Common signs point to depression in nursing home residents

By Miriam E. Tucker
NATIONAL HARBOR, 18 dec 2008 – Weight loss, verbally abusive behavior, and moderate pain were all significant predictors of a new diagnosis of depression among established nursing home residents in a longitudinal analysis.

Although studies have shown that depression affects 20%-55% of nursing home residents, the condition frequently goes unrecognized because of factors such as limited availability of formal psychiatric services, attribution of symptoms to physical ailments, and the tendency to see depressive symptoms as normal in residents. Developing a set of observable indicators of depression may facilitate earlier diagnosis and treatment by nursing home staffs, said Dr. Lorraine J. Phillips and her associates in a poster at the annual meeting of the Gerontological Society of America.

The data were taken from a sample of 13,588 nursing home residents who were among the 127,587 included in the Missouri Minimum Data Set (MDS) from Jan. 1, 2003, to March 31, 2005. The MDS is the federal system of periodic assessments of all nursing home residents’ health and functional status, reported state by state and in a national database.

Among the study’s inclusion criteria were two sequential assessments 90 days apart (excluding admission and discharge assessments), age 65 years and older, no prior diagnosis of depression or use of antidepressant medications, and no severe cognitive impairment.

Mean age of the study population was 85 years, 74% were female, and 88% were white. More than 66% of residents were widowed, 19.5% were married, and 12% had never married. About 49% had less than a high school education, 37% had finished high school, and 14% had a college education.

Documentation of weight loss at the study’s first assessment was associated with a significantly increased chance of being diagnosed with depression between the first and second assessments (odds ratio 1.68, P value less than.0001). Verbally abusive behaviors, such as threatening, screaming, or cursing at others, also predicted a depression diagnosis between the two study assessments (OR 1.44, P = .0004).

Moderate pain was a third significant predictor (OR 1.43, P less than.0001), reported Dr. Phillips of the Sinclair School of Nursing at the University of Missouri-Columbia, and her associates.

Conversely, frequent urinary incontinence was significantly associated a lower incidence of depression (OR 0.70, P less than .0001). Post hoc analysis showed a correlation between incontinence and cognitive impairment, suggesting that the lower incidence of depression being diagnosed in nursing home residents can be explained by cognitive impairment impeding the recognition of depression, the investigators said.

Never being married also predicted a lower incidence of depression (OR 0.66, P = .0004), as did age 95 and above (OR 0.70, P = .0006).

Among the residents with depression, only 12 had “excruciating” pain, a number too small for statistically significant analysis, the researchers noted.

This research was funded by the University of Missouri MDS and Quality Research Team (www.nursinghomehelp.org), an interdisciplinary research group that aims to improve the quality of nursing home care in Missouri and elsewhere. The team began work in 1993, and members have received funding for their work since 1994 through the Missouri Division of Aging, the Health Care Financing Administration, the National Institute for Nursing Research, the Agency for Health Care Policy and Research, and other agencies and foundations.