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Improvement of quality of life in hospitalized depressed elderly

Published online by Cambridge University Press:  18 August 2010

Maria I. Lapid ,
Katherine M. Piderman ,
Susan M. Ryan ,
Kristin J. Somers ,
Matthew M. Clark  and
Teresa A. Rummans
Maria I. Lapid*
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, U.S.A.
Katherine M. Piderman
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, U.S.A.
Susan M. Ryan
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, U.S.A.
Kristin J. Somers
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, U.S.A.
Matthew M. Clark
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, U.S.A.
Teresa A. Rummans
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, U.S.A.
*
Correspondence should be addressed to: Maria I. Lapid, MD, Mayo Clinic, Department of Psychiatry and Psychology, 200 First Street SW, Rochester, MN 55905, U.S.A. Phone: +1 507-255-7184; Fax: +1 507–255-7365. Email: [email protected].
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Abstract

Background: Quality of life is important for all individuals, but is frequently overlooked in psychiatric populations. Our purpose was to assess the quality of life (QOL) of depressed psychiatrically hospitalized elderly patients, examine the association of QOL and depression, and explore any QOL differences related to electroconvulsive therapy (ECT).

Methods: This Institutional Review Board (IRB)-approved prospective study recruited geropsychiatric inpatients aged 65 years and older who were depressed, had Mini-mental State Examination (MMSE) scores >18/30, and adequate communication skills. Surveys were completed upon admission and discharge to measure depression (Hamilton Depression Rating Scale (HDRS)), quality of life (Linear Analogue Scales of Assessment (LASA); Medical Outcomes Short Form-36 Health Survey (SF-36)), cognitive function (MMSE; Executive Interview (EXIT 25)), and coping (Brief COPE Inventory (COPE)). Spearman correlations and Wilcoxon signed rank tests were used to assess changes in measures during hospitalization and relationships among variables.

Results: The 45 study participants who completed the study had a mean age of 74 years. The majority were female (67%), married (58%), Protestant (60%), with at least high school education (78%). Admission scores demonstrated severe depression (HDRS 24.88 ± 10.14) and poor QOL (LASA overall QOL 4.4 ± 2.79, and SF-36 mental [27.68 ± 9.63] and physical [46.93 ± 10.41] component scores). At discharge, there was a significant improvement of depression (HDRS 24.88v12.04, p < 0.0001) and QOL (LASA overall QOL 4.4v6.66, p < 0.0001; and SF-36 mental [27.68v39.10, p < 0.0001] and physical [46.93v50.98, p = 0.003] component scores). Not surprisingly, depression was negatively correlated with overall QOL, mental well-being, physical well-being, and emotional well-being at both admission and discharge. For the group who received ECT, there was a greater magnitude of improvement in SF-36 vitality (p = 0.002) and general health perception (p = 0.04), but also a reduction in EXIT 25 scores at discharge (p = 0.008).

Conclusions: There was improvement of both QOL and depression during the course of hospitalization. Additionally, improvement of QOL was associated with improvement of depression. Perhaps future studies could develop interventions to improve both mood and QOL in elderly depressed inpatients.

Keywords

geriatricdepressionwell-beinginpatientpsychiatric hospitalpsychogeriatricelectroconvulsive therapy
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 3 , April 2011 , pp. 485 - 495
Copyright
Copyright © International Psychogeriatric Association 2010

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References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Washington, DC: American Psychiatric Press.Google Scholar
Antunes, P. B. and Fleck, M. P. (2009). Clinical outcomes and quality of life in patients submitted to electroconvulsive therapy. Journal of ECT, 25, 182–185.CrossRefGoogle ScholarPubMed
Bretscher, M. et al. (1999). Quality of life in hospice patients: a pilot study. Psychosomatics, 40, 309–313.Google Scholar
Bruce, M. L., Seeman, T. E., Merrill, S. S. and Blazer, M. D. (1994). The impact of depressive symptomatology on physical disability: MacArthur Studies of Successful Aging. American Journal of Public Health, 84, 1796–1799.CrossRefGoogle ScholarPubMed
Burns, N. and Grove, S. (1993). The Practice of Nursing Research: Conduct, Critique and Utilization. Philadelphia, PA: WB Saunders.Google Scholar
Carver, C. S. (1997). You want to measure coping but your protocol's too long: consider the brief COPE. International Journal of Behavioral Medicine, 4, 92–100.CrossRefGoogle ScholarPubMed
Carver, C. S., Scheier, M. F. and Weintraub, J. K. (1989). Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology, 56, 267–283.CrossRefGoogle ScholarPubMed
Ceroni, G., Rucci, P., Berardi, D., Berti Ceroni, F. and Katon, W. (2002). Case review vs. usual care in primary care patients with depression: a pilot study. General Hospital Psychiatry, 24, 71–80.CrossRefGoogle ScholarPubMed
Cohen, H. J. et al. (2002). A controlled trial of inpatient and outpatient geriatric evaluation and management. New England Journal of Medicine, 346, 905–912.Google Scholar
Cohen, J. (1988). Statistical Power for Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Decker, P. A. et al. (2006). Validation of single item Linear Analogue Scale Assessments (LASAs) for assessing quality of life (QOL) in patients with newly diagnosed high-grade gliomas. Poster presented at the American Society of Clinical Oncology.).CrossRefGoogle Scholar
Doraiswamy, P. M., Khan, Z. M., Donahue, R. M. J. and Richard, N. E. (2002). The spectrum of quality-of-life impairments in recurrent geriatric depression. Journal of Gerontology: Medical Sciences, 57A, M134–M137.Google Scholar
Fisher, L. J., Goldney, R. D., Furze, P. F., Williams, J. L., Mattner, J. and McCleave, D. J. (2004). Electroconvulsive therapy, depression, and cognitive outcomes: an Australian audit. Journal of ECT, 20, 174–178.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Grunberg, S., Groshen, S., Steingass, S., Zaretsky, S. and Meyerowitz, B. (1996). Comparison of conditional quality of life terminology and visual analogue scale measurements. Quality of Life Research, 5, 65–72.CrossRefGoogle ScholarPubMed
Gudex, C., Dolan, P., Kind, P. and Williams, A. (1996). Health state valuations from the general public using the visual analogue scale. Quality of Life Research, 5, 521–531.CrossRefGoogle ScholarPubMed
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278–296.Google Scholar
Herrman, H. et al. (2002). Longitudinal investigation of depression outcomes in primary care in six countries: the LIDO study. Functional status, health service use and treatment of people with depressive symptoms. Psychological Medicine, 32, 889–902.CrossRefGoogle ScholarPubMed
Kim, S. Y. H., Caine, E. D., Currier, G. W., Leibovici, A. and Ryan, J. M. (2001). Assessing the competence of persons with Alzheimer's disease in providing informed consent for participation in research. American Journal of Psychiatry, 158, 712–717.CrossRefGoogle ScholarPubMed
Krach, P., DeVaney, S., DeTurk, C. and Zink, M. (1996). Functional status of the oldest-old in a home setting. Journal of Advanced Nursing, 24, 456–464.CrossRefGoogle Scholar
Lapid, M. I. et al. (2007). Improving the quality of life of geriatric cancer patients with a structured multidisciplinary intervention: a randomized controlled trial. Palliative and Supportive Care, 5, 107–114.CrossRefGoogle ScholarPubMed
Lapid, M., Piderman, K., Stevens, S., Ryan, S., Clark, M. and Rummans, T. (2009). Improvement of depression and quality of life in elderly psychiatric inpatients. International Psychogeriatrics, 21 (Suppl. 2), S111.Google Scholar
Lavretsky, H., Lesser, I. M., Wohl, M., Miller, B. L. and Mehringer, C. M. (1999). Clinical and neuroradiologic features associated with chronicity in late-life depression. American Journal of Geriatric Psychiatry, 7, 309–316.CrossRefGoogle ScholarPubMed
Lebowitz, B. D. et al. (1997). Diagnosis and treatment of depression in late life: consensus statement update. JAMA, 278, 1186–1190.CrossRefGoogle ScholarPubMed
Locke, D. E. et al. (2007). Validation of single-item linear analog scale assessment of quality of life in neuro-oncology patients. Journal of Pain and Symptom Management, 34, 628–638.CrossRefGoogle ScholarPubMed
Mazumdar, S., Reynolds, C. F. III, Houck, P. R., Frank, E., Dew, M. A. and Kupfer, D. J. (1996). Quality of life in elderly patients with recurrent major depression: a factor analysis of the General Life Functioning Scale. Psychiatry Research, 63, 183–190.Google Scholar
McCall, W. V., Cohen, W., Reboussin, B. and Lawton, P. (1999). Pretreatment differences in specific symptoms and quality of life among depressed inpatients who do and do not receive electroconvulsive therapy: a hypothesis regarding why the elderly are more likely to receive ECT. Journal of ECT, 15, 193–201.CrossRefGoogle Scholar
McCall, W. V., Reboussin, B. A., Cohen, W. and Lawton, P. (2001). Electroconvulsive therapy is associated with superior symptomatic and functional change in depressed patients after psychiatric hospitalization. Journal of Affective Disorders, 63, 17–25.Google Scholar
McCall, W. V., Dunn, A. and Rosenquist, P. B. (2004). Quality of life and function after electroconvulsive therapy. British Journal of Psychiatry, 185, 405–409.CrossRefGoogle ScholarPubMed
McCall, W. V., Prudic, J., Olfson, M. and Sackeim, H. (2006). Health-related quality of life following ECT in a large community sample. Journal of Affective Disorders, 90, 269–274.CrossRefGoogle Scholar
McKenna, S. P. et al. (2001). International development of the Quality of Life in Depression Scale (QLDS). Journal of Affective Disorders, 63, 189–199.CrossRefGoogle ScholarPubMed
Miller, M. D. et al. (1992). Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research, 41, 237–248.CrossRefGoogle ScholarPubMed
Mytko, J. J. and Knight, S. J. (1999). Body, mind and spirit: towards the integration of religiosity and spirituality in cancer quality of life research. Psycho-Oncology, 8, 439–450.Google Scholar
O'Connor, M. K. et al. (2001). The influence of age on the response of major depression to electroconvulsive therapy: a C.O.R.E. Report. American Journal of Geriatric Psychiatry, 9, 382–390.CrossRefGoogle ScholarPubMed
Roberts, R. E., Kaplan, G. A., Shema, S. J. and Strawbridge, W. J. (1997). Does growing old increase the risk for depression? American Journal of Psychiatry, 154, 1384–1390.Google Scholar
Rosenquist, P. B., Dunn, A., Rapp, S., Gaba, A. and McCall, W. V. (2006). What predicts patients’ expressed likelihood of choosing electroconvulsive therapy as a future treatment option? Journal of ECT, 22, 33–37.CrossRefGoogle ScholarPubMed
Royall, D. R., Mahurin, R. K. and Gray, K. F. (1992). Bedside assessment of executive cognitive impairment: the Executive Interview. Journal of the American Geriatrics Society, 40, 1221–1226.CrossRefGoogle ScholarPubMed
Rummans, T. A., Bostwick, J. M., Clark, M. M. and Mayo Clinic Cancer Center Quality of Life Working Group (2000). Maintaining quality of life at the end of life. Mayo Clinic Proceedings, 75, 1305–1310.CrossRefGoogle ScholarPubMed
Rummans, T. A. et al. (2006). Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial. Journal of Clinical Oncology, 24, 635–642.CrossRefGoogle ScholarPubMed
Shmuely, Y., Baumgarten, M., Rovner, B. and Berlin, J. (2001). Predictors of improvement in health-related quality of life among elderly patients with depression. International Psychogeriatrics, 13, 63–73.CrossRefGoogle ScholarPubMed
Sloan, J. A. et al. (1998). Randomized comparison of four tools measuring overall quality of life in patients with advanced cancer. Journal of Clinical Oncology, 16, 3662–3673.CrossRefGoogle ScholarPubMed
Spitzer, W. O. et al. (1981). Measuring the quality of life of cancer patients: a concise QL-index for use by physicians. Journal of Chronic Diseases, 34, 585–597.Google Scholar
Steffens, D. C., Hays, J. C. and Krishnan, K. R. (1999). Disability in geriatric depression. American Journal of Geriatric Psychiatry, 7, 34–40.CrossRefGoogle ScholarPubMed
Story, T. J., Potter, G. G., Attix, D. K., Welsh-Bohmer, K. A. and Steffens, D. C. (2008). Neurocognitive correlates of response to treatment in late-life depression. American Journal of Geriatric Psychiatry, 16, 752–759.CrossRefGoogle ScholarPubMed
Taylor, M. G. and Lynch, S. M. (2004). Trajectories of impairment, social support, and depressive symptoms in later life. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 59, S238–246.CrossRefGoogle ScholarPubMed
Unützer, J., Patrick, D. L., Diehr, P., Simon, G. E., Grembowski, D. and Katon, W. (2000). Quality adjusted life years in older adults with depressive symptoms and chronic medical disorders. International Psychogeriatrics, 12, 15–33.CrossRefGoogle ScholarPubMed
Ware, J. E. (1993). SF-36 Health Survey: Manual and Interpretation Guide. Boston: New England Medical Center Health Institute.Google Scholar
Ware, J., Kosinski, M. and Dewey, J. (2000). How to Score Version Two of the SF-36 Health Survey. Lincoln, RI: QualityMetric, Inc.Google Scholar
Warner, J. P. (1998). Quality of life and social issues in older depressed patients. International Clinical Psychopharmacology, 13 (Suppl.), S19–24.Google Scholar