People with dementia suffer less depression in care homes – but why?

These days, you have to try hard to not come across a daily article or news piece about dementia, and care homes receive a great deal of negative press. The Care Quality Commission recently released a report on the standard of dementia care in care homes and hospitals, across England. It found that in 34% of care homes the physical, mental health, emotional and social needs of people with dementia were met with variable to poor care.

Depression is common in older adults and also among those with dementia. Upto 56% of people in the early stages and up to 60% in the later stages of the disease are reported to have depression. Alongside depression comes loneliness – the main reason or calls to a national helpline dedicated to older people.

Looking at dementia and the state of many care homes, then, one might expect depression to be more of a feature in those living in care homes. But in a study we published in International Psychogeriatrics we found the opposite. Instead, we found that those with severe dementia living in care homes were less depressed than those receiving home care.

We conducted a large interview study of 2,014 carers and family members caring for people with dementia across eight European nations: England, Estonia, Finland, France, Germany, the Netherlands, Spain and Sweden. For this particular focus on depression, we looked at data from 414 people with late-stage dementia and their carers. We considered those with late-stage dementia because this group has been little explored.

We only included those people with dementia who had a family carer either living with them or visiting them at least every fortnight. Most of the carers were wives or husbands, so loneliness, although a common feature of old age and common in 40% of people in  in England, Wales and Northern Ireland, should not have influenced these findings.

Home vs residential care

With family carers providing a great deal of unpaid care , it’s no wonder that staying at home for as long as possible is  a major aim in policy government guidance, because it minimises the costs of dementia care. But most people also say they would rather stay in their home – alongside the familiarity of home it is also a significant step, having to think about where you are going to spend your last days. And quality of life should be higher when you stay at home, providing you receive enough care and support.

So how come depression is lower in those people living in care homes? Bearing in mind that our study was wider than just England, it can’t be all attributed to the state of care homes in England. Quality and approach in homes is likely to vary across the eight nations we looked at.

Reading feelings

The decision to move into a care home is usually only made when family members begin to find it difficult to cope with caring for their loved one. This mostly happens in the later stages of dementia, where people have severe memory problems, struggle to express their thoughts and generally have no awareness of their problems. Our study looked at people in this late stage as little is known about this advanced stage – because people lack an understanding of their symptoms.