Major depression in hospitalized medically ill older men: Documentation, management, and outcome

Abstract

SUMMARYFifty-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 housestaff was a significant predictor of outcome. We conclude that serious clinical depression in medically ill older patients may persist for a considerable period after hospital discharge and neither detection nor current management strategies appear to have a major impact on outcome.KEY woms-Major depression, elderly, medically ill, hospital, treatment, outcome, documentation.Major depressive disorder is common among older medically ill hospitalized patients. Recent studies have demonstrated that the prevalence rate of this disorder in elderly hospitalized men may be 15 to 30 times as high as in community settings. The NIMH Epidemiologic Catchment Area studies a t five sites in the United States found rates of major depression in community-dwelling men age 65 or over averaged 0.4% (Weissman et al., 1988). Studies of hospitalized elderly male inpatients have found rates for major depressive disorder varying from 5% to 13%) (O'Riordan et al., 1989;Rapp et al., 1988a; Koenig etal., 1988a Koenig etal., , 1991. Despite this fact, very little is known about the epidemiology of serious depressive disorders in the medical setting, the detection and management of these disorders by medical physicians, or outcomes after hospital discharge. Part of the problem is that small samples have limited the number of major depressive disorders available for study, with cases ranging from 5 to 15 in most reports.Detection rates of depression have been reported as low as 9% by primary care physicians in older medical inpatients (Rapp et al., 1988b). Rates of antidepressant use in medical inpatients are in the range of 0.5-1.6% (Raft et al., 1975;Callies and

Life Expectancy following Psychogeriatric Reactivation

“…The data agree with the results of previous studies conducted in this field [23][24][25][26]. The difference in survival between the 'independent' group (median = 35 months) and the community-dwelling reference group (median = 95 months) highlights the frailty of psychogeriatric patients suffering from cognitive function disorders in conjunction with psychiatric function disorders.…”

Systematic detection and multidisciplinary care of depression in older medical inpatients: a randomized trial

“…In the usual-care group, the rates of request for psychiatric consultation and antidepressant therapy prescribed at discharge were 26.6% and 35.5%-45.2%, respectively, much higher than reported in descriptive studies. 3,12,13 Controvertibly, the rate of antidepressant use in the usual-care group was high (29%-35.5%) on admission.…”

“…Despite the apparent benefits of treatment, 11 up to 90% of cases of depression are not detected by attending physicians during the course of usual hospital care, 3,12 and few patients receive optimal treatment in hospital or after discharge. 12,13 Because a strategy of systematic detection and treatment has been shown to benefit elderly people with depression living in the community, [14][15][16][17][18] we conducted a randomized clinical trial to evaluate whether systematic detection and multidisciplinary treatment of depression could be effective in reducing symptoms of depression and improving mental and physical health status in elderly medical inpatients. Our secondary objective was to determine the effect of the intervention on basic and instrumental activities of daily living, cognitive status, side-effects profile, mortality and health services utilization (length of hospital stay, and number of readmissions and emergency department visits).…”

Depression in Older Medical Inpatients: One-Year Course and Outcome

“…Rates of improvement of depression in three surveys composed exclusively of male American veterans (Schuckit et al, 1980;Rapp et al, 1991;Koenig et al, 1992) were 33%, 35% and 36% respectively. Although depression improved in 55% of the 11 men in our sample, the dierences are probably not signi®cant given that the numbers involved were small, ranging between six (Schuckit et al, 1980) and 33 (Koenig et al, 1992).…”

“…Although nine surveys of depressive disorder among acutely ill medical/surgical inpatients aged 65 and older have included a longitudinal component (Bergmann and Eastham, 1974;Schuckit et al, 1980;Cooper, 1987;Koenig et al, 1989;Rapp et al, 1991;Antonelli et al, 1991Antonelli et al, , 1992Koenig et al, 1992;Evans, 1993), only four reported aective state as an outcome (Schuckit et al, 1980;Rapp et al, 1991, Koenig et al, 1992Evans, 1993) and three of these four enrolled men only. Thus, the purpose of this 1-year follow-up survey of depressed patients identi®ed in a crosssectional study (Fenton et al, 1994) was to determine the outcome of major depressive episode (MDE) among male and female inpatients separately and de®ne characteristics that distinguished between patients whose depression did and did not improve (prognostic factors).…”