Title: Auditing Depression in the elderly population using GDS15 in a General Practice Clinic in Hong Kong
1Auditing Depression in the elderly population
using GDS-15 in a General Practice Clinic in
Hong Kong????? -????????GDS-15??
- Dr. CHOI Kin
- Honorary Clinical Associate Professor
- Department of Community Family Medicine,
- Chinese University of Hong Kong
- ????
- ?????????????????????
2Geriatric population in Hong Kong???????
- 1996 10.2 population gt65
- ?????10.2 ????????
-
- 2001 11.2 population gt65
- ?????11.2 ????????
-
- 2031 24 population gt65
- ?????24 ????????
3Depression in the elderly Size of the problem
in USA??????????????
- Depression affects 5 million out of 31 million
Americans aged over 65. - ?????? 65?????????,???????????
4- 13 of community dwelling older adults suffers
from major or minor depression - 13 ???????????????????
- 24 of older medical outpatients, 30 of older
acute care patients, 43 of nursing home dwelling
older adults suffers from depression - 24???????,30??????,?43???????????????
- Kurlowicz et al Try This best practices in
nursing care to older adults Issue no. 4 2007
5Depression Size of the problem
world-wide????? ???????
- The World Health Organization estimates that
depression will become the second most important
cause of disability worldwide (after ischemic
heart disease) by 2020. - ?????????????????? (???????)????????????
6World-wide prevalence of elderly
depression????????????
- 9 35
- Inner London 18 (1994)
- ???(?????) 18
- Rural Malaya 18 of elderly with chronic illness
- ??????? 18????????
7- Rural China 26 over 65 screened positive
- ?????????????????,26 ??????
- Hong Kong 1994 over 75 using GDS 15, 29.2 for
men and 41.1 for women are depressed (Woo et
al) - ??(?????)???????????GDS-15????,29.2???41.1????
?? (Woo et al)
8The Prevalence of depressive symptoms in a
regional geriatric day hospital
???????????????????
- Wong et Chao 2004
- The prevalence of depressive symptoms in patients
in the geriatric day hospital was as high as
37.8. Depressive symptoms were more commonly
found in female (45.3) patients than in male
(27.4) patients. Depressive symptoms were
common in patients with financial constraints. - ?????????????????????37.8?????????????(45.3),??
??27.4???????????????????
9- Despite the high epidemiological relevance of
depressive disorder in daily clinical practice,
they are insufficiently diagnosed. - ?????????????????,?????????????
- Grulke N et al Wien Med Wochenschr 2005 July
10US Preventive Service Task Force???????????
- Overall, screening and feedback reduced the risk
for persistent depression - ????,??????????????
-
- Compare with usual care, screening for
depression can improve outcomes, particularly
when screening is coupled with system changes
that help ensure adequate treatment and follow
up. - ????????,???????????,???????????????,???????????
? Pignone et al Ann Inern Med. 2002 May 21
11Screening for Depression?????
- Lack of effective of antidepressants?
- ??????????
- Potential harms of screening?
- ????????
- Which screening instruments?
- ??????????
12- Impact on detection of depression?
- ?????????
- Borderline higher intervention rate amongst those
who received feedback of screening instrument
(Gilbody Cochrane Database 2007) - ???????????????,??????? (Gilbody Cochrane
Database 2007)
13Geriatric Depression Scale???????
- 1/6 elderly treated in general medical practice
are depressed, prevalence higher in hospitals
nursing homes - ??????????????????????,???????????????
-
- Elderly has highest suicide rate of any group
- ?????????????
14- GDS was developed 1982 by J.A. Yesavitch
- ???????J.A. Yesavitch ????????
-
- Score affected by dementia
- ????????
- Score affected by less education
- ????????
- 84 sensitive and 95 specific for a depression
diagnosis - ???????84????95???
15GDS 15 ?????? ???
- Arthur, Jagger, Lindesay et al.
- Using an annual over-75 health check to screen
for depression validation of the short Geriatric
Depression Scale (GDS 15) within general
practice. - ?75????????????????????????????????????????
- Intl Geriatric Psychiatry 1999 June
- The 15 item GDS had perfect sensitivity but low
specificity for detecting depression in elderly
people - ??????????????????????????????,???????
16C-GDS-15???????? ???
17AMT-10 Chinese version ??????? - ???
18Objective ??
- To audit records of patients over the age of 65
seen from December 2003 to September 2007 in a
general practice clinic in Wong Tai Sin, Kowloon,
HongKong - ?????????????????????,???????????????????????????
??? - To study the prevalence rate of depressed elderly
in that population and the associated demographic
data - ????????????????,?????????
19Design ??
- 1,495 elderly patients were seen from December
2003 to September 2007. - 2003?12??2007?9????1,495?????
- All of them were administered the Chinese version
of GDS-15 items previously validated in Hong
Kong. - ??????????????????????????????
- All of them were given a structured psychiatric
interview by a general physician with training in
community psychiatry - ???????????????????????????????????????
20Setting ??
- The clinic is a general clinic catered for
general patients - ???????????????
- Patients are seen for undifferentiated problems
such as upper respiratory infections,
gastroenteritis, hypertension, diabetes mellitus,
chronic obstructive airway disease, skin
ailments, emotional disorders, orthopedic
problems and cancers - ??????????????,???????????????????????????????????
???????????????
21Participants ???
- From December 2003 onwards, all patients over 65
are invited to answer the CGDS-15 and participate
in a structured psychiatric interview by the
doctor - ??????????,???????????????????????????,?????????
????? - All data are recorded
- ????????
22Participants ???
- A total of 1,495 patients were studied
- ???????????????
- 31 patients were diagnosed to have dementia and
excluded from analysis - ?????????????????????,??????????
- 25 patients were known to have depression and
also excluded from analysis - ???????????????,???????????
23Participants ???
- 4 patients were deaf and unable to participate in
the psychiatric interview - ??????????,??????????
-
- 11 patient records were incomplete and hence
invalid - ?????????????????
- 1,424 records remained for analysis
- ?????????????????
24Participants ???
- 787 patients were between 65-75 year old
- ???????????????????
- 632 patients were over 75
- ???????????????
- 490 patients were male and 928 female
- ???????????,?????????
25Participants ???
- 190 patients live alone while 1,231 live with
their families or in old age home - ??????????,?????????????????????
- 316 patients have no faith, while 1,102 believe
in one religion or another - ???????????????,?????????????????
26Patient demographic?????
- 636 patients were single, divorced or widowed
while 782 were married - ????????????,???????(??) ,????????????
-
- 1,297 patients were financially independent of
government while 120 were on public subsidy - ??????????????????,????????????
27Measurements ??
- 136/1,424 (9.6) of patients interviewed were
diagnosed with major depression - ??????????????????,?????? (9.6) ?????????
- 36/489 (7.4) male were diagnosed with major
depression and 99/927(10.7) female were
depressed - ??????????????(7.4) ?????????,??????????????(1
0.7) ??????
28Measurements ??
- Of the group between age 65-75, 78/787 (9.9)
were depressed while for gt75, 58/632 (9.2) were
depressed - ?????????????,??????????????? (9.9) ?????
???????????,??????????????? (9.2)????? - Of those living alone 19/190 (10) were depressed
while for those living with family or in homes,
117/1,231 (9.5) were depressed - ??????????,??? (10)????? ???????????????????,
?????? (9.5)?????
29Measurements ??
- For those receiving public assistance, 16/120
(13.3) were depressed, while those dependent on
themselves or on their children, 120/1297
(9.3) were depressed - ???????????????????, ??? (13.3)?????
????????????????????,??????? (9.3)?????
30Measurements ??
- For those with chronic illnesses (487) like
coronary heart disease, blindness, stroke,
cancer, cirrhosis etc., 78 (16) were diagnosed
with major depression while others without such
chronic illness only 58/935 (6.2) had major
depression - ??????????????????????????????????,???? (16)
????????? ??????????????????????(6.2)?????
31CGDS-15 and major depression??????????? ? ???
- The following results compared CGDS-15 with the
gold standard of a structured diagnostic
interview. - ??????????????????
- ?????????
32(No Transcript)
33Summary ??
- Screening for depression in primary care may
facilitate early diagnosis and management of a
debilitating illness in the community - ???????????????,????????????????????????
- Depression is more common in the elderly female,
the poor, the single person, those without
religious belief and those with major chronic
illness - ?????????????????????????,???????????
34Summary ??
- Depression is so common that 300 psychiatrists in
Hong Kong cannot provide enough manpower to
screen for this condition and screening should be
delegated to primary care doctors. - ???????,????????????????????????,????????????????
? - GDS-15 can be a useful screening tool for
depression in primary care for chinese patients - ???????,?GDS-15???????,??????????????
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