Changes in depressive symptoms and cognitive impairment in older long-stay nursing home residents in the USA: a latent transition analysis

Abstract

Objectives

To longitudinally examine the latent statuses of depressive symptoms and their association with cognitive impairment in older U.S. nursing home (NH) residents.

Method

Using Minimum Data Set 3.0, newly-admitted, long-stay, older NH residents with depression in 2014 were identified (n = 88,532). Depressive symptoms (Patient Health Questionnaire-9) and cognitive impairment (Brief Interview of Mental Status) were measured at admission and 90 days. Latent transition analysis was used to examine the prevalence of and the transition between latent statuses of depressive symptoms from admission to 90 days, and the association of cognitive impairment with the statuses at admission.

Results

Four latent statuses of depressive symptoms were identified: ‘Multiple Symptoms’ (prevalence at admission: 17.3%; 90 days: 13.6%), ‘Depressed mood’ (20.0%; 19.5%), ‘Fatigue’ (27.4%; 25.7%), and ‘Minimal Symptoms’ (35.3%; 41.2%). Most residents remained in the same status from admission to 90 days. Compared to residents who were cognitively intact, those with moderate impairment were more likely to be in ‘Multiple Symptoms’ and ‘Fatigue’ statuses; those with severe impairment had lower odds of belonging to ‘Multiple Symptoms’, ‘Depressed Mood’, and ‘Fatigue’ statuses.

Conclusion

By addressing the longitudinal changes in the heterogeneous depressive symptoms and the role of cognitive impairment, findings have implications for depression management in older NH residents.

Keywords:

• Late life depression
• cognitive impairment
• nursing home
• latent transition analysis

Institutional review board (IRB)

The University of Massachusetts Medical School IRB approved this study.

Disclosure statement

Dr. Christine Ulbricht reports grants from National Institute on Aging, National Institutes of Health during the conduct of the study. Dr. Anthony Rothschild reports grants from Allergan, grants from Janssen, grants from National Institute of Mental Health, non-financial support from Eli Lilly, non-financial support from Pfizer, grants from Irving S. and Betty Brudnick Endowed Chair of Psychiatry, personal fees from GlaxoSmithKline, personal fees from American Psychiatric Press, Inc., personal fees from University of Massachusetts Medical School, personal fees from Up-to-Date, personal fees from Sage Therapeutics, personal fees from Alkermes, grants from Otsuka, outside the submitted work. None were declared for the remaining authors.

Data availability statement

The data that support the findings of this study are available from the Centers for Medicare and Medicaid Services. Restrictions apply to the availability of these data, which were used under a data use agreement for this study. Data are available from www.resdac.org with the permission of the Centers for Medicare and Medicaid Services.

Additional information

Funding

This work was supported by the National Institutes of Health (NIH) National Institute on Aging (NIA) under Grant 1R21AG056965 (PI: Christine Ulbricht). All authors were supported by this grant.