Depression and mortality in nursing homes

Rovner, Barry W.; German, Pearl S.; Brant, Larry J.; Clark, Rebecca; Burton, Lynda; Folstein, Marshal F.

doi:10.1001/jama.265.8.993

Cited by 345 publications

(299 citation statements)

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“…In residential and nursing homes, some (Rovner et al 1991;O'Connor & Vallerand, 1998;Barca et al 2010;Kane et al 2010;Drageset et al 2013) but not all cohort studies (Cohen-Mansfield et al 1999;Parmelee et al 1992;Cuijpers, 2001;Sutcliffe et al 2007) have found a positive association of depression and depressive symptoms with mortality. Most of these studies were conducted over short follow-up periods and none has properly examined the potential role of detection in the association between depression and mortality, though one study did provide some related data (Rovner et al 1991). In a previous report, we found that 42% of depressed residents were undetected, corresponding to 18% of the whole institutionalised population (Damián et al 2010).…”

Section: Introductionmentioning

confidence: 99%

Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people

Damián

Pastor-Barriuso

Valderrama-Gama

et al. 2016

Epidemiol Psychiatr Sci

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Background. Studies on depression and mortality in nursing homes have shown inconclusive findings, and none has studied the role of detection. We sought to measure the association of depression with long-term all-cause mortality in institutionalised older people and evaluate a potential modification in the association by its detection status.Methods. We selected a stratified cluster sample of 591 residents aged 75 years or older (mean age 84.5 years) living in residential and nursing homes of Madrid, Spain, who were free of severe cognitive impairment at the 1998-1999 baseline interview. Mortality was ascertained until age 105 years or September 2013 (median/maximum follow-up 4.8/15.2 years) through linkage to the Spanish National Death Index. Detected depression was defined at baseline as a physician's diagnosis or antidepressant use, undetected depression as significant depressive symptoms (score of 4 or higher on the ten-item version of the Geriatric Depression Scale) without documented diagnosis or treatment, and no depression as the absence of diagnosis, treatment, and symptoms. Constant and age-dependent hazard ratios for mortality comparing detected and undetected depression with no depression were estimated using Cox models, and absolute years of life gained and lost using Weibull models.Results. The baseline prevalences of detected and undetected depression were 25.9 and 18.8%, respectively. A total of 499 participants died during 3575 person-years of follow-up. In models adjusted for age, sex, type of facility, number of chronic conditions, and functional dependency, overall depression was not associated with long-term all-cause mortality (hazard ratio 0.87, 95% confidence interval (CI): 0.70-1.08). However, compared with no depression, detected depression showed lower mortality (hazard ratio 0.63, 95% CI: 0.46-0.86), while undetected depression registered higher, not statistically significant, mortality (hazard ratio 1.35, 95% CI: 0.98-1.86). The median life expectancy increased by 1.8 years (95% CI: −3.1 to 6.7 years) in residents with detected depression and decreased by 6.3 years (95% CI: 2.6-10.1 years) in those undetected. Results were more marked in women than men and they were robust to the exclusion of antidepressants from the definition of depression and also to the use of a stricter cut-off for the presence of depressive symptoms.Conclusions. The long-term mortality risk associated with depression in nursing homes depends on its detection status, with better prognosis in residents with detected depression and worse in those undetected. The absolute impact of undetected depressive symptoms in terms of life expectancy can be prominent.

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Section: Introductionmentioning

confidence: 99%

Association of detected depression and undetected depressive symptoms with long-term mortality in a cohort of institutionalised older people

Damián

Pastor-Barriuso

Valderrama-Gama

et al. 2016

Epidemiol Psychiatr Sci

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“…There is mounting evidence for significant minor or subsyndromal depressive disorders in older populations (Rovner et al, 1991;Katz et al, 1995), suggesting that depression is likely a spectrum rather than a set of discrete entities (Caine et al, 1993). Comorbid medical problems present other diagnostic and therapeutic challenges, but also opportunities to better understand the relationship between mood and medical outcomes.…”

Section: Methodological Considerations For Antidepressant Trials In Tmentioning

confidence: 99%

“…The prevalence of major depression ranges from 6 to 9% of geriatric primary care patients, and is higher on medical in-patient services or in nursing homes (Katon and Schulberg, 1992). Depression is further associated with poorer outcomes of medical illnesses (Rovner et al, 1991;Frasure-Smith et al, 1993;Nemeroff et al, 1998;Jiang et al, 2001) and increased suicide rates (Conwell et al, 2002). Despite its associated morbidity and mortality, there are few published antidepressant placebo-controlled trials in the elderly.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Antidepressant Placebo-Controlled Trials for Geriatric Depression: Limitations of Current Data and Directions for the Future

Taylor

Doraiswamy

2004

Neuropsychopharmacol

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Depression in the elderly is a major public health problem as untreated depression adversely impacts comorbid illnesses. It is important to develop safe and effective antidepressant therapies for older individuals. We performed a systematic review of all published randomized, placebo-controlled antidepressant medication trials in populations over age 55 years. Papers were obtained via MEDLINE (1966( -August 2003 and PSYCINFO (1872-August 2003. Unpublished trials, trials examining nonpharmacologic interventions, and papers reporting post hoc analyses were not included in this review unless they provided new insights. A total of 18 placebo-controlled trials examining acute efficacy met our criteria. The combined sample size in these studies was 2252. The mean sample size was 51 (range 20-728) and mean trial duration was 7 weeks. A total of 12 trials examined tricyclic antidepressants (TCAs), five trials examined selective serotonin reuptake inhibitors (SSRIs), two trials examined bupropion, and one trial examined mirtazapine. There were no published trials of venlafaxine or nefazodone. In all, 71.5% of trials reported significantly greater efficacy with drug than placebo. In conclusions, there is a paucity of published controlled antidepressant trials in the elderly. Most published studies examine small sample sizes and do not include common comorbid conditions. Efficacy studies examining relapse prevention are lacking. Large placebo response rates, lack of controlled head to head comparisons, and other methodological design differences make crosstrial comparisons difficult. Large simple studies are urgently needed to address the unmet needs for data on safety and efficacy of antidepressants in this population.

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“…Auch die Schätzungen zur Prävalenz der Depressionen hängen stark von der zugrundeliegenden Population, den verwendeten Erhebungsinstrumenten und der Definition der Erkrankung ab (Rovner et al, 1991). Eine schwedische Studie der älteren Allgemeinbevölkerung fand Raten von 3,9% Major Depression bei den Nicht-Dementen bzw.…”

Section: Depressionenunclassified