Psychiatric consultation in the nursing home: referral patterns and recognition of depression.

OBJECTIVE To assess the accuracy of referrals to psychiatric consultants for depression (or depression-related disorders) among nursing home residents. METHODS Retrospective review of psychiatric consultations for nursing home residents in six facilities for a 3-year period. Reasons for referral, assigned diagnoses, rates of accuracy, sensitivity and specificity were examined to assess patterns of referral and recognition of clinical variants of depressive disorders. RESULTS Referrals for depression comprised 19.7% of all requested consultations. Of patients referred for depression, 74.2% were diagnosed with a depressive disorder. Of all residents diagnosed with depressive disorders, 53.5% were referred for other reasons. Men were referred for evaluation of depression significantly more often than women. However, rates of diagnosis of depression did not appear to differ significantly between men and women. CONCLUSIONS Nursing home staff often failed to recognize depression. Depressed residents are primarily referred for disruptive behaviors. Referrals for depression may be a secondary concern.