Effects of introducing a nursing guideline on depression in psychogeriatric nursing home residents.

Introduction: The prevalence rate of depression in psychogeriatric nursing home residents with dementia is recently estimated at 19%. Comorbid depression in dementia has been associated with decreased quality of life, greater health care utilization and higher mortality rates. The effects of introducing an evidence based nursing guideline on psychogeriatric nursing home wards were studied. Main principles of the guideline were (1) increasing individualized pleasant activities, (2) decreasing unpleasant events. Methods and Materials: A multi-centre (n=9) controlled intervention study with randomization at ward level (n=18) with pre-test, post-test and follow-up measurements was used. Participants were 97 residents of psychogeriatric nursing home wards with dementia and comorbid depression. Primary outcome was severity of depression measured with the MDS/RAI-Depression Rating Scale and the Cornell Scale for Depression in Dementia. Results: Residents on the experimental wards showed a significant reduction in depression on the Depression Rating Scale. With the Cornell scale a (not significant) reduction of depression was found as well. Conclusions: This study shows significant reductions in depression severity by introducing a nursing guideline on psychogeriatric nursing home wards. Better compliance with the guideline could probably enlarge the effects. Some ways to achieve this are: (1) additionally train non-certified nurse assistants, and (2) emphasize necessary conditions for successful introduction of the guideline to nursing team managers. (aut. ref.)