Characteristics of depression amongst hospitalized geriatric patients

Characteristics of depression amongst hospitalized geriatric patients

Munoz Gomez Elisa, Gosselin Isabelle, Praet Jean-Philippe, Pepersack Thierry.

elisamucl@gmail.com

Abstract

Introduction: The diagnosis of depression is difficult alongst hospitalized geriatric patients in the presence of multiple and acute medical problem. Anxiety could be secondary to acute disease(s), admission policies (emergency), social complexity (bereavement), or established depression. It is therefore possible that including a psychologist in the interdisciplinary geriatric team could be of value to make the distinction between depression and other situations such as anxiety related to hospitalisation. This situation leads to a large heterogenity in the therapeutic propositions to manage anxiety.

Objectives: 1) to assess the anxio-depressive affects (using the DSM V criteria and the HADS) presented by inpatients admitted upon an acute geriatric unit; 2) to analyze those characteristics according to the presence of depression (on the basis of the GDS>5/15) in order to try to find specific affects associated with the diagnostic of depression in clinical practice, and 3) to assess the therapeutics proposed.

Methods: Design: Observational study; Setting: a cute geriatric units of the University Hospital CHU St-Pierre ; Patients: One hundred >70 yrs old subjects consecutively admitted will be assessed between January and March 2018; assessments: use of anxiety and depression scales, comprehensive geriatric assessment.

INTRODUCTION

Depression is common among hospitalized geriatric patients.(1-13) However, the diagnosis of depression is difficult for several reasons. In particular, the severity of medical problems can lead clinicians to underestimate the presence of affective disorders in geriatric patients. On the other and anxiety related to the hospitalisation and the acute medical problem could over-estimate the diagnosis. Anxiety could be secondary to acute disease(s), admission policies (emergency), social complexity (bereavement), or established depression. It is therefore possible that including a psychologist in the interdisciplinary geriatric team could be of value to make the distinction between depression and other situations such as anxiety related to hospitalisation. This situation leads to a large heterogenity in the therapeutic propositions to manage anxiety.

OBJECTIVES

The aims of this study are: 1) to assess the anxio-depressive affects (using the DSM V criteria and the HADS) presented by inpatients admitted upon an acute geriatric unit; 2) to analyze those characteristics according to the presence of depression (on the basis of the GDS>5/15) in order to try to find specific affects associated with the diagnostic of depression in clinical practice, and 3) to assess the therapeutics proposed.

METHODS

Design:

Observational study.

Patients:

One hundred subjects consecutively admitted will be assessed between January and March 2018.

Inclusion criteria :

•  Age >70 years old
• Patients who accept to give their informed consent

Exclusion criteria: patients who are not able to answer questionnaire or patients with poor life expectancy. Patients presenting cognitive disorders with a Mini Mental Status Examination below 23 points/30.

Setting

Acute geriatric units of the University Hospital CHU St-Pierre/ Brussels (Belgium)

Anxiety and depression assessment

Assessements will be performed during the last week of hospitalization.

The presence of depression or related diagnosis will be assessed using the 15-items geriatric depression scale (GDS) and the variables of the DSM V criteria by a medical student.

The geriatric depression scale (GDS) will be used to assess the probability of a depressed state. (14) A score higher than 5 suggests the presence of depression.

The presence of recent bereavement will be noted (months).(15)

The possible history of depression will be collected.

Psychologist will assess the patients using the part concerning anixety (7 questions) of the hospital anxiety and depression scale HAD.(16, 17)

The HADS is a four- point 14-item self-report instrument assessing anxiety and depression in physically ill subjects. This scale was translated into French, and validated in a sample of cancer in-patients. (18)

Comprehensive geriatric assessment:

Patients will undergo comprehensive geriatric assessment which includes evaluations of the medical, therapeutic, social, functional, pain, and nutritional status.

Social evaluation including determination of age, sex, home (private versus institution), and the presence of co inhabitants.

All concomitant pathologies and their severities will be collected using the Cumulative Index Rating Scale (CIRS-G).(19-22)

The assessment of activities of daily living (ADL) will be made using the Katz’s scale. This will include following items: bathing, dressing, transfer, toilet, continence, and eating. Each task is graded in a 4-level scale (1 to 4 for Katz’s scale), where lower levels represent the absence of dependence, and upper level the maximal dependence for the task.(23)

Cognitive functions will be assessed using the Mini Mental State Examination.(24)

Nutritional status will be assessed using the Short-Form Mini Nutritional Assessment (SF-MNA). (25)

Most of these scales were systematically proposed and used in the Belgian acute geriatric units.(26, 27)

All drugs administrated to the patient within 2 months preceeding admission will be collected with a special attention to psychotropic druges (benzodiazepines, neuroleptics (Haloperidol, Risperidone, quetiapine, olanzapine, antidepressive, valproate, litihium).

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