Friday, December 21, 2018

Older Adults at Increased Risk of Depression, Anxiety After Rehab Ends

Older adults who receive rehabilitation services are at higher risk for depressive and anxiety symptoms up to a year after rehabilitative services are discontinued compared with those who do not receive rehabilitative services, according to a study in the American Journal of Geriatric Psychiatry.

“As mental illness is associated with considerable morbidity and may affect rehabilitation outcomes, additional efforts to identify and treat depression and anxiety in these older adults may be warranted,” wrote Adam Simning, M.D., Ph.D., of the University of Rochester School of Medicine and Dentistry and colleagues.

The researchers evaluated data from 5,979 adults in the 2016 National Health and Aging Trends Study (NHATS), a nationwide study of Medicare beneficiaries aged 65 years and older. As part of the NHATS, participants are interviewed annually. For this study, the researchers specifically focused on patient responses to the two-item Patient Health Questionaire (PHQ-2); the two-item Generalized Anxiety Disorder (GAD-2) scale; and a question regarding whether they had received rehabilitative services and, if so, where they received these services.

In the study sample, 16.5% reported receiving rehabilitation services in nursing home, inpatient, outpatient, or in-home settings in the prior year. A higher proportion of Medicare beneficiaries who received these rehabilitation services had clinically significant depressive and anxiety symptoms at follow-up than those who did not receive these services (depression: 18.4% vs. 10.4%; anxiety: 11.8% vs. 8.8%), Simning and colleagues reported.

The researchers found that the presence of depressive and anxiety symptoms varied according to where participants had received their rehabilitative services. The majority of participants with depressive symptoms had received their rehabilitative services in either a nursing home or inpatient facility (38.8%) or in their homes (35.3%), compared with those who received services as outpatients (8.6%) or at a combination of rehabilitative sites (20.3%). The rates of anxiety were higher for participants who had received rehabilitative services in a nursing home, inpatient facility, or their homes compared with the other sites, as well.

Compared with participants who did not have depressive or anxiety symptoms, those who had symptoms were more likely to be older, nonwhite, and living alone; have less formal education; have dementia and self-reported decreased functioning in self-care and household activities; and to have had depressive and anxiety symptoms at baseline.

The researchers noted a need for psychiatric interventions for older adults who receive rehabilitation services. “As depressive and anxiety symptoms are common in these patients, associated with considerable morbidity, and/or may interfere with rehabilitation treatment and recovery, devising interventions that target these symptoms in rehabilitation settings could have a significant public health impact,” Simning and colleagues wrote

For related information, see the Psychiatric News article “Older Adults Are More Likely to Receive Prescriptions for Depression, Anxiety.”

(Image: Diego Cervo/Shutterstock)


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