Hopkins study finds depressed nursing home residents have higher death rate


Nursing home residents who suffer from depression have a much higher death rate than do residents in good mental health, but the disorder is seldom diagnosed and treated by their physicians, Johns Hopkins School of Medicine researchers reported yesterday.

Dr. Barry W. Rovner, a Hopkins psychiatrist who led the study, said the research shows that too many physicians regard the overriding sadness suffered by many elderly people to be a normal symptom of aging -- rather than a definable, treatable illness that can kill when it is ignored.

"This tells you that there is something that is very lethal about depression," Dr. Rovner said in an interview yesterday. "But people accept these conditions as normal. It's like saying there's an epidemic of tuberculosis, but nobody sees it as a disorder."

Details of the study appear in today's Journal of the American Medical Association.

The Hopkins team based its conclusions on a study of 454 residents at eight nursing homes in metropolitan Baltimore. All the homes are owned by Meridian Healthcare Inc. -- the largest nursing home chain in Maryland -- which has funded a series of studies aimed at finding better ways to treat the elderly.

The study found that clinically depressed patients, who made up 12.6 percent of the total examined group, had a 59 percent greater chance of dying within a year than did non-depressed residents.

As many as 450,000 residents of nursing homes, or nearly one-third of the 1.5 million Americans in those facilities, may suffer from treatable depressive disorders or symptoms, the researchers estimated.

Major depression is a persistent condition marked by low self-esteem, recurrent thoughts of death and -- often -- fatigue, insomnia and anorexia, Dr. Rovner said.

"It doesn't come and go," Dr. Rovner said, distinguishing it from blue moods that may pass and go depending on transient life events.

The researchers found that 47 percent of the patients suffering from major depression died within one year -- as opposed to 30 percent of the patients who were not depressed.

But the family doctors and internists who visited patients in the nursing homes correctly diagnosed and treated less than one-quarter of the patients who, according to the Hopkins team, were truly depressed.

The depressed patients who died succumbed to physical problems that are extremely common to people who are crippled with sadness -- inadequate rest from insomnia, poor nutrition from anorexia and the many medical problems that result from immobility.

Dr. Rovner said the findings suggest that family doctors need better training in the art of diagnosing depression and prescribing medications that can bring about remarkable recoveries. But, he said, the problem goes deeper than that.

The low Medicaid reimbursements paid to doctors visiting patients in nursing homes means that many don't see their patients often enough or spend sufficient time, he said. And he said the rates for psychiatrists are even lower -- so they are rarely seen in nursing homes.

Arnold Richman, chairman of the Meridian chain, said he hoped the study would make the internists more sensitive to the psychiatric needs of the patients. But he said the industry has a shortage of family doctors trained to recognize and treat disorders such as depression.

Some elderly patients who enjoyed a healthy mental state all their lives fall into a deep depression once they are admitted to a nursing home, due to illness and separation from family. But some drugs and certain medical conditions such as a stroke to the left side of the brain can also cause depression, Dr. Rovner said.

"Patients need more than medication. They need to be in activities. They need to have support."

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