Depression and Mortality in Nursing Homes

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 03/1991; 265(8):993-6. DOI: 10.1001/jama.265.8.993
Source: PubMed


To determine the prevalence rates of major depressive disorder and of depressive symptoms and their relationship to mortality in nursing homes, research psychiatrists examined 454 consecutive new admissions and followed them up longitudinally for 1 year. Major depressive disorder occurred in 12.6% and 18.1% had depressive symptoms; the majority of cases were unrecognized by nursing home physicians and were untreated. Major depressive disorder, but not depressive symptoms, was a risk factor for mortality over 1 year independent of selected physical health measures and increased the likelihood of death by 59%. Because depression is a prevalent and treatable condition associated with increased mortality, recognition and treatment in nursing homes is imperative.

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    • "Rates of major and minor depression, and subsyndromal depressive symptoms, are higher in nursing homes than among community dwellers (Fullerton, McGuire, Feng, Mor, & Grabowski, 2009; teresi, abrams, Homes, Ramirez, & eimicke, 2001). Depression among those in residential care is related to decreased cognitive status, functional capacity, clinician-rated health, pain (Katz & Parmelee, 1997), greater use of nursing time (Fries et al., 1993), suicidality (Reynolds et al., 1998), and increased mortality (Rovner et al., 1991). the common comorbidity of depression and dementia further increases risks (Kales et al., 2005), including increased agitation and aggression (Lyketsos et al., 1999), increasing the amount of care, and the stress on the caregiver. "
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    ABSTRACT: Objectives.To report the primary outcomes of a cluster randomized clinical trial of Behavioral Activities Intervention (BE-ACTIV), a behavioral intervention for depression in nursing homes.Method.Twenty-three nursing homes randomized to BE-ACTIV or treatment as usual (TAU); 82 depressed long-term care residents recruited from these nursing homes. BE-ACTIV participants received 10 weeks of individual therapy after a 2-week baseline. TAU participants received weekly research visits. Follow-up assessments occurred at 3- and 6-month posttreatment. BE-ACTIV group participants showed better diagnostic recovery at posttreatment in intent-to-treat analyses adjusted for clustering. They were more likely to be remitted than TAU participants at posttreatment and at 3-month posttreatment but not at 6 months. Self-reported depressive symptoms and functioning improved in both groups, but there were no significant treatment by time interactions in these variables.Discussion.BE-ACTIV was superior to TAU in moving residents to full remission from depression. The treatment was well received by nursing home staff and accepted by residents. A large proportion of participants remained symptomatic at posttreatment, despite taking one or more antidepressants. The results illustrate the potential power of an attentional intervention to improve self-reported mood and functioning, but also the difficulties related to both studying and implementing effective treatments in nursing homes.
    Full-text · Article · Apr 2014 · The Journals of Gerontology Series B Psychological Sciences and Social Sciences
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    • "Recognition rates of depression in older persons have typically been reported to be low [13] although more recent research indicates that the situation may be improving [14]. Recognition in this age group is particularly difficult because of the overlap of symptoms between depression and physical health problems [15,16] and between depression and dementia [17,18]). "
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    ABSTRACT: Background Those working with elderly care recipients require a good working knowledge of depression and appropriate help giving responses. While it is important for age-care staff to recognize depression in care recipients it is also critical that they know the appropriate course of action to assist a care recipient who may be depressed. This study aims to determine the knowledge of age-care staff of appropriate help giving responses, their confidence in knowing what kind of assistance to provide and their actual likelihood of providing help to potentially depressed care recipients and to examine if these measures improve following an intervention training program. Methods One hundred and two age-care staff were surveyed on their confidence in helping age-care recipients and on their knowledge of appropriate ways to provide assistance. Staff then participated in a two hour depression awareness raising intervention. The survey was repeated immediately following the training and again six months later. Results Staff confidence in knowing how to provide assistance increased significantly subsequent to training and remained significantly improved at the six month follow up. In addition, a significantly higher proportion of staff reported helping care recipients at the six month follow up. Conclusions This study highlights the potential of a brief staff training program to provide a cost effective means to improve staff self-confidence and increase the likelihood of staff providing assistance to depressed care recipients.
    Full-text · Article · Apr 2013 · BMC Nursing
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    • "Depressive disorders have been found to be associated with increased impairment in role functioning, poorer quality of life, mortality due to physical illness, and suicide1234. Major depressive disorder (MDD) is one of the most common psychiatric disorders, with a 12-month prevalence estimates ranging from 5 to 10%5678910 ; 12-month prevalence estimates for dysthymic disorder (DYS) ranging from 2 to 5% [5, 6, 9]. "
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    ABSTRACT: Depressive disorders are a growing public health concern, however, a substantial number of depressed individuals do not receive treatment. This study examined the longitudinal predictors of receiving depression treatment among adults with persistent depressive disorders and no lifetime history of treatment. The sample included respondents to the National Epidemiologic Survey on Alcohol Related Conditions (NESARC), a large population-based survey, who met criteria for a 12-month major depressive disorder (MDD) or dysthymia (DYS) and had no prior depression treatment. Bivariate and multivariate analyses were conducted examining which socio-demographic and clinical predictors among individuals with depressive disorders and no prior treatment at Wave 1 were associated with receiving depression treatment at Wave 2 (N = 337). Only 47.2% of those with MDD or DYS and no prior treatment at Wave 1 had received depression treatment at Wave 2. Females were more likely to have received treatment at Wave 2: those of Hispanic ethnicity, other race, unmarried, 12 years of education, self-rated health of good/very good/excellent and anxiety disorders were less likely to have received treatment at Wave 2. Those with substance use disorders were more likely to have received treatment at Wave 2. This study highlights individuals who would likely benefit from increased efforts to enhance depression treatment utilization.
    Full-text · Article · Jan 2012 · Social Psychiatry
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