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Reichardt LA, van Seben R, Aarden JJ, van der Esch M, van der Schaaf M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. Trajectories of cognitive-affective depressive symptoms in acutely hospitalized older adults: The hospital-ADL study. J Psychosom Res 2019; 120:66-73. [PMID: 30929710 DOI: 10.1016/j.jpsychores.2019.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychology, Section of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
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Lunghi C, Zongo A, Guénette L. Utilisation des bases de données médico-administratives du Québec pour des études en
santé mentale : opportunités, défis méthodologiques et limites – cas de la dépression chez
les personnes diabétiques. SANTE MENTALE AU QUEBEC 2018. [DOI: 10.7202/1058612ar] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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McCusker J, Yaffe M, Sussman T, Cole M, Sewitch M, Strumpf E, Freeman E, Lambert S, de Raad M. La gestion de la dépression chez les aînés et leurs aidants naturels : résultats d’un programme de recherche au Québec. SANTE MENTALE AU QUEBEC 2017. [DOI: 10.7202/1040254ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La dépression est un problème répandu, sérieux, et souvent chronique chez les aînés, qui sont souvent atteints de maladies physiques chroniques, et affecte de façon négative leurs traitements et leurs soins. Malheureusement, le taux de détection et de suivi adéquat de la dépression est faible dans cette population. Au cours des deux dernières décennies, notre équipe a mené une série d’études pour mieux comprendre et améliorer la gestion de la dépression chez les aînés. Nous présentons une revue narrative et synthèse de 25 articles qui incluent : 4 revues systématiques, 10 études observationnelles, 9 essais d’interventions, et 2 conférences de consensus. Nous proposons en conclusion nos recommandations pour 1) la détection de la dépression dans les soins de santé primaires ; 2) les soins collaboratifs de la dépression ; 3) des interventions d’autogestion de la dépression ; 4) le rôle des aidants naturels dans les interventions d’autogestion de la dépression.
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Affiliation(s)
- Jane McCusker
- Centre de recherche de St. Mary, Montréal, Canada
- Département d’épidémiologie, biostatistique et santé au travail, Université McGill, Montréal, Canada
| | - Mark Yaffe
- Département de médecine familiale, Centre hospitalier de St. Mary, Montréal, Canada
- Département de médecine de famille, Université McGill, Montréal, Canada
| | - Tamara Sussman
- École de travail social, Université McGill, Montréal, Canada
| | - Martin Cole
- Centre de recherche de St. Mary, Montréal, Canada
- Département de psychiatrie, Centre hospitalier de St. Mary, Montréal, Canada
- Département de psychiatrie, Université McGill, Montréal, Canada
| | - Maida Sewitch
- Département d’épidémiologie, biostatistique et santé au travail, Université McGill, Montréal, Canada
- Institut de recherche du Centre universitaire de santé McGill, Montréal, Canada
- Centre universitaire de santé McGill, Divisions de gastroentérologie et d’épidémiologie clinique, Montréal, Canada
| | - Erin Strumpf
- Département d’économie, Université McGill, Montréal, Canada
| | - Ellen Freeman
- Centre de recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada
| | - Sylvie Lambert
- Centre de recherche de St. Mary, Montréal, Canada
- École des sciences infirmières Ingram, Université McGill, Montréal, Canada
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Canuto A, Gkinis G, DiGiorgio S, Arpone F, Herrmann FR, Weber K. Agreement between physicians and liaison psychiatrists on depression in old age patients of a general hospital: influence of symptom severity, age and personality. Aging Ment Health 2016; 20:1092-8. [PMID: 26155954 DOI: 10.1080/13607863.2015.1063103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Comorbid depressive episodes are common among general hospital inpatients. However, existing evidence shows that depression is often poorly recognized in patients aged over 60 years. The aim of the study was first to determine the degree of agreement between primary care physicians' and liaison psychiatrists' evaluation of depression, and second, to analyze how patients' clinical presentation and personality traits influence this degree of agreement. METHODS Agreement was defined as the matching of the physicians' initial referral for depressive mood and the actual diagnosis of a major depressive disorder evaluated by the consultation-liaison service in 148 inpatients aged 60+ years. Nature and severity of psychiatric symptoms were rated on the HoNOS65+ scale and patients' personality traits were assessed with the Big Five Inventory. RESULTS Forty percent of the patients referred for depressive mood were indeed diagnosed with major depression. Agreement between physicians and psychiatrists was most likely in patients with more severe depressive symptoms and younger age. In contrast, risk for non-agreement was increased for patients with more open personalities, yet lower levels of neuroticism, who were referred for depressive mood even though they presented another or even no psychiatric disorder. CONCLUSION These data reveal that the detection of late-life depression in general hospitals may be critically influenced by age, symptoms severity and personality traits.
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Affiliation(s)
- Alessandra Canuto
- a Division of liaison psychiatry and crisis intervention , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Geneva , Switzerland
| | - Georgios Gkinis
- a Division of liaison psychiatry and crisis intervention , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Geneva , Switzerland
| | - Sergio DiGiorgio
- a Division of liaison psychiatry and crisis intervention , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Geneva , Switzerland
| | - Francesca Arpone
- a Division of liaison psychiatry and crisis intervention , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Geneva , Switzerland
| | - François R Herrmann
- b Department of Internal Medicine, Rehabilitation and Geriatrics , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Thônex , Switzerland
| | - Kerstin Weber
- a Division of liaison psychiatry and crisis intervention , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Geneva , Switzerland
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Observer-rated depression in long-term care: Frequency and risk factors. Arch Gerontol Geriatr 2014; 58:332-8. [DOI: 10.1016/j.archger.2013.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 11/10/2013] [Accepted: 11/21/2013] [Indexed: 11/19/2022]
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Heidenblut S, Zank S. Screening for Depression with the Depression in Old Age Scale (DIA-S) and the Geriatric Depression Scale (GDS15). GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2014. [DOI: 10.1024/1662-9647/a000101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Purpose of the study. The Depression in Old Age Scale (DIA-S), a new screening tool for geriatric depression, was designed to be both practical and appropriate for use with medically ill geriatric patients. The diagnostic accuracy of the DIA-S and the short form of the Geriatric Depression Scale (GDS15) were tested and compared. Methods. Using the Montgomery and Asberg Depression Rating Scale (MADRS) as gold standard, the scales were validated with a sample of N = 331 geriatric inpatients. Results. ROC curves, AUC outcomes, sensitivity and specificity, and logistic regression models for impact factors on misclassification rates indicate good psychometrical qualities of the DIA-S, whereas the validity of the GDS15 was lower.
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Affiliation(s)
- Sonja Heidenblut
- Department of Rehabilitative Gerontology, University of Cologne, Germany
| | - Susanne Zank
- Department of Rehabilitative Gerontology, University of Cologne, Germany
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Pierluissi E, Mehta KM, Kirby KA, Boscardin WJ, Fortinsky RH, Palmer RM, Landefeld CS. Depressive symptoms after hospitalization in older adults: function and mortality outcomes. J Am Geriatr Soc 2012. [PMID: 23176725 DOI: 10.1111/jgs.12008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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 individuals aged 70 and older. MEASUREMENTS Ten depressive symptoms, instrumental activities of daily living (IADLs), and basic activities of daily living (ADLs) were measured at hospital discharge and 1, 3, 6, and 12 months later. Participant-specific changes in depressive symptoms (slopes) were determined using all data points. Four groups were also defined according to 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. Mortality was measured 3, 6, and 12 months after hospital discharge. RESULTS Participant-specific discharge depressive symptoms and change in depressive symptoms over time (slopes) were associated (P < .05) with functional and mortality outcomes. At 1 year, more participants in the low-low depressive symptom group (49%) were alive and independent in IADLs and ADLs than in the low-high group (37%, P = .02), and more participants in the high-low group (39%) were alive and independent in IADLs and ADLs than in the high-high group (19%, P < .001). CONCLUSION Number of depressive symptoms and change in number of depressive symptoms during the year after discharge were associated with functional and mortality outcomes in hospitalized older adults. Fewer participants with persistently high or increasing depressive symptoms after hospitalization were alive and functionally independent 1 year later than participants with decreasing or persistently low symptoms, respectively.
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Affiliation(s)
- Edgar Pierluissi
- Division of Geriatrics, University of California at San Francisco, San Francisco, California 94110, USA.
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Townsend L, Walkup JT, Crystal S, Olfson M. A systematic review of validated methods for identifying depression using administrative data. Pharmacoepidemiol Drug Saf 2012; 21 Suppl 1:163-73. [DOI: 10.1002/pds.2310] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lisa Townsend
- Institute for Health, Health Care Policy & Aging Research; Rutgers University; New Brunswick NJ USA
| | - James T Walkup
- Institute for Health, Health Care Policy & Aging Research; Rutgers University; New Brunswick NJ USA
| | - Stephen Crystal
- Institute for Health, Health Care Policy & Aging Research; Rutgers University; New Brunswick NJ USA
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons; Columbia University and the New York State Psychiatric Institute; New York NY USA
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Which version of the geriatric depression scale is most useful in medical settings and nursing homes? Diagnostic validity meta-analysis. Am J Geriatr Psychiatry 2010; 18:1066-77. [PMID: 21155144 DOI: 10.1097/jgp.0b013e3181f60f81] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Geriatric Depression Scale (GDS) has been evaluated in individual studies, but its validity and added value in medical settings and nursing homes is uncertain. Therefore, the authors conducted a meta-analysis, analyzing the diagnostic accuracy of long, short, and ultrashort versions of the GDS and stratified this into those with and without cognitive impairment. METHODS A comprehensive search identified 69 studies that measured the diagnostic validity of the GDS against a semistructured psychiatric interview, and of these, 43 analyses (in 36 publications) took place inmedical settings. Twenty-one studies examined the GDS₃₀, 12 studies examined the GDS₁₅, and 3 examined the GDS₄(/)₅. For comparison, the authors also summarized studies examining unassisted clinical judgment. Heterogeneity was moderate to high; therefore, random effects meta-analysis was used. RESULTS Across all studies, the prevalence of late-life depression was 29.2% (95% confidence interval [CI] = 24.7%–33.9%), with no difference between inpatients, outpatients, and nursing homes. Diagnostic accuracy of the GDS₃₀ aftermeta-analytic weighting was given by a sensitivity of 81.9% (95% CI = 76.4%–86.9%) and a specificity of 77.7% (95% CI = 73.0%–82.1%). For the GDS₁₅, sensitivity was 84.3% (95% CI = 79.7%–88.4%) and specificity was 73.8% (95% CI = 68.0%–79.2%). For the GDS₄(/)₅, the sensitivity and specificity were 92.5% (95% CI = 85.5%–97.4%) and 77.2% (95% CI = 66.6%–86.3%), respectively. Results were not significantly influenced by the presence of dementia. Concerning added value, when identification using the GDS was compared with routine clinicians’ ability to diagnose late-life depressions, at a prevalence of 30%, of every 100 attendees, the GDS₃₀ would help correctly identify an additional 22 people as depressed but at a cost of 13 additional false positives. The GDS₁₅ performed the same as GDS₃₀ but with 15 false positives. The ultrashort form would help identify an additional 25 true positives with only 10 false positives. Thus, the best option when choosing between versions of the GDS seems to be the GDS₄(/)₅. CONCLUSION All versions of the GDS yield potential added value in medical settings, but the GDS₄(/)₅ is the most efficient. In nursing homes, given an absence of data on the GDS₄(/)₅, the GDS₁₅ may be preferred until more studies are reported.
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