Depression in the nursing home: Using a stepped collaborative care model to improve treatment - DAVOS

Background Depression is the second most common psychiatric illness in older people. Its prevalence rate in nursing homes is almost twice as high as that of the older population in general; however, depression often goes unnoticed and is consequently not treated despite a good prognosis. In Germany, only around 40% of nursing home residents suffering depression receive an adequate diagnosis and only half of these receive any treatment at all (normally psychotropic medications). This glaring lack of care results in a lower quality of life, poorer physical functioning and higher mortality rates for those affected. Methods The aim of DAVOS was to develop, implement and evaluate an innovative case management concept to improve treatment of depression in nursing home residents. An initial 449 residents with and without depression were recruited for the cluster-randomized study in a stepped-wedge design (307 women (68.4%), age: M = 82.5 years (SD = 10.5)). Depression symptoms were present in 38.8% of the participants at baseline. Psychometric testing was conducted to record the outcomes (including on depressiveness, quality of life, functional level) at six assessment points. The specially qualified depression case managers from the nursing homes used a screening process developed to identify residents suffering depression and to refer them for psychotherapeutic treatment in line with their diagnosis. Results Implementation of the case management concept was successful, as is evident from the summative evaluation by the parties involved, among other indicators. Despite lack of confirmation of the main hypothesis that the intervention results in a reduction in prevalence and severity of depression, both outcomes remained relatively constant even under the negative psychosocial effects of the coronavirus pandemic. In contrast, positive tendencies were seen at the facility level, and in some cases, there were even significant improvements in depression severity (p = 0.026). A heterogeneous picture emerged with regard to secondary parameters such as quality of life, with constant to slightly positive development. Conclusion Due to massive pandemic restrictions, the overall intervention was unable to deliver its full impact at times. Nevertheless, in addition to practicable concepts to qualification for nursing home staff, DAVOS also offers important approaches to improving the care of nursing home residents in need of psychotherapy.