Depressed mood, cognitive impairment, and survival in older people admitted to care homes in England

Abstract

Objective: To investigate psychiatric morbidity, cognitive impairment, dependency, and survival in residents newly admitted to care homes.

Methods: A total of 308 older people were assessed using measures of cognitive impairment and depressive symptomatology, and interviewable residents completed a quality-of-life interview. Dependency levels were assessed by interviews with staff and medication data were collected from home records. Follow-up assessments were carried out at five and nine months. A telephone follow-up approximately 12 months later augmented the survival data.

Results: Of residents whose outcomes were known, 73% survived throughout the nine-month study period. Residents who died before the five-month follow-up had higher scores on the depression measure than those surviving longer. Reduced survival was predicted by greater dependency at baseline. Of 188 surviving residents, 63 (38%) were classified as depressed at baseline. Twenty-seven (43%) of the latter were still classed as depressed at five and nine months. Just 19% of residents rated as depressed at baseline were prescribed antidepressant medication, increasing to 26% at each follow-up. There was significant coexistence of cognitive impairment and depressive symptomatology.

Conclusion: High levels of mortality, psychiatric morbidity, and chronicity of depressed mood among residents requires care homes to improve access to specialist resources such as geriatric consultation, old-age psychiatry, occupational therapy, and physiotherapy. Findings suggest that future care standards should include external factors, such as the extent of access to relevant specialist services for vulnerable older people.