Depression in Older Patients Admitted for Postacute Nursing Home Rehabilitation

Abstract

OBJECTIVES: To describe the prevalence, recognition, and persistence of depression in older adults undergoing postacute rehabilitation in a nursing home (NH) setting and to explore the effect of depression on rehabilitation outcomes. DESIGN: Prospective cohort study. SETTING: One rehabilitative NH in the Los Angeles area. PARTICIPANTS: One hundred fifty-eight patients (aged >/=65) admitted for postacute rehabilitation over a 9-month recruitment period. MEASUREMENTS: Depression was assessed using the 15-item Geriatric Depression Scale (GDS-15) or the Cornell Scale for Depression (in participants with dementia). Medical records were reviewed for documentation of depression and antidepressant use before and during the rehabilitative NH stay. Rehabilitation process was assessed using total amount of successfully completed therapy (minutes). Rehabilitation outcome was assessed using the motor component of the Functional Independence Measure (mFIM). Measures were performed at admission and 2 months later. RESULTS: Of the 646 potentially eligible patients admitted during the study, 158 consented, and 151 were screened for depression. Forty-two (27.8%) had depressive symptoms (GDS=6 or Cornell=5). Of these, only 15 had a documented diagnosis of depression, and 12 were receiving antidepressants. Depression was associated with longer NH stay but not with discharge mFIM score. Two months later, depression persisted in 24 participants and was associated with worse mFIM (55.5+/-22.7 vs 67.0+/-23.7, depressed vs nondepressed; P=.03). CONCLUSION: Depression was common, underrecognized, and undertreated in these postacute rehabilitation patients. Depression generally persisted and was associated with worse functional status at 2-month follow-up.