Symptoms of depression in people aged 65 and over living in residential aged care
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For people in permanent residential aged care, entry to care assessments until October 2022 included a modified version of the Cornell Scale for Depression in Dementia, a 19-item measure of depressive symptoms completed by both the resident (if possible) and by an informant (carer, staff member). The Cornell Scale for Depression in Dementia was used for all people entering residential aged care, whether or not they have dementia.
Key findings
On the Cornell Scale for Depression in Dementia, 62.5% of people aged 65 years and over that entered residential aged care from 1 July 2017 to 30 June 2022 were recorded as having at least mild symptoms of depression. About 16% were recorded with major symptoms of depression.
People with dementia were slightly less likely to be recorded with any symptoms of depression (59.6%) than people without dementia (65.1%).
Since October 2022, the Cornell Scale for Depression in Dementia is no longer included in funding assessments in residential aged care. These assessments no longer include any items assessing mental health needs.
Two estimates are calculated from the Cornell Scale for Depression in Dementia.
- A total score. Some people will not have a total score recorded because assessors can choose not to complete the Cornell Scale for Depression in Dementia. Of the 296,217 people aged 65 years and over that entered residential aged care in the study period, 76,314 people (25.8%) did not complete a Cornell Scale for Depression in Dementia and do not have a total score recorded.
- An assigned category, based on the total score (that is, minimal or no, mild, moderate, major symptoms). Of the 76,314 people that did not complete a Cornell Scale for Depression in Dementia, 76,171 were recorded with the explanation that this was because there were no symptoms of depression present. These people were categorised by the assessor in the ‘Minimal or no symptoms’ category.
Figure 10: Distribution of scores on the Cornell Scale for Depression in Dementia among people aged 65 years and over entering permanent residential aged care, 2017–18 to 2021–22
Symptoms of depression were categorised into four groups ranging from minimal or no symptoms, to mild symptoms, moderate symptoms, and major symptoms. Approximately 62% of residents were recorded as having at least mild symptoms of depression and around 16% were recorded as having major symptoms of depression. Overall, the number of residents decreased as scores increased with scores tending to spike when moving from one symptom category to the next.
Figure 10 shows the distribution of scores on the Cornell Scale for Depression in Dementia in people aged 65 years and over who entered permanent residential aged care from 1 July 2017 to 30 June 2022 (excluding 76,314 people without a Cornell Scale for Depression in Dementia total score). Total scores tended to spike when moving from one category to the next.
Among 290,224 people aged 65 years and over who entered permanent residential aged care between July 2017 and June 2022 and were assigned a category using the Cornell Scale for Depression in Dementia, 181,332 (62.5%) were recorded as having at least mild symptoms of depression (Table 1). About 16% were recorded with major symptoms of depression.
| Financial year | 2017–18 | 2018–19 | 2019–20 | 2020–21 | 2021–22 | Total |
|---|---|---|---|---|---|---|
(1) Minimal or no symptoms, or no scale completed: n (%) | 23,253 (39.0%) | 22,527 (38.4%) | 21,948 (37.2%) | 20,431 (35.8%) | 20,733 (37.1%) | 108,892 (37.5%) |
(2) Mild symptoms: n (%) | 16,128 (27.0%) | 16,111 (27.5%) | 16,251 (27.5%) | 15,742 (27.6%) | 15,059 (26.9%) | 79,291 (27.3%) |
(3) Moderate symptoms: n (%) | 10,891 (18.3%) | 11,030 (18.8%) | 11,704 (19.8%) | 11,934 (20.9%) | 11,400 (20.4%) | 56,959 (19.6%) |
(4) Major symptoms: n (%) | 9,360 (15.7%) | 8,942 (15.3%) | 9,140 (15.5%) | 8,896 (15.6%) | 8,744 (15.6%) | 45,082 (15.5%) |
All with symptoms (2–4): n (%) | 36,379 (61.0%) | 36,083 (61.6%) | 37,095 (62.8%) | 36,572 (64.2%) | 35,203 (62.9%) | 181,332 (62.5%) |
Total: n (%) | 59,632 (100%) | 58,610 (100%) | 59,043 (100%) | 57,003 (100%) | 55,936 (100%) | 290,224 (100%) |
In entry to residential care assessments, people with dementia were slightly less likely to be recorded with symptoms of depression (59.6%) than people without dementia (65.1%) (Table 2).
Dementia status | With dementia | Without dementia | Total |
|---|---|---|---|
(1) Minimal or no symptoms, or no scale completed: n | 56,308 (40.4%) | 52,584 (34.9%) | 108,892 (37.5%) |
(2) Mild symptoms: n (%) | 38,350 (27.5%) | 40,941 (27.2%) | 79,291 (27.3%) |
(3) Moderate symptoms: n (%) | 25,945 (18.6%) | 31,014 (20.6%) | 56,959 (19.6%) |
(4) Major symptoms: n (%) | 18,850 (13.5%) | 26,232 (17.4%) | 45,082 (15.5%) |
All with symptoms (2–4): n (%) | 83,145 (59.6%) | 98,187 (65.1%) | 181,332 (62.5%) |
Total: n (%) | 139,453 (100%) | 150,771 (100%) | 290,224 (100%) |
In both men and women, symptoms of depression became less common with increasing age (Figure 11).
Figure 11: Cornell Scale for Depression in Dementia assigned categories among people aged 65 years and over entering permanent residential aged care, by age and sex, 2017–18 to 2021–22
Symptoms of depression were categorised into four groups ranging from minimal or no symptoms, to mild symptoms, moderate symptoms, and major symptoms. The highest proportion of men and women reported minimal or no symptoms. The proportion of men and women reporting symptoms decreased with increasing symptom severity. The proportion of men and women with minimal or no symptoms and mild symptoms increased as age increased, while the proportion of men and women with moderate and major symptoms decreased as age increased.
The percentage of residents recording ‘Major symptoms’ ranged from 9% in Northern Territory and Western Australia, to 22% in Victoria (Figure 12).
Figure 12: Cornell Scale for Depression in Dementia assigned categories among people entering permanent residential aged care, by characteristic, 2017–18 to 2021–22
Symptoms of depression were categorised into four groups ranging from minimal or no symptoms, to mild symptoms, moderate symptoms, and major symptoms. For each characteristic, the highest proportion of residents had minimal or no symptoms followed by mild symptoms, moderate symptoms, and major symptoms. There was little variation between symptom categories according to cultural and linguistic diversity status, dementia status, Indigenous status, living alone, being partnered and geographical remoteness. There was some variation in assigned categories by state and territory.
Notably, there was variation by region in the proportion of people entering residential aged care for whom no Cornell Scale for Depression in Dementia was completed. Of all people entering residential aged care, a Cornell Scale for Depression in Dementia was not completed for:
- 17.3% of those in Victoria
- 20.2% in Tasmania and Australian Capital Territory
- 26.0% in New South Wales
- 27.6% in Queensland
- 28.3% in South Australia
- 41.8% in Western Australia
- 44.0% in Northern Territory.
This may reflect regional differences in approaches to assessment, demographic diversity within people entering care, or other factors.
There was little variation in assigned categories by other demographic factors (Figure 12).
Notes on data quality
Data from the Cornell Scale for Depression in Dementia provides a snapshot of symptoms of depression at entry to permanent residential aged care. The tool has been validated for use in Australian residential aged care settings by clinicians (McCabe et al. 2006). However, it has not been validated for use by aged care staff, and the training and experience of aged care staff administering the tool may vary.
The English-language version of the Cornell Scale for Depression in Dementia, used in entry to residential care assessments, is also not validated for use with people for whom English is not their first language, or for First Nations people.
As mentioned above, the ACFI was used until October 2022 to inform funding requirements. It is possible that the needs of people accessing residential aged care were at times overestimated to maximise funding. Since October 2022, the Cornell Scale for Depression in Dementia is no longer included in care needs assessments at entry to residential aged care to determine funding.
McCabe M, Davison T, Mellor D, Kuruvilla G, Moore K & Ski C (2006) ‘Depression among older people with cognitive impairment: prevalence and detection’, International Journal of Geriatric Psychiatry, 21:633–644.