Screening for Depression in Nursing Home Palliative Care Patients

Abstract

The purpose of the this study was to evaluate the existing tools for assessing depression in nursing home patients referred to palliative care services. The patients referred to palliative care were assessed for depression by a geriatric fellow and a psychiatrist (gold standard). The questions asked by the fellow were derived from the existing validated screening scales and diagnostic tools. The psychiatrist’s assessment had a strong agreement with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV;. = 0.400) and Geriatric Depression Scale (GDS;. = 0.462) and least agreement with the Cornell Scale for Depression in Dementia (CDS). However, depression in the most severe dementia patients (Mini-Mental State Examination = 0) was able to be assessed only by the CDS. Thus, although items from the DSM-IV and GDS may be used to ascertain depression in geriatric patients, to date there is no scale valid and reliable enough to effectively ascertain depression in the most severely demented patients.

Keywords

geriatrics palliative care depression nursing home screening

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References

1. Alexopoulos GS , Abrams RC , Young RC , et al. Use of Cornell Scale in nondemented patients. J Am Geriatr Soc. 1988;36:230-236.

2. Kitchell MA , Barnes RF , Veith RC , et al. Screening for depression in the hospitalized geriatric medical patients. J Am Geriatr Soc. 1982;30:164-176.

3. Pomeroy IM , Clark CR , Philp I. The effectiveness of very short scales for depression screening in elderly medical patients. Int J Geriatr Psychiatry. 2001;16:321-326.

4. Block SD . Assessing and managing depression in the terminally ill patient. Ann Intern Med. 2000;132:209-218.

5. Lees N , Lloyd-Williams M. Assessing depression in palliative care patients using the visual analogue scale: a pilot study. Eur J Cancer Care. 1999;8:220-223.

6. Le FP , Devereux J , Lawrie SM , et al. Screening for psychiatric illness in the palliative care inpatient setting: a comparison between the Hospital Anxiety and Depression Scale and the General Health Questionnaire-12. Palliat Med. 1999;13:399-407.

7. Rosenblatt L , Block SD . Depression, decision making and the cessation of life-sustaining treatment. West J Med. 2001;175:320-325.

8. Kurlowicz LH , Evans LK , Strumpf NE , Maislin G. A psychometric evaluation of the Cornell Scale for Depression in Dementia in a frail, nursing home population. Am J Geriatr Psychiatry. 2002;10:600-608.

9. Urch CE , Chamberlain J , Field G. The drawback of the Hospital Anxiety and Depression Scale in the assessment of depression in the hospice patient. Palliat Med. 1998;12:395-396.

10.

10. Yesavage JA , Brink TL . Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatry Res. 1983;17:37-49.

11.

11. Almeida OP , Almeida SA . Short versions of the Geriatric Depression Scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriat Psychiatry. 1999;14:858-865.

12.

12. Chochinov HM , Wilson KG , Enns M , et al. “Are you depressed?” Screening for depression in terminally ill. Am J Psychiatry. 1997;154:674-676.

13.

13. Fleis JL . Statistical Methods for Rates and Proportions. 2nd ed. New York, NY: John Wiley and Sons; 1981.

14.

14. Lilienfeld AM , Lilienfeld DE . Foundations of Epidemiology. 2nd ed. New York, NY: Oxford University Press; 1980.

15.

15. SPSS Inc. Statistical Package for the Social Sciences [Computer program]. Chicago, Ill: SPSS Inc; 2002.

16.

16. Teresi JA , Abrams R , Holmes D , Ramirez M , Shapiro C , Eimicke J. Influence of cognitive impairment, illness, gender and African-American status on psychiatric ratings and staff recognition of depression. Am J Geriatr Psychiatry. 2002;10:506-514.

17.

17. Weintraub D , Moberg P , Duda J , Katz I , Stern M. Recognition and treatment of depression in Parkinson’s disease. J Geriatr Psychiatry Neurol. 2003;16:178-183.

18.

18. Olin J , Schneider L , Katz I , et al. Provisional diagnostic criteria for depression of Alzheimer disease. Am J Geriatr Psychiatry. 2002;10:125-128.

19.

19. Olin JU , Katz I , Meyers B , Shneider L , Lebowitz B. Provisional diagnostic criteria for depression of Alzheimer disease: rationale and background. Am J Geriatric Psychiatry. 2002;10:129-141.

20.

20. Sullivan M. Hope and hopelessness at the end of life. Am J Geriatr Psychiatry. 2003;11:393-405.

21.

21. Incalzi R , Cesari M , Pedone P , Carbonin U. Construct validity of the 15-item Geriatric Depression Scale in older medical inpatients. J Geriatr Psychiatry Neurol. 2003;16:23-28.

22.

22. Kales H , Valenstein M. Complexity in late-life depression: impact of confounding factors on diagnosis, treatment and outcomes. J Geriatr Psychiatry Neurol. 2002;15:147-155.

23.

23. Meyers B. Depression and dementia: comorbidities, identification and treatment. J Geriatr Psychiatry Neurol. 1998;11:201-205.

24.

24. Wood S , Cummings JL , Hsu M , Barclay T , et al. The use of the neuropsychiatric inventory in nursing home residents: characterization and measurement. Am J Geriatr Psychiatry. 2000;8:75-83.

25.

25. Ownby RL , Harwood DG , Acevedo A , Barker W , Duara R. Factor structure of the Cornell Scale for Depression in dementia for Anglo and Hispanic patients with dementia. Am J Geriatr Psychiatry. 2001;9:217-224.