Regular Research Articles
Rates of Clinical Depression Diagnosis, Functional Impairment, and Nursing Home Placement in Coexisting Dementia and Depression

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Objective

Depression is commonly found as a coexisting condition in dementia. An earlier retrospective study by the authors found that patients with coexisting dementia and depression (CDD) were high utilizers of inpatient and nursing home care. The current prospective study was designed to investigate specific factors that might contribute to outcomes such as nursing home placement by examining the detection and course of CDD subjects as compared with subjects with either disorder alone.

Methods

Eighty-two subjects (N = 29 with CDD, N = 27 with Depression Alone, and N = 26 with Dementia Alone) were recruited and reassessed at 3, 6, and 12 months after baseline assessment.

Results

Lower rates of depression detection by treating (non-study) physicians were found in CDD subjects. Only 35% of the CDD group were correctly diagnosed and receiving adequate treatment for their depression. Although the CDD group did not differ in baseline dementia stage or cognitive functioning as compared with the dementia-only group, they had significantly higher levels of functional impairment. CDD subjects used nursing home care at significantly higher rates; nursing home placement correlated significantly with baseline severity of functional impairment and mood measures, but not with other factors, including dementia stage and medical burden.

Conclusions

Undetected, untreated, or inadequately treated depression may result in higher rates of nursing home placement in patients with dementia by increasing their functional disability. Aggressive outpatient treatment of depression could improve the course of coexisting dementia and depression.

Section snippets

METHODS

This was a 1-year prospective study comparing outcomes among elderly subjects with either depression alone, dementia alone, or coexisting dementia and depression. Subjects were recruited sequentially from inpatient (medical/surgical and psychiatric units) and outpatient (both primary and specialty clinic) settings at the Veterans Affairs Ann Arbor Healthcare System, between 1998 and 2000, and screened using both the Geriatric Depression Scale (GDS)11 and the Mini-Mental State Exam (MMSE).12

Demographic Characteristics

Table 1 presents sociodemographic characteristics of the subjects in the three study groups. There were no significant demographic differences between study groups except mean age and level of medical burden. DEM and CDD subjects were significantly older than DEP subjects. DEP subjects had significantly higher baseline and follow-up medical burden than DEM subjects.

In terms of mortality, 18.5% of the DEP group (N = 5), 15.4% of the DEM group (N = 4), and 31.0% of the CDD (N = 9) group died

DISCUSSION

The findings of this prospective study confirm the results of our earlier retrospective study that patients with coexisting dementia and depression have significantly higher rates of nursing home placement than patients with either depression or dementia alone. Eventual nursing home placement during the 12-month follow-up was significantly correlated with baseline functional impairment and dementia mood scores but not with other factors, such as physical illness burden or dementia stage. Also,

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  • Cited by (0)

    This work was presented in part at the American Association for Geriatric Psychiatry 14th Annual Meeting, San Francisco, CA, February 23–26, 2001.

    We thank Betty Bigger for her dedicated efforts in the recruitment of study subjects.

    This research was supported by: a pilot grant from the University of Michigan Geriatrics Center/Institute of Gerontology; the Rachel Upjohn Clinical Scholars Program at the University of Michigan; the Geriatric Research Education and Clinical Center, the VA Ann Arbor Healthcare System; and the VA HSR&D Career Development Program.

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