations have occurred can substantially improve prediction of
subsequent course.”
Wilson,
R.S., et. al. Journal
of Neurology, Neurosurgery, and Psychiatry.
2000; 69:172-177.
Treating
Poststroke Depression Aids Cognitive Recovery.
(Reuters
Health). Poststroke
depression can lead to pseudodementia, while treatment for
depression improves cognitive recovery.
In the acute period after stroke, about 40% of patients show
signs of depression, with about half having major depression and
half having minor depression. Of patients with frontal lobe damage, about 70% - 80% will
develop depression. Patients
who received antidepressant medication (nortriptyline) showed
significant improvement in cognitive recovery over 6-12 weeks
compared with patients who received placebo.
About a 12% increase was found in the intellectual function
in patients receiving antidepressant medication.
Researchers concluded that physicians and family members need
to ensure that the stroke patient is evaluated for depression,
“Because we now know that not only can depression be alleviated,
but also that intellectual recovery from stroke can be improved.
Robinson,
R.G., et. al. Stroke.
2000; 31:1482-1486
Employee
Anniversaries
Christopher
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August 3, 1999
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