Audit of assessment of anxiety and depression in older inpatients with end stage COPD

Abstract

Background Anxiety and depression are common in patients with COPD, particularly in those with physical disability and more severe disease. It is under-diagnosed and under treated yet has profound consequences on the patient and their carers resulting in increased social isolation, heightened sensation of dyspnoea, poor treatment tolerance and increased hospitalisation. There are validated screening tools for anxiety and depression in COPD but they are underutilised. When patients present with an exacerbation to secondary care services, this becomes an ideal opportunity to assess for anxiety and depression. Aims To evaluate our current service in assessing older (over 78 years) inpatients with end stage COPD, presenting with an exacerbation, for symptoms of anxiety and depression as recommended by NICE guidelines. Method Retrospective clinical case note audit of eighteen older patients with an inpatient admission resulting from an exacerbation of COPD. Results Sixteen of the 18 patients had WHO performance status of three or four indicating physical dependency. Only one patient had a prior diagnosis of anxiety and depression and was on treatment. Despite medical and nursing observational entries in the clinical notes indicating possible underlying depression and/or anxiety in seven patients (‘low mood’, ‘poor eye contact’, ‘anxious’), none of the 18 patients had a recorded mental health assessment or completed screening tool for identification and diagnosis of anxiety or depression. Conclusion Despite extensive evidence that anxiety and depression is common in patients with end stage COPD and has significant consequences on their quality of life, we are not following national guidelines and assessing for anxiety and depression in our older inpatients presenting with exacerbation. We see this as a missed opportunity to intervene to improve symptoms and optimise physical and psychological functioning towards the end of life. Our audit presents plans for service development and improvement and re-audit schedule.