In 2005, the MDS data indicate that the number of new nursing home admissions with a mental illness exceeded the number with dementia (see ). Of the 996,311 new nursing home admissions across the U.S., 24% had a mental illness as defined by schizophrenia, bipolar disorder, depression, and anxiety disorders, while 18% had Alzheimer's Disease or other dementias. There is some overlap with 6% of all residents admitted having both mental illness and dementia. The remaining 63% of new nursing home admits had no mental illness or dementia diagnoses.
Venn Diagram of the Prevalence of Dementia and Mental Illness in Nursing Homes among New Admissions, 2005
The relative proportion as well as the absolute number of new nursing home admits with mental illness and dementia reflects important changes over recent years (see –). In 1999, the number of new admissions with dementia exceeded the number with mental illness. By 2005, the number with mental illness exceeded the number with dementia. Residents admitted with mental illness increased from 168,721 to 187,478 and the number of residents admitted with dementia fell from 208,505 to 118,290. The percent of individuals admitted with both mental illness and dementia was roughly constant.
New admission trends for dementia, mental illness, or both, 1999–2005
New Admission trends for dementia, mental illness, or both 1999–2004 in long-stay residents
In 1999, long-stay admissions accounted for 38.5% of admissions. By 2005, this proportion was 25.3%. Similar trends to those above are seen in short-stay and long-stay residents. As expected, the absolute percentage of dementia only residents is higher in the long-stay population. From 1999–2004, the proportion of residents admitted with dementia decreased in both the short-stay (by 4.4 percentage points) and long-stay (by 3.4 percentage points) populations. Alternatively, the proportion of residents admitted with mental illness increased in both the short-stay (by 4.7 percentage points) and long-stay residents (by 3.2 percentage points). In both cases, the trends are stronger in the short-stay population. Finally, the proportion of residents admitted with both dementia and mental illness increased in the long-stay population (by 3.4 percentage points).
The number of individuals admitted with depression increased four percentage points from 11.0% (N=128,566) to 15.5% (N=154,262) between 1999 and 2005 (). There was a one tenth of one percentage point increase in bipolar disorder admissions (from 0.4% (N=4,597) to 0.5% (N=5,299)), a two tenths of one percentage point decline in anxiety admissions (from 2.5% (N=29,221) to 2.3% (N=22,513)), and the percent of schizophrenia admissions remained roughly constant at 0.5%. Thus, the large increase in mental illness admissions over 1999–2005 was primarily due to the increase in residents with a depression diagnosis.
New admission trends for mental illness excluding dementia, 1999–2005
Individuals admitted with mental illness or dementia differed from other nursing home residents (and one another) in their demographics, co-morbidities and treatments received (see ). Relative to new admits without mental illness or dementia, individuals with a mental illness were generally younger and white (excluding those with schizophrenia). Those admitted with schizophrenia, anxiety, or dementia were more poorly educated and those with schizophrenia or bipolar were less likely to have been married. Admissions with schizophrenia or bipolar disorder had relatively lower activities of daily living scores and higher levels of cognitive impairment than individuals with depression, anxiety, or neither mental illness nor dementia. Individuals with anxiety, depression, or dementia were more likely to have cardiovascular, musculoskeletal, or neurological comorbidities. Those with any mental illness were more likely to have pulmonary disease. Individuals with schizophrenia or dementia were on fewer medications. As expected, individuals with depression had higher rates of antidepressant treatment, individuals with schizophrenia; bipolar disorder, and to a lesser extent dementia, had higher rates of anti-psychotic use; and individuals with anxiety had higher rates of anxiolytic/hypnotic use. Those with schizophrenia and dementia were less likely to receive training in skills required to return to the community and more likely to be physically or chemically restrained than those with bipolar, depression, anxiety, or without mental illness or dementia. Finally, those with mental illness or dementia were more likely to receive evaluation or therapy by a licensed mental health professional. Given the large numbers involved, all overall differences were statistically significant at a p<0.001 level.
Demographic and treatment variables for new nursing home admissions in 2005
Because of the substantial increase in individuals admitted with depression over time, we examined the demographic, clinical, and treatment variables above for 1999 as well as 2005. Age, gender and racial make up were largely the same. We saw an increase in depressed individuals who were married (31.7 to 35.2) and decrease in those who were widowed (55.1 to 50.2). Functional status was similar. With the exception of diabetes and lung disease both of which increased, all other comorbidities decreased from 1999 to 2005. Treatment variables showed that in 2005 individuals were on more medications (12.2 versus 10.4 in 1999), used more psychotropics (antipsychotics: 11.0% in 2005 versus 8.3% in 1999; antidepressants: 81.8% versus 77.8%; and anxiolytics: 34% versus 32.5%) and required fewer restraints (1.3 in 2005 versus 2.4 in 1999). Finally, a higher percentage of depressed residents received skills training to return to the community in 2005 (58.7% versus 41.8%) and fewer were evaluated by a mental health professional (5.4% versus 10.4%).