Does Depression Predict Adverse Outcomes for Older Medical Inpatients
Does Depression Predict Adverse Outcomes for Older Medical Inpatients
Objective: to examine the relationship between depressive symptoms and hospital outcomes in an unselected consecutive sample of older medical inpatients.
Design: a prospective cohort study of individuals screened for a trial.
Setting: medical wards of UK district general hospital in rural East Anglia.
Participants: six hundred and seventeen medical inpatients aged 65+ were randomly selected from consecutive admissions.
Baseline Measures: 15-item Geriatric Depression Scale (GDS-15), the Abbreviated Mental Test Score (AMTS) and the Cumulative Illness Rating Scale -- Geriatric (CIRS-G).
Main Outcome Measures: length of hospital stay; discharge to a community hospital (for rehabilitation), institutional care or usual place of residence; dying in hospital.
Results: depressive symptoms are independently associated with an increased likelihood of inpatient death and transfer to a community hospital for rehabilitation, but are not associated with longer length of stay.
Conclusions: research evaluating effectiveness of identification and treatment of depression in older medical inpatients should consider including inpatient death and use of rehabilitation services as potential outcomes.
Studies suggest that a substantial proportion of older hospital inpatients have depressive symptoms that may hinder their recovery. Adverse outcomes include delayed discharge, greater risk of readmission, increased need for rehabilitation or institutional care and higher mortality. In order to attempt to reduce the impact of depression on patients' health outcomes and healthcare costs, recent UK health policy encourages screening and treatment programmes for older people in mainstream healthcare settings. However, the research evidence cited above derives mainly from countries other than the UK and may not be generalisable to older people in UK hospitals. The aim of this study is to examine the relationship between depressive symptoms and hospital outcomes in an unselected consecutive sample of older medical inpatients in a UK hospital, thus informing the selection of measurable outcomes that might be impacted by a policy of screening and treatment of depression in this population.
Abstract and Introduction
Abstract
Objective: to examine the relationship between depressive symptoms and hospital outcomes in an unselected consecutive sample of older medical inpatients.
Design: a prospective cohort study of individuals screened for a trial.
Setting: medical wards of UK district general hospital in rural East Anglia.
Participants: six hundred and seventeen medical inpatients aged 65+ were randomly selected from consecutive admissions.
Baseline Measures: 15-item Geriatric Depression Scale (GDS-15), the Abbreviated Mental Test Score (AMTS) and the Cumulative Illness Rating Scale -- Geriatric (CIRS-G).
Main Outcome Measures: length of hospital stay; discharge to a community hospital (for rehabilitation), institutional care or usual place of residence; dying in hospital.
Results: depressive symptoms are independently associated with an increased likelihood of inpatient death and transfer to a community hospital for rehabilitation, but are not associated with longer length of stay.
Conclusions: research evaluating effectiveness of identification and treatment of depression in older medical inpatients should consider including inpatient death and use of rehabilitation services as potential outcomes.
Introduction
Studies suggest that a substantial proportion of older hospital inpatients have depressive symptoms that may hinder their recovery. Adverse outcomes include delayed discharge, greater risk of readmission, increased need for rehabilitation or institutional care and higher mortality. In order to attempt to reduce the impact of depression on patients' health outcomes and healthcare costs, recent UK health policy encourages screening and treatment programmes for older people in mainstream healthcare settings. However, the research evidence cited above derives mainly from countries other than the UK and may not be generalisable to older people in UK hospitals. The aim of this study is to examine the relationship between depressive symptoms and hospital outcomes in an unselected consecutive sample of older medical inpatients in a UK hospital, thus informing the selection of measurable outcomes that might be impacted by a policy of screening and treatment of depression in this population.
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