Using the Minimum Data Set 2.0 Mood Disturbance Items as a Self-Report Screening Instrument for Depression in Nursing Home Residents

University of Pennsylvania, Department of Psychiatry and Philadelphia VA Medical Center, Philadelphia, PA, USA.
American Journal of Geriatric Psychiatry (Impact Factor: 4.24). 02/2004; 12(1):43-9. DOI: 10.1097/00019442-200401000-00006
Source: PubMed


Seeking to enhance nursing home residents' involvement in their care, the authors examined whether the Minimum Data Set, Version 2.0 (MDS) Mood Disturbance items could be administered by self-report. They compared the MDS to the Geriatric Depression Scale (GDS) in terms of its association with depression diagnosis.
Subjects (N=204) were nursing home residents who were interviewed with a psychiatric diagnostic instrument, the GDS, and a self-report version of the MDS mood disturbance items.
Analyses of variance and receiver operating characteristics analyses demonstrated that MDS items distinguished subjects with any versus no depression about as well as did the GDS. This pattern held within cognitive, gender, and ethnicity subgroups.
The MDS Mood Disturbance items can be reliably and validly administered via self-report to persons scoring at least 12 on the Mini-Mental State Exam.

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    • "Detection characteristics were similar to the 15-item GDS. Recent reports have recommended using the MDS in concert with other measures, such as the GDS (Ruckdeschel et al., 2004; Snowden et al., 2003). "
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    ABSTRACT: The assessment and treatment of depression in long-term care (LTC) settings poses unique challenges to both clinicians and researchers. In this review we discuss the variety of forms depression can take among LTC residents and the influence the LTC environment can play on the development and maintenance of depression. We describe instruments that can be used to assess depressive symptoms, along with their strengths and liabilities. Additionally, we summarize treatment approaches, with an emphasis on the relatively limited number of empirically informed interventions. Throughout, we describe modifications that may improve the accuracy of assessment and the effectiveness of psychological treatments. Depression, while common among LTC residents, appears amenable to psychological intervention, although the field is far from identifying empirically supported treatments in the LTC setting.
    Clinical Psychology Science and Practice 08/2005; 12(3):280 - 299. DOI:10.1093/clipsy.bpi031 · 2.92 Impact Factor
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    • "In their study, the CSDD was collected by primary caregivers, while the MDS was abstracted from the chart, and these authors suggest that the nurse administrators that completed the MDS did not consult the primary caregivers and the resident in completing the MDS depression items. Contrast with these findings a recent study by Ruckdeschel and colleagues [18], who converted the MDS items into a self-report assessment device and reported a very high correlation with depression symptom data collected with the GDS (r = 0.71). "
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    ABSTRACT: The objective of this study was to examine the Minimum Data Set (MDS) and Geriatric Depression Scale (GDS) as measures of depression among nursing home residents. The data for this study were baseline, pre-intervention assessment data from a research study involving nine nursing homes and 704 residents in Massachusetts. Trained research nurses assessed residents using the MDS and the GDS 15-item version. Demographic, psychiatric, and cognitive data were obtained using the MDS. Level of depression was operationalized as: (1) a sum of the MDS Depression items; (2) the MDS Depression Rating Scale; (3) the 15-item GDS; and (4) the five-item GDS. We compared missing data, floor effects, means, internal consistency reliability, scale score correlation, and ability to identify residents with conspicuous depression (chart diagnosis or use of antidepressant) across cognitive impairment strata. The GDS and MDS Depression scales were uncorrelated. Nevertheless, both MDS and GDS measures demonstrated adequate internal consistency reliability. The MDS suggested greater depression among those with cognitive impairment, whereas the GDS suggested a more severe depression among those with better cognitive functioning. The GDS was limited by missing data; the DRS by a larger floor effect. The DRS was more strongly correlated with conspicuous depression, but only among those with cognitive impairment. The MDS Depression items and GDS identify different elements of depression. This may be due to differences in the manifest symptom content and/or the self-report nature of the GDS versus the observer-rated MDS. Our findings suggest that the GDS and the MDS are not interchangeable measures of depression.
    BMC Geriatrics 02/2005; 5(1):1. DOI:10.1186/1471-2318-5-1 · 1.68 Impact Factor
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    ABSTRACT: Use of long-term care (LTC) facilities has become a necessary alternative in the health armamentarium in all developed countries. In the United States, 24% die in nursing homes (Porock et al., 2005) . Although only 5% of individuals over age 65 are living in LTC facilities at any given point in time, nearly 40% will spend at least some portion of their lives there (U.S. Census Bureau, 2002 ). Annually almost 2 million adults are admitted to one of 16,800 nursing homes in the United States (Hyer & Ragan, 2002 ; Rhoades & Krauss, 1999) . The recent growth of assisted living facilities too - now estimated at over 36,000 facilities serving about one million residents (Stefanacci, 2005) - complements these nursing homes within the spectrum of LTC settings. Nursing homes themselves are now mini-medical facilities, functioning not as "homes" but as hospitals from the perspective of the residents (Bergman-Evans, 2004) . In this regard, LTC environments present residents with many challenges, including lack of privacy, confinement to an institutional schedule, and the knowledge that the LTC setting is likely to be an individual's final home. In this environment, the challenge of integrating mental health into the care of the aging within these varied LTC settings is enormously important. In fact, mental and medical pathologies often share a common expression and function. Physical changes, like those seen in Parkinson's disease, have definite medical etiologies, but frequently fall into the domain of mental health, given their neuropsychological properties and high incidence of comorbid depression (Dening & Bains, 2004). A majority of residents living in LTC facilities carry a least one psychiatric diagnosis. As many as 80% of nursing home residents will have dementia or another diagnosable psychiatric disorder (Hyer & Ragan, 2002 ; Rovner et al., 1990) . Furthermore, between 6 and 24% have a major depressive disorder diagnosis, 30% have minor depression or dysthymia, and as many as 35% manifest depressive symptoms. Minimum Data Set (MDS) reports that 14.6% of LTC residents have been diagnosed with anxiety disorder, though this rate may be deceptively low given limitations of assessment and in reporting anxiety symptoms within the MDS (Centers for Medicare and Medicaid Studies, 2004). Despite these high rates of psychiatric disorders, most residents are not under the care of a mental health clinician. Typically, these services are provided by independent psychiatric consultants who see specific residents on an as-needed, on-call basis (Bartels, Moak, & Dums, 2002) . In many cases medication alone is given. The Centers for Medicare and Medicaid Services (Boyle et al., 2004) report a 97% increase in antidepressant medications for all residents from 12.6% to 24.9%. Datto et al. (2002) suggest that 35% of nursing home residents receive antidepressant medication. The Practice of Mental Health in LTC Matters . Ormel, Van cen Brink, and Koeter (1995) indicated that evidence tells us that there are consequences to a lack of mental health input in these facilities, including (1) higher health care utilization and costs; (2) greater functional impairment; (3) increased utilization of staff time; (4) nonadherence to medical care; (5) increased mortality; and (6) reduced quality of life. Clinical common sense tells us that both dementia and depression result in increased time for staff, even after controlling for physical illness and disability (Fries et al., 1993) . Behavioral health care also makes a difference with medical procedures, as in hip-fracture, where residents receiving psychiatric services experienced fewer complications and were 9 times more likely to resume functioning at preoperative levels (Strain, Lyons, & Hammer, 1991). In this chapter we will address these issues. We discuss the medical model, as well as psychosocial models. We also provide a typology of residents in LTC for which the practice of psychology is applied. From here, we will address the psychiatric care of residents as viewed from the literature and clinical care in LTC. We then consider the practice of psychology in these settings, both assessment and treatment. Throughout, we argue that psychology, as a profession, makes a difference in LTC environments, and that integrated care is important, if not key, in the overall scheme of healthcare and life quality.
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