Screening for Depressive Symptoms Using the Cornell Scale for Depression in Dementia

Abstract

Background: Dementia and depression are two of the most common mental illnesses among the older adults. Some older adults have both diagnoses. The prevalence of depression among those over 65 years of age ranges between 1-5% in the community, 13.5% in those who require homehealth care, and 25% in those residing in long-term and assisted living facilities. Prevalence of depression among older adults residing in long-term facilities or assisted living facilities is a significant issue because the number of these facilities in the United States is increasing. However, it is difficult to assess depressive symptoms in patients with dementia in long-term and assisted living facilities as those patients are often unable to accurately articulate their feelings and thoughts. Local Problem: The provider for residents at an assisted living facility on the east coast currently has the Patient Health Questionnaire-9 as a screening tool for depressive symptoms. The screening for depressive symptoms is not being conducted because most residents have moderate to severe dementia and are unable to answer the questions on PHQ-9. Therefore, there is a need for another screening tool that could be used for those with dementia. Interventions: The purpose of this DNP project was to screen residents at the assisted living facility using the Cornell Scale for Depression in Dementia (CSDD) to identify those who may need intervention and to educate and involve the staff in screening. The CSDD is a screening tool for depressive symptoms that can be used for those with and without dementia. The CSDD is useful because the questions can be answered by those around individuals with dementia. The possible score for CSDD ranges between 0 and 38. The score of 8 is considered a person is presenting with depressive symptoms. Score of 12 and above is considered significant depressive symptoms. Results: Fifty residents were screened using the Cornell Scale for Depression in Dementia. Among those screened, the lowest score was 0 and the highest was 13. The mean score was 5.36 (SD 2.66). Eleven out of 50 residents had CSDD score of 8 or above. All residents with a diagnosis of depression were already receiving a pharmacological intervention. A significant number of residents without diagnosis of were also on pharmacological interventions for other medical diagnoses such as anxiety, insomnia, and Parkinson’s disease Conclusion: The screening for depressive symptoms using CSDD provided a structure to screen residents with dementia. It also provided an objective measurement of residents’ level of depressive symptoms. Having an objective number allows the provider to assess the improvement or progression of depressive symptoms in residents in the future. This assisted living facility had a small number of residents with frequent access to their provider, which may explain a low mean CSDD score and their existing treatments. This screening can be implemented in other facilities that do not have a screen tool or have large volume of patients with dementia, especially in underserved areas. However, the need for screening for depressive symptoms must be assessed prior to the actual screening.