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. 

  1. 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.
  2. 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

The bar graph shows the number of residents aged 65 years and over by their Cornell Scale for Depression score in Dementia (Cornell scale) for the period 2017-18 to 2021-22, categorised into four Cornell groups according to the severity of the symptoms: minimal or no symptoms (score 0-8), mild symptoms (9-13), moderate symptoms (14-18), and major symptoms (19-38). The x-axis represents the Cornell Scale scores ranging from 0 to 38, and the y-axis represents the number of residents, ranging from 0 to 25,000. The graph shows that the highest number of residents falls within the 9-10 score range, corresponding to the mild symptoms category. The number of residents decreases as the score increases, with the fewest residents in the highest score ranges (31-38), which are part of the major symptoms group. Additionally, total scores tend to spike when moving from one 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.

Table 1: Proportion of people aged 65 years and over entering permanent residential aged care recorded in each category of symptoms of depression by financial year, 2017–18 to 2021–22
Financial year2017–182018–192019–202020–212021–22Total

(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).

Table 2: Proportion of people aged 65 years and over entering permanent residential aged care recorded in each category of symptoms of depression by dementia status, 2017–18 to 2021–22 

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

The stacked bar graph shows the percentage of residents aged 65 years and over with different symptoms of depression across various age groups for both females and males for the period 2017-18 to 2021-22. The symptoms of depression are categorised into four groups: minimal or no symptoms (purple), mild symptoms (green), moderate symptoms (dark blue), and major symptoms (light blue). The x-axis represents age groups ranging from 65-69 to 95+, and the y-axis represents the percentage, ranging from 0% to 100%. The graph shows a similar pattern for both females and males. In all age groups, minimal or no symptoms (purple) account for the highest proportion, followed by mild symptoms (green), moderate symptoms (dark blue), and major symptoms (light blue). The proportion of residents with minimal or no symptoms (purple) and mild symptoms (green) increases as age increases, while the proportions of residents with moderate (dark blue) and major symptoms (light blue) decrease as age increases.

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

The bar graph shows the Cornell Scale for Depression in Dementia assigned categories among people aged 65 years and over entering permanent residential aged care, by characteristic, for the period 2017-18 to 2021-22. The x-axis represents different characteristics, and the y-axis represents the percentage, ranging from 0% to 100%. The bars are stacked to show the proportion of residents in each of four symptoms of depression categories: minimal or no symptoms (purple), mild symptoms (green), moderate symptoms (dark blue), and major symptoms (light blue).

The graph is dynamic, allowing users to filter by various characteristics such as cultural and linguistic diversity status, dementia status, indigenous status, living alone, partnered, remoteness, and state/territory. By clicking on each characteristic option provided, the sub-title and the data displayed in the graph will change accordingly.

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.

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