Treating Depression and Pain Together Best for Older Patients

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Treating these chronic conditions together may minimize the stigma of depression treatment.
Treating these chronic conditions together may minimize the stigma of depression treatment.

Late-life depression affects adults aged 60 years and older and is associated with increased healthcare utilization and costs, reduced quality of life, poorer prognosis for comorbid conditions, lower survival rates, and suicide.1,2

Approximately 5% of community-dwelling older adults are estimated to be affected by depression; the prevalence increases to 10% among those with medical comorbidities in primary care settings and as high as 35% after critical care hospitalizations.3,4

Chronic pain warrants attention in older adults due to its high prevalence. An estimated  25% to 50% of community-dwelling older adults and 49% to 83% of nursing home residents report chronic pain, and the condition is independently associated with anxiety and depression. 

“Chronic low back pain (CLBP) is one of the most disabling and therapeutically challenging pain conditions afflicting older adults,” explained Jordan F. Karp, MD, an associate professor of psychiatry, anesthesiology, and clinical and translational science and medical director for psychiatry at the University of Pittsburgh Medical Center in Pennsylvania. 

In a study comparing patients with CLBP to those with knee arthritis, Dr. Karp and colleagues found that patients with CLBP had higher rates of mood disorders, slower gait (0.88 m/s vs 0.96 m/s; P = .002), and more comorbid conditions (mean 3.36 vs 1.97; P < .001).4 Furthermore, patients with CLBP performed significantly worse on psychological measures than those with knee arthritis. 

“Treating these chronic conditions together may minimize the stigma of depression treatment and improve treatment acceptability,” Dr. Karp said.

Cognitive impairment is common in late-life depression, affecting executive functioning, attention, and memory; it is associated with long-term risk for dementia. “Cognitive deficits may thus be signs of accelerated brain aging that confers a predisposition to and perpetuates depression,” Dr. Karp said.

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