Abstract
BackgroundDepressive symptoms in old age are common, but the prevalence, persistence, and incidence of depressive symptoms in older adults with and without dementia receiving in-home care is less well studied, and descriptions of the relationship between severity of cognitive decline and depressive symptoms over time is, to our knowledge, lacking. The aim of the present study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older adults receiving in-home care at baseline, and to explore the association between cognitive function and the course of depressive symptoms over time.MethodsIn all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study with three assessments over 36 months. Depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. Clinical Dementia Rating Scale, diagnosis of dementia and mild cognitive impairment, general medical health, personal and instrumental activities of daily living, neuropsychiatric symptoms and the use of psychotropic medication were evaluated during the three assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated.ResultsThe baseline prevalence and cumulative incidence of single depressive symptoms were higher in those with dementia at baseline than in those without dementia. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive impairment and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. Furthermore, being younger, female, in very poor physical health, with neuropsychiatric symptoms and not becoming a nursing home resident were associated with more depressive symptoms when assessed simultaneously.ConclusionThe baseline prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, as well as the relationship we found between the degree of cognitive decline and depressive symptoms over time show that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older adults receiving in-home care.
Highlights
Depression is a frequent cause of emotional suffering in old age, and it may contribute to reduced physical functioning, reduced quality of life [1,2,3], increased risk of nursing home admission [4], and reduced life expectancy [5, 6]
mild cognitive impairment (MCI) Mild Cognitive Impairment, GMHR General Medical Health Rating Scale, P-ADL Personal functioning assessed with Lawton and Brody’s Physical Self-Maintenance
I-ADL Instrumental functioning assessed with Instrumental Activities of Daily Living Scale, CDR sum of boxes (CDR-SoB) Clinical Dementia Rating Scale with sum of boxes aMissing information from one participant bMissing information from three participants cMissing information from two participants significant symptom level indicating depression, i.e. a mean Cornell Scale for Depression in Dementia (CSDD) score higher than 0.42, which was equivalent to a sum-score cut-off of 9 and higher at CSDD
Summary
Depression is a frequent cause of emotional suffering in old age, and it may contribute to reduced physical functioning, reduced quality of life [1,2,3], increased risk of nursing home admission [4], and reduced life expectancy [5, 6]. The prevalence of clinically significant depressive symptoms in older adults with dementia receiving in-home care varied from 11 to 60% between countries [10, 11]. There are no reports of studies that provide a detailed description of the prevalence, persistence, incidence and remission of individual depressive symptoms in older adults receiving in-home care in the Nordic countries or Norway. Depressive symptoms in old age are common, but the prevalence, persistence, and incidence of depressive symptoms in older adults with and without dementia receiving in-home care is less well studied, and descriptions of the relationship between severity of cognitive decline and depressive symptoms over time is, to our knowledge, lacking. The aim of the present study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older adults receiving in-home care at baseline, and to explore the association between cognitive function and the course of depressive symptoms over time
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