Suspicion Of Depression Research Articles

Residential Environment Assessment by Older Adults in Nursing Homes during COVID-19 Outbreak.

The most vulnerable residential settings during the COVID-19 pandemic were older adult's nursing homes, which experienced high rates of incidence and death from this cause. This paper aims to ascertain how institutionalized older people assessed their residential environment during the pandemic and to examine the differences according to personal and contextual characteristics. The COVID-19 Nursing Homes Survey (Madrid region, Spain) was used. The residential environment assessment scale (EVAER) and personal and contextual characteristics were selected. Descriptive and multivariate statistical analysis were applied. The sample consisted of 447 people (mean age = 83.8, 63.1% = women, 50.8% = widowed, 40% = less than primary studies). Four residential assessment subscales (relationships, mobility, residential aspects, privacy space) and three clusters according to residential rating (medium-high with everything = 71.5% of cases, low with mobility = 15.4%, low with everything = 13.1%) were obtained. The logistic regression models for each cluster category showed to be statistically significant. Showing a positive affect (OR = 1.08), fear of COVID-19 (OR = 1.06), high quality of life (OR = 1.05), not having suspicion of depression (OR = 0.75) and performing volunteer activities (OR = 3.67) were associated with the largest cluster. It is concluded that a better residential evaluation was related to more favourable personal and contextual conditions. These results can help in the design of nursing homes for older adults in need of accommodation and care to facilitate an age-friendly environment.

Método para establecer la reserva funcional de la velocidad de marcha en una muestra de adultas mayores autosuficientes chilenas: la relevancia del estímulo

Background and objectiveAging as a complex and multifactorial process involves multisystemic changes associated with physical performance with loss of functionality such as walking speed and reserve. The study established the method that best evidences the functional reserve (FR) of walking speed (FRWS) according to the incorporation of stimuli in older adults (OAs). Material and methodAnalytical observational study with a sample made up of 30OAs between 65 and 69years, self-administered without risk, normal weight and without suspicion of depression, controlled in Centro Comunitario de Salud Familiar and Centro de Salud Familiar of Talca. The walking speed (WS) was measured by three methods: M1 (usual gait), M2 (maximum gait) and M3 (maximum gait with stimuli); to later calculate the FRWS in the AO, executed on a 10m track that included 2m acceleration, 2m deceleration and 6m centrals to measure the time in seconds it took to travel them. ResultsThe mean velocities of the sample in the usual, maximum and maximum stimulated methods were 1.17, 1.38 and 1.57m/s respectively; the resulting FRs between the method differences: FR-A (M2−M1) 0.26m/s; FR-B (M3−M1) 0.45m/s and FR-C (M2−M3) 0.19m/s, for most of the cases and according to the corresponding order, the statistical differences were significant. ConclusionThe method that best evidenced the FRWS was through the differences in means between M3 and M1, being an objective way to verify this dimension of human movement as an expression of OA functionality.

Improving the precision of depression diagnosis in general practice: a cluster-randomized trial

BackgroundMethods to enhance the accuracy of the depression diagnosis continues to be of relevance to clinicians. The primary aim of this study was to compare the diagnostic precision of two different diagnostic strategies using the Mini International Neuropsychiatric Interview (MINI) as a reference standard. A secondary aim was to evaluate accordance between depression severity found via MINI and mean Major Depression Inventory (MDI) sum-scores presented at referral.MethodsThis study was a two-armed, cluster-randomized superiority trial embedded in the Collabri trials investigating collaborative care in Danish general practices. GPs performing case-finding were instructed always to use MDI when suspecting depression. GPs performing usual clinical assessment were instructed to detect depression as they would normally do. According to guidelines, GPs would use MDI if they had a clinical suspicion, and patients responded positively to two or three core symptoms of depression. We compared the positive predictive value (PPV) in the two groups.ResultsFifty-one GP clusters were randomized. In total, 244 participants were recruited in the case-finding group from a total of 19 GP clusters, and 256 participants were recruited in the usual clinical assessment group from a total of 19 GP clusters. The PPV of the GP diagnosis, when based on case-finding, was 0.83 (95% CI 0.78–0.88) and 0.93 (95% CI 0.89–0.96) when based on usual clinical assessment. The mean MDI sum-scores for each depression severity group indicated higher scores than suggested cut-offs.ConclusionsIn this trial, systematic use of MDI on clinical suspicion of depression did not improve the diagnostic precision compared with the usual clinical assessment of depression.Trial registrationThe trial was retrospectively registered on 07/02/2016 at ClinicalTrials.gov. No. NCT02678845.

Diagnostic Agreement between Physicians and a Consultation-Liaison Psychiatry Team at a General Hospital: An Exploratory Study across 20 Years of Referrals.

Consultation–liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000–2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen’s kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937; 32.3%), followed by agitation (n = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.

Sintomas depressivos e déficit cognitivo na população de 60 anos e mais em um município de médio porte do interior paulista*

Introdução: a população mundial está envelhecendo e o Brasil segue essa tendência, o que demanda uma reorganização da sociedade para o cuidado desses idosos. Observa-se, nesta tendência, um aumento do número de casos de depressão e demência, além da vinculação destas com outras doenças crônico-degenerativas. Objetivo: estimar a prevalência dos sintomas depressivos e déficits cognitivos em uma população de 60 anos e mais, moradora de um município de médio porte do interior do estado de São Paulo, e sua associação com outras doenças crônico-degenerativas mais prevalentes. Métodos: estudo transversal, com 364 idosos, utilizando: instrumentos sociodemográficos e de morbidade; o Mini Exame do Estado Mental (MEEM), a Escala de Yesavage, a Escala de Atividades de Vida Diária e a Escala de Atividades Instrumentais de Vida Diária (AIVD). Foram realizadas: análises estatísticas de frequências dos escores dos instrumentos; apresentação da sumarização das variáveis e as possíveis associações entre depressão/demência, aplicando-se o teste do X2 seguido do ajuste de um modelo de regressão logística para dados ordinais. Resultados: a suspeita de depressão foi encontrada em 44% (160) e o déficit cognitivo foi identificado em 38,7% (141) dos idosos. Aproximadamente 75% dos idosos, com suspeita de depressão ou déficit cognitivo, eram portadores de pelo menos mais uma patologia crônica. Foi possível estabelecer associações estatisticamente significativas entre: suspeita de depressão e AIVD (p<0,0001; OR=7,59; IC=3,361-7,139) e déficit cognitivo e AIVD (p=0,0007; OR=3,967; IC=1,788-8,799). Não foram encontradas associações entre idade, situação conjugal, escolaridade, inserção no mercado de trabalho, aposentadoria ou renda. Conclusão: idosos de ambos os sexos estão vulneráveis a doenças como depressão e demência. Por outro lado, sintomas depressivos e déficit cognitivo foram associados ao escore dos idosos comprometidos, segundo as AIVD.*Parte da Dissertação de Mestrado apresentada à Faculdade de Medicina de Botucatu para a obtenção do Título de Mestre em Saúde Pública.

Perfil de consumo farmacológico y función cognoscitiva en edad avanzada: estudio de población general no institucionalizada

Background Drug consumption in the general population is concentrated in the elderly. The aim of this study was to assess the pharmacological profile of elderly people 75 years of age and older, to assess the relationship with the cognitive function and the variables associated with drug consumption. Methods This is an epidemiological, cross-sectional, door-to-door study among the non-institutionalised population in a rural area. Participants were inhabitants aged 75 and older from the Anglès Primary Healthcare Area (Girona). Drug prescriptions were recorded from participants’ medicine chest. Cognitive function was assessed using the Mini-Mental State Examination. Results A total of 875 individuals took part (82%). Participants with mild and moderate cognitive impairment consumed an average of 4.6 (SD = 2.9) and 5.2 (SD = 3.2) drugs, participants without cognitive impairment consumed an average of 4 (SD = 2.7) drugs ( P < 0.005). In the bivariate analysis, taking into account the degree of cognitive impairment, there was a change in drugs acting on the digestive tract and metabolism ( P = 0.003) and nervous system ( P = 0.001). Multivariate analysis identified four variables associated with the central nervous system drugs: age, sex, comorbidity and suspicion of depression ( P <0.05). Conclusions Participants with severe cognitive impairment had a higher frequency of anti-psychotic and antidepressant drug consumption. However, the multivariate analysis shows that advanced age, female sex and suspicion of depression are variables associated with a higher central nervous system drug consumption.

Drug consumption and cognitive function in non-institutionalized elderly: A population-based study

Background Drug consumption in the general population is concentrated in the elderly. The aim of this study was to assess the pharmacological profile of elderly people 75 years of age and older, to assess the relationship with the cognitive function and the variables associated with drug consumption. Methods This is an epidemiological, cross-sectional, door-to-door study among the noninstitutionalised population in a rural area. Participants were inhabitants aged 75 and older from the Anglès Primary Healthcare Area (Girona). Drug prescriptions were recorded from participants’ medicine chest. Cognitive function was assessed using the Mini-Mental State Examination. Results A total of 875 individuals took part (82%). Participants with mild and moderate cognitive impairment consumed an average of 4.6 (SD = 2.9) and 5.2 (SD = 3.2) drugs, participants without cognitive impairment consumed an average of 4 (SD = 2.7) drugs (P < 0.005). In the bivariate analysis, taking into account the degree of cognitive impairment, there was a change in drugs acting on the digestive tract and metabolism (P = 0.003) and nervous system (P = 0.001). Multivariate analysis identified four variables associated with the central nervous system drugs: age, sex, comorbidity and suspicion of depression (P < 0.05). Conclusions Participants with severe cognitive impairment had a higher frequency of anti-psychotic and antidepressant drug consumption. However, the multivariate analysis shows that advanced age, female sex and suspicion of depression are variables associated with a higher central nervous system drug consumption.

Characteristics of Mood Disorders in Japanese Patients with Medication-Overuse Headache

The importance of psychiatric comorbidity in migraine has long been recognized. There is a growing body of evidence that these psychiatric comorbidities share diverse epidemiological properties, pathophysiological mechanisms, and treatment response. The prevalence of psychiatric comorbidities is high in patients with medication-overuse headache (MOH). To understand the characteristics of mood disorders in MOH in Japanese patients, we studied and evaluated the characteristics of psychiatric comorbidities in MOH. The results suggested that mood disorders in MOH are similar to those in endogenous depression but different from those of secondary mood disorders associated with other diseases. Suspicion of depression and intervention are essential for providing medical care for patients with MOH. Affective disorders diagnosed in migraine patients might later progress to MOH. In contrast, migraine patients without MOH and healthy subjects had a similar prevalence of mood disorders.

A proposal for an abbreviated onco-geriatric assessment in daily practice

18565 Background: In order to describe the elderly population in Institut Curie and to determine if a brief multidimensional assessment may influence our decision to treat elderly patients with cancers we decided to realize a short assessment for each patient, 70 years and older. In a prospective study we evaluated such diverse areas as functional status, comorbidity, nutrition, polypharmacy and the presence or absence of geriatric syndromes. Methods: We studied 105 elderly cancer patients, median age 80 years with solid tumors. In addition to PS, their physical function was assessed by the activity of daily living (ADL) and instrumental activity of daily living (IADL) scales. During consultation comorbidities, Geriatric depression scale (GDS), the number of falls in the past year, concomitant medications, weight measurements and social environment were collected in a questionnaire. Cognitive functions were assesed if troubles were suspected. Blood tests were performed secondary. Results: To date 105 patients were evaluated : 10 % live in institution, 16% have no social environment, 35 % have a loss of autonomy in ADL and 7% were dependant. In the IADL: 30% presented a loss of autonomy and 24% were dependant. The median Body Mass Index (BMI) was 23.8 kg/m2, but the BMI was in 14% &lt; 19kg/m2; 20% of the patients fall more than 2 times in the year and 53% have a suspicion of depression in the GDS in 4 items. 74% take more than 3 drugs per day. The median of comorbidities was 1.3. According to the results the decision of treatment was modified in 28% of patients. Conclusion: This questionnaire is not a replacement for the entire Comprehensive Geriatric assessment but is a reasonable prescreening instrument that may be performed in less than 15 minutes and be helpful to the clinician in his decision. No significant financial relationships to disclose.