Utility of clinical characteristics in identifying depression in geriatric ED patients.

We will determine if clinical characteristics can be useful in identifying depression in geriatric Emergency Department (ED) patients. We have provided a cross-sectional observational study of geriatric patients presenting to an urban university-affiliated public hospital. A brief self-rated depression scale (SRDS) was used to identify depression. Clinical characteristics, examined retrospectively, included chief complaint, chronic illnesses, mode and time of arrival and discharge disposition. Relative prevalence of depression was calculated for these clinical characteristics. 70 (27%; 95% CI, 22% to 32%) of 259 patients were found to be depressed by the SRDS. Patients with nonspecific chief complaints were more commonly depressed than patients with system-specific chief complaints, but not significantly (relative prevalence 1.6; 95% CI, 1.0 to 2.4; p = 0.19). The relative prevalence of depression also did not vary significantly when analyzed by specific chronic illness (P = 0.42) except cardiac disease (1.6; 95% CI, 1.1 to 2.4), PM or night arrival (1.3; 95% CI, 0.8 to 2.3; p = 0.17), ambulance use (1.1; 95% CI, 0.7 to 1.7; p = 0.88), or need for medical admission (1.0; 95% CI, 0.7 to 1.5; p = 0.97). Depression is common in geriatric ED patients. Clinical characteristics fail to identify elderly ED patients who are likely to be depressed. Use of a brief SRDS can aid in recognition of depression in this group.

Depression in geriatric ED patients: prevalence and recognition.

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.