Effect of micronutrient supplementation on mood in nursing home residents.

One third of older people in nursing and/or residential homes have significant symptoms of depression. In younger people, deficiencies in selenium, vitamin C and folate are associated with depression. This study examines the association between micronutrient status and mood before and after supplementation. The objective was to determine whether the administration of selenium, vitamin C and folate improved mood in frail elderly nursing home residents. Mood was assessed using the Hospital Anxiety and Depression rating scale (HAD), and Montgomery-Asberg Depression Rating Scale (MADRS). Micronutrient supplementation was provided for 8 weeks in a double-blinded randomised controlled trial. Significant symptoms of depression (29%) and anxiety (24%) were found at baseline. 67% of patients had low serum concentrations of vitamin C, but no-one was below the reference range for selenium. Depression was significantly associated with selenium levels, but not with folate or vitamin C levels. No individual with a HAD depression score of >or=8, had selenium levels >1.2 microM. In those patients with higher HAD depression scores, there was a significant reduction in the score and a significant increase in serum selenium levels after 8 weeks of micronutrient supplementation. Placebo group scores were unchanged. This small study concluded that depression was associated with low levels of selenium in frail older individuals. Following 8 weeks of micronutrient supplementation, there was a significant increase in selenium levels and improved symptoms of depression occurred in a subgroup.

Development and validation of a brief observer-rated screening scale for depression in elderly medical patients.

OBJECTIVE: to develop a depression screening scale that does not rely on verbal communication. SETTING: an acute geriatric unit in a teaching hospital. SUBJECTS: 96 patients (mean age 81 years, range 68-92, 59 women); 40% of the initial study group of 50 and 22% of the validation group of 46 were diagnosed as depressed. METHODS: we devised a scale using nine items which could be rated by an observer; we determined inter-rater reliability, sensitivity, specificity and predictive values for each item compared with a Geriatric Mental State-AGECAT diagnosis of depression; we validated a final scale of six items. RESULTS: inter-rater reliability was poor for two items (irritability and sleep disturbance) while two items (sleep disturbance and night sedation) had poor sensitivity; we omitted these items in a revised scale. Re-analysis of data from the initial study showed that a cut-off of > or = 3 on the revised scale gave a sensitivity of 83%, a specificity of 95%, a positive predictive value of 0.89 and a negative predictive value of 0.90. Spearman's correlation coefficient between the six-item questionnaire and the Hamilton rating scale was 0.79. In the validation study, the cut-off score of > or = 3 on the revised six-item scale had a sensitivity of 90%, specificity of 72%, a positive predictive value of 0.69 and a negative predictive value of 0.96. CONCLUSIONS: this simple, short, observation-based screening scale completed by nurses is sensitive and specific in identifying depression in elderly medically ill patients, and may be a useful addition to clinical practice.

Rating depression severity in the elderly physically ill patient: reliability and factor structure of the Hamilton and the Montgomery-Asberg Depression Rating Scales.

OBJECTIVES: To assess the appropriateness of the Hamilton Depression Rating Scale and the Montgomery-Asberg Depression Rating Scale in depressed elderly physically ill patients. DESIGN: Depression scale scores from depressed medical inpatients were assessed for internal consistency using Cronbach's alpha, and subjected to exploratory principal components factor analyses. SUBJECTS: 100 medical inpatients, aged 65 years and over (median age 80.5 years, range 66-99), 74 female, with Geriatric Mental State Schedule-AGECAT case level diagnoses of depression. MATERIALS: The 17-item Hamilton Depression Rating Scale (HDS) and the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: Coefficient alpha for the HDS was 0.46; for the MADRS 0.61. Successive deletion of HDS items to maximize alpha resulted in a six-item scale (alpha = 0.60); after deletion of five MADRS items, alpha was 0.77. Factor analysis of the HDS yielded a four-factor solution accounting for 57% of the variance, the majority due to anxiety and insomnia items; the MADRS yielded a two-factor solution explaining 60% of the variance. CONCLUSIONS: Coefficient alpha for both scales is well below the minimum necessary for the total score to be used to represent a single construct. The HDS appears to be an unreliable measure of depression severity in elderly people with physical illness, as the major variance in the scores is due to anxiety and insomnia. The MADRS performs better, and with modification may be an appropriate measurement of depression severity in this population.