Factors Associated with Depression among Long-Term Care Residents in Korea

Abstract

Depression is one of the most prevalent and disabling psychological conditions in old age. With increases in numbers of people receiving long-term supports in facilities, the well-being of this population is becoming a growing concern. Those residing in nursing homes are especially vulnerable to depressive symptoms, due to their poor physical and cognitive health, lower levels of functioning, limited opportunities of social engagement, and the routine and stale environment of the facilities. Despite the growing significance of the long-term care community, much of the literature on the depressive symptoms of the elderly in Korea remain centered around the community-dwelling population. Therefore the purpose of this study is to identify the demographic, health-and function related, and social factors associated with depressive symptoms using a nationally representative dataset of long-term care facility residents in Korea.

This study analyzes secondary data from 1,466 older adults residing in 91 long-term care facilities across Korea. The data was collected using the interRAI Long-Term Care Facility Resident Assessment System (interRAI LTCF), a comprehensive geriatric assessment tool that has been validated for international use. A conceptual framework for the study was drawn through comprehensive review of the literature, and utilized to create an analytic model including demographic, health-and-function, and social factors. Depression was measured using the Depression Rating Scale, a 14 point scale developed for use in the nursing home setting. A cut off of 3 was utilized for defining significant depressive symptoms.

Descriptive statistics were carried out to get an understanding of the basic profile of the sample and the institutions in which they reside in. Next, Chi-squared and t-tests were performed to compare the characteristics of those with significant depressive symptoms and those without. Third, multilevel multivariate logistic regressions were run to identify the factors associated with depressive symptoms. Finally further bivariate and multilevel multivariate regression analyses were performed after stratifying the data by cognitive impairment levels to observe differences in depression rates and associated factors across different levels of cognitive function.

Out of the analytic sample of 1,466 long-term care facility residents, 42% were found to have significant depressive symptoms as measured by the DRS. Study results showed that the female gender, moderate cognitive impairment, increasing pain levels, experience of interpersonal conflict within the nursing home, loneliness, and stressful life events to be independently significant factors associated with depressive symptoms in the nursing home.

Stratified analyses by cognitive impairment levels revealed that depressive symptoms were most prevalent among those who had moderate cognitive impairment. Severe functional impairment was a risk factor of depressive symptoms only among those with intact cognition. Among those with moderate cognitive impairment, gender, pain, and social engagement was found to be significant factors. Sensory impairment, pain, and chronic disease were identified as factors associated with depressive symptoms among those with severe cognitive impairment. The three social factors, experience of interpersonal conflict, loneliness, and stressful life event were identified as significant contributors of depressive symptoms throughout all levels of cognitive impairment.

The study revealed high levels of depressive symptoms found in long-term care settings in Korea. The multidimensional factors associated with depressive symptoms indicate the need for a comprehensive approach to delivering care in the nursing home. Also, the strong association between social factors and depressive symptoms suggests that creating a healthy and interactive social environment within the nursing facility may be an effective strategy to lower depressive symptoms. Finally, special attention must be given to those with milder levels of cognitive impairments that are more vulnerable to depressive symptoms and also more sensitive to various factors.