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Depressed Older Adults Enter Nursing Homes Sooner

NEW YORK (Reuters Health) - Older adults suffering from depression may perceive their health to be worsening more quickly, speeding the need for nursing home care, a study suggests.

Wednesday, October 17, 2007

NEW YORK (Reuters Health) - Older adults suffering from depression may perceive their health to be worsening more quickly, speeding the need for nursing home care, a study suggests.

Researchers found that among nearly 3,000 elderly European adults receiving home health services, those with depression were more likely to enter a nursing home over the next year.

Even when other factors were considered -- including physical health and mental impairment -- depression was linked to a 43 percent higher risk of nursing home admission.

The findings are published in the Journal of Clinical Psychiatry.

Depression may speed older adults' need for nursing home care, in part, by directly affecting their physical health, suggested lead study author, Dr. Graziano Onder, of the Gemelli Hospital in Rome.

By affecting nervous system activity, he told Reuters Health, depression can alter the functioning of the cardiovascular, immune, hormonal and digestive systems.

The nervous system acts as a "control system" to maintain balance in the body, Onder noted. When it does not work properly -- owing to chronic stress or depression, for example -- this may worsen an older person's health and raise the risk of hospital or nursing home admission.

Onder and his colleagues based their findings on 2,718 elderly adults from across Europe who were receiving help from a home care agency. All were screened for depression, and the rate of nursing home admissions was followed over the next year.

Overall, 14.8 percent of depressed study participants entered a nursing home, versus 10.6 percent of those without symptoms of depression.

The researchers considered a range of factors that could explain the relationship -- including poorer physical health, disability, dementia or living alone -- but depression remained an independent risk of nursing home admission.

A diagnosis of depression was confirmed in 12.2 percent of the study participants, but only one fifth of them were being treated for the disorder with antidepressants.

Onder pointed out that antidepressants have been shown to be safe and effective for older adults, so concern about side effects is unlikely to explain the low rate of treatment. He instead suspects that few patients had their depression recognized before.

Depression symptoms can be hard to distinguish from those of physical health problems, Onder explained. On top of this, he noted, older adults may be more reluctant than younger people to accept a diagnosis of depression -- which, for some, carries more of a stigma for them.

Onder said studies should now look at whether better diagnosis and treatment of depression can delay the need for nursing home care.

SOURCE: Journal of Clinical Psychiatry, September 2007.

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