Auditing Depression in the elderly population using GDS15 in a General Practice Clinic in Hong Kong

1
Auditing 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
• ????
• ?????????????????????

2
Geriatric population in Hong Kong???????

• 1996 10.2 population gt65
• ?????10.2 ????????
• 2001 11.2 population gt65
• ?????11.2 ????????
• 2031 24 population gt65
• ?????24 ????????

3
Depression 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

5
Depression 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.
• ?????????????????? (???????)????????????

6
World-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)

8
The 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

10
US 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

11
Screening 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)

13
Geriatric 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???

15
GDS 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
• ??????????????????????????????,???????

16
C-GDS-15???????? ???
17
AMT-10 Chinese version ??????? - ???
18
Objective ??

• 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
• ????????????????,?????????

19
Design ??

• 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
• ???????????????????????????????????????

20
Setting ??

• 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
• ??????????????,???????????????????????????????????
  ???????????????

21
Participants ???

• 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
• ????????

22
Participants ???

• 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
• ???????????????,???????????

23
Participants ???

• 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
• ?????????????????

24
Participants ???

• 787 patients were between 65-75 year old
• ???????????????????
• 632 patients were over 75
• ???????????????
• 490 patients were male and 928 female
• ???????????,?????????

25
Participants ???

• 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
• ???????????????,?????????????????

26
Patient 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
• ??????????????????,????????????

27
Measurements ??

• 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) ??????

28
Measurements ??

• 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)?????

29
Measurements ??

• 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)?????

30
Measurements ??

• 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)?????

31
CGDS-15 and major depression??????????? ? ???

• The following results compared CGDS-15 with the
  gold standard of a structured diagnostic
  interview.
• ??????????????????
• ?????????

32
(No Transcript)
33
Summary ??

• 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
• ?????????????????????????,???????????

34
Summary ??

• 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???????,??????????????

35

• ??!
• Thank you!