Treatment decisions on antidepressants in nursing homes: a qualitative study
Open accessAbstract
OBJECTIVE: To explore decision-making on treatment with antidepressants among doctors and nurses in nursing homes. DESIGN AND SUBJECTS: A qualitative study based on interviews with three focus groups comprising eight physicians engaged full time, eight physicians engaged part time, and eight registered nurses, respectively. The interview guide comprised questions on initiating, evaluating, and withdrawing treatment with antidepressants. The interviews were audio-recorded, transcribed, and analysed by systematic text condensation. RESULTS: The first theme was the diagnostic process. The informants expressed difficulty in differentiating between depression and sorrow resulting from loss in old age. Further, the doctors reported that they relied on nurses' observations and rarely carried out systematic diagnostic work and follow-up of patients with depression. The second theme was treatment. Antidepressants were usually the only type of treatment provided, and patients were kept on medication even though staff felt uncertain whether this was effective. The third theme was who really determines the treatment. Registered nurses reported that unskilled and auxiliary nursing staff requested drug treatment, and doctors felt some pressure from the nurses to prescribe antidepressants. CONCLUSIONS: This study suggests that the quality of diagnosis and treatment for depression in nursing homes needs to be improved in Norway. Doctors should be more available and take responsibility and leadership in medical decisions.
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The most frequent indications for psychotropic prescribing were depression in nine studies, sleeping disorders in seven and anxiety in six.
“The most frequent indications for psychotropic prescribing were depression in nine studies [50, 51, 55, 56, 60, 62, 73, 74, 82], sleeping disorders in seven [54–56, 59, 63, 74, 82] and anxiety in six [54–56, 73, 74, 82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [62]
Findings suggested differences between healthcare professional groups with nurses seeming more likely than doctors to encourage use of psychotropic medicines in some situations.
“Findings also suggested differences between healthcare professional groups with nurses seeming more likely than doctors to encourage use of psychotropic medicines in some situations [62, 81].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [62]
Nurses were identified as the main driver of prescribing.
“Nurses were identified as the main driver of prescribing [49, 62, 81].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [62]
Doctors and nurses were of the view that assessing whether psychotropic medication was appropriate in older people was challenging.
“Doctors and nurses were of the view that assessing whether psychotropic medication was appropriate in older people was challenging [49, 53–56, 62, 65, 80–82].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [62]
Difficulties identified included establishing a clear diagnosis, communication difficulties and increased sensitivity to the side effects of psychotropic medication in older people.
“Difficulties that were identified included: establishing a clear diagnosis [56, 62], communication difficulties [56, 80] and the increased sensitivity to the side effects of psychotropic medication in older people.”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [62]
Some stakeholders stated that doctors often relied on nurses' judgement to inform decision-making, with little mention of other staff involved in the older people's care.
“Some stakeholders stated that doctors often relied on nurses’ judgement to inform decision-making, with little mention of other staff involved in the older people’s care [62, 80, 81].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [62]
Doctors believed that nurses with a better understanding of BPSD, non-drug interventions and the risks and benefits of psychotropic medication may be less likely to request drug treatment.
“Doctors believed that nurses with a better understanding of BPSD, non-drug interventions and the risks and benefits of psychotropic medication may be less likely to request drug treatment [53, 62, 80, 81].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [62]
Some were of the view that medication reviews could help identify inappropriate use while acknowledging that these were not always carried out.
“Some were of the view that medication reviews could help identify inappropriate use while acknowledging that these were not always carried out [49, 55, 56, 62].”
From Stakeholders' views on the use of psychotropic medication in older people: a systematic review (2022) · cites this paper as [62]
Cites
Focus Groups as Qualitative Research
Morgan, D. (1997) · doi:10.4135/9781412984287 · Cited by 8,863 · see citing works
Shared understanding of the qualitative research process. Guidelines for the medical researcher
MALTERUD, K. (1993) · Family Practice · doi:10.1093/fampra/10.2.201 · Cited by 278 · see citing works
Schmidt, I., Claesson, C. B., Westerholm, B., et al. (1998) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1998.tb01017.x · Cited by 191 · see citing works
Psychotropic drug use in nursing homes - diagnostic indications and variations between institutions
Ruths, S., Straand, J., & Nygaard, H. A. (2001) · European Journal of Clinical Pharmacology · doi:10.1007/s002280100348 · Cited by 115 · see citing works
Self-citationEvaluation of the quality of drug therapy among elderly patients in nursing homes
Bergman, Å., Olsson, J., Carlsten, A., Wærn, M., & Fastbom, J. (2006) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813430600991980 · Cited by 112 · see citing works
A 12 months follow-up study of depression among nursing-home patients in Norway
Barca, M. L., Engedal, K., Laks, J., & Selbaek, G. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.04.028 · Cited by 104 · see citing works
The role of the specialist physician in nursing homes: the Netherlands' experience
Hoek, J. F., Ribbe, M. W., Hertogh, C. M. P. M., & van der Vleuten, C. P. M. (2003) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.816 · Cited by 94 · see citing works
Wood-Mitchell, A., James, I. A., Waterworth, A. M., Swann, A., & Ballard, C. G. (2008) · Age and Ageing · doi:10.1093/ageing/afn135 · Cited by 77 · see citing works
Factors associated with depression in Norwegian nursing homes
Barca, M. L., Selbæk, G., Laks, J., & Engedal, K. (2008) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2139 · Cited by 76 · see citing works
Gaboda, D., Lucas, J. A., Siegel, M. J., Kalay, E., & Crystal, S. (2011) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03322.x · Cited by 75 · see citing works
Lapane, K. L., & Hughes, C. M. (2004) · Medical Care · doi:10.1097/00005650-200410000-00008 · Cited by 47 · see citing works
Nurses’ and Nursing Assistants’ Recognition of Depression in Elderly Who Depend on Long-Term Care
Brühl, K. G., Luijendijk, H. J., & Muller, M. T. (2007) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2007.05.010 · Cited by 32 · see citing works
Is Covert Medication in Norwegian Nursing Homes Still a Problem?
Kirkevold, Ø., & Engedal, K. (2009) · Drugs & Aging · doi:10.2165/00002512-200926040-00004 · Cited by 29 · see citing works
Nygaard, H. A., Ruths, S., Straand, J., & Naik, M. (2004) · Aging Clinical and Experimental Research · doi:10.1007/bf03324552 · Cited by 27 · see citing works
Self-citationCorrelates of knowledge and beliefs about depression among long‐term care staff
Ayalon, L., Areán, P. A., & Bornfeld, H. (2007) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1884 · Cited by 25 · see citing works
Rosenvinge, B., & Rosenvinge, J. H. (2003) · PubMed · Cited by 25 · see citing works
Changing the Culture of Nursing Homes
Johnson, M. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.550 · Cited by 24 · see citing works
Choi, N. G., Wyllie, R. J., & Ransom, S. (2009) · Journal of Gerontological Social Work · doi:10.1080/01634370802609155 · Cited by 19 · see citing works
Finding Meaning in Life, at Midlife and Beyond
Guttmann, D. (2008) · Greenwood Publishing Group Inc. eBooks · doi:10.5040/9798400651373 · Cited by 19 · see citing works
Lövheim, H., Sandman, P., Karlsson, S., et al. (2009) · International Psychogeriatrics · doi:10.1017/s1041610209990329 · Cited by 18 · see citing works
Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced?
Lindström, K., Ekedahl, A., Carlsten, A., Mårtensson, J., & Mölstad, S. (2006) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813430600958427 · Cited by 18 · see citing works
Finding Meaning in Life, at Midlife and Beyond: Wisdom and Spirit from Logotherapy
Guttmann, D. (2008) · Medical Entomology and Zoology · Cited by 15 · see citing works
Fastbom, J., & Schmidt, I. (2004) · PubMed · Cited by 7 · see citing works
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Maund, E., Dewar-Haggart, R., Williams, S., Bowers, H., Geraghty, A. W. A., Leydon, G., May, C., Dawson, S., & Kendrick, T. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.10.107 · Cited by 90 · see citing works
Bowers, H. M., Williams, S. J., Geraghty, A. W. A., Maund, E., O’brien, W., Leydon, G., May, C. R., & Kendrick, T. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-027837 · Cited by 31 · see citing works
Stakeholders' views on the use of psychotropic medication in older people: a systematic review
Bednarczyk, E., Cook, S., Brauer, R., & Garfield, S. (2022) · Age and Ageing · doi:10.1093/ageing/afac060 · Cited by 22 · see citing works
“Difficulties that were identified included: establishing a clear diagnosis [56, 62], communication difficulties [56, 80] and the increased sensitivity to the side effects of psychotropic medication in older people.”
BackgroundInfluential
- Authors
- Iden, K. R., Hjørleifsson, S., & Ruths, S.
- Affiliations
- University of Bergen (NO)
- Corresponding author
- Iden, Kristina Riis
- Venue
- Scandinavian Journal of Primary Health Care
- Publisher
- Informa UK Limited
- Published
- 2011-11-29
- Volume
- 29
- Issue
- 4
- Pages
- 252-256
- ISSN
- 0281-3432 (ISSN-L)
- 1502-7724
- PMC
- PMC3308458
- OpenAlex
- W2016720951
- Cited by
- 35
- References
- 23
- Citations by year
- 2025: 3 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 1 · 2020: 4 · 2019: 4 · 2018: 4 · 2017: 4 · 2016: 1 · 2015: 3 · 2014: 2 · 2013: 3 · 2012: 1
- FWCI
- 3.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Scandinavian Journal of Primary Health Care (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- antidepressants, nursing homes, geriatric depression, treatment decision-making, nurse-physician relationship, diagnostic uncertainty, drug withdrawal, quality of care
- MeSH terms
- Workforce, Antidepressive Agents, Attitude of Health Personnel, Clinical Competence, Decision Making, Depression, Depressive Disorder, Follow-Up Studies, Humans, Nurses, Nursing Homes, Practice Patterns, Physicians', Surveys and Questionnaires, Focus Groups, Qualitative Research, General Practitioners
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