Some predictors of mortality in acutely medically ill elderly inpatients

Shah, Ajit; Hoxey, Katharina; Mayadunne, Vidurath

doi:10.1002/1099-1166(200006)15:6<493::aid-gps150>3.0.co;2-e

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…1, March 2003 tia in the general geriatric population and between suicidal ideas and nonsuicidal death in medical older inpatients are examples of such a possibility. 27,28 Multidimensional assessment is the cornerstone of the current approach to the elderly patient. 29 Assessing social, medical, neuropsychological, and functional status allows for complete information on the health status of the patient and the planning of interventions aimed at improving that status or preventing further worsening.…”

Section: Discussionmentioning

confidence: 99%

Construct Validity of the 15-Item Geriatric Depression Scale in Older Medical Inpatients

Incalzi

Cesari

Pedone

et al. 2003

J Geriatr Psychiatry Neurol

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The construct validity of the 15-item Geriatric Depression Scale (sfGDS) has been assessed in selected populations. The aim of this study was to assess the appropriateness of applying the sfGDS to unselected older inpatients. The main component analysis of sfGDS was performed in 2032 medical inpatients (mean age = 76.3 +/- 8.4). sfGDS did not qualify as a unidimensional test. Three factors explained 47.7% of variance and explored the following dimensions: positive attitude toward life, distressing thoughts/negative judgment about the own condition, and inactivity/reduced self-esteem. The internal homogeneity was poor (Cronbach's alpha = .46). A higher fraction of variance was explained in patients independent in all or dependent in> or = 1 activity of daily living (ADL). In older medical inpatients, sfGDS is not a single construct, which prevents the univocal interpretation of the final score. The higher fraction of explained variance in patients with comparable ADL performance probably reflects the dependency of affective from physical status.

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Section: Discussionmentioning

confidence: 99%

Construct Validity of the 15-Item Geriatric Depression Scale in Older Medical Inpatients

Incalzi

Cesari

Pedone

et al. 2003

J Geriatr Psychiatry Neurol

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“…More attention should be paid to elderly inpatients with physical illness because they are more likely to have a suicide attempt and suicide death because of old age, burden of physical diseases, and an increased concurrence of depression [5]. Thus, to single out elderly inpatients with SI at an early stage and provide timely adequate treatment in a general hospital, may decrease rates of suicidal behaviors and related mortality [5, 22]. Although this issue is important, only a small number of studies have explored the prevalence and characteristics of SI in elderly inpatients with medical or surgical conditions.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan

Liao

Liu

et al. 2018

BMC Psychiatry

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BackgroundWorldwide, the elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. Therefore, a study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted.MethodsA total of 2199 hospitalized elderly patients over age 65 were enrolled. Demographic data, 5-item Brief Symptom Rating Scale (BSRS-5), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) data were collected. Logistic regression models were used to find the SI-related factors for all participants and to investigate the covariates correlated with WTD in patients with SI. Receiver operating characteristic (ROC) curve analysis was used to find the most important items of the BSRS-5 predictive of SI in this population.ResultsSI was found in 3.1% (68/2199) of the elderly. The statistically significantly factors associated with SI were: BSRS-5 item 2 (depression) (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.56–2.98), item 4 (inferiority) (OR = 1.62, 1.23–2.13), item 5 (insomnia) (OR = 1.52, 1.13–2.05), and physical domain of WHOQOL (OR = 0.84, 0.72–0.99). QOL15 (mobility) (OR = 0.64, 0.46–0.90) and QOL 16 (satisfaction with sleep) (OR = 0.62, 0.44–0.88) were also significantly associated with SI. The status of living alone (OR = 4.44, 1.24–15.87), QOL 26 (absence of negative feeling) (OR = 0.38, 0.15–0.98), and QOL 27 (being respected/accepted) (OR = 0.43, 0.20–0.92) were significantly associated with WTD among inpatients with SI. The ROC curve analysis revealed that depression, inferiority, and insomnia were the most important items in the BSRS-5 significantly associated with SI among the elderly inpatients.ConclusionTo provide physical recovery and maintain mental health for physically ill elderly inpatients, setting up a multi-faceted approach targeting the aforementioned determinants of SI and WTD for reducing the risk of suicide attempt, and exploring other factors correlated with suicidal behaviors, are important topics and directions for clinical practice and further research.

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“…While individuals with major depression are among the most likely to express suicidal ideation, ideation at more passive levels frequently presents among older adults in the absence of depression. (8) There is some evidence that suicidal ideation predicts mortality in elderly community (9–10) and acutely medically ill inpatients, (11) but other studies have not found such a relationship. (12–13)…”

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confidence: 99%

The Wish to Die and 5-Year Mortality in Elderly Primary Care Patients

Raue

Morales

Post

et al. 2010

The American Journal of Geriatric Psychiatry

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Objectives-We examined the impact of the wish-to-die on mortality over a 5-year period, stratified by baseline depressive status (i.e., major, minor, no depression diagnosis). We also examined whether a depression care management intervention would minimize these relationships. Design-Longitudinal analyses of the practice-randomized Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT).Setting-20 primary care practices from New York City, Philadelphia, and Pittsburgh.Participants-1202 participants were identified via two-stage, age-stratified (60-74; 75+) depression screening of randomly sampled participants. Intervention-Practices randomized to Care Management Intervention or Usual Care conditions.Measurements-Vital status at 5 years using the National Death Index.Results-Rates of the wish-to-die were 29% (major depression), 11% (minor depression), and 7% (no depression). In Usual Care, the wish-to-die was associated with an increased risk of 5-year mortality across depressive status (adjusted hazard ratios ranging from 1.62 to 1.71). In Intervention practices, this association was greater among the no depression (adjusted hazard ratio 1.64) compared to major depression group (adjusted hazard ratio 0.68). Conclusions-The wish-to-die was associated with mortality in the usual care of elderly primary care patients, suggesting that the wish-to-die has clinical significance and may be worth assessing even in patients without other evidence of depression. This association was not observed among depressed patients located in primary care practices that implemented the PROSPECT intervention, suggesting potential long-term benefits of treatment and management of depression. Prospective studies have documented a relationship between depression and mortality in community samples, (1-4) with fewer investigations in primary care. (5) Our group found that elderly primary care patients with major or minor depression were almost twice as likely to die over a 2-year follow-up period, (6) in comparison to non-depressed patients, after controlling for medical illnesses. In a longer-term follow-up of the same sample, patients with major depression whose physicians participated in a depression care management intervention were less likely to die over a 5-year course, in comparison to those who received usual care. (7) Less is known about the impact of suicidal ideation on natural-cause mortality in primary care, and whether its impact contributes over and above depression. While individuals with major depression are among the most likely to express suicidal ideation, ideation at more passive levels frequently presents among older adults in the absence of depression. (8) There is some evidence that suicidal ideation predicts mortality in elderly community (9-10) and acutely medically ill inpatients, (11) but other studies have not found such a relationship. (12-13) Documentation of specific types of suicidal ideation as risk factors for mortality in the absence of depression, and independent of medic...

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Some predictors of mortality in acutely medically ill elderly inpatients

Cited by 13 publications

References 27 publications

Construct Validity of the 15-Item Geriatric Depression Scale in Older Medical Inpatients

Construct Validity of the 15-Item Geriatric Depression Scale in Older Medical Inpatients

Prevalence and characteristics of suicidal ideation among 2199 elderly inpatients with surgical or medical conditions in Taiwan

The Wish to Die and 5-Year Mortality in Elderly Primary Care Patients

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