Mood and Chronic Illness: Depression in the Chronic Medically-Ill Elderly. Preliminary Results

2.50
Hdl Handle:
http://hdl.handle.net/10755/155764
Type:
Presentation
Title:
Mood and Chronic Illness: Depression in the Chronic Medically-Ill Elderly. Preliminary Results
Abstract:
Mood and Chronic Illness: Depression in the Chronic Medically-Ill Elderly. Preliminary Results
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:June, 2001
Author:Schrader, Kathleen
P.I. Institution Name:Sharp HealthCare
OBJECTIVE: To screen for sub-clinical and clinical depression in the chronic, medically-ill elderly and measure its impact on clinical outcomes, healthcare utilization, and hospital readmission rates. BACKGROUND: The incidence of depression in the medically ill elderly (20-50%) has been demonstrated to be approximately 10 times that of the normal, healthy, community-dwelling elderly (1-4%). Studies have demonstrated a strong, association between the presence of depressive symptoms (minor to severe) and diminished physical and social functioning; prolonged recovery time; increased hospital stays; poor patient compliance with therapy; impaired self-care ability; diminished quality of life; increased healthcare resource utilization; and increased risk for hospital re-admission. DESIGN: A prospective, correlation design was used. POPULATION, SAMPLE, SETTING, YEARS: Subjects (N=344) were recruited prior to discharge from an acute care unit in a 500 bed non-profit hospital in San Diego, Ca. from March 1999 to December, 2000. Five subjects were disqualified for failure to meet inclusion criteria, resulting in a final study N of 339 subjects. OUTCOME VARIABLES: At baseline, 3, 6, and 9 months, subjects were screened for clinical outcomes. These outcomes included depression (Geriatric Depression Scale - GDS); life satisfaction (Life Satisfaction Scale); perceptions of control (Wallhagen’s Experience of Current Situation Subscale), functional status (Specific Activity Scale), severity of illness (Co Morbidity Scale); risk for hospital readmission (Pra Scale); subjective reports of pain and social support. Data at 9 months will include outpatient (physician office) and inpatient utilization. METHODS: Subjects were enrolled and interviewed at baseline while still in the hospital. Subsequent 3, 6 and 9 months interviews were conducted via phone by one research assistant. Subjects unavailable for follow-up calls were called up to three times in an attempt to obtain data. All data was obtained and recorded by one research assistant and entered into an ACCESS database for data management. FINDINGS: Data analysis on 339 subjects using SPSS revealed 148 males and 191 females. Subjects with GDS scores above 11 on a 0-30 scale were classified as depressed. At Baseline the depressed subjects had a mean GDS of 15.03 (SD 3.3), while the non-depressed demonstrated a mean GDS of 5.08 (SD 1.7). At 3 months depressed subjects had a mean GDS of 13.77 (SD2.8) while non-depressed had a GDS of 5.88 (SD1.5). A mortality rate of 16% was seen in depressed subjects at 3 months as compared to 9% in non-depressed subjects (r=.210, p<.01). Increased depression at baseline correlated with ¯ functional status (r=-.603, p<.000, N=334); ¯ life satisfaction (r=-.438, p<.000, N=341); and ¯ perceived control (r=-.596, p<.000, N=341). Despite focused education and physician notification of patients’ depression at baseline, physicians increased antidepressant therapy by only 2% at 3 months. CONCLUSIONS: Preliminary results indicate the negative relationships between depression and clinical outcomes (­ mortality, ¯ functional status, ¯ life satisfaction and ¯ perceived control). Financial outcomes will be reported 6/2001. IMPLICATIONS: Initial clinical results and the lack of effective physician intervention; suggest the need for nurse-directed case management of depression in the chronic medically ill elderly.
Repository Posting Date:
26-Oct-2011
Date of Publication:
Jun-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleMood and Chronic Illness: Depression in the Chronic Medically-Ill Elderly. Preliminary Resultsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/155764-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Mood and Chronic Illness: Depression in the Chronic Medically-Ill Elderly. Preliminary Results</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">June, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Schrader, Kathleen</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Sharp HealthCare</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">kathy.schrader@aacn.org</td></tr><tr><td colspan="2" class="item-abstract">OBJECTIVE: To screen for sub-clinical and clinical depression in the chronic, medically-ill elderly and measure its impact on clinical outcomes, healthcare utilization, and hospital readmission rates. BACKGROUND: The incidence of depression in the medically ill elderly (20-50%) has been demonstrated to be approximately 10 times that of the normal, healthy, community-dwelling elderly (1-4%). Studies have demonstrated a strong, association between the presence of depressive symptoms (minor to severe) and diminished physical and social functioning; prolonged recovery time; increased hospital stays; poor patient compliance with therapy; impaired self-care ability; diminished quality of life; increased healthcare resource utilization; and increased risk for hospital re-admission. DESIGN: A prospective, correlation design was used. POPULATION, SAMPLE, SETTING, YEARS: Subjects (N=344) were recruited prior to discharge from an acute care unit in a 500 bed non-profit hospital in San Diego, Ca. from March 1999 to December, 2000. Five subjects were disqualified for failure to meet inclusion criteria, resulting in a final study N of 339 subjects. OUTCOME VARIABLES: At baseline, 3, 6, and 9 months, subjects were screened for clinical outcomes. These outcomes included depression (Geriatric Depression Scale - GDS); life satisfaction (Life Satisfaction Scale); perceptions of control (Wallhagen&rsquo;s Experience of Current Situation Subscale), functional status (Specific Activity Scale), severity of illness (Co Morbidity Scale); risk for hospital readmission (Pra Scale); subjective reports of pain and social support. Data at 9 months will include outpatient (physician office) and inpatient utilization. METHODS: Subjects were enrolled and interviewed at baseline while still in the hospital. Subsequent 3, 6 and 9 months interviews were conducted via phone by one research assistant. Subjects unavailable for follow-up calls were called up to three times in an attempt to obtain data. All data was obtained and recorded by one research assistant and entered into an ACCESS database for data management. FINDINGS: Data analysis on 339 subjects using SPSS revealed 148 males and 191 females. Subjects with GDS scores above 11 on a 0-30 scale were classified as depressed. At Baseline the depressed subjects had a mean GDS of 15.03 (SD 3.3), while the non-depressed demonstrated a mean GDS of 5.08 (SD 1.7). At 3 months depressed subjects had a mean GDS of 13.77 (SD2.8) while non-depressed had a GDS of 5.88 (SD1.5). A mortality rate of 16% was seen in depressed subjects at 3 months as compared to 9% in non-depressed subjects (r=.210, p&lt;.01). Increased depression at baseline correlated with &macr; functional status (r=-.603, p&lt;.000, N=334); &macr; life satisfaction (r=-.438, p&lt;.000, N=341); and &macr; perceived control (r=-.596, p&lt;.000, N=341). Despite focused education and physician notification of patients&rsquo; depression at baseline, physicians increased antidepressant therapy by only 2% at 3 months. CONCLUSIONS: Preliminary results indicate the negative relationships between depression and clinical outcomes (&shy; mortality, &macr; functional status, &macr; life satisfaction and &macr; perceived control). Financial outcomes will be reported 6/2001. IMPLICATIONS: Initial clinical results and the lack of effective physician intervention; suggest the need for nurse-directed case management of depression in the chronic medically ill elderly.</td></tr></table>en_GB
dc.date.available2011-10-26T14:09:09Z-
dc.date.issued2001-06en_GB
dc.date.accessioned2011-10-26T14:09:09Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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