High Rates of Depressive Symptoms Seen in the Last Year of Life

High rates of depression were observed in older adults during the year preceding death, according to study data published in the Journal of the American Geriatric Society. Depressive symptoms arising in the final year of life were greater among women, young adults, and nonwhite adults.

Elissa Kozlov, PhD, of Rutgers University in New Brunswick, New Jersey, led study efforts to identify the epidemiology and trajectory of depressive symptoms immediately prior to death. Data were abstracted from the Health and Retirement Study, a nationally representative panel study of older adults (ages >50 years) in the United States. Assessments, conducted biennially, captured sociodemographic and clinical characteristics through a battery of tests.

Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD-8). The analysis used data from respondents who died within 12 months of initial study interview. The mean CESD-8 score was compared across patient age groups over time before death. Analyses were adjusted for age, race, sex, net worth, educational attainment, self-reported illnesses, and activities of daily living limitations.

For 3274 individuals (47.5% women; 86.0% white) who died within 12 months of the survey interview, even distribution across age groups was observed: 20.9% were ≤65 years; 27.5% were 66 to 75 years; 32.5% were 76 to 85; and 19.1% were >85 years. The majority (59.3%) of patients screened positive for depression in the final month before death.

Mean CESD-8 score increased over time during the last year of life. Specifically, gradual increases in CESD-8 scores were observed from 12 to 4 months before death (+0.05 points/month; 95% CI, 0.01-0.08), while steeper increases occurred across the final 4 months (+0.29 points/month; 95% CI, 0.16-0.39).

Elevated rates of depression were observed in women compared with men over the final year (P <.01), although these differences were no longer significant in the final month alone (P =.49). Similarly, younger patients reported a significantly greater burden of depression in the final year overall (P =.07) although not in the final month (P =.26). Nonwhite patients also experienced higher nonsignificant rates of depression compared with white patients (P =.17).

Impairment in activities of daily living and lung disease were associated with persistently elevated CESD-8 scores across the final year of life. By contrast, cancer was only associated with elevated levels of depression in the final month of life (P =.01).

These data underscore the significant burden of depression among older adults in the final year of life, with differential rates observed across gender, race/ethnicity, and clinical strata. As a study limitation, investigators noted that the survey did not collect CESD-8 data when a proxy respondent was used. As the number of proxy responders increased with greater proximity to death, the lack of CESD-8 data from these participants may have led to an underreporting of depressive symptoms.

“While depressive symptoms at the end of life are common, they are treatable and must be proactively addressed to reduce distress and ensure that everyone has the opportunity to experience a ‘good death,’ free of depressive symptoms,” the investigators concluded.

Reference

Kozlov E, Dong X, Kelley AS, Ankuda CK. The epidemiology of depressive symptoms in the last year of life [published online November 5, 2019]. J Am Geriatr Soc. doi:10.1111/jgs.16197