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Effects of depression, dementia and delirium on activities of daily living in elderly patients after discharge. BMC Geriatr 2019; 19:261. [PMID: 31604425 PMCID: PMC6787981 DOI: 10.1186/s12877-019-1294-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/26/2019] [Indexed: 01/28/2023] Open
Abstract
Background The three geriatric conditions, depression, dementia and delirium (3D’s), are common among hospitalized older patients and often lead to impairments of activities of daily living. The aim of this study is to explore the impact of depression, dementia and delirium on activities of daily living (ADLs) during and after hospitalization. Methods A prospective cohort study was conducted between 2012 and 2013 in a tertiary medical center in Taiwan. Patients who aged over 65 years and admitted to the geriatric ward were invited to this study. Geriatric Depression Scale Short Form, Mini-Mental State and Confusion Assessment Method were used to identify patients with depression, dementia and delirium on admission, respectively. Barthel Index (BI) was used to evaluate patients’ functional status on admission, at discharge, 30-day, 90-day and 180-day after discharge. Generalized Estimating Equation (GEE) was used to calculate the associations between 3 D’s and BI. Results One-hundred-and-forty-nine patients were included in this study. Twenty-seven patients (18.1%) had depression, 37 (24.8%) had dementia, and 85 (57.0%) had delirium. The study demonstrated that all the geriatric patients with functional decline presented gradual improvements of physical function up to 180 days after discharge. Whether depression exists did not substantially affect functional recovery after discharge, whilst either dementia or delirium could impede elder people functional status. The recovery of functional improvement in delirium or dementia was relatively irreversible when comparing with depression. Once delirium or dementia was diagnosed, poorer functional restore was expected. In brief, intensive work and strategies on modifying delirium or dementia should be put more effort as early as possible. Conclusions Old hospitalized patients with depression can recover well after adequate intervention. We emphasize that early detection of dementia and delirium is imperative in subsequent functional outcome, even if at or before admission. Comprehensive plan must be implemented timely.
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Lawes S, Demakakos P, Steptoe A, Lewis G, Carvalho LA. Combined influence of depressive symptoms and systemic inflammation on all-cause and cardiovascular mortality: evidence for differential effects by gender in the English Longitudinal Study of Ageing. Psychol Med 2019; 49:1521-1531. [PMID: 30220259 PMCID: PMC6541870 DOI: 10.1017/s003329171800209x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/13/2018] [Accepted: 07/23/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depressive symptoms and inflammation are risk factors for cardiovascular disease (CVD) and mortality. We investigated the combined association of these factors with the prediction of CVD and all-cause mortality in a representative cohort of older men and women. METHODS We measured C-reactive protein (CRP) and depressive symptoms in 5328 men and women aged 52-89 years in the English Longitudinal Study of Ageing. Depressive symptoms were measured using the eight-item Centre for Epidemiological Studies Depression Scale. CRP was analysed from peripheral blood. Mortality was ascertained from national registers and associations with depressive symptoms and inflammation were estimated using Cox proportional hazard models. RESULTS We identified 112 CVD related deaths out of 420 all-cause deaths in men and 109 CVD related deaths out of 334 all-cause deaths in women over a mean follow-up of 7.7 years. Men with both depressive symptoms and high CRP (3-20 mg/L) had an increased risk of CVD mortality (hazard ratio; 95% confidence interval: 3.89; 2.04-7.44) and all-cause mortality (2.40; 1.65-3.48) after adjusting for age, socioeconomic variables and health behaviours. This considerably exceeds the risks associated with high CRP alone (CVD 2.43; 1.59-3.71, all-cause 1.49; 1.20-1.84). There was no significant increase in mortality risk associated with depressive symptoms alone in men. In women, neither depressive symptoms or inflammation alone or the combination of both significantly predicted CVD or all-cause mortality. CONCLUSIONS The combination of depressive symptoms and increased inflammation confers a considerable increase in CVD mortality risk for men. These effects appear to be independent, suggesting an additive role.
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Affiliation(s)
- Samantha Lawes
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Livia A. Carvalho
- Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
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McCusker J, Cole MG, Voyer P, Monette J, Champoux N, Ciampi A, Vu M, Belzile E. Six-month outcomes of co-occurring delirium, depression, and dementia in long-term care. J Am Geriatr Soc 2014; 62:2296-302. [PMID: 25482152 DOI: 10.1111/jgs.13159] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the 6-month outcomes of co-occurring delirium (full syndrome and subsyndromal symptoms), depression, and dementia in a long-term care (LTC) population. DESIGN Observational, prospective cohort study with 6-month follow-up conducted from 2005 to 2009. SETTING Seven LTC facilities in the province of Quebec, Canada. PARTICIPANTS Newly admitted and long-term residents recruited consecutively from lists of residents aged 65 and older admitted for LTC, with stratification into groups with and without severe cognitive impairment. The study sample comprised 274 residents with complete data at baseline on delirium, dementia, and depression. MEASUREMENTS Outcomes were 6-month mortality, functional decline (10-point decline from baseline on 100-point Barthel scale), and cognitive decline (3-point decline on 30-point Mini-Mental State Examination). Predictors included delirium (full syndrome or subsyndromal symptoms, using the Confusion Assessment Method), depression (Cornell Scale for Depression in Dementia), and dementia (chart diagnosis). RESULTS The baseline prevalences of delirium, subsyndromal symptoms of delirium (SSD), depression, and dementia were 11%, 44%, 19%, and 66%, respectively. By 6 months, 10% of 274 had died, 19% of 233 had experienced functional decline, and 17% of 246 had experienced cognitive decline. An analysis using multivariable generalized linear models found the following significant interaction effects (P < .15): between depression and dementia for mortality, between delirium and depression for functional decline, and between SSD and dementia for cognitive decline. CONCLUSION Co-occurrence of delirium, SSD, depression, and dementia in LTC residents appears to affect some 6-month outcomes. Because of limited statistical power, it was not possible to draw conclusions about the effects of the co-occurrence of some syndromes on poorer outcomes.
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Affiliation(s)
- Jane McCusker
- St. Mary's Research Centre, St Mary's Hospital Center, Montreal; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec
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Affiliation(s)
- Renzo Rozzini
- Department of Internal Medicine and Geriatrics; Poliambulanza Hospital; Brescia; Italy
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Cuijpers P, Vogelzangs N, Twisk J, Kleiboer A, Li J, Penninx BW. Differential mortality rates in major and subthreshold depression: meta-analysis of studies that measured both. Br J Psychiatry 2013; 202:22-7. [PMID: 23284149 DOI: 10.1192/bjp.bp.112.112169] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although the association between depression and excess mortality has been well established, it is not clear whether this is greater in major depression than in subthreshold depression. AIMS To compare excess mortality in major depression with that in subthreshold depression. METHOD We searched bibliographic databases and included prospective studies in which both major and subthreshold depression were examined at baseline and mortality was measured at follow-up. RESULTS A total of 22 studies were included. People with major depression had a somewhat increased chance of dying earlier than people with subthreshold depression but this difference was not significant, although there was a trend (relative risk 1.13, 95% CI 0.98-1.30, P = 0.1). The population attributable fraction was 7% for major depression and an additional 7% for subthreshold depression. CONCLUSIONS Although excess mortality may be somewhat higher in major than in subthreshold depression, the difference is small and the overall impact on excess mortality is comparable.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands.
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Katz AJ, Dusetzina SB, Farley JF, Ellis AR, Gaynes BN, Castillo WC, Stürmer T, Hansen RA. Distressing Adverse Events After Antidepressant Switch in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial: Influence of Adverse Events During Initial Treatment with Citalopram on Development of Subsequent Adverse Events with an A. Pharmacotherapy 2012; 32:234-43. [DOI: 10.1002/j.1875-9114.2011.01020.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Aaron J. Katz
- Division of Pharmaceutical Outcomes and Policy; UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill; North Carolina
| | - Stacie B. Dusetzina
- Department of Health Care Policy; Harvard Medical School; Boston; Massachusetts
| | - Joel F. Farley
- Division of Pharmaceutical Outcomes and Policy; UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill; North Carolina
| | - Alan R. Ellis
- Cecil G. Sheps Center for Health Services Research; University of North Carolina at Chapel Hill
| | - Bradley N. Gaynes
- Department of Psychiatry; School of Medicine; University of North Carolina at Chapel Hill
| | - Wendy C. Castillo
- Department of Epidemiology; Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill; North Carolina
| | - Til Stürmer
- Department of Epidemiology; Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill; North Carolina
| | - Richard A. Hansen
- Department of Pharmacy Care Systems; Harrison School of Pharmacy; Auburn University; Auburn; Alabama
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Vilalta-Franch J, Planas-Pujol X, López-Pousa S, Llinàs-Reglà J, Merino-Aguado J, Garre-Olmo J. Depression subtypes and 5-years risk of mortality in aged 70 years: a population-based cohort study. Int J Geriatr Psychiatry 2012; 27:67-75. [PMID: 21308792 DOI: 10.1002/gps.2691] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 01/04/2011] [Indexed: 11/09/2022]
Abstract
AIMS To estimate the mortality risk related to different mood disorders in a geriatric sample of subjects aged 70 years and over without dementia. METHOD All non-demented subjects at baseline who participate on a second phase of a population-based cohort study were included. Adjusted Cox proportional hazards models were used to determine the association between depression and 5-year survival of 451 elderly people without dementia originally recruited for a representative community dementia cohort study. Baseline evaluation included the Cambridge Mental Disorders of the Elderly Examination Schedule. Depressive disorders (major and minor episode) were assessed according DSM-IV criteria and classified according the age of onset (late vs. early). The late-onset depression was classified according to the presence or absence of depression-executive dysfunction syndrome (DEDS). RESULTS The initial cohort size was 451 subjects, among which 10.9% (n = 49) suffered a major depressive episode and 10.4% (n = 47) a minor depressive disorder. Among the total affective disorders, 77.9% (n = 74) were late-onset depressions and 29.5% (n = 28) had executive dysfunction. After 5 years, the vital status of 94% (n = 424) of the participants was known and the mortality was 18.9% (n = 80). Late-onset major depressive episode with executive dysfunction was related to mortality after adjustment by age, gender, marital status, level of education, comorbidity (or health global status) and cognitive impairment (HR = 3.70; 95% CI = 1.55-8.83). The executive dysfunction was found to be an independent mortality risk factor (HR = 2.05; 95% CI = 1.15-3.64). CONCLUSIONS There is a statistically significant association between mortality and late-onset major depression with executive dysfunction.
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Depressive symptoms and disability in acute patients with comorbidities in departments of internal medicine. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Williams BR, Zhang Y, Sawyer P, Mujib M, Jones LG, Feller MA, Ekundayo OJ, Aban IB, Love TE, Lott A, Ahmed A. Intrinsic association of widowhood with mortality in community-dwelling older women and men: findings from a prospective propensity-matched population study. J Gerontol A Biol Sci Med Sci 2011; 66:1360-8. [PMID: 21903611 DOI: 10.1093/gerona/glr144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Widowhood is associated with increased mortality. However, to what extent this association is independent of other risk factors remains unclear. In the current study, we used propensity score matching to design a study to examine the independent association of widowhood with outcomes in a balanced cohort of older adults in the United States. METHODS We used public-use copies of the Cardiovascular Health Study data obtained from the National Heart, Lung, and Blood Institute. Of the 5,795 community-dwelling older men and women aged 65 years and older in Cardiovascular Health Study, 3,820 were married and 1,436 were widows or widowers. Propensity scores for widowhood, estimated for each of the 5,256 participants, were used to assemble a cohort of 819 pairs of widowed and married participants who were balanced on 74 baseline characteristics. The 1,638 matched participants had a mean (± standard deviation) age of 75 (± 6) years, 78% were women, and 16% African American. RESULTS All-cause mortality occurred in 46% (374/819) and 51% (415/819) of matched married and widowed participants, respectively, during more than 11 years of median follow-up (hazard ratio associated with widowhood, 1.18; 95% confidence interval, 1.03-1.36; p = .018). Hazard ratios (95% confidence intervals) for cardiovascular and noncardiovascular mortalities were 1.07 (0.87-1.32; p = .517) and 1.28 (1.06-1.55; p = .011), respectively. Widowhood had no independent association with all-cause or heart failure hospitalization or incident cardiovascular events. CONCLUSIONS Among community-dwelling older adults, widowhood was associated with increased mortality, which was independent of confounding by baseline characteristics and largely driven by an increased noncardiovascular mortality. Widowhood had no independent association with hospitalizations or incident cardiovascular events.
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Meeks T, Vahia I, Lavretsky H, Kulkarni G, Jeste D. A tune in "a minor" can "b major": a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord 2011; 129:126-42. [PMID: 20926139 PMCID: PMC3036776 DOI: 10.1016/j.jad.2010.09.015] [Citation(s) in RCA: 342] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/15/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND With emphasis on dimensional aspects of psychopathology in development of the upcoming DSM-V, we systematically review data on epidemiology, illness course, risk factors for, and consequences of late-life depressive syndromes not meeting DSM-IV-TR criteria for major depression or dysthymia. We termed these syndromes subthreshold depression, including minor depression and subsyndromal depression. METHODS We searched PubMed (1980-Jan 2010) using the terms: subsyndromal depression, subthreshold depression, and minor depression in combination with elderly, geriatric, older adult, and late-life. Data were extracted from 181 studies of late-life subthreshold depression. RESULTS In older adults subthreshold depression was generally at least 2-3 times more prevalent (median community point prevalence 9.8%) than major depression. Prevalence of subthreshold depression was lower in community settings versus primary care and highest in long-term care settings. Approximately 8-10% of older persons with subthreshold depression developed major depression per year. The course of late-life subthreshold depression was more favorable than that of late-life major depression, but far from benign, with a median remission rate to non-depressed status of only 27% after ≥1 year. Prominent risk factors included female gender, medical burden, disability, and low social support; consequences included increased disability, greater healthcare utilization, and increased suicidal ideation. LIMITATIONS Heterogeneity of the data, especially related to definitions of subthreshold depression limit our ability to conduct meta-analysis. CONCLUSIONS The high prevalence and associated adverse health outcomes of late-life subthreshold depression indicate the major public health significance of this condition and suggest a need for further research on its neurobiology and treatment. Such efforts could potentially lead to prevention of considerable morbidity for the growing number of older adults.
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Affiliation(s)
- Thomas Meeks
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
| | - Ipsit Vahia
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
| | - Helen Lavretsky
- Department of Psychiatry, University of California, Los Angeles
| | | | - Dilip Jeste
- Department of Psychiatry, University of California, San Diego (UCSD),Sam and Rose Stein Institute for Research on Aging, UCSD
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Prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China. Gen Hosp Psychiatry 2010; 32:268-75. [PMID: 20430230 DOI: 10.1016/j.genhosppsych.2010.01.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 01/27/2010] [Accepted: 01/27/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China. METHOD A total of 513 patients were randomly selected from 1923 inpatients from three general hospitals and evaluated with a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual-IV Axis I disorders by eight psychiatrists. Logistic regression was used to identify factors that were associated with depression. RESULTS The prevalence (95% confidence interval) of all current depressive disorders and major depressive disorder (MDD) was found to be 16.2% (13.0-19.4%) and 9.4% (6.8-11.9%), respectively. The correlates for depression include higher hospital class, divorce/being widowed/separation, low family income, chronic diseases, lack of medical insurance, dwelling in rural area, suffering from severe illness and multiple hospitalization history. None of the patients with current MDD were detected, treated or referred to psychiatric consultation. CONCLUSIONS The prevalence of depression among inpatients of general hospitals in Wuhan, China, was high. None of the depressive patients were recognized or treated for depression, indicating a serious neglect of depression in general hospitals. Our studies suggest an urgent need to improve clinicians' ability to detect and treat depression.
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Ryan J, Carriere I, Ritchie K, Stewart R, Toulemonde G, Dartigues JF, Tzourio C, Ancelin ML. Late-life depression and mortality: influence of gender and antidepressant use. Br J Psychiatry 2008; 192:12-8. [PMID: 18174502 DOI: 10.1192/bjp.bp.107.039164] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Depression may increase the risk of mortality among certain subgroups of older people, but the part played by antidepressants in this association has not been thoroughly explored. AIMS To identify the characteristics of older populations who are most at risk of dying, as a function of depressive symptoms, gender and antidepressant use. METHOD Adjusted Cox proportional hazards models were used to determine the association between depression and/or antidepressant use and 4-year survival of 7,363 community-dwelling elderly people. Major depressive disorder was evaluated using a standardised psychiatric examination based on DSM-IV criteria and depressive symptoms were assessed using the Center for Epidemiological Studies-Depression scale. RESULTS Depressed men using antidepressants had the greatest risk of dying, with increasing depression severity corresponding to a higher hazard risk. Among women, only severe depression in the absence of treatment was significantly associated with mortality. CONCLUSIONS The association between depression and mortality is gender-dependent and varies according to symptom load and antidepressant use.
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Affiliation(s)
- Joanne Ryan
- Institut National de la Santé et de la Recherche Médicale (INSERM) U888, University of Montpellier, France
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Cole MG. Does depression in older medical inpatients predict mortality? A systematic review. Gen Hosp Psychiatry 2007; 29:425-30. [PMID: 17888809 DOI: 10.1016/j.genhosppsych.2007.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 07/05/2007] [Accepted: 07/06/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine whether depression in older medical inpatients predicts mortality. METHOD Medline, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews were searched for potentially relevant articles; the bibliographies of relevant articles were searched for additional references. Retrieved studies were screened to meet five inclusion criteria. Validity of studies was assessed according to four criteria adapted from the Evidence-Based Medicine Working Group. Data were abstracted from each study and tabulated. Data synthesis involved a qualitative meta-analysis. RESULTS Many of the studies had methodological limitations. Six reported that depression predicted increased mortality, five reported that depression did not predict mortality, and one reported that depression predicted decreased mortality when there was a history of prior depression. Unadjusted risk ratios for death ranged from 0.60 to 12.6; adjusted risk ratios ranged from 0.42 to 7.4. The disparate findings may be explained in part by differences in the proportions of young older patients and men enrolled in the different studies. CONCLUSION The evidence that depression in older medical inpatients predicts mortality is inconclusive. There is a need for further studies that pay attention to design, populations enrolled, and analysis.
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Affiliation(s)
- Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada.
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McCusker J, Cole M, Ciampi A, Latimer E, Windholz S, Belzile E. Major depression in older medical inpatients predicts poor physical and mental health status over 12 months. Gen Hosp Psychiatry 2007; 29:340-8. [PMID: 17591511 DOI: 10.1016/j.genhosppsych.2007.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 03/21/2007] [Accepted: 03/22/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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)]. CONCLUSION 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.
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal (Quebec), Canada H3T 1M5.
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McCusker J, Cole M, Latimer E, Ciampi A, Windholz S. REPLY TO LETTER FROM ROZZINI AND COLLEAGUES ABOUT DEPRESSION IN OLDER MEDICAL INPATIENTS. J Gerontol A Biol Sci Med Sci 2007. [DOI: 10.1093/gerona/62.7.798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McCusker J, Cole M, Ciampi A, Latimer E, Windholz S, Elie M, Belzile E. Twelve-month course of depressive symptoms in older medical inpatients. Int J Geriatr Psychiatry 2007; 22:411-7. [PMID: 17096457 DOI: 10.1002/gps.1689] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, and Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
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