There exists a growing body of literature which supports the view that depression is both highly prevalent among residents of nursing homes -- particularly among residents with varying degrees of dementia -- and that this depression goes largely unrecognized and untreated. The central aim of the proposed study is to examine the degree to which staffs in nursing homes recognize and response to depression among elderly residents and to evaluate a program aimed at enhancing depression recognition. From this background, the proposed project will: 1. Assess the extent of depression recognition among nursing and social work staff; 2. Examine the relationship between depression recognition and cognitive, functional and behavioral characteristics of residents; 3. Examine the manner and extent to which depression is treated in the nursing home and the relationship of treatment to depression recognition and resident characteristics; 4. Using existing instruments, standardized for use in nursing homes, to further develop, implement and evaluate a procedure to assist nursing home staff and others who work with cognitively impaired in recognition of depression; 5. Develop a training program for nursing and other facility staff in the recognition of depression the cognitively impaired as well as cognitively intact. A probability sample of 300 residents will be drawn from a sample of 6 nursing homes. Recognition of depression by nursing home staff will be examined by comparing psychiatric diagnoses to staff recognition using (a) standard chart data and queries versus (b) a standardized depression recognition protocol for us by staff. It is hypothesized that the depression recognition intervention will enhance recognition of depression among residents by nursing and social work staff. Based upon the results of the evaluation of the recognition enhancement program, a depression recognition protocol suitable for regular ongoing use by nursing home staff will be disseminated in the form of a training and facilitating package.
