Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada.
Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada.
Palliat Support Care. 2024 Feb;22(1):137-145. doi: 10.1017/S1478951522001821.
This study examined potential predictors of persistent depressive symptoms in a cohort of seriously ill older adults (aged 65+ years) receiving home care services.
This was a retrospective cohort study using secondary data collected from the Resident Assessment Instrument for Home Care for all assessments completed between 2001 and 2020. The cohort included seriously ill individuals with depressive symptoms at baseline and who continued to have depressive symptoms on reassessment within 12 months ( = 8,304). Serious illness was defined as having severe health instability, a prognosis of less than 6 months, or a goal of care related to palliative care (PC) on admission to the home care program.
The mean age of the sample was 80.8 years (standard deviation [SD] = 7.7), 61.1% were female, and 82.1% spoke English as their primary language. The average length of time between assessments was 4.9 months (SD = 3.3). During that time, 64% of clients had persistent symptoms of depression. A multivariate logistic regression model found that language, pain, caregiver burden, and cognitive impairment were the most significant predictors of experiencing persistent depressive symptoms.
Persistent depressive symptoms are highly prevalent in this population and, left untreated, could contribute to the person experiencing a "bad death." Some of the risk factors for this outcome are amenable to change, making it important to continually assess and flag these factors so interventions can be implemented to optimize the person's quality of life for as long as possible.
本研究考察了接受家庭护理服务的重病老年患者（年龄≥65 岁）队列中持续性抑郁症状的潜在预测因素。
这是一项回顾性队列研究，使用 2001 年至 2020 年间完成的所有居民评估工具家庭护理评估的二级数据。该队列包括基线时有抑郁症状且在 12 个月内再次评估时仍有抑郁症状的重病患者（n=8304）。严重疾病的定义为严重健康不稳定、预后不到 6 个月或入院时的护理目标与姑息治疗（PC）相关。
样本的平均年龄为 80.8 岁（标准差[SD]=7.7），61.1%为女性，82.1%以英语为主要语言。两次评估之间的平均时间为 4.9 个月（SD=3.3）。在此期间，64%的患者有持续性抑郁症状。多变量逻辑回归模型发现，语言、疼痛、照顾者负担和认知障碍是出现持续性抑郁症状的最显著预测因素。
持续性抑郁症状在该人群中患病率很高，如果不加以治疗，可能会导致患者经历“糟糕的死亡”。该结果的一些风险因素是可以改变的，因此重要的是要持续评估和标记这些因素，以便可以实施干预措施，尽可能长时间地优化患者的生活质量。
