Depression in Geriatric ED Patients: Prevalence and Recognition☆,☆☆,★
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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.
Parameters No. (%) Age (years) [mean±SD] 74.5±6.9 Female 162 (62.5) Race White 163 (62.9) Black 79 (30.5) Hispanic 16 (6.2) Other 1 (.4) Education (years) ≤8 118 (45.6) <12 75 (28.9) High school graduate 49 (18.9) College 17 (6.6) Residence status Independent 216 (83.4) Nursing home 34 (13.1) Homebound 9 (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
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Cited by (0)
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From the Departments of Emergency Medicine* and Psychiatry‡, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
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Reprint no.47/1/82887
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Address for reprints: Stephen W Meldon, MD, Emergency Medicine, S1-203 MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109