Patterns and correlates of depression in hospitalized older adults (original) (raw)
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Depressive Symptoms After Hospitalization in Older Adults: Function and Mortality Outcomes
Journal of the American Geriatrics Society, 2012
Objectives-To determine the relationship between depressive symptoms after hospitalization and survival and functional outcomes. Design-Secondary analysis of a prospective cohort study Setting-General medical service of two urban, teaching hospitals in Ohio Participants-Hospitalized patients, age 70 years or older. Measurements-We measured 10 depressive symptoms, instrumental activities of daily living (IADL), and basic activities of daily living (ADL) at hospital discharge and 1, 3, 6, and 12 months later. Using all data points, we determined subject-specific changes in depressive symptoms (slopes). We also defined four groups according to the number of depressive symptoms (≤3 symptoms, Low; 4-10 symptoms, High) at discharge and follow-up: Low-Low, Low-High, High-Low, and High-High. We measured mortality at 3, 6, and 12 months after hospital discharge. Results-Both subject-specific discharge depressive symptoms and change in depressive symptoms over time (slopes) were associated (P<0.05) with functional and mortality outcomes. At 1 year, more patients in the Low-Low depressive symptom group were alive and independent in instrumental activities of daily living (IADL) and basic activities of daily living (ADL), compared
The American journal of psychiatry, 1997
The purpose of this study was to examine and compare rates of depression, correlates, and course of symptoms in medically ill hospitalized elders through use of six diagnostic schemes (inclusive, etiologic, exclusive-inclusive, exclusive-etiologic, substitutive-inclusive, and substitutive-etiologic). A consecutive series of 460 cognitively unimpaired patients aged 60 or over who were admitted to the medical inpatient services of Duke Hospital underwent a structured psychiatric evaluation administered by a psychiatrist. Patients with depression were contacted by telephone at 12-week intervals after discharge to assess weekly change in depressive symptoms (median follow-up time = 47 weeks). The prevalence of major depression varied from 10% to 21% depending on diagnostic scheme; similarly, minor depression varied from 14% to 25%. Diagnostic strategy made little difference in known psychological and health characteristics of patients with depression (predictive validity) or severity of...
Depressive Symptoms and 3-Year Mortality in Older Hospitalized Medical Patients
Annals of Internal Medicine, 1999
Background: Depressive symptoms are common in hospitalized older persons. However, their relation to longterm mortality is unclear because few studies have rigorously considered potential confounders of the relation between depression and mortality, such as comorbid illness, functional impairment, and cognitive impairment.
Major depression in hospitalized medically ill older men: Documentation, management, and outcome
International Journal of Geriatric Psychiatry, 1992
Fifty‐three hospitalized elderly men with medical illness were diagnosed with major depressive disorder and followed up for a mean of 2.3 months. Documentation and management of the depression by medical housestaff during the followup period were examined. There was no note of depression in the medical records of 44% of depressed patients, and depression was on the active problem list of only 32%. Followup and management plans for the depression after discharge were documented in 29%. No form of treatment was prescribed for 44% of depressed patients. Outcomes were determined by psychiatric evaluation at the end of the followup period. Of the 33 patients still alive and evaluated at followup, 64% had persistent depression, 18% improved, and 18% were in complete remission. No baseline patient sociodemographic or health characteristic, including severity of depression, was significantly related to improvement. Likewise, neither extent of documentation nor treatment implemented by house...
Journal of Psychosomatic Research, 2019
Objective: To identify trajectories of cognitive-affective depressive symptoms among acutely hospitalized older patients and whether trajectories are related to prognostic baseline factors and three-month outcomes such as functional decline, falls, unplanned readmissions, and mortality. Methods: Prospective multicenter cohort of acutely hospitalized patients aged ≥70. Depressive trajectories were based on Group Based Trajectory Modeling, using the Geriatric Depression Scale-15. Outcomes were functional decline, falls, unplanned readmission, and mortality within three months post-discharge. Results: The analytic sample included 398 patients (mean age = 79.6 years; SD = 6.6). Three distinct depressive symptoms trajectories were identified: minimal (63.6%), mild persistent (25.4%), and severe persistent (11.0%). Unadjusted results showed that, compared to the minimal symptoms group, the mild and severe persistent groups showed a significantly higher risk of functional decline (mild: OR = 3.9, p < .001; severe: OR = 3.0, p = .04), falls (mild: OR = 2.0, p = .02; severe: OR = 6.0, p < .001), and mortality (mild: OR = 2.2, p = .05; severe: OR = 3.4, p = .009). Patients with mild or severe persistent symptoms were more malnourished, anxious, and functionally limited and had more medical comorbidities at admission. Conclusion: Nearly 40% of the acutely hospitalized older adults exhibited mild to severe levels of cognitive-affective depressive symptoms. In light of the substantially elevated risk of serious complications and the fact that elevated depressive symptoms was not a transient phenomenon identification of these patients is needed. This further emphasizes the need for acute care hospitals, as a point of engagement with older adults, to develop discharge or screening procedures for managing cognitive-affective depressive symptoms.
The Prevalence and Correlates of Major and Minor Depression in Older Medical Inpatients
Journal of the American Geriatrics Society, 2000
OBJECTIVES: To describe the prevalence of and characteristics associated with major and minor depression in older medical inpatients and to compare associated characteristics by sex and history of depression. DESIGN: Cross-sectional study of two patient samples, with and without a screening diagnosis of major or minor depression. SETTING: The medical services of two acute care hospitals. PARTICIPANTS: Medical admissions of people aged 65 and older with at most mild cognitive impairment (N 5 380). MEASUREMENTS: Diagnoses of major and minor depression (Diagnostic Interview Schedule), cognitive impairment (Mini-Mental State Examination), premorbid disability, sociodemographic variables (including social networks and support), comorbidity, severity of illness, history of depression. RESULTS: The prevalence of major depression differed by hospital, ranging from 14.2% (95% confidence interval (CI) 5 11.7-17.1) in Hospital A to 44.5% (95% CI 5 33.1-56.4) in Hospital B. The prevalence of minor depression was similar in the two hospitals, ranging from 9.4% (95% CI 5 7.4-11.9) in Hospital A to 7.9% (95% CI 5 2.9-16.3) in Hospital B. After adjustment for hospital, the same characteristics (history of depression, premorbid disability, cognitive impairment, perceived adequacy of support, and visits from friends) were associated with major and minor depression, although most of these associations tended to be weaker for minor depression. Most of these factors were also associated with depression in multivariate analyses. The most important characteristics in women were premorbid disability, history of depression, and adequacy of emotional support; in men they were history of depression, cognitive impairment, and adequacy of emotional support. A cerebrovascular or other cardiovascular diagnosis did not explain the association between depression and cognitive impairment. CONCLUSION: Major and minor depression occur frequently in older medical inpatients and are associated with similar patient characteristics. A history of depression and the patient's sex should be considered in the identification and interpretation of these associated factors. J Am Geriatr Soc 53: 1344-1353, 2005.
General Hospital Psychiatry, 2007
The aim of this study was to determine the 12-month effects upon physical and mental health status of a diagnosis of major or minor depression among older medical inpatients.Patients 65 years and older, admitted to the medical wards of two university-affiliated hospitals, with at most mild cognitive impairment, were screened for major and minor depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). All depressed patients and a random sample of nondepressed patients were invited to participate. The physical functioning and mental health subscales of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were measured at baseline and at 3, 6 and 12 months.Two hundred ten patients completed the SF-36 at baseline and at one or more follow-ups. In multiple linear regression analysis for longitudinal data, adjusting for baseline level of the SF-36 subscale outcome, severity of physical illness, premorbid disability, age, sex and other covariates, patients with major depression at baseline had lower SF-36 scores at follow-up, in comparison to patients with no depression [physical health, 9.22 (95% CI −15.52 to −2.93); mental health, 6.28 (95% CI −11.76 to −0.79)].A diagnosis of major depression in cognitively intact older medical inpatients is associated with sustained poor physical and mental health status over the following 12 months.
Twelvemonth course of depressive symptoms in older medical inpatients
International Journal of Geriatric Psychiatry, 2007
BackgroundThe study aimed: (1) to describe the 12-month course of depressive symptoms among medical inpatients aged 65 +, and (2) to investigate predictors of a more severe course that could be identified easily by non-psychiatric staff.The study aimed: (1) to describe the 12-month course of depressive symptoms among medical inpatients aged 65 +, and (2) to investigate predictors of a more severe course that could be identified easily by non-psychiatric staff.MethodsPatients were recruited at two Montreal hospitals. Inclusion criteria were: aged 65 +, admitted to medical service, at most mild cognitive impairment. Patients were screened for major and minor depression (DSM-IV criteria). All depressed patients and a random sample of non-depressed patients were invited to participate in the prospective study. The Hamilton Depression Scale (HAMD) was administered at admission, 3, 6, and 12 months. Individual patient trajectories of depressive symptoms over time were grouped using hierarchical clustering into three patient groups with a minimal, mild, and moderate/severe course of symptoms, respectively. The baseline predictors of a more severe clinical course were identified using ordinal logistic regression.Patients were recruited at two Montreal hospitals. Inclusion criteria were: aged 65 +, admitted to medical service, at most mild cognitive impairment. Patients were screened for major and minor depression (DSM-IV criteria). All depressed patients and a random sample of non-depressed patients were invited to participate in the prospective study. The Hamilton Depression Scale (HAMD) was administered at admission, 3, 6, and 12 months. Individual patient trajectories of depressive symptoms over time were grouped using hierarchical clustering into three patient groups with a minimal, mild, and moderate/severe course of symptoms, respectively. The baseline predictors of a more severe clinical course were identified using ordinal logistic regression.ResultsTwo hundred and thirty-two patients completed baseline and one or more follow-up interviews. Baseline patient characteristics that independently predicted a more severe symptom course included higher initial HAMD score, depressive core symptoms lasting 6 months or more, and female sex.Two hundred and thirty-two patients completed baseline and one or more follow-up interviews. Baseline patient characteristics that independently predicted a more severe symptom course included higher initial HAMD score, depressive core symptoms lasting 6 months or more, and female sex.ConclusionThe 12-month course of depression symptoms in this medically ill older sample was generally stable. Patients who will experience a more severe course can be identified by non-psychiatric staff at admission to hospital. Copyright © 2006 John Wiley & Sons, Ltd.The 12-month course of depression symptoms in this medically ill older sample was generally stable. Patients who will experience a more severe course can be identified by non-psychiatric staff at admission to hospital. Copyright © 2006 John Wiley & Sons, Ltd.
Background: Depression among the physically ill is common and frequently under-diagnosed. Elderly patients with depressive symptoms are at higher risk of hospital admission for non psychiatric conditions and are more likely to have longer hospital stays and worse hospital outcomes, compared with non depressed patients. Objectives: The aim of this study was to find out if depression can be considered a predictor of prolonged hospital stay in elderly patients. Design: A prospective cohort study. Participants: 205 consecutive patients 60 years and over both males and females. Settings: Ain shams university hospitals. Measurements: All participants were assessed using comprehensive geriatric assessment including Geriatric depression scale (GDS) and the length of stay was registered. Results: Depressed patients had longer length of hospital stay compared to non depressed patients and the least length of hospital stay was for cases with no risk on GDS scale compared to other groups and the difference is highly significant statistically (p=<0.001). Conclusion: length of hospital stay is significantly longer among depressed elderly.