With the decline in physical and cognitive functioning, older adults gradually emphasize emotional experiences (Carstensen, Reference Carstensen1991). However, older adults are more likely to experience depression than those in other stages of life, and such negative emotions significantly decrease their quality of life (Doraiswamy et al., Reference Doraiswamy, Khan, Donahue and Richard2002; Shao et al., Reference Shao, Yu and Zhang2022). The present commentary mainly focused on the uniqueness of later-life depression and the difference in later-life depression between nursing home residents and private households. We attempted to answer these questions by commenting on this article titled, “Depression in Nursing Home Residents and Its Correlation with Meaning of Family Involvement and Depression of Family.” Finally, we added to Wu et al.’s (Reference Lu, Wu, Pei and Peng2022) future research areas to advance the field of older adults’ adoption and well-being in nursing homes.
What is unique about later-life depression compared to other stages of life
With the significant changes in physical, and cognitive functioning and lifestyle, older adults struggle to suffer from depression (Djernes, Reference Djernes2006; Gao et al., Reference Gao, Xie, Jia and Wang2020; Lum, Reference Lum2022). There are many surveys examining the prevalence of depression to reveal the uniqueness of later-life depression (Luppa et al., Reference Luppa2012; Rodda et al., Reference Rodda, Walker and Carter2011). However, previous studies did not show a consistent tendency. For instance, the meta-analysis by Moreno-Agostino et al. (Reference Moreno-Agostino, Wu, Daskalopoulou, Hasan, Huisman and Prina2021) found that the prevalence of older adults over 65 years was lowest (ranging from 3.3% to 4.9%), followed by youth under 30 years (ranging from 2.1% to 12.8%), and then adults aged 30–64 (ranging from 2.1% to 37.3%). However, some other studies exhibited a relatively high prevalence of depression in older adults (Chi et al., Reference Chi2005; Kim et al., Reference Kim, Jo and Shin2020; Sjöberg et al., Reference Sjoberg, Andres, Buburuzan and Brakemeier2017). For example, the study by Kim et al. (Reference Kim, Jo and Shin2020) showed that the prevalence of depression increased with age, and the prevalence of older adults over 65 years was around 15% in 2013. The study by Chi et al. (Reference Chi2005) showed similar results, finding that 11.0% and 14.5% of community-dwelling Chinese older adults age 60 and over scored above the cutoff, a prevalence rate similar to those found in other countries, including the United States, England, and Finland. In summary, previous studies exhibited an inconsistent tendency of the prevalence of depression with age increases, some showing the prevalence of depression decreasing with age and others showing the opposite trend.
Although the inconsistent results on the prevalence of later-life depression, depression is a common and disabling psychiatric disorder for older adults (Lu et al., Reference Lu, Wu, Pei and Peng2022; Shao et al., Reference Shao, Yu and Zhang2022). It harms older adults’ well-being and daily functioning and even increases their suicidal thoughts and mortality (Cramm et al., Reference Cramm2012; Ko et al., Reference Ko2019; Shao et al., Reference Shao, Yu and Zhang2022). Compared to other life stages, some unique factors lead to the prevalence of later-life depression. Specifically, increasing age, female gender, lower household income, cognitive impairment (especially hearing loss), functional impairment, growing number of medical conditions, social capital, history of depression, and lower social support were associated with depression in older adults (Blazer, Reference Blazer2003; Djernes, Reference Djernes2006; Glaesmer et al., Reference Glaesmer, Riedel-Heller, Braehler, Spangenberg and Luppa2011; Lawrence et al., Reference Lawrence, Jayakody, Bennett, Eikelboom, Gasson and Friedland2020; Kok and Reynolds, Reference Kok and Reynolds2017; Lu et al., Reference Lu, Wu, Pei and Peng2022; Riedel-Heller et al., Reference Riedel-Heller, Busse and Angermeyer2006).
What is unique about later-life depression in nursing home compared with private households
Older adults living place might partly contribute to the inconsistent tendency in the prevalence of later-life depression. Previous studies have shown that depression rates are higher among older adults who live in nursing homes than those who live in private households (Anstey et al., Reference Anstey, von Sanden, Salim and O’Kearney2007; Donna et al., Reference Donna, Marin, Bhardwaj, Lichlyter, Thurston and Mohankumar2010; Jongenelis et al., 2004). They found that the prevalence of later-life depression in nursing homes was higher than twice as high or three to four times higher than in private households, with the prevalence rates varying from 6 to 50% (Anstey et al., Reference Anstey, von Sanden, Salim and O’Kearney2007; Donna et al., Reference Donna, Marin, Bhardwaj, Lichlyter, Thurston and Mohankumar2010; Jongenelis et al., 2004; McDaniel et al., 1995). For example, the review by Djernes (Reference Djernes2006) found that the prevalence of major later-life depression ranged from 0.9% to 9.4% in private households and 14% to 42% in institutional living.
Unlike older adults living in private households, nursing home residents have different living surroundings and stressors. Therefore, factors associated with depression might differ between nursing home residents and private households. Besides the above factors, older adults in nursing homes suffer a heavier lack of social support, negative life events, perceived inadequacy of care, and other care-related reasons, resulting in severe depression (Tiong et al., Reference Tiong, Yap, Huat Koh, Phoon Fong and Luo2013; Wu et al., Reference Lu, Wu, Pei and Peng2022).
A more recent study by Wu et al. (Reference Lu, Wu, Pei and Peng2022) used Geriatric Depression Scale-Short Form 11 to measure the prevalence of later-life depression for eight nursing home residents in northern Taiwan through face-to-face interviews. Furthermore, it also used the Center for Epidemiologic Studies Depression Scale-Short 12 Form to measure family members’ depression and the Family Meaning of Nursing-Home Visits scale to measure caregivers’ nursing home visits to examine the relationship between family Involvement and family members’ depression and later-life depression for nursing homes residents. It found that the prevalence of later-life depression in nursing homes in northern Tianwan was 58.3%.
Besides nursing home residents’ age and self-perceived health status commonly evidenced by previous studies, it initially found that depressive symptoms for nursing home residents increased with having a caregiver motivated to visit to assuage their guilt. The authors argued that when cultures emphasized filial piety, older adults expected that children would care for them. Furthermore, residents’ adjustment is related to caregiver adjustment (Whitlatch et al., Reference Whitlatch, Schur, Noelker, Ejaz and Looman2001). Therefore, when perceiving children’s motivation to visit to assuage their guilt, which is similar to filial piety responsibilities and cannot meet the filial piety expectation, aging parents may exacerbate depression. The authors claimed that longitudinal and cross-culture studies were needed to understand the cause and effect between children’s motivation to visit to assuage their guilt and nursing home residents’ depression.
Future work
Moving beyond later-life depression, we provide two recommendations for future research on older adults’ adoption and well-being in nursing homes. First, longer lifespans, a low birth rate, and widespread industrialization result in an increasing number of older adults residing in nursing homes worldwide. For older adults, being institutionalized is a stressful life event. Before adapting to the new living situation in nursing homes, they experience stress and need adjustments (McCubbin and McCubbin, Reference McCubbin, McCubbin and Thompson1987; McCubbin, Reference McCubbin, McCubbin and Thompson1987). However, most of the included studies in the systematic review are correlational and cross-sectional research (Lu et al., Reference Lu, Wu, Pei and Peng2022; Wang et al., Reference Wang2021; Wu et al., Reference Lu, Wu, Pei and Peng2022). Therefore, longitudinal studies are needed to understand the adoption process in nursing homes for older adults and identify factors that influence and affect their adoption. Second, institutionalizing older adults has become an indispensable way of old-age care even in cultures emphasizing filial piety (Lan et al., Reference Lan, Xiao and Chen2019; Wang et al., Reference Wang2021). Previous studies indicated that social support reduced the negative effects of limited daily living and loneliness on suicidal ideation of nursing home residents and life satisfaction (Lin et al., Reference Lin, Xiao, Lan, Wen and Bao2020; Lu et al., Reference Lu, Wu, Pei and Peng2022; Wang et al., Reference Wang2021). Therefore, future work can find ways to help nursing home residents adapt to the new situation and reduce their negative emotions, such as adults and children keeping in touch with them and providing the emotional connection.
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With the decline in physical and cognitive functioning, older adults gradually emphasize emotional experiences (Carstensen, Reference Carstensen1991). However, older adults are more likely to experience depression than those in other stages of life, and such negative emotions significantly decrease their quality of life (Doraiswamy et al., Reference Doraiswamy, Khan, Donahue and Richard2002; Shao et al., Reference Shao, Yu and Zhang2022). The present commentary mainly focused on the uniqueness of later-life depression and the difference in later-life depression between nursing home residents and private households. We attempted to answer these questions by commenting on this article titled, “Depression in Nursing Home Residents and Its Correlation with Meaning of Family Involvement and Depression of Family.” Finally, we added to Wu et al.’s (Reference Lu, Wu, Pei and Peng2022) future research areas to advance the field of older adults’ adoption and well-being in nursing homes.
What is unique about later-life depression compared to other stages of life
With the significant changes in physical, and cognitive functioning and lifestyle, older adults struggle to suffer from depression (Djernes, Reference Djernes2006; Gao et al., Reference Gao, Xie, Jia and Wang2020; Lum, Reference Lum2022). There are many surveys examining the prevalence of depression to reveal the uniqueness of later-life depression (Luppa et al., Reference Luppa2012; Rodda et al., Reference Rodda, Walker and Carter2011). However, previous studies did not show a consistent tendency. For instance, the meta-analysis by Moreno-Agostino et al. (Reference Moreno-Agostino, Wu, Daskalopoulou, Hasan, Huisman and Prina2021) found that the prevalence of older adults over 65 years was lowest (ranging from 3.3% to 4.9%), followed by youth under 30 years (ranging from 2.1% to 12.8%), and then adults aged 30–64 (ranging from 2.1% to 37.3%). However, some other studies exhibited a relatively high prevalence of depression in older adults (Chi et al., Reference Chi2005; Kim et al., Reference Kim, Jo and Shin2020; Sjöberg et al., Reference Sjoberg, Andres, Buburuzan and Brakemeier2017). For example, the study by Kim et al. (Reference Kim, Jo and Shin2020) showed that the prevalence of depression increased with age, and the prevalence of older adults over 65 years was around 15% in 2013. The study by Chi et al. (Reference Chi2005) showed similar results, finding that 11.0% and 14.5% of community-dwelling Chinese older adults age 60 and over scored above the cutoff, a prevalence rate similar to those found in other countries, including the United States, England, and Finland. In summary, previous studies exhibited an inconsistent tendency of the prevalence of depression with age increases, some showing the prevalence of depression decreasing with age and others showing the opposite trend.
Although the inconsistent results on the prevalence of later-life depression, depression is a common and disabling psychiatric disorder for older adults (Lu et al., Reference Lu, Wu, Pei and Peng2022; Shao et al., Reference Shao, Yu and Zhang2022). It harms older adults’ well-being and daily functioning and even increases their suicidal thoughts and mortality (Cramm et al., Reference Cramm2012; Ko et al., Reference Ko2019; Shao et al., Reference Shao, Yu and Zhang2022). Compared to other life stages, some unique factors lead to the prevalence of later-life depression. Specifically, increasing age, female gender, lower household income, cognitive impairment (especially hearing loss), functional impairment, growing number of medical conditions, social capital, history of depression, and lower social support were associated with depression in older adults (Blazer, Reference Blazer2003; Djernes, Reference Djernes2006; Glaesmer et al., Reference Glaesmer, Riedel-Heller, Braehler, Spangenberg and Luppa2011; Lawrence et al., Reference Lawrence, Jayakody, Bennett, Eikelboom, Gasson and Friedland2020; Kok and Reynolds, Reference Kok and Reynolds2017; Lu et al., Reference Lu, Wu, Pei and Peng2022; Riedel-Heller et al., Reference Riedel-Heller, Busse and Angermeyer2006).
What is unique about later-life depression in nursing home compared with private households
Older adults living place might partly contribute to the inconsistent tendency in the prevalence of later-life depression. Previous studies have shown that depression rates are higher among older adults who live in nursing homes than those who live in private households (Anstey et al., Reference Anstey, von Sanden, Salim and O’Kearney2007; Donna et al., Reference Donna, Marin, Bhardwaj, Lichlyter, Thurston and Mohankumar2010; Jongenelis et al., 2004). They found that the prevalence of later-life depression in nursing homes was higher than twice as high or three to four times higher than in private households, with the prevalence rates varying from 6 to 50% (Anstey et al., Reference Anstey, von Sanden, Salim and O’Kearney2007; Donna et al., Reference Donna, Marin, Bhardwaj, Lichlyter, Thurston and Mohankumar2010; Jongenelis et al., 2004; McDaniel et al., 1995). For example, the review by Djernes (Reference Djernes2006) found that the prevalence of major later-life depression ranged from 0.9% to 9.4% in private households and 14% to 42% in institutional living.
Unlike older adults living in private households, nursing home residents have different living surroundings and stressors. Therefore, factors associated with depression might differ between nursing home residents and private households. Besides the above factors, older adults in nursing homes suffer a heavier lack of social support, negative life events, perceived inadequacy of care, and other care-related reasons, resulting in severe depression (Tiong et al., Reference Tiong, Yap, Huat Koh, Phoon Fong and Luo2013; Wu et al., Reference Lu, Wu, Pei and Peng2022).
A more recent study by Wu et al. (Reference Lu, Wu, Pei and Peng2022) used Geriatric Depression Scale-Short Form 11 to measure the prevalence of later-life depression for eight nursing home residents in northern Taiwan through face-to-face interviews. Furthermore, it also used the Center for Epidemiologic Studies Depression Scale-Short 12 Form to measure family members’ depression and the Family Meaning of Nursing-Home Visits scale to measure caregivers’ nursing home visits to examine the relationship between family Involvement and family members’ depression and later-life depression for nursing homes residents. It found that the prevalence of later-life depression in nursing homes in northern Tianwan was 58.3%.
Besides nursing home residents’ age and self-perceived health status commonly evidenced by previous studies, it initially found that depressive symptoms for nursing home residents increased with having a caregiver motivated to visit to assuage their guilt. The authors argued that when cultures emphasized filial piety, older adults expected that children would care for them. Furthermore, residents’ adjustment is related to caregiver adjustment (Whitlatch et al., Reference Whitlatch, Schur, Noelker, Ejaz and Looman2001). Therefore, when perceiving children’s motivation to visit to assuage their guilt, which is similar to filial piety responsibilities and cannot meet the filial piety expectation, aging parents may exacerbate depression. The authors claimed that longitudinal and cross-culture studies were needed to understand the cause and effect between children’s motivation to visit to assuage their guilt and nursing home residents’ depression.
Future work
Moving beyond later-life depression, we provide two recommendations for future research on older adults’ adoption and well-being in nursing homes. First, longer lifespans, a low birth rate, and widespread industrialization result in an increasing number of older adults residing in nursing homes worldwide. For older adults, being institutionalized is a stressful life event. Before adapting to the new living situation in nursing homes, they experience stress and need adjustments (McCubbin and McCubbin, Reference McCubbin, McCubbin and Thompson1987; McCubbin, Reference McCubbin, McCubbin and Thompson1987). However, most of the included studies in the systematic review are correlational and cross-sectional research (Lu et al., Reference Lu, Wu, Pei and Peng2022; Wang et al., Reference Wang2021; Wu et al., Reference Lu, Wu, Pei and Peng2022). Therefore, longitudinal studies are needed to understand the adoption process in nursing homes for older adults and identify factors that influence and affect their adoption. Second, institutionalizing older adults has become an indispensable way of old-age care even in cultures emphasizing filial piety (Lan et al., Reference Lan, Xiao and Chen2019; Wang et al., Reference Wang2021). Previous studies indicated that social support reduced the negative effects of limited daily living and loneliness on suicidal ideation of nursing home residents and life satisfaction (Lin et al., Reference Lin, Xiao, Lan, Wen and Bao2020; Lu et al., Reference Lu, Wu, Pei and Peng2022; Wang et al., Reference Wang2021). Therefore, future work can find ways to help nursing home residents adapt to the new situation and reduce their negative emotions, such as adults and children keeping in touch with them and providing the emotional connection.
Acknowledgements
This work was supported by the Fundamental Research Funds for the Central Universities [GK202205021].