174 Older Emergency Department Patients Who Screen Positive for Depression are Less Likely to Receive Referrals for Treatment and Counseling

Abstract

Establishment of “senior” (geriatric) emergency departments (SEDs) is becoming more frequent across the US, and many of these centers screen for for various key comorbidities associated with the elderly. However, the selection of which items to include in screening has not been validated. Treatment of depression is known to be efficacious and can significantly enhance quality of life, even in the elderly. It is critical to determine whether those who screen positive for depression are receiving appropriate treatment, and that referrals are made to appropriately intervene for these individuals. This study evaluated these parameters in a senior cohort as a function of ED patient age. This was a nested prospective study in the senior ED of a community hospital with an annual volume of approximately 52,000. The study included screening, interview and chart review of SED patients > 65 years of age. All consenting patients were screened for depression using the Yesavage 5-point depression scale (GDS). Patients were excluded if not considered competent by mini-Cog testing (unless they had an authorized representative) or if they were prisoners. Patients with a GDS of > 2 were considered “at-risk” and assessed for prior diagnosis of depression and whether they are currently under treatment. Demographic features and insurance status were recorded, as was the presence or absence of current treatment and whether follow-up referral was provided by the ED. Groups were divided into the “younger old” ages 65-74, and “older old,” ages >75 for analysis. Chi square/Fisher’s exact analysis was conducted for the two age cohorts, using GraphPad Prism 6.0.1 (GraphPad Software Inc., San Diego, California, USA). A total of 6,312 patients were screened, with 93 screening positive for depression. Sixty-two patients were either not being treated for depression (65.6% female) or had not been previously diagnosed. Among those not currently receiving treatment, the older group was much less likely to receive treatment ( 65-75 age group 57.9%, >75 age group 19.4 %, Fisher’s exact, two tailed, p=0.0018). In the ED, referrals were less likely to be made for the older group than the younger group (see diagram). In a cohort of geriatric ED patients screening positive for depression, older seniors >75 were much less like to be receiving prior treatment or to receive referrals than those aged < 75. Whether this is due to “apathy towards seniors” in the health system or other causes, an opportunity exists to improve provision of referral for psychiatric care for senior ED users screening positive for depression.Tabled 1Treatment of depression stratified by ageTreatmentY/NAges 65-75Age > 75TotalYes11718No83644Total194362% Treated57.919.4 Open table in a new tab