Residents suffer and die as interventions go unused

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John O'Connor
John O'Connor

When providers consider the challenges residents face, it's usually within the context of activity of daily living limits. Things like trouble with walking, dressing, bathing and eating tend to be top of mind.

To the extent that mental conditions enter the discussion, Alzheimer's or some sort of dementia usually dominates the conversation. That's probably not too surprising, as dementia affects half to three-quarters of all residents.

But a phenomenon that fuels both physical and mental decline often flies under the radar. I'm referring, of course, to the pain-depression cycle.

Most caregivers have seen its downward cascade play out: Residents experience pain that makes them feel helpless and perhaps hopeless. Depression sets in, which then fuels fatigue, loss of conditioning, irregular sleep — and even more physical suffering. Along the way, residents might lose interest in taking their meds or following other medical advice, while racking up a twofold risk for Alzheimer's and a premature death.

While it's not known exactly how often this vicious cycle occurs, the Centers for Disease Control and Prevention has estimated that 5% or more of people age 65 and older residing in community settings are battling major depression at any given time.

According to a study published in 2009, 14.4% of nursing home residents suffer acutely from major depression, 14.4% suffer from minor depression, and 18.6% have a depressive diagnosis.

The suffering alone should give us all reason for pause.

But suffering is hardly the only cost. Researchers at the University of Washington School of Medicine calculated that annual medical outlays for Medicare members who had depression, diabetes and congestive heart failure exceeded $20,000 each. For similarly afflicted people who weren't depressed, the cost was $12,000. Put another way, depression can increase caregiving costs by two-thirds.

So you'd think that researchers would be flocking to determine whether counseling and other interventions that stave off depression might help. Sadly, the connection has been largely ignored.

One rare exception is a five-year study now taking place at the University of Pittsburgh Medical Center. Now in its third year, the Pitt study has targeted three groups of seniors particularly vulnerable to depression: those with mild cognitive impairment, those with osteoarthritis of the knee, and those who are frail and in need of social and medical assistance.

Treatments largely focus on improving life quality — such as ways to improve sleep or physical functioning or to develop problem-solving skills — rather than the use of anti-depressant medications.

Charles Reynolds III, a geriatric psychiatrist heading up the Pittsburgh study, said the goal is to give seniors better strategies for preventing mood swings and to stave off the learned helplessness that is at the core of depression.

It's sad that residents are needlessly suffering and dying, while possible interventions are going unused. But the real outrage here is that there is no outrage here.

John O'Connor is the editorial director at McKnight's. Follow him on Twitter at @ltcritr.
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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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