Risk Factors for Depression in Long-term Care: A Prospective Observational Cohort Study

• Published in: Clinical gerontologist Vol. 44; no. 2; pp. 112 - 125
• Main Authors: Chau, Rebecca, Kissane, David W., Davison, Tanya E.
• Format: Journal Article
• Language: English
• Published: United States Routledge 15.03.2021; Taylor & Francis Ltd
• Subjects: aged care; aging; Antidepressants; Change agents; Clinical significance; Cognitive ability; Cognitive impairment; Cohort analysis; depression; Functional impairment; Intervention; Long term health care; Long-term care; Medical screening; Mental depression; nursing homes; Observational studies; Older adults; Older people; Pain; Person-Environment fit; Prevention programs; Psychotherapy; Risk assessment; Risk factors; Sleep; sleep disturbance; Social support; Uptake; pain; risk factors; sleep disturbance; long-term care; aging; depression; Older adults; aged care; nursing homes
• ISSN: 0731-7115; 1545-2301
• DOI: 10.1080/07317115.2019.1635548

Objectives: Depression among older adults in long-term care remains a problem, despite the uptake of antidepressants and the development of intervention programs. A better understanding of the risk factors for depression is much needed. Guided by a systematic assessment of the evidence, this prospective observational cohort study sought to clarify existing evidence, identify modifiable risk factors and explore novel variables. Methods: Adults aged ≥65 (T1 n=147, T2 n= 81) were recruited from 15 long-term-care facilities in Melbourne, Australia. Cognitive impairment, functional impairment, pain, sleep disturbance, social support, and person-environment fit were investigated as risk factors. Outcomes were depressive symptoms and indicated Major Depressive Episode. Results: Generalized Estimating Equations (GEE) identified that changes in pain (b= 0.06, p <.05), sleep disturbance (b= 0.02, p< .001), social support (b= −0.02, p< .001) and person-environment fit (b= −0.02, p= <.01) were significantly associated with changes in depression score. Conclusions: Pain, sleep disturbance, social support, and person-environment fit are modifiable risk factors, making them strongly positioned to strategically inform prevention and intervention strategies. Clinical Implications: Individuals with clinically significant symptoms on these risk factors for depression should be selected for interventions that target these risk factors. For depressed individuals, psychotherapy should prioritize the potential role of these risk factors. Finally, these risk factors should be used as screening and monitoring variables: clinically significant changes in symptoms warrant investigation.