Elderly depression at discharge related to future outcomes

The number of depressive symptoms present in elderly patients at hospital discharge is associated with their future functional and mortality outcomes, indicate study results.

Changes in depressive symptoms after discharge in this population, aged 70 years and above, are also significantly associated with these outcomes, remark the researchers in the Journal of the American Geriatrics Society.

Specifically, the findings show that fewer patients with persistently high or increasing depressive symptoms after discharge from hospital were alive and able to complete activities of daily living (ADL) after 1 year compared with their counterparts with decreasing or persistently low symptoms.

"These results provide a rationale for monitoring depressive symptoms during and after hospitalization and demonstrate a need for interventions that can reduce symptoms and improve function and survival in at-risk individuals," say Edgar Pierluissi (University of California, San Francisco, USA) and colleagues.

Of 1129 elderly individuals who were hospitalized between 1993 and 1997, the majority were independent in ADL and had three or fewer depression symptoms, measured on the 10-item Center for Epidemiologic Studies Depression Scale. The researchers considered four or more symptoms to be clinically meaningful.

Participants were divided into four groups: low-low, who had with three or fewer symptoms at discharge and 1-year follow up; low-high, with three or fewer symptoms at discharge and four or more at 12 months; high-low, with four or more symptoms at discharge but three or fewer at 12 months; and high-high, with four or more symptoms at both time points.

Significantly more study participants in the low-high group (n=76) were unable to carry out ADL including bathing, dressing, and using the toilet, or instrumental ADL (IDL), including using a telephone and public transport, or were dead within 1 year of discharge compared with the low-low (n=643) group, at 50% versus 33%.

Similarly, significantly more participants in the high-high (n=152) group were unable to carry out ADL, IDL, or were dead within 1 year compared with their high-low (n=258) peers.

All of these associations remained significant after adjustment for potential confounders, note Pierluissi et al.

By 10 years after discharge, patients in the low-high group were more likely to have died than those in the low-low group, while those in the high-high group were more likely to have died than their high-low group peers.

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