Depression in Geriatric ED Patients: Prevalence and Recognition,☆☆,

Presented in part at the Society for Academic Emergency Medicine Annual Meeting, May 1995, San Antonio, TX.
https://doi.org/10.1016/S0196-0644(97)70132-XGet rights and content

Abstract

Study objective: To determine the prevalence of depression in geriatric ED patients and to assess recognition of geriatric depression by emergency physicians. Methods: We conducted an observational survey of geriatric patients who presented to an urban, university-affiliated public hospital ED. A convenience sample of 259 patients aged 65 years or older were administered a brief, self-rated depression scale. Main outcome measures were prevalence of depression (using a predetermined cutoff score for detecting depression) and recognition of depression by the treating emergency physician, assessed by chart review. Results: Seventy subjects (27%; 95% confidence interval [CI], 22% to 32%) were rated as depressed. Depressed and nondepressed patients were not significantly different with regard to age, sex, race, or education. Forty-seven percent of nursing home residents were depressed, compared with 24% of those living independently (95% CI for difference of 23%, 6% to 41%). Patients who described their health as poor were also more likely to be depressed (33 of 65, 51%) than patients who reported their health to be good or fair (37 of 194, 19%) (95% CI for difference of 32%, 18% to 45%). Emergency physicians failed to recognize depression in all the patients found to be depressed on this scale (95% CI, 0 to 5%). Conclusion: The prevalence of unrecognized depression in the geriatric ED patients we studied was high, especially in those who reported their health as poor. Use of a brief depression scale can aid recognition of depression in older patients, leading to appropriate referral and treatment. [Meldon SW, Emerman CL, Schubert DSP, Moffa DA, Etheart RG: Depression in geriatric ED patients: Prevalence and recognition. Ann Emerg Med August 1997;30:141-145.]

Section snippets

INTRODUCTION

Depression is the most common psychiatric disorder in the geriatric population,1 although prevalence varies. In the community, the prevalence of major depressive disorder ranges from 2% to 5% among subjects aged 65 years and older.2, 3 This prevalence increases to 8% to 10% when geriatric medical outpatients are screened for depression.4, 5 However, primary care physicians often fail to recognize depression. In the ambulatory care setting, primary care physicians detect depression in fewer than

MATERIALS AND METHODS

We conducted a cross-sectional observational survey over a 3-month period at a large urban, university-affiliated public hospital. The study population consisted of a convenience sample of ED patients 65 years or older who gave oral consent. Exclusion criteria were medical instability, history of or current obvious cognitive impairment (disorientation or poor recall), significant communication problem (aphasia, deafness, or language barrier), and prior enrollment in the study. We used a brief,

RESULTS

We evaluated 259 patients. Patient demographics, including education and living status, are shown in the Table.

Table. Patient demographics.

ParametersNo. (%)
Age (years) [mean±SD]74.5±6.9
Female162 (62.5)
Race
White163 (62.9)
Black79 (30.5)
Hispanic16 (6.2)
Other1 (.4)
Education (years)
≤8118 (45.6)
<1275 (28.9)
High school graduate49 (18.9)
College17 (6.6)
Residence status
Independent216 (83.4)
Nursing home34 (13.1)
Homebound9 (3.5)

Seventy of the 259 patients (27.0%; 95% CI, 22% to 32%) scored at or above the

DISCUSSION

Depression is increasingly recognized as a serious mental health problem in older people. Although screening has been performed in other settings, we know of no previous study in which geriatric ED patients have been screened for depression.

Because a structured psychiatric interview is not applicable in most clinical settings, self-rated depression scales such as the Geriatric Depression Scale (GDS) have been developed to help detect depression. The GDS is a 30-item screening instrument

References (31)

  • KB Wells et al.

    Detection of depressive disorder for patients receiving prepaid or fee-for-service care

    JAMA

    (1989)
  • AC Nielsen et al.

    Depression in ambulatory medical patients: Prevalence by self-report questionnaire and recognition by non-psychiatric physicians

    Arch Gen Psychiatry

    (1980)
  • DSP Schubert et al.

    Increase of medical hospital length of stay by depression in stroke and amputation patients: A pilot study

    Psychother Psychosom

    (1992)
  • ML Bruce et al.

    Psychiatric disorders and 15 month mortality in a community sample of older adults

    Am J Public Health

    (1989)
  • K Blazer et al.

    Epidemiology of dysphoria and depression in an elderly population

    Am J Psychiatry

    (1980)
  • Cited by (0)

    From the Departments of Emergency Medicine* and Psychiatry, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.

    ☆☆

    Reprint no.47/1/82887

    Address for reprints: Stephen W Meldon, MD, Emergency Medicine, S1-203 MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109

    View full text