Anxiety and Depression Among US Nursing Home Residents with Chronic Obstructive Pulmonary Disease

Figures & data

Table 1 Characteristics of Long Stay Residents with Chronic Obstructive Pulmonary Disease Living in US Nursing Homes in 2018

Characteristics	Total (n = 239,615)
	Percentage
Age category (years):
50–64	10.8
65–74	23.2
75–84	32.2
≥85	33.8
Women	62.0
Race/Ethnicity:
Non-Hispanic White	80.5
Non-Hispanic Black	12.8
Hispanic	4.8
American Indian/Native Alaskan or Hawaiian/Pacific Islander	1.9
Length of stay in nursing home ≥ 1 year	38.8
Receiving hospice care	4.6
Life expectancy < 6 months	4.0
Activities of daily living limitations:
Independent/Supervised	24.2
Moderate dependence	55.1
Total Dependence	20.8
Cognitive Impairment:
Cognitively Intact	41.5
Mildly Impaired	24.9
Moderately Impaired	27.0
Severely Impaired	6.5
Body mass index (kg/m^2):
<18.5	7.1
18.5 to 25	32.3
25 to <30	25.7
≥30	34.9
Current tobacco user	9.7
High level of social connectedness	85.8
Co-Morbid Conditions
Dementia	48.1
Coronary Artery Disease	27.2
Cerebrovascular Disease	12.1
Renal Insufficiency / End Stage Renal Disease	19.8
Hypertension	81.9
Heart Failure	35.7
Hyperlipidemia	51.5
Peripheral Vascular Disease	15.7
Atrial Fibrillation	26.0
Anemia	36.1
Pneumonia	3.3
Cancer	6.7
Cirrhosis	1.0
Diabetes mellitus	41.6
Gastroesophageal Reflux Disease/ Ulcer	46.4
Osteoporosis	11.8
Arthritis	31.0
Charlson Comorbidity Index:
1–4	56.3
5	17.6
6–7	20.5
≥ 8	5.7
Fall history	19.6
Urinary incontinence:
Always continent	19.6
Occasionally	18.5
Frequently	26.7
Always	29.0
Catheter/ no urine output	6.2
Bowel incontinence:
Always continent	35.7
Occasionally	11.1
Frequently	21.7
Always	29.4
Ostomy/ no bowel movement	2.1
PHQ-9:
≥ 15	1.3
Between 10 and 14	5.0
Between 5 and 9	11.8
Pain*
Severe	9.6
Moderate	24.7
Any shortness of breath	23.1
Shortness of breath with exertion	14.7
Shortness of breath sitting	5.2
Shortness of breath lying down	16.1
Oxygen use	27.4

Note: *Missing data for 11,127 residents.

Table 2 Prevalence of Anxiety and Association Between Sociodemographic, Clinical Characteristics, and Comorbid Conditions with Anxiety Among Nursing Home Residents with Chronic Obstructive Pulmonary Disease

Characteristics	n	Prevalence of Anxiety	Prevalence Ratio (95% Confidence Interval)
			Unadjusted	Multivariable Adjusted
Age category (years):
50–64	25,979	45.2	1.13 (1.11–1.15)	1.13 (1.11–1.15)
65–74	55,570	40.0	1.0	1.0
75–84	77,067	36.8	0.92 (0.91–0.93)	0.92 (0.90–0.93)
≥85	80,999	33.0	0.83 (0.82–0.84)	0.84 (0.82–0.85)
Sex:
Women	148,637	41.6	1.39 (1.38–1.41)	1.35 (1.33–1.36)
Men	90,978	29.9	1.0	1.0
Race/Ethnicity:
Non-Hispanic White	192,981	40.1	1.0	1.0
Non-Hispanic Black	30,608	23.7	0.63 (0.61–0.64)	0.70 (0.69–0.72)
Hispanic	11,586	30.2	0.82 (0.80–0.84)	0.89 (0.87–0.92)
American Indian/Native Alaskan or Hawaiian/Pacific Islander	4440	19.7	0.59 (0.56–0.63)	0.68 (0.64–0.72)
Activities of daily living limitations:
Independent/Supervised	57,908	40.2	1.0	1.0
Moderate dependence	131,921	36.1	0.91 (0.89–0.92)	0.90 (0.89–0.92)
Total Dependence	49,786	36.4	0.93 (0.92–0.94)	0.91 (0.89–0.92)
Cognitive Impairment:
Cognitively Intact	99,520	39.1	1.0	1.0
Mildly Impaired	59,770	35.5	0.91 (0.90–0.92)	0.99 (0.97–1.00)
Moderately Impaired	64,674	36.1	0.93 (0.91–0.94)	1.06 (1.05–1.08)
Severely Impaired	15,651	35.8	0.93 (0.91–0.95)	1.10 (1.08–1.13)
Body mass index (kg/m^2):
<18.5	16,952	37.8	1.06 (1.04–1.08)	1.03 (1.01–1.06)
18.5 to 25	77,424	35.8	1.0	1.0
25 to <30	61,567	36.2	1.0 (0.99–1.02)	0.98 (0.96–0.99)
≥30	83,672	39.0	1.12 (1.05–1.08)	0.93 (0.92–0.94)
Current tobacco user	23,329	42.3	1.12 (1.10–1.14)	1.04 (1.02–1.06)
Level of social connectedness:
High	205,490	35.8	0.78 (1.10–1.14)	0.80 (0.79–0.82)
None/lower level	34,125	45.8	1.0	1.0
Charlson Comorbidity Index:
1–4	134,895	36.0	1.0	1.0
5	42,126	37.5	1.01 (0.99–1.02)	1.00 (0.99–1.02)
6–7	49,047	38.7	1.02 (1.00–1.03)	1.01 (1.00–1.03)
≥ 8	13,547	42.3	1.07 (1.05–1.10)	1.07 (1.05–1.09)
Depression			2.11 (2.08–2.14)	1.84 (1.81–1.86)
PHQ-9:
≥ 15	3024	50.1	1.40 (1.35–1.46)	1.15 (1.11–1.20)
Between 10 and 14	12,044	44.0	1.23 (1.20–1.27)	1.12 (1.10–1.15)
Between 5 and 9	28,308	43.4	1.22 (1.20–1.24)	1.10 (1.08–1.12)
Between 0 and 4	196,239	35.7	1.0	1.0
Pain:
Severe	21,889	49.6	1.49 (1.47–1.52)	1.25 (1.23–1.27)
Moderate	56,482	42.8	1.29 (1.27–1.30)	1.16 (1.15–1.18)
None	150,117	33.2	1.0	1.0
Any shortness of breath	55,283	43.0	1.20 (1.19–1.22)	1.07 (1.06–1.09)
Oxygen use	65,618	43.3	1.22 (1.21–1.24)	1.14 (1.13–1.15)

Figure 1 Frequency of self-reported depressive symptoms.

0-1 days

2-6 days

7-11 days

12-14 days. May not add up to 100% due to rounding.

Figure 2 Frequency of staff observed depressive symptoms.

0-1 days

2-6 days

7-11 days

12-14 days. May not add up to 100% due to rounding.

Table 3 Prevalence of Depression, and Association Between Sociodemographic, Clinical Characteristics, and Comorbid Conditions with Depression Among Nursing Home Residents with Chronic Obstructive Pulmonary Disease

Characteristics	n	Prevalence of Depression	Prevalence Ratio (95% Confidence Interval)
			Unadjusted	Multivariable Adjusted
Age category (years):
50–64	25,979	60.9	1.02 (1.01–1.03)	1.01 (1.00–1.02)
65–74	55,570	61.0	1.0	1.0
75–84	77,067	59.2	0.96 (0.95–0.97)	0.96 (0.95–0.97)
≥85	80,999	52.6	0.85 (0.84–0.86)	0.86 (0.86–0.87)
Sex:
Women	148,637	60.8	1.15 (1.14–1.16)	1.11 (1.11–1.12)
Men	90,978	52.4	1.0	1.0
Race/Ethnicity:
Non-Hispanic White	192,981	60.6	1.0	1.0
Non-Hispanic Black	30,608	44.1	0.75 (0.74–0.76)	0.78 (0.77–0.79)
Hispanic	11,586	51.3	0.90 (0.88–0.91)	0.92 (0.91–0.94)
American Indian/Native Alaskan or Hawaiian/Pacific Islander	4440	36.7	0.70 (0.68–0.73)	0.76 (0.73–0.79)
Activities of daily living limitations: Independent/Supervised	57,908	56.3	1.0	1.0
Moderate dependence	131,921	58.9	1.04 (1.03–1.05)	1.07 (1.06–1.08)
Total Dependence	49,786	55.5	1.01 (0.99–1.02)	1.06 (1.04–1.07)
Cognitive Impairment:
Cognitively Intact	99,520	59.2	1.0	1.0
Mildly Impaired	59,770	58.7	0.99 (0.98–1.00)	1.04 (1.03–1.05)
Moderately Impaired	64,674	56.6	0.96 (0.95–0.97)	1.03 (1.02–1.04)
Severely Impaired	15,651	47.1	0.81 (0.80–0.83)	0.88 (0.87–0.90)
Body mass index (kg/m^2):
<18.5	16,952	52.4	0.97 (0.95–0.98)	0.96 (0.95–0.98)
18.5 to 25	77,424	54.2	1.0	1.0
25 to <30	61,567	57.3	1.05 (1.04–1.06)	1.03 (1.02–1.04)
≥30	83,672	62.0	1.13 (1.12–1.14)	1.05 (1.02–1.04)
Current tobacco user	23,329	59.7	1.05 (1.04–1.06)	1.02 (1.01–1.03)
Level of social connectedness:
High	205,490	57.1	0.94 (0.93–0.95)	0.98 (0.97–0.98)
None/lower level	34,125	60.7	1.0	1.0
Charlson Comorbidity Index:
1–4	134,895	53.7	1.0	1.0
5	42,126	60.6	1.11 (1.10–1.12)	1.11 (1.10–1.12)
6–7	49,047	62.9	1.14 (1.13–1.15)	1.14 (1.13–1.15)
≥ 8	13,547	67.4	1.20 (1.19–1.22)	1.20 (1.18–1.21)
Anxiety			1.55 (1.54–1.56)	1.44 (1.43–1.45)
Pain:
Severe	21,889	66.3	1.21 (1.20–1.23)	1.08 (1.07–1.09)
Moderate	56,482	62.7	1.15 (1.14–1.16)	1.05 (1.04–1.06)
None	150,117	54.6	1.0	1.0
Any shortness of breath	55,283	60.8	1.06 (1.05–1.07)	1.00 (0.99–1.01)
Oxygen use	65,618	60.3	1.05 (1.04–1.06)	0.99 (0.98–0.99)