Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Center for Psychopharmacologic Research and Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
Int J Geriatr Psychiatry. 2017 Nov;32(11):1172-1181. doi: 10.1002/gps.4723. Epub 2017 May 23.
The objective of this study is to describe the prevalence of depression and cognitive impairment among newly admitted nursing home residents in the USA and to describe the treatment of depression by level of cognitive impairment.
We identified 1,088,619 newly admitted older residents between 2011 and 2013 with an active diagnosis of depression documented on the Minimum Data Set 3.0. The prevalence of receiving psychiatric treatment was estimated by cognitive impairment status and depression symptoms. Binary logistic regression using generalized estimating equations provided adjusted odds ratios and 95% confidence intervals for the association between level of cognitive impairment and receipt of psychiatric treatment, adjusted for clustering of residents within nursing homes and resident characteristics.
Twenty-six percent of newly admitted residents had depression; 47% of these residents also had cognitive impairment. Of those who had staff assessments of depression, anhedonia, impaired concentration, psychomotor disturbances, and irritability were more commonly experienced by residents with cognitive impairment than residents without cognitive impairment. Forty-eight percent of all residents with depression did not receive any psychiatric treatment. Approximately one-fifth of residents received a combination of treatment. Residents with severe cognitive impairment were less likely than those with intact cognition to receive psychiatric treatment (adjusted odds ratio = 0.95; 95% confidence interval: 0.93-0.98).
Many newly admitted residents with an active diagnosis of depression are untreated, potentially missing an important window to improve symptoms. The extent of comorbid cognitive impairment and depression and lack of treatment suggest opportunities for improved quality of care in this increasingly important healthcare setting. Copyright © 2017 John Wiley & Sons, Ltd.
本研究旨在描述美国新入住养老院居民中抑郁和认知障碍的患病率，并描述根据认知障碍程度对抑郁的治疗情况。
我们确定了 2011 年至 2013 年间有 1,088,619 名新入住的老年居民患有活跃的抑郁诊断，这些诊断在最小数据集 3.0 上有记录。根据认知障碍状况和抑郁症状，估计接受精神科治疗的患病率。使用广义估计方程的二元逻辑回归为认知障碍程度与接受精神科治疗之间的关联提供了调整后的优势比和 95%置信区间，调整了居民在养老院中的聚类和居民特征。
26%的新入住居民患有抑郁；其中 47%的患者也有认知障碍。在有工作人员评估抑郁、快感缺失、注意力集中受损、精神运动障碍和易怒的患者中，有认知障碍的患者比没有认知障碍的患者更常见。所有患有抑郁的居民中，有 48%未接受任何精神科治疗。大约五分之一的患者接受了联合治疗。认知障碍严重的患者接受精神科治疗的可能性低于认知功能正常的患者（调整后的优势比=0.95；95%置信区间：0.93-0.98）。
许多新入住的患有活跃抑郁诊断的患者未接受治疗，可能错过了改善症状的重要窗口期。认知障碍和抑郁的共病程度以及缺乏治疗表明，在这个日益重要的医疗保健环境中，有机会改善护理质量。版权所有 © 2017 约翰威立父子公司。
