Depression and aggressive behaviour in continuing care: how cognitive impairment might not explain the whole story

Context: There is currently little research examining the relationship between depression and aggressive behaviour among individuals receiving long-term care. Previous research has focused on older adults with neurocognitive disorders (e.g., Alzheimer’s). These studies have found a positive association between aggressive behaviour and depression and are additionally associated with cognitive impairment in older adults. Objectives: The current study aims to better understand the relationship between aggressive behaviour and depression amongst older adults with and without cognitive impairment, as previous studies have not yet examined how these relationships may differ across levels of cognitive functioning. Methods: Data from the Continuing Care Reporting System administered by the Canadian Institute for Health Information was used. At the time of analysis, data for individuals receiving continuing care was available across seven Canadian provinces and one territory. Findings: Data from 2,682,612 individuals were extracted (Mage = 80.42, SD = 11.5). A positive relationship between aggressive behaviour and depressive symptoms was found for those with and without cognitive impairment. There was no evidence of a mediating effect of cognitive impairment on aggressive behaviour. Individuals with symptoms of depression demonstrated more aggressive behaviours. Limitations: A limitation of the current work is the cross-sectional nature of the data examined. This restricts the ability to determine causation, and the questions of “Do depressive symptoms predict aggressive behaviour?” or “Are aggressive behaviours early symptoms of depression?” remain. Implications: These findings indicate that, independent of cognition, those with depressive symptoms are more likely to exhibit aggressive behaviour. Recommendations on identification and treatment of depression in this population are discussed and related policy changes are considered.