214 A Prospective Study of Screening, Triage, Referral, and Follow-Up of Screen-Positive Depressive Patients in a New Geriatric Emergency Department

Abstract

Dedicated senior (geriatric) emergency departments (SEDs) are becoming more common in the US. Selected SEDs currently screen for depression in seniors. An important feature of senior EDs is that they feature enhanced screening for common comorbidities in the elderly. It is critical to validate the selection of individual tests that are used in this screening, and there is currently debate as to the inclusion of depression screening. The value and importance of treatment for depression is widely accepted, including in the geriatric population. The purpose of this study is to measure 1) the prevalence of depression with ED screening, and 2) among those who screen positive for active depression to determine what proportion are not being treated. This is a prospective observational study conducted in the senior ED of a community hospital with an ED annual volume of approximately 45,000. The study included screening, consenting, interview and chart review of SED patients > 65 years of age. All patients were screened using the Yesavage/Stanford Geriatric Depression Scale (GDS, 5-point). Patients with a GDS of > 2 were assessed for prior diagnosis of depression and whether they are currently under treatment. Demographic features and insurance status were recorded. A total of 6312 patients were screened using the Geriatric Depression Scale. Ninety-three patients screened positive for depression with a GDS of > 2. Of these, 63 patients consented for the study (34.4% male) . These patients were then assessed for prior diagnosis of depression and whether they are currently under treatment. Forty-six patients (73.0%) had not been previously diagnosed with clinical depression and/or were not taking an antidepressant medication as determined by interview and chart review, and 1% stated they were unsure. Fifty-six patients (87.5%) received no social work referral during their current visit. It is important to validate the screening methods being used by the growing number of senior emergency departments, including depression. This study found a low percentage of geriatric patients with depression. However, the majority of the screen-positive depressive patients had not yet been treated, indicating an important opportunity for improved follow-up and intervention.