The American Geriatrics Society - Newsroom - Geriatrics Experts Spotlight New Standards of Care for Mental Health Treatment in Nursing Homes

For Immediate Release
September 2, 2003

For Further Information:
Pamela Ingham
AGS Communications Manager
(212) 308-1414, ext. 302
Kate McDuffie
AAGP Communications Associate Director
(301) 654-7850, ext. 113

Geriatrics Experts Spotlight Mental Health Treatment for Nursing Home Residents:
Expert Panel Calls for New Standards of Care

New York-An expert interdisciplinary panel led by the American Geriatrics Society (AGS) and the American Association for Geriatric Psychiatry (AAGP), and including representatives from numerous stakeholder organizations, has issued a new consensus statement calling for significant revisions to the standards of care for nursing home residents with depression and behavioral symptoms associated with dementia. The AGS and AAGP have also issued health policy recommendations that address implementation of the expert panel's clinical recommendations.

Approximately 1.5 million older adults currently reside in nursing homes across the United States and about one-fifth of those residents have symptoms of depression. Up to 40 percent of residents with dementia have both behavioral and psychiatric symptoms that could be alleviated by proper care and treatment, according to the panel.

"The current protocols for the screening and management of these problems are inadequate," says Joseph G. Ouslander, MD, former AGS President and co-chair of the expert panel. "The current system does not provide enough specific recommendations for nursing home staff to develop optimal, individualized care plans based on their assessment of depression and behavioral symptoms."

Among its recommendations, the panel calls for routine and regular screening for depression in every nursing home resident. They also call for improved screening instruments and first-line treatment of major depression with antidepressant medications in combination with nonpharmacologic interventions. The consensus statement also outlines numerous approaches for nursing home administrators and staff to improve the environment for residents, thus enhancing their independence, sense of well-being, and quality of life.

The panel states that better assessment tools for residents with dementia-related behavioral symptoms are required, as well as careful and regular evaluation to determine if a resident's symptoms may be the result of adverse drug interactions or other medical conditions. The panel says that barriers to using effective drug therapies, such as restrictive formularies and attitudes about using psychotropic drugs as "chemical restraints," should be reassessed in order to provide the best care for residents.

"Most importantly, we need to take advantage of the large body of research on effective interventions by ensuring that evidence-based mental health treatments are provided in nursing homes," says Stephen J. Bartels, MD, former AAGP President and expert panel co-chair.

"Improving the quality of care for residents with mental health problems will require enhanced training and staffing in nursing homes needs, complimented by greater availability of mental health consultation services."

The AGS and AAGP policy recommendations include:

making mental health services more available to nursing homes, particularly in rural areas and those that are publicly financed;
including coverage for mental health services and health medications in public and private insurance plans that cover nursing home residents;
rewarding facilities that provide appropriate pharmacologic and nonpharmacologic treatment for residents with mental illness;
encouraging staff training to identify residents with mental illness; and
promoting research to identify the best practices in meeting the mental health care needs of nursing home residents.

The consensus statement and policy recommendations are intended to assist regulators at the Centers for Medicare and Medicaid Services (CMS) and other agencies as they make revisions to the current guidelines and quality measures for nursing homes.

The consensus statement, the policy recommendations, and a literature review authored by Mark Snowden, MD, MPH, University of Washington, which was conducted to provide the expert panel with an evidence base for making their recommendations, will be printed in the September issue of the Journal of the American Geriatrics Society.

Members of the consensus panel and the organizations they represent include: Joseph G. Ouslander, MD (co-chair), Emory University, Atlanta, GA (American Geriatrics Society); Stephen J. Bartels, MD (co-chair), Dartmouth Medical School, Hanover, NH (American Association for Geriatric Psychiatry); Cornelia Beck, RN, PhD, University of Arkansas for Medical Sciences, Little Rock, AR (Alzheimer's Association); Nancy Beecham, RNC, CDONA, Retro Medical Billing, El Cajon, CA (National Association of Directors of Nursing Administration in Long-term Care); Sarah Greene Burger, RN, MPH, Washington, DC (National Citizen's Coalition for Nursing Home Reform); Thomas R. Clark, RPH, MHS, Alexandria, VA (American Society of Consultant Pharmacists), Lori Daiello, PharmD, BCPP, Pharmacotherapy Solutions, Orlando, FL (American Society of Consultant Pharmacists), Jiska Cohen-Mansfield, PhD, George Washington University Medical Center and the Hebrew Home of Greater Washington, Washington, DC (American Psychological Association); Thomas F. Dugan, MSW, St. John Vianney Center, Downington, PA (American College of Health Care Administrators); James A. Greene, MD, Geriatric Partners, Knoxville, TN (American Psychiatric Association: Council on Aging); Marshall Kapp, JD, MPH, Wright State University School of Medicine, Dayton, OH (American Society on Aging); Ira Katz, MD, PhD, University of Pennsylvania, Philadelphia, PA (Gerontological Society of America); Mary Ann Kehoe, RN, NHA, Good Shepherd Services, Seymour, WI (American Association of Homes and Services for the Aging); Ann Murfitt, LICSW, HCR-Manor Care, Toledo, OH (American Health Care Association); Jonathan Musher, MD, CMD, Beverly Healthcare, Chevy Chase, MD (American Medical Directors Association); Valisa Saunders, MN, GNP, Kaiser Permanente, Honolulu, HI (National Conference of Gerontological Nurse Practitioners); and Dennis G. Shea, PhD, Pennsylvania State University, University Park, PA (member-at-large).

The project was supported by unrestricted grants from Eli Lilly and Janssen Pharmaceutica.

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit association of geriatrics health care professionals dedicated to improving the health, independence and quality of life of all older people. The society supports this mission in many ways through its activities in: clinical practice; professional education on the clinical care of older people; research; public education and information; public policy efforts; and through collaborative relationships with other organizations. For more information about AGS programs and initiatives, visit the AGS Web site at www.americangeriatrics.org.

The American Association for Geriatric Psychiatry (www.AAGPonline.org) is a national association representing and serving its members and the field of geriatric psychiatry. It is dedicated to promoting the mental health and well being of older people and improving the care of those with late-life mental disorders. AAGP's mission is to enhance the knowledge base and standard of practice in geriatric psychiatry through education and research and to advocate for meeting the mental health needs of older Americans.