Day: October 31, 2023

In the realm of long-term care, where leaders and caregivers are dedicated to enhancing the quality of life for individuals, understanding the interplay between mental health and cognitive decline is crucial. A recent large-scale study has shed light on the profound association between depression and dementia, unveiling insights that could be pivotal in shaping future care strategies. 

The study conducted on over 1.4 million Danish citizens from 1977 to 2018, has revealed that individuals with depression were over twice as likely to develop dementia compared to those without depression. This association remained steadfast whether depression was diagnosed early, in the middle, or later in life. Intriguingly, the risk was noted to be higher in men, although the risk for dementia lingered regardless of the timing of depression diagnosis in both genders​¹​. 

The meticulous research conducted over four decades underscores the persistent relationship between these two conditions, stirring the medical and caregiving communities to delve deeper into the underlying mechanisms. Dr. Holly Elser, MD, PhD, a resident at the Hospital of the University of Pennsylvania, emphasized the need for future research to unravel the potential mechanisms linking depression in early adulthood to the subsequent onset of dementia. 

Among the participants, a notable percentage had comorbid conditions such as cardiovascular disease and substance use disorders. The presence of these comorbidities was higher among individuals with a depression diagnosis, hinting at a complex interplay of factors influencing cognitive health. 

Addressing the Concerns: 

The implications of these findings may raise concerns and questions among leaders and caregivers in long-term care centers. Here’s a look at some common inquiries and objections: 

1. Is Depression a Modifiable Risk Factor? 

• With the revealed association between depression and dementia, the question arises whether treating depression could potentially mitigate dementia risk. While this study doesn’t provide a conclusive answer, it certainly paves the way for exploring depression management as a preventive measure against cognitive decline. 

2. How Should Care Strategies Evolve? 

• The findings necessitate a holistic approach to care that encompasses not only physical but also mental health. Tailored interventions addressing depression could be integrated into care plans to promote overall cognitive health. 

3. What About Other Comorbid Conditions? 

• The higher prevalence of cardiovascular disease and substance use disorders among individuals with depression underscores the need for comprehensive care plans that address all aspects of an individual’s health. 

4. How Can Long-term Care Centers Foster a Supportive Environment? 

• Establishing a nurturing environment that prioritizes mental health can be a cornerstone in promoting better cognitive health. Engaging in open conversations about mental health, providing access to psychiatric care, and creating a stigma-free environment are steps in the right direction. 

The revelations from this extensive study serve as a catalyst for a paradigm shift in how we perceive and address mental health in long-term care settings. By embracing a multidimensional approach to care that intertwines physical and mental health, we can stride towards a future where the quality of life for individuals in long-term care centers is significantly enhanced, creating a ripple effect of positive change in the caregiving community. 

Sources: 

Fischer, K. (2023) Depression may raise dementia risk, large study shows, McKnight’s Long-Term Care News. Available at: https://www.mcknights.com/news/clinical-news/depression-may-raise-dementia-risk-large-study-shows/  (Accessed: 23 October 2023).  

Elser H, Horváth-Puhó E, Gradus JL, et al. Association of Early-, Middle-, and Late-Life Depression With Incident Dementia in a Danish Cohort. JAMA Neurol. 2023;80(9):949–958. doi:10.1001/jamaneurol.2023.2309 

Long-term care leaders and caregivers play a critical role in navigating grief, whether it’s the grief of the older adult, the older adult’s family, or their own. It’s essential, then, to address the narrative surrounding grief, and the often-cited ‘Stages of Grief’ that has deeply embedded itself into the fabric of our understanding of loss. 

Elisabeth Kübler-Ross, MD, revolutionized the field of thanatology with her groundbreaking work on the five stages of grief: denial, anger, bargaining, depression, and acceptance. Over time, her work was expanded upon; with professionals like David Kessler adding a sixth stage of finding meaning, while others integrated sub-stages or alternative perspectives. 

However, Rebecca S. Morse, PhD, MA, in her illuminating article recently published in MEDPAGE Today, points out two predominant concerns about this stage theory in the context of grief: 

1. A Lack of Scientific Rigor: The ‘stages’ remain largely descriptive and don’t quite advance to the explanatory, predictive, or controlling objectives that define scientific inquiry. While these stages might offer insights into what individuals are experiencing, they don’t provide universal or consistent patterns that can be applied to everyone. 

2. Prescriptive Application: Perhaps more concerning is the shift from using the stages as a descriptive tool to viewing them as a prescriptive path. Grief is profoundly individualistic. The danger lies in forcing individuals into a mold, potentially alienating them from the support they need, and stigmatizing their unique grieving process. 

Morse explains the allure of stage theories, especially in the realm of developmental psychology. Stages offer simplified frameworks, giving us cognitive shortcuts, or heuristics, to understand complex phenomena. But these very heuristics can be a double-edged sword. By relying on them, we risk succumbing to stereotypes, inadvertently diminishing the profound, multifaceted experiences of grief that individuals undergo. 

The emphasis on these stages often pushes individuals into a box. If someone doesn’t grieve “by the book,” they, or those around them, might mistakenly believe they’re grieving “incorrectly.” This perception can further isolate those in pain, particularly if they belong to historically marginalized groups. Such a limited focus can obstruct cultural humility and more nuanced understandings of grief. 

Morse’s call to retire the stages is a timely reminder for all caregivers and leaders in long-term . While Kübler-Ross’s work was pioneering and remains crucial in understanding grief, it’s vital to ensure that these stages don’t become a restrictive prescription. 

By broadening our perspective, we can offer more comprehensive, compassionate care to those grappling with loss. This is especially crucial in older adult care, where both older adults and caregivers confront grief in multifarious forms. 

In the poignant words of Morse, it’s time to transition from something “wonderfully descriptive” to avoiding that which has become “dangerously prescriptive.” 

[Author’s Note: Special thanks to Rebecca S. Morse, PhD, MA, for her insights and expertise.] 

Sources: 

Morse, R. (2023, August 20). Opinion: Why the “stages of grief” need to be retired. Medical News. https://www.medpagetoday.com/opinion/second-opinions/105952