DEPRESSION IN ELDERLY MEDICAL INPATIENTS - A METAANALYSIS OF OUTCOMES

Objective: To determine the prognosis of elderly medical inpatients wi th depression. Data sources: A MEDLINE search for relevant articles pu blished from January 1980 to September 1996 and a search of the PSYCH INFO database for articles published from January 1984 to September 19 96. The bibliographies of identified articles were searched for additi onal references. Study selection: Eight reports (involving 265 patient s with depression) met the following 5 inclusion criteria: original re search, published in English or French, population of general medical inpatients, mean age of depressed patients 60 years and over, and affe ctive state reported as an outcome. The validity of the studies was as sessed according to the criteria for prognostic studies described by t he Evidence-Based Medicine Working Croup. Data extraction: Information about the patient population, the proportion of cases detected and tr eated by attending physicians, the length of follow-up, the affective outcome and the prognostic factors was abstracted from each report. Da ta synthesis: All of the studies had some methodologic limitations. A metaanalysis of outcomes at 3 months or less indicated that 18% of pat ients were well, 43% were depressed and 22% were dead. At 12 months or more, 19% were well, 29% were depressed and 53% were dead. Factors as sociated with worse outcomes included more severe depression, more ser ious physical illness and symptoms of depression before admission. Con clusions: Elderly medical inpatients who are depressed appear to have a very poor prognosis: the recovery rate among these patients is low a nd the mortality rate high.