From the Department of Internal Medicine (Reichardt, Nederveen, van Seben, Henstra, Buurman), Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam; Department of Rehabilitation (Aarden, van der Schaaf, Engelbert), Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam; ACHIEVE - Center of Applied Research (Aarden, Engelbert, van der Esch, Buurman), Faculty of Health, Amsterdam University of Applied Sciences; Reade (Esch), Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center; Department of Epidemiology and Biostatistics (Twisk), Amsterdam UMC, Vrije Universiteit Amsterdam; Department of Clinical Psychology (Bosch), University of Amsterdam; and Department of Psychology (Bosch), Section of Psychology, Amsterdam UMC, University of Amsterdam, the Netherlands (Bosch).
Psychosom Med. 2019 Jun;81(5):477-485. doi: 10.1097/PSY.0000000000000694.
Depression among older adults predicts mortality after acute hospitalization. Depression is highly heterogeneous in its presentation of symptoms, whereas individual symptoms may differ in predictive value. This study aimed to investigate the prevalence of individual cognitive-affective depressive symptoms during acute hospitalization and investigate the predictive value of both overall and individual cognitive-affective depressive symptoms for mortality between admission up to 3-month postdischarge among older patients.
A prospective multicenter cohort study enrolled 401 acutely hospitalized patients 70 years and older (Hospitalization-Associated Disability and impact on daily Life Study). The predictive value of depressive symptoms, assessed using the Geriatric Depression Scale 15, during acute hospitalization on mortality was analyzed with multiple logistic regression.
The analytic sample included 398 patients (M (SD) = 79.6 (6.6) years; 51% men). Results showed that 9.3% of participants died within 3 months, with symptoms of apathy being most frequently reported. The depression total score during hospitalization was associated with increased mortality risk (admission: odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.2-1.3; discharge: OR = 1.2, 95% CI = 1.2-1.4). Stepwise multiple logistic regression analyses yielded the finding that feelings of hopelessness during acute hospitalization were a strong unique predictor of mortality (admission: OR = 3.6, 95% CI = 1.8-7.4; discharge: OR = 5.7, 95% CI = 2.5-13.1). These associations were robust to adjustment for demographic factors, somatic symptoms, and medical comorbidities.
Symptoms of apathy were most frequently reported in response to acute hospitalization. However, feelings of hopelessness about their situation were the strongest cognitive-affective predictor of mortality. These results imply that this item is important in identifying patients who are in the last phase of their lives and for whom palliative care may be important.
老年人的抑郁预测急性住院后的死亡率。抑郁在其症状表现上具有高度异质性，而个体症状的预测价值可能不同。本研究旨在调查急性住院期间个体认知情感抑郁症状的患病率，并研究总体和个体认知情感抑郁症状对老年患者入院至出院后 3 个月内死亡率的预测价值。
前瞻性多中心队列研究纳入了 401 名 70 岁及以上的急性住院患者（住院相关残疾和对日常生活的影响研究）。使用老年抑郁量表 15 评估住院期间抑郁症状对死亡率的预测价值，并采用多因素逻辑回归进行分析。
分析样本包括 398 名患者（M（SD）=79.6（6.6）岁；51%为男性）。结果显示，3 个月内有 9.3%的参与者死亡，其中最常报告的症状是冷漠。住院期间的抑郁总分与死亡率增加相关（入院时：比值比[OR] = 1.2，95%置信区间[CI] = 1.2-1.3；出院时：OR = 1.2，95% CI = 1.2-1.4）。逐步多因素逻辑回归分析发现，住院期间的绝望感是死亡率的一个强有力的独立预测因素（入院时：OR = 3.6，95% CI = 1.8-7.4；出院时：OR = 5.7，95% CI = 2.5-13.1）。这些关联在调整人口统计学因素、躯体症状和合并症后仍然稳健。
在对急性住院的反应中，最常报告的是冷漠症状。然而，对自己病情的绝望感是对死亡率的最强认知情感预测因素。这些结果意味着，这个项目对于识别处于生命最后阶段的患者以及对他们进行姑息治疗很重要。
