Depression symptoms and cognitive impairment in older nursing home residents in the USA: A latent class analysis.
Depression symptoms and cognitive impairment in older nursing home residents in the USA: A latent class analysis.
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DOI：
10.1002/gps.5301
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发表时间：
2020-07
影响因子：
4
通讯作者：
Ulbricht CM
中科院分区：
文献类型：
--
作者：
Yuan Y;Min HS;Lapane KL;Rothschild AJ;Ulbricht CM
旨在确定美国疗养院 (NH) 居民中出现同质抑郁症状的亚组，并评估亚组是否因认知障碍而异。我们使用最小数据集 3.0 确定了 2014 年 NH 入院时诊断为抑郁症的 104,465 名新入院长期住院居民。患者健康问卷 9 用于测量抑郁症状和认知障碍（完整；中度障碍；严重障碍）的精神状态简短访谈。采用逻辑回归的潜在类别分析 (LCA) 用于：1) 构建抑郁亚组，2) 估计亚组与认知障碍水平之间关联的调整优势比 (aOR) 和 95% 置信区间 (CI)，并根据人口统计学和临床特征进行调整。最拟合的 LCA 模型提出了四个抑郁亚组：轻微症状（潜伏类患病率：42.4%）、疲劳（32.0%）、抑郁情绪（14.5%）和多种症状（11.2%）。亚组成员的几率因认知障碍而异。与认知完整的居民相比，患有中度或重度认知障碍的居民属于疲劳亚组的可能性较小[aOR（95% CI）：中度：0.75（0.71-0.80）；严重：0.26 (0.23–0.29)]并且更有可能属于抑郁情绪亚组[aOR (95% CI)：中度：4.54 (3.55–5.81)；严重：6.41 (4.86–8.44)]。患有中度认知障碍的居民的几率增加[aOR (95% CI): 1.19 (1.12–1.27)]，而患有严重认知障碍的居民属于多种症状亚组的几率降低[aOR (95% CI): 0.63 (0.58–0.68)]。研究结果为改善抑郁症管理提供了基础，同时考虑了抑郁症状亚组和认知功能水平。
To identify subgroups of nursing home (NH) residents in the USA experiencing homogenous depression symptoms and evaluate if subgroups vary by cognitive impairment. We identified 104,465 newly-admitted, long-stay residents with depression diagnosis at NH admission in 2014 using the Minimum Data Set 3.0. The Patient Health Questionnaire-9 was used to measure depression symptoms and the Brief Interview of Mental Status for cognitive impairment (intact; moderately impaired; severely impaired). Latent class analysis (LCA) with logistic regression was used to: 1) construct the depression subgroups and 2) estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the associations between the subgroups and cognitive impairment level, adjusting for demographic and clinical characteristics. The best-fitted LCA model suggested four subgroups of depression: minimal symptoms (latent class prevalence: 42.4%), fatigue (32.0%), depressed mood (14.5%), and multiple symptoms (11.2%). Odds of subgroup membership varied by cognitive impairment. Compared to residents with intact cognition, those with moderate or severe cognitive impairment were less likely to belong to the fatigue subgroup [aOR(95% CI): moderate: 0.75 (0.71–0.80); severe: 0.26 (0.23–0.29)] and more likely to belong to the depressed mood subgroup [aOR (95% CI): moderate: 4.54 (3.55–5.81); severe: 6.41 (4.86–8.44)]. Residents with moderate cognitive impairment had increased odds [aOR (95% CI): 1.19 (1.12–1.27)] while those with severe impairment had reduced odds of being in the multiple symptoms subgroup [aOR (95% CI): 0.63 (0.58–0.68)]. Findings provide a basis for improving depression management with consideration of both subgroups of depression symptoms and levels of cognitive function.
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