Lieberman D, Galinsky D, Fried V, Grinshpun Y, Mytlis N, Tylis R
Department of Geriatrics and Division of Internal Medicine, Soroka Medical Center of Kupat Holim Klalit, Beer-Sheva, Israel.
Int J Geriatr Psychiatry. 1999 Jul;14(7):549-55. doi: 10.1002/(sici)1099-1166(199907)14:7<549::aid-gps960>3.0.co;2-4.
To determine the prevalence of symptoms of depression and the factors affecting their presence in an elderly population at the start of rehabilitation. To assess changes in the severity of these symptoms during rehabilitation and the correlation between these changes and corresponding changes in the patient's functional state.
A population-based prospective study.
A geriatric ward in a general university hospital in southern Israel.
Two hundred and seventy-six elderly patients hospitalized for physical rehabilitation, 150 following hip fracture (HF) and 126 after stroke.
Symptoms of depression were measured by the Geriatric Depression Screening Scale (GDS). The functional state was assessed using the FIM scale. A broad spectrum of clinical, functional, social and demographic variables was measured using conventional tests. The association between the GDS and these variables was tested by stepwise multiple regression.
One hundred and thirteen patients (41%) showed signs of depressions (GDS>10), with 12 (4%) patients having severe symptoms (GDS>20). No significant difference was found between HF and stroke patients in symptoms of depression. Only four of the 41 variables tested were found to be significantly and independently associated with the GDS: pre-event functional state (beta=-0.311, p<0.001), the self-care component of the FIM scale on admission to the hospital (beta=-0.267, p<0.001), living alone (beta=0.149, p=0.015) and impaired visual acuity (beta=0.137, p=0.026). The total variance in GDS accounted for by these four variables (adjusted R-square) was 0. 24. The severity of depression symptoms decreased significantly during rehabilitation and the GDS at discharge was significantly lower than on admission (p=0.008). This change correlated significantly with the corresponding change in functional state (R=-0.15, p=0.03).
Symptoms of depression are common in elderly patients beginning rehabilitation. These symptoms are affected independently, and almost exclusively, by the functional state of the patient, both prior to the event and after its occurrence. The depressed condition improves towards the end of hospitalization and the degree of improvement is correlated with the corresponding change in the patient's functional state.
确定康复初期老年人群中抑郁症状的患病率及其影响因素。评估康复期间这些症状严重程度的变化以及这些变化与患者功能状态相应变化之间的相关性。
基于人群的前瞻性研究。
以色列南部一所综合大学医院的老年病房。
276名因身体康复住院的老年患者，其中150名髋部骨折（HF）后患者，126名中风后患者。
采用老年抑郁筛查量表（GDS）测量抑郁症状。使用FIM量表评估功能状态。使用常规测试测量一系列广泛的临床、功能、社会和人口统计学变量。通过逐步多元回归检验GDS与这些变量之间的关联。
113名患者（41%）表现出抑郁迹象（GDS>10），其中12名（4%）患者有严重症状（GDS>20）。髋部骨折患者和中风患者在抑郁症状方面未发现显著差异。在测试的41个变量中，仅发现4个与GDS显著且独立相关：事件前功能状态（β=-0.311，p<0.001）、入院时FIM量表的自我护理部分（β=-0.267，p<0.001）、独居（β=0.149，p=0.015）和视力受损（β=0.137，p=0.026）。这四个变量解释的GDS总方差（调整R平方）为0.24。康复期间抑郁症状的严重程度显著降低，出院时的GDS显著低于入院时（p=0.008）。这种变化与功能状态的相应变化显著相关（R=-0.15，p=0.03）。
抑郁症状在开始康复的老年患者中很常见。这些症状几乎完全独立地受到患者事件发生前后功能状态的影响。住院末期抑郁状况有所改善，改善程度与患者功能状态的相应变化相关。
