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Michael Dennis, Adil Kadri, John Coffey, Depression in older people in the general hospital: a systematic review of screening instruments, Age and Ageing, Volume 41, Issue 2, March 2012, Pages 148–154, https://doi.org/10.1093/ageing/afr169
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Abstract
Background: depression is common in later life, particularly in people with poor physical health. In the acute hospital setting this is associated with poor outcomes, increased length of stay and compromised care. The recognition and diagnosis of depression is therefore a key first step in managing depression in the general hospital, and this may be facilitated by the use of an appropriate screening instrument.
Objective: the aim of this study is to review all relevant literature on rating scales used to detect depression in older people in general hospitals so as to identify the most appropriate tool and cut-off score with optimal performance.
Method: an electronic search was conducted applying key search terms. Selection of articles was conducted in a staged manner and by utilising predetermined quality criteria. When appropriate pooled analysis was undertaken.
Findings: only 14 studies satisfied the inclusion criteria and only one instrument—the Geriatric Depression Scale (GDS)—has been studied to an adequate extent in older people in the acute general hospital setting. Best performance for the GDS was for a cut-off of 5/6 for the GDS-15 and 10/11 for the GDS-30.
Conclusion: further research is required before recommending the use of brief depression screening instruments (single or two items) in the acute hospital setting. The GDS would appear the most validated instrument currently (in either 15 or 30 item versions), though other tools such as the BASDEC show promise.
Comments
The importance of detecting depression in older patients cannot be underscored. There is no doubt that depression affects quality of life as well as increasing medical comorbidities. It is clear, for instance, that depression is an independent risk factor for cardiovascular disease. It is also known that if depression
occurs after myocardial infarction besides worsening quality of life, there is increased morbidity and mortality1.
In the recent article, Dennis M, Kadri A and Coffey J, Depression in older people in the general hospital: a systematic review of screening instruments, the authors discuss that depression is common in older patients, especially in those with medical problems. They emphasize that depression in hospital patients may lead to greater lengths of stay as well as other negative outcomes. Because of the importance of recognizing and treating depression in older patients, the authors investigated the use of brief depression screening tests. Clearly an effective short screening tool would be greatly beneficial2.
In, McKibbin C, Deacon B, Psychosocial Interventions for Mental Disorders in Late Life: Are We Making Progress Toward Efficiency and Impact? The Am J or Geriatric Psych.2011;19(10):835-8, the authors underscore that mental disorders like late-life major depression is often underdiagnosed and undertreated. The lack of recognition of late-life mental disorders, the authors feel, results in detrimental consequences to both the patients and their family members including increased patient disability and mortality3.
The notion that primary care physicians assess their elderly patients for depression infrequently was also echoed in, Understanding Primary Care Physicians' Propensity to Assess Elderly Patients for Depression Using Interaction and Survey Data. The authors emphasize the need to treat patients as whole persons, with the appropriate goal of physicians to take a comprehensive approach to their patients, including assessment for depression4.
Dennis M, Kadri A, Coffey . Depression in older people in the general hospital: a systematic review of screening instruments. Age Ageing.2012;41(2):148- 154. Doi:10.1093/ageing/afr 169, has focused on an extremely important topic. Publications like this that highlight the consequences of depression in older patients with the need for clinicians to recognize and treat it are of major significance.
References: 1. Lutwak N, Dill C. A Depressed Post-Menopausal Woman. J Emerg Med. 2011 Jul 14. [Epub ahead of print] 2. Dennis M, Kadri A, Coffey . Depression in older people in the general hospital: a systematic review of screening instruments. Age Ageing.2012;41(2):148- 154. Doi:10.1093/ageing/afr 169. 3. McKibbin C, Deacon B.Psychosocial Interventions for Mental Disorders in Late Life: Are We Making Progress Toward Efficiency and Impact?. The Am J of Geriatric Psych.2011;19(10):835-8. 4. Tai-Seale M, Bramson R, Drukker D, et al: Understanding primary care physicians' propensity to assess elderly patients for depression using interaction and survey data. Med Care 2005; 43: 1217-1224.
Conflict of Interest:
None declared