Victoria Tang, M.D.

Having more preoperative symptoms of depression was associated with a higher chance of functional decline in the year following orthopedic, gastrointestinal or vascular surgery, according to a study published this week in the Journal of the American Geriatrics Society.

Researchers found that older adults with depressive symptoms were more likely to be discharged to a post-acute care facility, but those same symptoms conditions weren’t linked to longer hospitalizations or 30-day readmissions.

The findings hold importance for skilled nursing providers sending residents out for needed procedures as well as those receiving new residents after surgical interventions, lead author Victoria Tang, M.D., told McKnight’s.

“For SNF residents that have depression prior to their surgery, they are less likely to recover their previous function,” said Tang, assistant professor of medicine in the Division of Geriatrics at the University of California, San Francisco School of Medicine. “SNFs should think about helping the residents and their family members to set appropriate expectations for recovery and help guide them in preparing for the new norm when the resident returns home.”

For the study, a team from UCSF and aging brain researchers in Boston examined patients aged 70 or more years who were headed for surgery at two Harvard-affiliated medical centers. They gave 560 patients preoperative evaluations using the 15‐item, short‐form Geriatric Depression Scale to assess whether each individual had a low, moderate or high symptom burden.

They then tracked whether those patients experienced a decline in seven activities of daily living — including housekeeping, handling finances and medication adherence — one year later. Thirteen percent of participants never returned to preoperative functional status, and those with six or more depressive symptoms were 2.7 times more likely to struggle with recovery.

The team also found that 73% of individuals with the highest level of depressive symptoms needed follow-up care in a post-acute setting, compared with 50% of those in the group with least symptoms.

Tang urged those interested in patient-centered outcomes to incorporate depression screenings as part of routine pre-surgical preparation.

“Preoperative screening for depressive symptoms can help … to identify those that may be at risk for functional decline after surgery and in whom measures can be taken to prepare for the functional decline … and to identify those in whom a preoperative intervention may be useful, such as treating depressive symptoms through medications or counseling and/or proactively preventing functional decline after surgery with pre- and post-operative physical therapy,” she wrote.

Tang also noted that previous research has shown that depressed patients are less likely to engage with physical therapy. SNFs, she told McKnight’s, could focus on tailoring interventions to increase engagement in the pursuit of better outcomes.