Depression in Long Term Care Heart Patients Often Goes Untreated

Cardiologists, other doctors and long term carestaff might be missing the big picture as one survey suggeststhat only a third of heart disease patients with serioussymptoms of depression or anxiety get any treatment.The findings are significant because psychological problems havebeen linked to poorer health and higher death rates in heartdisease patients. Unfortunately, long term care residents andother heart patients just aren't being screened becausephysicians are just focused on the heart disease and don't thinkabout other factors that could contribute to the condition.

We know that heart attack survivors suffer from psychologicaldistress twice as much as the general population and, withcongestive heart failure patients, who are often residing innursing homes, the figure is twice that?Staggering!However, only about one third of heart disease patients who report thesymptoms are ever treated by a mental-health provider. This isappalling because research suggests that psychological problemsoften contribute to the onset of heart disease and worsen itsprogression.

It's not entirely clear how psychological distressand heart disease are connected. However, there is somespeculation that psychological symptoms may contribute to bloodclots or make the heart beat less efficiently.Since the overwhelming amount of long term care residents are women, it'simportant for staff to note that women with mild and moderatedepression are 50 percent more likely to have heart attacks thanare other women.

It's also crucial to note that depression andanxiety are frequent responses to traumatic events, such as thelife-threatening and chronically debilitating illnesses, whichare often seen in long term care settings. The seriousness ofthese symptoms is usually proportional to their duration anddepth and the degree to which they compromise the resident'slife quality and/or participation in the treatment process.

Triggers for referral for a psychological evaluation includesymptoms that have continued for more than two weeks orsignificantly impair functioning, life quality or participationin prescribed treatment programs.

The role of heart doctors in detecting psychological problems in their patients who are longterm care residents is a big problem. They often don't havetime because of the new emphasis on quick turnaround and highproductivity. That places the onus squarely on the long termcare staff who see the resident every day.

One remedial protocol to identify the residents who really need help might befor nurses and other staff members to help screen residentsbefore they meet with their cardiologists. Neglectingidentification and treatment of psychological symptoms inresidents with heart disease is very unfortunate because doctorsnow have effective tools to treat psychological problems, whichmight lead to a lessening of both the psychological distress andcardiac dysfunction.

Copyright 2005, M. Shery

Dr. Michael Shery is the founder of Long Term Care Specialists in Psychology, a mental health firm specializing in consulting to the long term care industry. Itswebsite, http://www.NursingHomes.MD provides state-of-the-art mental health treatment, facility staffing and career information to long term care professionals. To get a copy of the special report, "How to Reduce Resident Agitation Using Strength-Embedded Counseling," email: and put "Special Report" in the subject field.

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