Niemöller Ulrich, Arnold Andreas, Stein Thomas, Juenemann Martin, Farzat Mahmoud, Erkapic Damir, Rosenbauer Josef, Kostev Karel, Meyer Marco, Tanislav Christian
Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, Germany Wichernstrasse 40, 57074 Siegen, Germany.
Departement of Neurology, Justus Liebig University, 35392 Giessen, Germany.
Geriatrics (Basel). 2023 Mar 12;8(2):37. doi: 10.3390/geriatrics8020037.
BACKGROUND/OBJECTIVES: Depressive symptoms (DS) may interfere with comprehensive geriatric care (CGC), the specific multimodal treatment for older patients. In view of this, the aim of the current study was to investigate the extent to which DS occur in older hospitalized patients scheduled for CGC and to analyze the associated factors. Furthermore, we aimed to investigate whether DS are relevant with respect to outcomes after CGC.
For this retrospective study, all patients fulfilling the inclusion criteria were selected by reviewing case files. The main inclusion criterion was the completion of CGC within the defined period (May 2018 and May 2019) in the geriatrics department of the Diakonie Hospital Jung-Stilling Siegen (Germany). The Geriatric Depression Scale was used to asses DS in older adults scheduled for CGC (0-5, no evidence of DS; 6-15 points, DS). Scores for functional assessments (Timed Up and Go test (TuG), Barthel Index, and Tinetti Gait and Balance test) were compared prior to versus after CGC. Factors associated with the presence of DS were studied.
Out of the 1263 patients available for inclusion in this study, 1092 were selected for the analysis (median age: 83.1 years (IQR 79.1-87.7 years); 64.1% were female). DS (GDS > 5) were found in 302 patients (27.7%). The proportion of female patients was higher in the subgroup of patients with DS (85.5% versus 76.3%, = 0.024). Lower rates of patients diagnosed with chronic pulmonary obstructive disease were detected in the subgroup of patients without DS (8.0% versus 14.9%, = 0.001). Higher rates of dizziness were observed in patients with DS than in those without (9.9% versus 6.2%, = 0.037). After CGC, TuG scores improved from a median of 4 to 3 ( < 0.001) and Barthel Index scores improved from a median of 45 to 55 ( < 0.001) after CGC in both patients with and without DS. In patients with DS, the Tinetti score improved from a median of 10 (IQR: 4.75-14.25) prior to CGC to 14 (IQR 8-19) after CGC ( < 0.001). In patients without DS, the Tinetti score improved from a median of 12 (IQR: 6-7) prior to CGC to 15 (IQR 2-20) after CGC ( < 0.001).
DS were detected in 27.7% of the patients selected for CGC. Although patients with DS had a poorer baseline status, we detected no difference in the degree of improvement in both groups, indicating that the performance of CGC is unaffected by the presence of DS prior to the procedure.
背景/目的：抑郁症状（DS）可能会干扰老年综合护理（CGC），这是一种针对老年患者的特定多模式治疗方法。有鉴于此，本研究的目的是调查计划接受CGC的老年住院患者中DS的发生程度，并分析相关因素。此外，我们旨在研究DS与CGC后的预后是否相关。
在这项回顾性研究中，通过查阅病例档案选取了所有符合纳入标准患者。主要纳入标准是在德国锡根市扬-施蒂林慈善医院老年医学科规定时间内（2018年5月至2019年5月）完成CGC。采用老年抑郁量表评估计划接受CGC的老年人的DS（0 - 5分，无DS证据；6 - 15分，有DS）。比较CGC前后的功能评估得分（计时起立行走测试（TuG）、巴氏指数以及Tinetti步态和平衡测试）。研究与DS存在相关的因素。
在本研究可纳入的1263名患者中，选取1092名进行分析（中位年龄：83.1岁（四分位间距79.1 - 87.7岁）；64.1%为女性）。302名患者（27.7%）存在DS（老年抑郁量表得分>5）。DS患者亚组中的女性患者比例更高（85.5%对76.3%，P = 0.024）。无DS患者亚组中被诊断患有慢性阻塞性肺疾病的患者比例较低（8.0%对14.9%，P = 0.001）。DS患者中头晕发生率高于无DS患者（9.9%对6.2%，P = 0.037）。CGC后，有DS和无DS患者的TuG得分从中位值4改善至3（P < 0.001），巴氏指数得分从中位值45改善至55（P < 0.001）。DS患者的Tinetti得分从CGC前的中位值10（四分位间距：4.75 - 14.25）改善至CGC后的14（四分位间距8 - 19）（P < 0.001）。无DS患者的Tinetti得分从CGC前的中位值12（四分位间距：6 - 7）改善至CGC后的15（四分位间距2 - 20）（P < 0.001）。
在选取接受CGC的患者中，27.7%检测到DS。尽管有DS的患者基线状态较差，但我们发现两组的改善程度没有差异，这表明CGC的实施不受术前DS存在的影响。
