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Under-diagnosis and under-treatment of depression are major problems in nursing home residents. The purpose of this study was to determine antidepressant use among nursing home residents who were diagnosed with depression using three different methods: (1) the Geriatric Depression Scale, (2) Minimum Data Set, and (3) primary care provider assessments. As one would expect, the odds of being treated with an antidepressant were about eight times higher for those diagnosed as depressed by the primary care provider compared to the Geriatric Depression Scale or the Minimum Data Set. Men were less likely to be diagnosed and treated with antidepressants by their primary care provider than women. Depression detected by nurses through the Minimum Data Set was treated at a lower rate with antidepressants, which generates issues related to interprofessional communication, nursing staff communication, and the need for geropsychiatric role models in nursing homes.

The proliferation of state lotteries and casinos has led to an increased participation in gambling and its associated problems. Older retired adults have more opportunities to gamble and available funds than other demographic groups. For these reasons, older adults may constitute a special risk group for pathological gambling. Because substance misuse, mood, anxiety, and personality disorders are common in problem and pathological gamblers, we sought to examine rates of comorbid psychiatric disorders in 40 older adults with lifetime pathological gambling using structured assessments of known reliability. The results indicate a high level of psychiatric comorbidity in this population including depression, alcohol dependence, panic, and generalized anxiety disorders, as well as obsessive compulsive and avoidant personality disorders. Implications of these findings for psychiatric nurses are discussed.