Prevalence and sociodemographic correlates of antidepressant use in Italian residential care facilities

Background

The increasing older population worldwide presents both a remarkable societal achievement reflecting medical and public health advances, as well as a growing public health and socioeconomic challenge. As a result of an aging demographic and reduced family caregiving capacity, the reliance on nursing homes for the care of the elderly population is projected to continue to increase [1]

Aims

In the age of advancements and higher needs from a growing population, a cross-sectional, observational study was designed to explore the association antidepressant therapy and sociodemographic, clinical, and functional characteristics in the elderly.

Methods

This study included a sample of 452 elderly individuals aged 60 years and older, recruited from both long-term care facilities, Residenze Strutture Sanitarie (RSA), Istituto Geriatrico Redaelli di Vimodrone and Residenzia Ambrosiana. Inclusion criteria encompassed older adults with available clinical, functional, and cognitive data, including Beck Depression Inventory (BDI) scores. Exclusion criteria involved patients with incomplete records on key variables or severe cognitive impairment precluding informed evaluation. The sample was characterized numerically by age, sex, education level, previous occupation, and duration of stay in residential care. The primary outcome was the level of depressive symptoms, measured using the BDI. Descriptive statistics were used to summarize sociodemographic characteristics. Continuous variables were reported using means and medians to account for potential deviations from normal distribution, while categorical variables were described as frequencies and percentages. All analyses were conducted using MATLAB (The MathWorks, Inc.).

Results

The final cleaned dataset used for the analysis of sociodemographic variables and BDI (Beck Depression Inventory) scores consisted of 347 participants with valid BDI data. Among them, 229 (66.0%) presented with minimal depressive symptoms, 53 (15.2%) had mild depression, 47 (13.5%) had moderate depression, and 18 (5.2%) were classified as having severe depression. The sample included both male and female participants. With an overall predominance of females in the sample with 341 participants (74.44%) and 111 (24.56%) males. Age was subcategorized into three different groups with an overall preponderance in the age range of 80-89 with 207 participants (45.80%), and >90 with 172 participants (38.05%). The mean age corresponded to 86.6 + 7.7 years. Among the 452 patients analyzed, 152 individuals (33.6%) were prescribed at least one class of antidepressant. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly used, prescribed to 88 patients (19.5%), followed by trazodone with 66 patients (14.6%), atypical antidepressants with 20 patients (4.4%), followed by SNRI with 18 patients (4.0%). 48 patients (10.6%) had a declared psychiatric diagnosis and were on antidepressants.

Conclusions

Depression remains highly prevalent among residents of Italian RSAs, yet antidepressant use may not always reflect clinical need. The high exposure to these medications underscores the necessity of regular mental health assessment, careful diagnostic evaluation, and evidence-based prescribing to optimize care for institutionalized older adults.

References

Brugiavini, A., Carrino, L., Pasini, G., 2023. Long-term Care in Italy. NBER Working Paper 31861. National Bureau of Economic Research, Cambridge, MA. https://doi.org/10.3386/w31861