13 year follow up of morbidity, mortality and use of health services among elderly depressed patients and general elderly populations.

OBJECTIVES: The aim of this study was to establish the predictive value of an ICD-10 diagnosis of depressive disorder or dysthymia (depressive patients) among 70 years + frail rural community living patients by measuring morbidity, mortality and use of health services. Identical measures were studied over time in general elderly populations. OUTCOME MEASURES: morbidity, mortality and use of health services were registered over 13 years in: (i) a clinical cohort of frail community-living depressive patients (n = 38), a frail control group (n = 116) and non-frail elderly people (n = 575), all living in the same municipality, and (ii) register-based samples of general rural (n = 4 115) and capital living (n = 54 977) elderly populations. The outcome measures were compared using data from Danish national health registers. RESULTS: Every one of the clinical cohort of depressive patients had died at the end of the study. Compared with both the frail control group and the non-frail elderly people, the depressive patients had significantly more psychiatric hospital days, outpatient home visits, antidepressant use, antipsychotic use, GP service use and more psychiatric diagnoses with higher morbidity. However, greater use of somatic hospital services or more somatic diagnoses among the depressive elderly patients were not observed. The general elderly population living in the capital had, compared with rural equals, significantly more somatic and psychiatric diagnoses, larger use of somatic hospital services, psychiatric hospital days, antipsychotics and anxiolytics, but less use of antidepressants, psychiatric outpatient home visits and GP services. CONCLUSIONS: An ICD-10 diagnosis of depressive disorder or dysthymia predicted increased use of psychiatric services, more psychiatric diagnoses and increased mortality, indicating poor late-life psychiatric outcome. Contrasting with other studies, depression did not predict increased use of somatic hospital services or more somatic diagnoses. The differences in health care status and use between elderly living in the capital and in rural areas elderly are novel findings.

[A nine-year controlled follow-up study of delirium patients discharged after treatment in a psychogeriatric university department]. / En niårs kontrolleret opfølgningsundersøgelse af deliriumpatienter udskrevet efter behandling på en gerontopsykiatrisk universitetsafdeling.

INTRODUCTION: Although delirium is a reversible cerebral syndrome, the effect of treatment of the elderly is unsatisfactory, involving prolonged hospitalizations and increased risk of relapse and mortality. The purpose of this study was to evaluate whether hospitalization for delirium (severe delirium) diagnosed by ICD-10 criteria predicts increased morbidity, utilization of health services and mortality. MATERIALS AND METHODS: Delirious inpatients (n = 26) discharged after treatment in an old-age psychiatric university clinic were studied for nine years. In a register-based design, the above-mentioned parameters of the delirium cohort were compared with a group of controls (n = 116). RESULTS: There was a trend to increased mortality in the delirium cohort. Compared with the controls, the delirium cohort had a significantly increased incidence of disorders of vital organs, serious psychiatric disorders, particularly depression, increased use of hospital psychiatry and general practitioner's out-of-hours service, but less use of office-hour services. The incidence of delirium in the cohorts was low. In the delirium cohort, there was no significantly increased use of services or the number of diagnoses in somatic hospitals. CONCLUSION: Increased somatic and psychiatric morbidity and a trend to increased mortality indicate a serious prognosis after severe delirium in the elderly. It is noteworthy that the delirium cohort had increased use of GPs' out-of-hours services but less use of office-hour services.

[Diagnosis and treatment of Lewy body dementia]. / Diagnostik og behandling af Lewy body-demens.

Dementia with Lewy bodies (DLB) has recently gained recognition as a separate disease. Lewy bodies are pathoanatomical inclusion bodies in the CNS. They are well known as part of Parkinson's disease where they are present mainly in the substantia nigra, and they are also found in large numbers in the neocortex. It is still an unanswered question why Lewy bodies are formed, but their appearance is connected with cellular degeneration of unknown aetiology. Neuropathological investigations of dementia populations show that DLB accounts for 12-36%, which places it as the second most frequent dementia disease after Alzheimer's disease (AD) with a frequency close to that of vascular dementia. This article reviews the development of the term DLB and describes the clinical characteristics, including the neuropsychological symptom profile, which can contribute to the diagnostic discrimination between DLB and AD. Furthermore, relevant treatment possibilities are discussed.