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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Depression in the elderly looks like depression in adulthood, without mention of a strict clinical specificity. In fact, depression in the elderly presents a semiologic inflexion, and a symptomatology attenuation. Some signs could be considered by others to twists as belonging the normal aging, but are in reality clinical elements of depression symptomatology. These reasons, as well as the variability of evaluation methods used, make that this pathology remains often underdiagnosed. Nevertheless, epidemiological studies have pointed out that this trouble is relatively frequent. Depression in the elderly is important to be detected, in reason that it could be treated, allowing to prevent somatic complications, repetition of troubles, relapse, suicide solution, and dementia development. Most of authors considers that the most useful diagnostic tests are screening assessments. In the geriatric population, about 43 tools exists for the depression, but some of these are better than other. Three validated rating scales are specially interessant for the depression in the elderly: GDS of Yesavage (Geriatric Depression Scale), HDRS of Hamilton (Hamilton Depression Rating Scale) and MADRS of Montgomery and Asberg (Montgomery and Asberg Depression Rating Scale). The purpose of this work is to present a psychiatric interview guide, allowing to better specify depressive symptoms with old subjects, constructed and adapted from these 3 rating scales and the DSM IV criteria. In order that, we have first synthetized all of the items of the 3 scales. Then, by following diagnostic criteria of the DSM IV, we have constructed with uniform manner the interview guide. It has been built to evaluate general clinical aspects, but also to precise clinical points. The interviewer can ask question, take into account the clinical dimension, and appreciate the intensity of the trouble. The guide has been experimented and tested with older depressive subjects. After a necessary training phase to control the assessment system, the guide is usable during a clinical interview. It allows to collect, in a standardized manner, sufficiently data to establish the diagnosis and to quantify the intensity of the trouble. Conceived initially for a practical clinic use, this guide will have future use in research studies, in return for some ulterior validation works.
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PMID:[Structured interview guide for evaluating depression in elderly patients, adapted from DSM IV and the GDS, HDRS and MADRS scales]. 1095 4

Newly admitted residents in long-term care facilities are particularly vulnerable to depression and the early recognition and treatment of depression is therefore crucial around the time of admission to a home. Staff from 30 nursing and residential homes were asked to assess newly admitted residents for depression using HoNOS 65+ and their responses were compared with residents' scores on the Geriatric Depression Scale (GDS-15). The findings indicated low levels of recognition by staff, with rates ranging from 15% to 27% of those identified as depressed, depending on the definition of depression used. There was no statistically significant difference in the rate of recognition between nursing staff and other care staff. A staff survey conducted in the 30 study homes indicated that fewer than 2% had received specific in-service training on depression in older people. The findings suggest that more needs to be done to raise staff awareness of depression in residents of nursing and residential homes, particularly in newly admitted residents.
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PMID:Recognition of depression by staff in nursing and residential homes. 1123 20

The effects of a multifaceted secondary prevention intervention in residential homes in the Netherlands were examined, using a quasi-experimental design. In five experimental residential homes, the caregivers received three training sessions on detecting depression and on supporting depressed residents. Furthermore, an information session was organized for all personnel, a further session was organized for residents and their relatives, and several group interventions were offered. 213 residents participated in the study. 211 residents of five other residential homes, matched on basic variables, served as a comparison group. Effects on depressive symptoms (geriatric depression scale) and health related quality of life (MOS-SF-36) were measured at pretest and after the intervention, one year later. Because the drop-out rate was high and drop-outs differed significantly from the remaining population, the scores of drop-outs were imputed. Since we used a quasi-experimental design, we controlled for confounding variables. Regression analyses resulted in significant effects of the intervention on the GDS and on role functioning in the total population. When the analyses were limited to those scoring high on the GDS at pretest, significant effects were found on the GDS, and on four domains of health-related quality of life: psychological distress, role functioning, pain and social functioning. The improvement in GDS scores in GDS cases was significantly larger than in other subjects. Our results suggest that general approaches aimed at a residential home are capable of influencing depressive symptoms in inhabitants. Possibly, it may not be necessary to wait until depressive symptoms have escalated and inhabitants need extensive treatment.
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PMID:Secondary prevention of depressive symptoms in elderly inhabitants of residential homes. 1146 49

To ascertain how effective the seven-item Beck Depression Inventory-FastScreen for medical patients (BDI-FS) was in screening geriatric (> 55 years old) patients for depression, the BDI-FS and the 15-item Geriatric Depression Scale (GDS-S) were administered to 33 (44%) male and 42 (56%) female outpatients who were scheduled for routine office visits by physicians specializing in geriatric medicine. The internal consistency of the BDI-FS was high (coefficient alpha = 0.83), and it was positively correlated with the GDS-S, r = 0.81, p < 0.001. The BDI-FS scores were not related to sex, age, ethnicity, or type of medical diagnosis, but were positively correlated with a diagnosis of depression (r = 0.49, p < 0.001) and being prescribed an antidepressant (r = 0.55, p < 0.001). A BDI-FS cut-off score of four and above had 100% sensitivity and 84% specificity rates, respectively, for identifying patients who were and were not diagnosed with depression.
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PMID:Evaluating geriatric medical outpatients with the Beck Depression Inventory-Fastscreen for medical patients. 1151 Oct 61

It is becoming increasingly clear that, in order to better understand the implications of global aging, more cross-cultural research is needed. In the present study, the structure and validity of the Geriatric Depression Scale-Short Form (GDS-SF) was examined in Korean and US samples of older adults. The participants included 153 older adults living in Korea (mean age=65.9 years) and 459 older adults from Florida (mean age=72.4 years). All participants completed the original or translated versions of the GDS-SF, as well as additional demographic and health-related measures. The results indicated that the GDS-SF exhibited good reliability in both samples. However, the results of a principal components analysis indicated that the structure was not well replicated across the two samples. In general, the present study suggests that, despite great efforts to make the questionnaires equivalent in the two cultures, the concept of depression for older adults may vary greatly in Korea and the USA. Possible explanations for cross-cultural differences are discussed, as well as implications.
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PMID:Cross-cultural comparability of the Geriatric Depression Scale: comparison between older Koreans and older Americans. 1151 10

Within a group of homebound elders with urinary incontinence, the objectives of this study were to (1) examine the prevalence of depressive symptoms, (2) examine the extent to which depression had previously been recognized by health care providers, (3) describe the type and intensity of antidepressant treatment prescribed for subjects, and (4) identify the demographic and functional characteristics associated with depressive symptomatology. A descriptive correlational design was used. The 15-item Geriatric Depression Scale (GDS-15) was administered to 345 homebound adults age 60 years and over referred to a study examining the effectiveness of behavioral therapy for urinary incontinence. Individuals were referred to the study by home care nurses from two large Medicare-approved home health agencies in a large metropolitan county in Pennsylvania. Data were collected during in-home assessments and by chart review. Measures included the GDS-15, structured medical history, in-home review of medications, Older Americans Research and Service Center Physical and Instrumental Activities of Daily Living scales, Mini-Mental State Examination (MMSE), Clock Drawing Test, Performance-Based Toileting Assessment, and bladder diaries. One half of the participants (n = 173; 50.1%) had significant depressive symptomatology, with 35.7% having scores suggesting mild depression and 14.5% severe depression. Only 26.4% and 34.7% of those with mild and severe depressive symptoms, respectively, had a previous diagnosis of depression and only 21.7% and 34.0%, respectively, had been prescribed an antidepressant. The most commonly prescribed class of antidepressants was tricyclic antidepressants, being taken by 9.0% (n = 31) of the total sample, 14 (11.4%) of those with mild symptoms and 4 (8.0%) of those with severe depressive symptomatology. A little over half (60.0%) of subjects being treated with antidepressants continued to exhibit significant depressive symptomatology. Greater dependence in physical activities of daily living, the need for assistance during ambulation, higher MMSE scores, and higher levels of comorbidity were associated (P < .05) with a GDS-15 score of 5 or higher. Depression symptoms are common in homebound older adults with urinary incontinence, but clinical recognition and treatment are limited.
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PMID:Prevalence and recognition of depressive symptoms among homebound older adults with urinary incontinence. 1156 36

Depression in the elderly is often unknown, underdiagnosed and undertreated. In primary care, there is a need to help this clinical challenge. The aim of this study is to show that a detection tool which is reliable, easy and rapid to use, the mini-GDS, could be an aid to detect depression in the elderly in general practice and to sensitize to treat these patients. A survey realized with 75 general practitioners permit to have data about 1,532 elderly patients. Three logistic regression analysis were done to assess effect of different variables on the dichotomized score of the mini-GDS, on the psychotropics prescription and on the diagnosis of depressive disorder. There was a depressive and/or anxious symptomatology (DAS) in 44% of cases. Some variables had an effect on the obtained mini-GDS score, but this score also seemed to influence psychotropics prescription (10% increase), even though an observed DAS did not indicate to this prescription. Other variables as a previous psychotropic treatment, a recent life event, or somatic complaints had an effect on this prescription. In antidepressants prescriptions, 94% agreed with a positive score on mini-GDS and 89% to a diagnosis of DAS, but in anxiolytics prescriptions, 79% agreed with a positive score on mini-GDS and 81% to a diagnosis of DAS. Finally, with cut-off score 1, a statistically significant correlation was observed between positivity and the presence of DAS (p < 0.0001), but also between positivity and psychotropics prescription (p < 0.0001) and more particularly with an antidepressant prescription (p < 0.0001). A post survey after one year with 30 practitioners who participated in this sensitization study showed that, within the 16 respondents, this kind of training had been helped them to better recognize depression (13/16) and modified their therapeutic attitude (9/16). This clinical approach should be more and more recommended to improve the still very bad prognosis of depression in the elderly.
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PMID:[Mini-GDS in elderly population administered by general practitioners]. 1168 54

Depression is very common in patients with dementia but the relationship is very complex. Depression is regarded as a cause of excess disability in persons with dementia and contributes to their functional decline. The assessment of depression in dementia patients, however, has been difficult in that the validity of self-reported depression in patients with dementia has been questioned. This study was done to investigate whether self-reported depression by persons with dementia (using the GDS) is related to their functional abilities as rated by a family caregiver (using the IADL scale) above and beyond demographic variables. This study was conducted at the Detroit Satellite of the Michigan Alzheimer's Disease Research Center. There were 141 participants, 67% were African American and 33% were European American. Statistical analyses included a correlational and multiple regression approach to determine the predictive relationships of cognitive and depressive symptoms above and beyond the influence of demographic variables and cognition. The results of the study further support the notion that depression in dementia is significantly related to functional decline but, more importantly, that self-reported depression in patients with dementia can be valuable information in understanding patients' functioning.
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PMID:Depression, cognitive impairment and function in Alzheimer's disease. 1174 57

The aim of the undertaken studies based on many years' observation of the group of elderly people was to describe psychopoathological pictures typical of preclinical phase of Alzheimer disease (AD) as well as the changes in social functioning. The obtained data were to serve to work out the criteria making initial recognition of preclinical phase of AD possible. Estimation of direct degree--in the perspective of next few years--of the danger of dementia of Alzheimer type should simplify making a decision about including therapeutic activities. 204 persons have completed the five-year-observation (70% of the qualified). During the observation AD has developed at 19 persons, five of the examined at the beginning of the observation were described as "no disturbances of cognitive functions"--I according to the GDS scale and 14 were qualified as "slight impairment of cognitive functions"--GDS II. The basis for further conclusions was the comparison of the results obtained in the groups of people at whom, during the five-year-observation, in the examination with the GDS scale, no changes regarding cognitive functions have been observed, with those examined in whom dementia has been recognised. Statistic analysis has been done mostly for the results obtained before the appearance of the dementia. The conducted studies made it possible to verify the stated hypotheses and draw the following conclusions: preclinical period of AD is connected with intensification of psychopathological disturbances, especially depression; in the period preceding the development of AD usually slight disturbances of cognitive functions appear which are most often revealed during the particular examination of cognitive functions; clear decrease in social activity is typical of the preclinical phase of AD; people in premorbid period showed various disturbances but no symptom has been observed that would be pathognomic for the preclinical phase of AD; it is possible, on the basis of the examination by means of proper clinical scales, to predict the danger of dementia but it is necessary to take into account various elements of psychic state and social functioning.
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PMID:[The psychopathological symptoms of the preclinical stages of Alzheimer's disease]. 1187 82

The objective of this study was to determine whether lower extremity peripheral arterial disease (PAD) is associated with depressive symptoms and whether PAD-related disability mediates the association between PAD and depressive symptoms. The study used a cross-sectional design set in an academic medical center. A cohort of men and women aged 55 years and older with (n = 93) or without (n = 74) PAD was recruited. PAD subjects were identified from a blood flow laboratory and a general medicine practice. Non-PAD subjects were identified from the same general medicine practice. PAD was diagnosed and quantified using the ankle-brachial index (ABI). Depressive symptoms were assessed by the 15-item short version of the Geriatric Depression Scale (GDS-S; score range 0-15, 0 = no depressive symptoms). The six-minute walk test and the Walking Impairment Questionnaire (WIQ) distance score (score range 0-100, 100 = better walking ability) were measures of walking impairment. PAD subjects had depressive mood (DM) (defined by GDS-S score >5) twice as often as controls (24% vs 12%, p = 0.06). After adjustment for age, education, and number of comorbidities, the prevalence of depressive mood among PAD subjects was increased, but this association was not significant (OR = 1.8, 95% CI 0.7-4.4). The WIQ distance score weakened the association between PAD and DM, and higher distance scores were associated with a lower likelihood of DM (OR = 0.98 per one unit of the WIQ, 95% CI 0.96-0.99). Among PAD subjects, severe PAD (ABI <0.5) was not significantly associated with DM (OR = 1.4, 95% CI 0.5-4.1), but a greater 6-min walk distance was associated with a lower likelihood of DM (OR = 0.8 per 100 feet, 95% CI 0.70-0.97). Substituting the WIQ scores for six-min walk distance in the model showed that higher WIQ scores were associated with lower likelihood of DM among PAD subjects (OR= 0.98 per one unit of the WIQ, 95% CI 0.95-1.0), though the association did not achieve statistical significance. In conclusion, these data suggest that PAD may be associated with an increased risk of DM and that this relationship may be related to PAD-associated disability. An evaluation for depression may be appropriate in men and women with PAD. Findings should be evaluated in a larger study cohort.
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PMID:Peripheral arterial disease and depressed mood in older men and women. 1195 88


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