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Depression is a common disorder in later life. The prevalence of depression in aged nursing home patients in 36 studies in various countries was reviewed. Results show prevalence rates ranging from 2% to 61%. Average prevalences were calculated for depressive symptoms, minor depression and major depression each. The averages thus found are 43.9% for depressive symptoms, 25.7% for minor depression and 15.5% for major depression. In order to find an explanation for the variation in occurrence of depression in nursing homes, factors that may have influenced the results are described. Both the definition of depression and the kind of instrument used in measuring depression appear to be highly responsible for the variations found.

The prevalence and recognition of depression among physically frail patients living in an urban Dutch nursing home were estimated. To patients with Mini-Mental-Status-Examination (MMSE) scores of 15 or above, the Geriatric Depression Scale (GDS) was administered (N=80). With this screen clinically relevant depressive symptoms can be established. For diagnosing major depression according to the DSM-IV criteria, the Diagnostic Interview Schedule (DIS) (N=57) was administered using a MMSE cut-off of 20. 49% of the respondents showed a score above the GDS cut-off (>11), which means having clinically relevant depressive symptoms. 16% met the criteria for major depression according to DIS. Nursing home physicians recognized 39% of the patients with clinically relevant depressive symptoms and 67% of those with a major depression. Nurses recognized depressive patients slightly better but they were less specific in their judgement (more false-positive rates). We also found that in situations in which physicians and nurses had the same opinion the recognition of depression improved. Therefore it is recommended that physicians and nurses exchange their judgements on patients' mood on a regular basis.

This study evaluated some psychometric qualities of the Dutch short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE-N). The score profile on the short form IQCODE-N was comparable in two outpatient populations. Short form and regular IQCODE-N are equivalent, as they were highly correlated (r = 0.97). However, using IQCODE-N cut-off scores the short form appeared to be more strict in defining 'decline'. A moderately high correlation was found between informant ratings and dementia screening tests CST (r = -0.47) and ADS (r = -0.46). Informant ratings were not influenced by patient's age or level of education. The short form IQCODE-N describes cognitive change in everyday activities of elderly patients and can be an efficient rating scale for clinical assessment of dementia

Decubitus must be considered an important problem in public health care. In the Netherlands (total population 15 million) the costs of prevention and treatment of decubitus in the hospitals and nursing homes are approximately Dfl. 700 million per year. In order to identify patients at risk for the development of decubitus at an early stage. Norton and colleagues developed a scoring system that includes an assessment of general physical condition, mental status, activity level, mobility and incontinence. In a prospective study in 224 somatic nursing home patients we investigated the relationship between the Norton-score and the appearance of decubitus. The authors conclude that, when using the Norton-score, it is not possible to differentiate patients at risk clearly from patients with no risk. From the five items used by Norton, only mobility and, to a lesser degree, general physical condition, show a significant relation with the occurrence of decubitus ulcers. In order to identify the patients at risk roughly, the physician can suffice with scoring these two items.