A high prevalence of depression and anxiety was found in nursing home residents with chronic obstructive pulmonary disease (COPD), according to a study in the International Journal of Chronic Obstructive Pulmonary Disease.
Although it is widely known that COPD disproportionately affects older adults, the researchers noted they know little about the epidemiology of COPD for those living in nursing homes; limited information is available on COPD’s psychological impact.
The researchers explained that, based on the characteristics of nursing home residents with COPD, such patients most likely have accompanying depression or anxiety. Consequently, they conducted a study “to estimate the prevalence of depression and anxiety among middle-aged and older long-term stay nursing home residents with COPD and evaluate sociodemographic and clinical factors associated with depression and anxiety in this population.”
To conduct their study, the researchers used the US 2018 Minimum Dataset (MDS), which contains information on all nursing home residents in Medicare- and Medicaid-certified facilities. MDS is a mandated process for the clinical assessment of all nursing home residents that includes their demographic information, symptoms, clinical conditions, and cognitive and physical functioning measures.
The study population consisted of 239,615 long-term stay nursing home residents 50 years and older. All patients included had at least 1 quarterly or annual MDS assessment in 2018 and had a COPD diagnosis on the MDS or on Medicare hospital claims using International Classification of Diseases, Tenth Revision (ICD-10) codes J41, J43, and J44.
The mean (SD) age of participants was 79 (10.6) years, with one-third of the study sample 85 years or older. The researchers noted that 62% of the population were women, 80% were non-Hispanic White patients, and 43.7% had 5 or more comorbid conditions, like hypertension, dyspnea, obesity, and dementia.
The researchers explained that anxiety and depression were diagnosed through clinical diagnoses, treatment orders, and physical examination findings. In this population, 57.6% had depression, 37.2% had anxiety, and 27.5% had both mental health conditions. Current tobacco users, women, patients 50 to 64 years old, those who reported having moderate or severe pain, and residents with multimorbidity were more likely to have anxiety or depression.
Nursing home residents with COPD and anxiety were 1.84 times (95% CI, 1.81-1.86) more likely to have accompanying depression compared with those without either disease state. In comparison, patients with COPD and depression were 1.44 times more likely (95% CI, 1.43-1.45) to receive an anxiety diagnosis than residents without either.
“A higher prevalence of depression than anxiety in our study population can be due to the considerably increasing prevalence of comorbidities and high prevalence of pain, as well as the insufficient recognition of depression and lack of adequate guideline-based treatment by physicians,” the authors wrote.
The findings also showed that a large proportion of nursing home residents with depression and anxiety were being treated with medication. Eighty-six percent of residents with depression were treated with antidepressants, and 54.8% with anxiety were treated with anxiolytics.
Despite this, several studies showed that patients with COPD exhibit lower medication adherence rates. Consequently, the researchers suggested clinical teams consider nonpharmacological interventions for COPD-related anxiety and depression, like pulmonary rehabilitation, education, and psychosocial support.
The researchers acknowledged several limitations to their study, one being that it did not differentiate between early-onset and late-onset depression, the latter being more frequently associated with the selected comorbidities. Another was that they lacked data on forced expiratory volume, which could have helped them to determine the form and severity of COPD within residents using the Global Initiative for Chronic Obstructive Lung Disease grades.
In the future, the researchers urged clinicians to watch for anxiety and depression in those with COPD, urging them to use a multidisciplinary team approach to manage these conditions.
“Further investigation is also needed for appropriate and effective screening, diagnosis, and management of anxiety and depression among nursing home residents with COPD since these conditions have been shown to lead to an increased risk of disease exacerbation and death,” the authors concluded.
Osundolire S, Goldberg RJ, Lapane KL. Anxiety and depression among US nursing home residents with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2023;18(8):1867-1882. doi:10.2147/COPD.S417449