Depression, Frailty, and Quality of Life

Image result for depression brain wordmapDepression has often been featured prominently in discussions about the impact of isolation on nursing home residents during the COVID-19 pandemic. For many, the virus itself, compounded by the absence of usual support systems, has increased their risk for depression. 

When depression is accompanied by frailty (and often cognitive impairment), the challenges of care and the urgency to address the condition are heightened. But there are steps clinicians can take.

Taking Patients from Denial to Determination

The complexity of caring for someone with depression, especially when frailty and cognitive impairment are also present, is challenging and made worse by the reluctance of many older people to admit their feelings. They often quietly accept their sadness, apathy, or withdrawal as something to be expected “at their age.” Sadly, there is still a stigma attached to depression for many older adults; so recognizing and treating it becomes more difficult. It’s not a surprise that depression is often under-recognized and then untreated. 

Tools can help. Clinicians in the nursing home setting have the advantage of resources such as the Patient Health Questionnaire (PHQ-9), an assessment for a Major Depressive Disorder (MDD). 

These assessments not only give an indication of the presence and degree of depression but also identify the emotions of the resident who is depressed. This lends itself to the opportunity to care plan to meet their specific needs. Identifying the specific symptoms of depression and the degree of frailty will enhance the management plan as both need to be addressed together. 

Something to Consider

A recent, small study adds a new wrinkle to managing depression in a frail person. Brown and colleagues looked at elderly patients with depressive disorders and comorbid frailty to see if they responded differently to antidepressants compared with non-frail elderly patients with major depressive disorder. They found this to be true, although it is important to note that the study was small and only two antidepressants were involved.

Better Days Ahead

Of course, we want to be sure that when the diagnosis of depression is confirmed in a frail resident we provide person-centered care. This means the best possible medication for that individual, as well as nonpharmacologic interventions specific to their needs and interests. 

These combined approaches will address the primary risks for late-life depression: cognitive impairment, isolation, grief, loss, declining health, and frailty while giving time for a trial of antidepressants, as appropriate. We can reduce the burden of depressive symptoms now and stay informed on future research and clinical interventions.

Contact us to learn more about frailty and its impact on care in the nursing home population.