Study finds seniors with depressive symptoms have worse health status, poorer quality of life
More than two in five (44%) Canadian seniors living in residential care homes are diagnosed with or have symptoms of depression, according to a new study released today by the Canadian Institute for Health Information (CIHI).
The study, Depression Among Seniors in Residential Care, is one of the largest of its kind in Canada to examine the prevalence of depression and the impact it has on persons living in residential care facilities, such as long-term care, nursing or personal care homes. Based on data from CIHI's Continuing Care Reporting System, the study included nearly 50,000 residents age 65 and older across four provinces and one territory (Nova Scotia, Ontario, Manitoba, Saskatchewan and the Yukon).
CIHI's study found that, while about one in four (26%) seniors living in a residential care facility had a diagnosis of depression, a further one in five (18%) had symptoms of depression with no documented diagnosis. Residents were considered to have symptoms of depression if they had a score of at least 3 on the Depression Rating Scale, which measures symptoms such as persistent anger, tearfulness and repetitive anxiety.
"Depression can have a major impact on individuals' quality of life and also represents significant costs to society. Research also suggests that among seniors depression often goes unrecognized and therefore untreated," explains Nancy White, Manager of Home and Continuing Care Development at CIHI. "As Canada's population ages, and more people could potentially move into residential care, it is important to understand how this population is affected by depression or depression symptoms in order to be able to identify the right treatment options and improve quality of life for these seniors."
Quality of life worse for seniors with symptoms of depression
CIHI's study shows seniors with symptoms of depression experienced significant medical, social, functional and quality-of-life challenges, regardless of whether they were diagnosed with the mental disorder.
Seniors with symptoms of depression were more likely to display aggressive behaviour, have conflicts with family members or staff and withdraw from activities of interest. They were also three times more likely to experience sleep disturbances, were less self-sufficient than seniors with no symptoms of depression and were more likely to have difficulty communicating.
Dr. Marie-France Rivard, chair of the Seniors' Advisory Committee of the Mental Health Commission of Canada and professor of psychiatry at the University of Ottawa, explains, "Moving into a care facility is usually quite stressful and often prompted by significant losses in terms of health, degree of independence and/or social supports. This can contribute to the development of a depressive disorder that may include feelings of hopelessness, self-blame and loneliness, possibly accompanied by physical symptoms such as poor sleep, decreased appetite and lack of energy, often leading to social withdrawal."
People diagnosed with depression more likely to receive mental health evaluations
The study showed that seniors who were diagnosed with and had symptoms of depression were twice as likely to receive a mental health evaluation from a licensed mental health practitioner and more than twice as likely to receive antidepressant medication than those with symptoms but no diagnosis. Very few residents received psychological therapy, regardless of the presence of symptoms and/or a diagnosis. Two-thirds of seniors with a documented diagnosis showed no or only mild symptoms of depression on the Depression Rating Scale, suggesting that their symptoms were being effectively managed.
Clinical tools allow for better detection of depression symptoms
Previous research has shown there can be challenges with diagnosing depression among seniors. Standardized clinical assessment instruments like the RAI-MDS 2.0 used in this study offer better information to identify seniors at risk of poor outcomes as a result of depression or depression symptoms. By focusing on symptoms and behaviours, the RAI-MDS 2.0 provides a more holistic view of the challenges faced by seniors with depression or depression symptoms and can be used to monitor the effectiveness of interventions put into place.
At Copper Ridge Place in Whitehorse, Yukon, care providers have been using the outcome scores of this assessment instrument since 2007 to better understand their patient population and provide more focused and comprehensive care plans.
"We assess our residents with the RAI-MDS 2.0 when they first enter the facility and we often identify people with depression symptoms that would have previously gone undetected," says Cynthia Fraser, a licensed practical nurse and an MDS assessor at the facility. "Once we identify a problem we present this to the team who can work with the residents to address their needs. As a result, we have seen real success in reducing residents' depression symptoms and improving the quality of their lives."
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