Assessment and treatment of nursing home residents with depression or behavioral symptoms associated with dementia: a review of the literature.

Depression and the behavioral symptoms associated with dementia remain two of the most significant mental health issues for nursing home residents. The extensive literature on these conditions in nursing homes was reviewed to provide an expert panel with an evidence base for making recommendations on the assessment and treatment of these problems. Numerous assessment instruments have been validated for depression and for behavioral symptoms. The Minimum Data Set, as routinely collected, appears to be of limited utility as a screening instrument for depression but is useful for assessing some behavioral symptoms. Laboratory evaluations are often recommended, but no systematic study of the outcomes of these evaluations could be found. Studies of nonpharmacological interventions out-number those of pharmacological interventions, and randomized, controlled trials document the efficacy of many interventions. Antidepressants are effective for major depression, but data for minor depressive syndromes are limited. Recreational activities are effective for major and minor depression categories. Neither pharmacological nor nonpharmacological interventions totally eliminate behavioral symptoms, but both types of interventions decrease the severity of symptoms. In the absence of comparison studies, it is unclear whether one approach is more effective than another. Despite federal regulations limiting their use, antipsychotics are effective and remain the most studied medications for treating behavioral symptoms, whereas benzodiazepines and antidepressants have less support. Structured activities are effective, but training interventions for behavioral symptoms had limited results. There are sufficient data to formulate an evidenced-based approach to treatment of depression and behavioral symptoms, but more research is needed to prioritize treatments.