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Nursing home psychiatry: Is it time for a reappraisal?

T issue of the Journal is devoted to nursing home psychiatry. Over the past two decades, numerous studies have documented the striking prevalence of psychiatric illness in nursing homes. Dementia, behavioral and psychological symptoms of dementia (BPSD), depression, medical comorbidity, and a growing severity of functional disability characterize the resident population of these facilities. In a recent review, Seitz and colleagues1 reported on the prevalence of major psychiatric disorders in long-term care derived from a number of carefully screened epidemiological studies and the 2004 National Nursing Home Survey.1 Overall, the median prevalence of dementia in nursing home residents was 58% whereas the prevalence of BPSD was 78%. Major depressive disorder had a median prevalence of 10%, and the median prevalence was 29% for depressive symptoms. Minimum data set results from December 2005 reveal that 46.5% of nursing home residents have dementia, 47% have depression, 30% show behavioral symptoms, 3% have mental retardation, and 20% have other psychiatric disorders such as schizophrenia or anxiety.2 Many experts have argued that minimum data set may underrepresent the full extent of psychiatric morbidity in long-term care settings as compared with medical record review and other assessment methods. Increasingly, in North America, newly admitted residents of nursing homes are older women and they are physically and mentally frail with more extensive medical comorbidities than community-residing