Purpose: The primary aim of this study was to assess NPs’ ability to identify depression as a risk factor for cardiovascular disease (CVD) and CVD as a risk factor for depression in older adults.

Rationale: Heart disease is the leading cause of death for those aged 65 and older, and NPs routinely incorporate CVD risk reduction into patient care. A large body of evidence supports depression, prevalent in older adults, as a significant and independent risk factor for, as well as a comorbidity of, CVD.

Supporting literature: Numerous studies support the association between depression in seemingly healthy individuals and future development of CVD. Depression can also exacerbate classic CVD risk factors (e.g., smoking). A meta-analysis of studies of older adults identified depression as an independent risk factor for the onset of CVD and concluded clinically diagnosed MDD to be the most important risk factor for developing CVD. Effective treatment of depression reduces disability, improves outcomes, and quality of life. Yet, older adults are less likely to be diagnosed or receive help for depression compared to younger adults.

Methods: NPs recruited from the AANP membership developed a risk profile using a standardized checklist of potential health risks after reviewing a series of four older adult vignettes.

Results: A national sample of practicing NPs participated (N=111). Risk for CVD in the presence of diagnosed MDD or depression symptoms (DS) was identified by 60-66% of subjects. Risk for depression in the presence of diagnosed CVD was identified among 56-62%. Suicide risk in the presence of MDD or DS was identified by 39-56%.

Implications: Rooted in the biopsychosocial model, NPs are well-suited to integrate physical and mental health in care. Many, however, do not recognize the bi-directional risk of depression and CVD, potentially missing valuable opportunities to implement screening and preventive services to reduce risk, promote early identification, diagnosis, and management in an overall effort to reduce disability, improve outcomes, and quality of life.

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.

Lorraine Novosel PhD, RN, APRN-CNP, AGPCNP-BC, NEA-BC

Appearances