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CORRECTION: Depression ups risk for nursing home admission

Posted on: Monday, 15 May 2006, 14:26 CDT

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.

Source: REUTERS

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