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Rates of Clinical Depression Diagnosis, Functional Impairment, and Nursing Home Placement in Coexisting Dementia and Depression

Received October 8, 2003; revised April 12, May 26, 2004; accepted June 1, 2004. From the Serious Mental Illness Treatment Research Education and Clinical Center (SMITREC), Health Services Research and Development, VA Ann Arbor Healthcare System (HCK,PC,FCB,DEW); the Division of Geriatric Psychiatry, University of Michigan, Ann Arbor, MI (HCK,PC,FCB,AMM); the Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System (HCK), and the VISN 11 Mental Health Service Line, Dept. of Veterans Affairs (AMM). Send correspondence and reprint requests to Dr. Helen Kales, Psychiatry Service (116A), Ann Arbor VA Medical Center, 2215 Fuller Road, Ann Arbor, MI 48105. e-mail: kales{at}umich.edu
© 2005 American Association for Geriatric Psychiatry

Objective: Depression is commonly found as a coexisting condition in dementia. An earlier retrospective study by the authors found that patients with coexisting dementia and depression (CDD) were high utilizers of inpatient and nursing home care. The current prospective study was designed to investigate specific factors that might contribute to outcomes such as nursing home placement by examining the detection and course of CDD subjects as compared with subjects with either disorder alone. Methods: Eighty-two subjects (N=29 with CDD, N=27 with Depression Alone, and N=26 with Dementia Alone) were recruited and reassessed at 3, 6, and 12 months after baseline assessment. Results: Lower rates of depression detection by treating (non-study) physicians were found in CDD subjects. Only 35% of the CDD group were correctly diagnosed and receiving adequate treatment for their depression. Although the CDD group did not differ in baseline dementia stage or cognitive functioning as compared with the dementia-only group, they had significantly higher levels of functional impairment. CDD subjects used nursing home care at significantly higher rates; nursing home placement correlated significantly with baseline severity of functional impairment and mood measures, but not with other factors, including dementia stage and medical burden. Conclusions: Undetected, untreated, or inadequately treated depression may result in higher rates of nursing home placement in patients with dementia by increasing their functional disability. Aggressive outpatient treatment of depression could improve the course of coexisting dementia and depression.

Key Words: Health Service Use • Nursing Home Residents • Depression • Functional Impairment

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