CORRECTION: Depression ups risk for nursing home admission
By Charnicia Huggins
NEW YORK (Reuters Health) – Consistent feelings of sadness
or depression may predict later nursing home admission among
seniors, study findings show.
“Even after taking into account physical health and
functional status, people with unmanaged depression are much
more likely to be admitted to a nursing home,” study author,
Dr. Yael Harris, of the Centers for Medicare and Medicaid
Services in Baltimore, told Reuters Health.
This suggests that “appropriate identification and
management of depression could prevent or postpone the use of
nursing home services,” she added.
Previous researchers have linked depression with illness,
death and increased use of various resources, and
investigations conducted in nursing homes have revealed that
many residents — as many as 60 percent of otherwise mentally
healthy seniors in one study — have depression or experience
symptoms of the condition. Yet, little research has explored
the relationship between depression symptoms in the elderly and
their risk of entering a nursing home.
To investigate, Harris and co-author Dr. James K. Cooper,
of George Washington University, in Washington, DC, analyzed
data from the Health Outcomes Survey, which included 137,000
seniors, the Nursing Home Minimum Data Set and the Medicare
Enrollment Database. The survey participants, included more
than 141,000 community-dwelling seniors who were able to
personally respond to the questions, were followed for a
3.5-year period.
A total 13,261 respondents said they had “felt sad or
depressed much of the time” during the past year of the survey.
By the end of the study period, 2,005 of them — 13 percent —
had been admitted to a nursing home, Harris and Cooper report
in the Journal of the American Geriatrics Society.
Diabetes and heart failure were the most strongly
associated with subsequent nursing home admission, but
depressive symptoms was the third greatest predictor,
surpassing other chronic health conditions like cancer and
arthritis, study findings indicate.
Other factors associated with an increased risk of nursing
home admission included older age, low income and decreased
physical functioning. In fact, for each additional impairment
on a rating scale of a senior’s ability to perform daily living
activities, the risk of nursing home admission increased by 27
percent.
The relationship between depression and nursing home entry
may be due to depression’s effect on disease states and
lifestyles, the researchers speculate. Studies have shown that
depressed individuals may have higher levels of certain risk
factors for high blood pressure and cardiovascular disease, for
example, while other studies have linked depression to
increased alcohol drinking and poor diets.
On the other hand, depressive symptoms may simply be a
marker of another condition, such as early Alzheimer’s disease,
as has been found in previous studies, Harris and Cooper note.
Based on the findings, Harris recommends that adults
“demand that their physician include a quick three question
assessment of their mood at every check up or doctor visit.”
Noting that “the normal symptoms of depression such as
change in sleeping patterns or appetite may not be as
appropriate in an elderly person, as these symptoms are often
also common features of the aging process,” she pointed out,
there are a variety of other tools and questions available to
assess sadness and depression.
“The key is to identify if someone is feeling sad
immediately so that these feelings can be addressed in a timely
manner,” she told Reuters Health.
“Only once physicians take depression seriously and begin
monitoring for it like they do for blood pressure and weight
gain will we begin to tackle this problem which affects so many
seniors and is associated with so many adverse outcomes,” she
added.
While she is affiliated with Medicare and Medicaid
Services, Harris stressed that these opinions are her own and
do not reflect government policy.
SOURCE: Journal of the American Geriatrics Society, April
2006.