Dh. Ryan et al., DEPRESSION AND DEMENTIA IN GERIATRIC INPATIENTS - DIAGNOSTIC COMPARISONS BETWEEN PSYCHIATRISTS, GERIATRICIANS AND TEST-SCORES, International journal of geriatric psychiatry, 10(6), 1995, pp. 447-456
A clinical and psychometric survey of depression and dementia in acute
geriatric admissions (n = 50) found clincial evidence of depression a
nd dementia in 25% and 35% of patients respectively, consistent with t
he results of prevalence surveys of geriatric hospital inpatients. The
re was a significant correlation between clinical assessment of dement
ia by geriatricians, and psychiatrists, and cognitive impairment using
the Middlesex Elderly Assessment Memory Schedule (p < 0.01). Although
an intercorrelation between clinical diagnosis of depression by geria
tricians, psychiatrists and scores on the Geriatric Depression Scale (
GDS) just reached significance (p < 0.05), there was no association be
tween diagnosis of depression by geriatricians and GDS at a cutoff sco
re of 11/30. The relationship was significant at a cutoff score of 16/
30 (p < 0.02). In contrast, the associations between diagnosis of depr
ession by psychiatrists and GDS were highly significant at both cutoff
points (p < 0.002 and p < 0.001 respectively). No significant differe
nces were found between geriatricians and psychiatrists on indications
for (1) antidepressant medication, (2) referral to liaison psychiatry
, or (3) referral to a community mental health team. None of the inpat
ients assessed were receiving antidepressant medication at the time of
their discharge from hospital although depression was diagnosed in a
quarter of all inpatients and geriatricians supported the use of antid
epressant treatment in 40% of those cases identified. Factor analysis
suggested that geriatricians were identifying a subgroup of patients a
s depressed who were not recognized either by psychiatrists or by psyc
hometric testing. Patients with abnormal scores on psychometric testin
g were followed up after discharge and retested. There was evidence of
a significant fall in GDS scores and a non-significant trend to incre
ased fail scores on the MEAMS test suggesting an improvement in depres
sive symptoms with physical recovery and further cognitive decline fol
lowing discharge. The results of the present study underline the need
for active liaison between geriatricians and psychiatrists to improve
the recognition and treatment of concurrent psychological problems dur
ing inpatient episodes.