886 – A case series of depressed elderly (>64 years) presenting in a general hospital in singapore

Abstract

A recent national survey highlighted the considerable treatment gap for depression (59.6%) in modern Singapore. Asians tend to focus on physical features of a disease than the psychological ones, which might contribute to the relative lack of disease pick up by physicians. Literature suggests a distinct clinical entity of depression among the elderly, with a different clinical presentation from adults. This retrospective case series was undertaken to understand the clinical features and management decisions of elderly patients presenting with depression in Singapore. To describe the demographics, clinical presentation, psychiatric and medical co-morbidities, and management decisions of depression in the elderly. Inter-departmental referrals to the Department of Psychological Medicine of Tan Tock Seng Hospital from 1/1/2011 to 31/3/2011 for the management of patients ages above 64 with the diagnosis of depression were collated for case description. A total of 40 inpatients ages 65 to 104 years (mean 76.2 years) were recruited. 14 (35%) were male and 26 (65%) were female. 70% of them does not have a co-existing psychiatric diagnosis. The highest number of referrals were form the department of General Medicine (42.5%) followed by Geriatric Medicine (25%). Most of the elderly were admitted for infection (20%), followed by equal proportions of those admitted for cardiovascular problems (12.5%), recurrent falls (12.5%), psychiatric issues (12.5%), and orthopedic problems (12.5%). As the population of Singapore ages, clinicians should be mindful that depression often co-exist with medical co-morbidities, and the complex interaction amongst the two entities.