Assessing the Impact of Depression on 1-Year Outcomes of Older Adults in Community Long-Term Care

Background & Purpose: Publicly-funded community long-term care (CLTC) services, such as in-home aides and chore workers, home-delivered meals, case management, and adult day services aim to sustain older adults' independence and improve their overall quality of life. Depression may detrimentally affect these service outcomes because of its known association with increased disability and because of the disproportionately high prevalence of depression in CLTC settings. This study compares outcomes of institutionalization, life satisfaction, and quality of life for depressed and non-depressed clients after one-year of CLTC services. Methods: Clients entering Missouri's CLTC system were invited to participate in a telephone survey for a clinical epidemiological study of depression. Interviewers used the Diagnostic Interview Schedule and the CES-D to determine depression status. Depressed clients, along with a random sample of non-depressed clients (CES-D score of 4 or less), were reassessed one year later for their disposition (i.e., institutionalized vs. remaining in the community), satisfaction with their living arrangements, and overall life satisfaction. A Short-Form of the Medical Outcome Studies' health-related quality of life measure (SF-8) was also used at baseline and follow-up, with higher scores indicating greater quality of life. Analysis involved regression models that included sociodemographics, medical comorbidity, cognitive status, and functioning. Results: Clients (n = 614) were predominantly female, 27% African American, all Medicaid recipients, and had a mean age of 72.6 (S.D. 8.05). The disposition model was significant (X2 = 29.20, df=11 p<0.01). Depression, medical and functioning comorbidities were not significantly associated with institutionalization; whereas, being Caucasian, urban residence, and having a mild cognitive impairment did significantly increase the likelihood of entering a nursing home. Depression was significantly associated with lower satisfaction with one's living arrangement (F =4.35, df=11, p<0.0001) and lower overall life satisfaction (F=7.33, df=11, p<0.0001). For the quality of life outcome, depressed clients had lower mean SF-8 physical summary scores at baseline and follow-up [Baseline, Mean (depressed) = 30.4, SD = 9.6 vs. Mean (not depressed) = 35.5, SD = 11.6; Follow-up, Mean (depressed) = 33.7, SD = 9.5 vs. Mean (not depressed) = 36.3, SD = 11.6], and minimal change occurred in quality of life over the one-year period. For the follow-up outcome of quality of life, increased age, increased number of medical conditions, and increased number of functional impairments were significantly associated with lower quality of life; whereas, depression was not significantly associated (F=12.99, df=13, p<0.0001). Conclusions & Implications: Unlike other research documenting the extensive impact of depression on disability, health-related quality of life, and service utilization, these findings are not replicated in CLTC services according to this study. Here, depression is not associated with institutionalization, yet it is linked to lower life satisfaction outcomes. Although depression was persistently associated with lower quality of life over time, it was not associated with the one-year outcome for quality of life. While future is needed to confirm these findings, CLTC service providers should continue to assess the potential contribution of depression, cognitive status, race, urbanicity, and medical and functional comorbidities on service outcomes.