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Depressive symptomatology and associated factors in dementia in Europe: home care versus long-term care

  • Clarissa Giebel (a1), Caroline Sutcliffe (a1), Hilde Verbeek (a2), Adelaida Zabalegui (a3), Maria Soto (a4), Ingalill Rahm Hallberg (a5), Kai Saks (a6), Anna Renom-Guiteras (a7), Riitta Suhonen (a8) and David Challis (a1)...



This study forms part of a larger European programme investigating the transition from home care to long-term care (LTC) facility in people with dementia (PwD) at the margins of LTC. The aim of this study was to explore the factors associated with depressive symptomatology in PwD in different settings.


A total of 1,538 PwD, of which 957 received home care and 581 lived in a LTC facility, and their carers were interviewed. The Cornell Scale for Depression in Dementia (CSDD) measured depressive symptomatology. PwD completed measures of cognition and quality of life (QoL), and informal or formal carers completed measures on the PwD’ QoL, neuropsychiatric behavior, activities of daily living, comorbidities, pain, and falls. Logistic regression was used to assess which factors contributed to depressive symptomatology in the two settings.


Those receiving home care, living in Germany, and with severe dementia, showed the highest prevalence of depressive symptomatology. In the home care group, high levels of pain, neuropsychiatric behavior, and comorbidity, as well as low self- and proxy-rated QoL were factors associated with depressive symptomatology. In the LTC group, low proxy-rated QoL, more severe neuropsychiatric behavior, being a male informal carer and living in Germany were associated with depressive symptomatology.


Evidence highlights the need for targeting different aspects in the management of depression in dementia, including offering improved pain management for those living in the community. Further research needs to explore cultural variations and carer gender factors associated with higher levels of depressive symptomatology.


Corresponding author

Correspondence should be addressed to: Clarissa Giebel, PSSRU, Second Floor Crawford House, The University of Manchester, Booth Street East, Manchester, M13 9QS, UK. Phone: +44 161 275 5652. Email:


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Alexopoulos, G. S. (1988). The Cornell Scale for Depression in Dementia: Administration & Scoring Guidelines. NY: Cornell Institute of Geriatric Psychiatry.
Alexopoulus, G. S., Abrams, R. S., Young, R. C. and Shamoian, A. C. (1988). Cornell scale for depression in dementia. Biological Psychiatry, 23, 271284.
Alzheimer's Disease International (ADI) (2014). World Alzheimer Report 2014. London: Alzheimer's Disease International.
Beerens, H. et al. (2014). Quality of life and quality of care for people with dementia receiving long term institutional care or professional home care: the European RightTimePlaceCare study. Journal of the American Medical Directors Association, 15, 5461.
Bielinski, K. and Lawlor, B. (2006). Depression in severe dementia. In Burns, A. and Winblad, B. (eds.), Severe Dementia (pp. 6374). Chichester: Wiley.
Borza, T., Engedal, K., Bergh, S., Barca, M. L., Benth, J. S. and Selbaek, G. (2015). The course of depressive symptoms as measured by the Cornell scale for depression in dementia over 74 months in 1158 nursing home residents. Journal of Affective Disorders, 175, 209216.
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373383.
Chou, K. L. (2007). Reciprocal relationship between pain and depression in older adults: evidence from the English longitudinal study of ageing. Journal of Affective Disorders, 102, 115123.
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314.
Donaldson, C., Tarrier, N. and Burns, A. (1998). Determinants of carer stress in Alzheimer's disease. International Journal of Geriatric Psychiatry, 13, 248256.
Dunn, J. and Clare, L. (2007). Learning face-name associations in early-stage dementia: comparing the effects of errorless learning and effortful processing. Neuropsychological Rehabilitation, 17, 735754.
Folstein, M., Folstein, S. and McHugh, P. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Giebel, C. M., Challis, D. and Montaldi, D. (2014a). A revised interview for deterioration in daily living activities in dementia reveals the relationship between social activities and well-being. Dementia, doi: 10.1177/1471301214553614.
Giebel, C. M. et al. (2014b). Deterioration of basic activities of daily living and their impact on quality of life across different cognitive stages of dementia: a European study. International Psychogeriatrics, 26, 12831293.
Giebel, C. M. et al. (2015). Depressive symptomatology in severe dementia in a European sample: prevalence, associated factors and prescription rate of antidepressants. International Psychogeriatrics, 27, 657667.
Gruber-Baldini, A. L., Zimmerman, S., Boustani, M., Watson, L. C., Williams, C. S. and Reed, P. S. (2005). Characteristics associated with depression in long-term care residents with dementia. Gerontologist, 45, 5055.
Hoe, J., Hancock, G., Livingston, G. and Orrell, M. (2006). Quality of life of people with dementia in residential care homes. British Journal of Psychiatry, 188, 460464.
Hutchinson, A. M. et al. (2010). The Resident Assessment Instrument – Minimum Data Set 2.0 quality indicators: a systematic review. BMC Health Services Research, 10, 166179.
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A. and Jaffee, M. W. (1963). Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA, 85, 914919.
Kaufer, D. I. et al. (2000). Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. Journal of Neuropsychiatry and Clinical Neuroscience, 12, 233239.
Knapskog, A. B., Barca, M. L. and Engedal, K. (2013). Prevalence of depression among memory clinic patients as measured by the cornell scale of depression in Dementia. Aging and Mental Health, 18, 579587.
Kosteniuk, J. G. et al. (2014). Prevalence and covariates of elevated depressive symptoms in rural memory clinic patients with mild cognitive impairment or dementia. Dementia and Geriatric Cognitive Disorders, 4, 209220.
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L. (1999). Quality of life in Alzheimer's disease: patient and caregiver reports. Journal of Mental Health and Aging, 5, 2132.
Majic, T., Pluta, J. P., Mell, T., Treusch, Y., Gutzmann, H. and Rapp, M. A. (2012). Correlates of agitation and depression in nursing home residents with dementia. International Psychogeriatrics, 24, 17791789.
Mioshi, E. et al. (2013). The impact of dementia severity on caregiver burden in frontotemporal dementia and Alzheimer disease. Alzheimers Disease and Associated Disorders, 27, 6873.
Molloy, D. W. and Standish, T. I. M. (1997). A guide to the standardized mini-mental state examination. International Psychogeriatrics, 9, 8794.
National Institute for Health and Clinical Excellence (NICE) (2006). Final Appraisal Determination: Donepezil, Galantamine, Rivastagmine (Review) and Memantine for the Treatment of Alzheimer's Disease. London: Department of Health.
Robinson, M. J., Edwards, S. E., Iyengar, S., Bymaster, F., Clark, M. and Katon, W. (2009). Depression and pain. Frontiers Bioscience, 14, 50315051.
Snowden, M. B. et al. (2015). Longitudinal association of dementia and depression. American Journal of Geriatric Psychiatry, 23, 897905.
Starkstein, S. E., Jorge, R., Mizrahi, R. and Robinson, R. G. (2005). The construct of minor and major depression in Alzheimer's disease. American Journal of Psychiatry, 162, 20862093.
Steinberg, M. et al. (2008). Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the cache county study. International Journal of Geriatric Psychiatry, 23, 170177.
Stopford, C. L., Thompson, J. C., Neary, D., Richardson, A. and Snowden, J. (2012). Working memory, attention, and executive function in Alzheimer's disease and frontotemporal dementia. Cortex, 48, 429446.
Tombaugh, T. N. and Mclntyre, N. J. (1992).The mini-mental state examination: a comprehensive review. Journal of the American Geriatrics Society, 40, 922935.
Van der Mussele, S. et al. (2013). Prevalence and associated behavioral symptoms of depression in mildcognitive impairment and dementia due to Alzheimer's disease. International Journal of Geriatric Psychiatry, 28, 947958.
Verbeek, H. et al. (2012). A European study investigating patterns of transition from home care towards institutional dementia care: the protocol of a RightTimePlaceCare study. BMC Public Health, 12, 68.
Wimo, A., Wetterholm, A. L., Mastey, V. and Winblad, B. (1998). Evaluation of the resource utilization and caregiver time in Anti-dementia drug trials – a quantitative battery. In Wimo, A., Jonsson, B., Karlsson, G. and Winblad, B (eds.), The Health Economics of Dementia (pp. 465499). London: John Wiley and Sons.
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist, 20, 649655.
Zwakhalen, S., Koopmans, R., Geels, P., Berger, M. P. and Hamers, J. P. (2009). The prevalence of pain in nursing home residents with dementia using an observational pain scale. European Journal of Pain, 13, 8993.



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