DEPRESSION AND DEMENTIA IN GERIATRIC INPATIENTS - DIAGNOSTIC COMPARISONS BETWEEN PSYCHIATRISTS, GERIATRICIANS AND TEST-SCORES

A clinical and psychometric survey of depression and dementia in acute geriatric admissions (n = 50) found clincial evidence of depression and dementia in 25% and 35% of patients respectively, consistent with the results of prevalence surveys of geriatric hospital inpatients. There was a significant correlation between clinical assessment of dementia 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 geriatricians, psychiatrists and scores on the Geriatric Depression Scale (GDS) just reached significance (p < 0.05), there was no association between diagnosis of depression by geriatricians and GDS at a cutoff score of 11/30. The relationship was significant at a cutoff score of 16/30 (p < 0.02). In contrast, the associations between diagnosis of depression by psychiatrists and GDS were highly significant at both cutoff points (p < 0.002 and p < 0.001 respectively). No significant differences 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 inpatients 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 antidepressant treatment in 40% of those cases identified. Factor analysis suggested that geriatricians were identifying a subgroup of patients as depressed who were not recognized either by psychiatrists or by psychometric testing. Patients with abnormal scores on psychometric testing were followed up after discharge and retested. There was evidence of a significant fall in GDS scores and a non-significant trend to increased fail scores on the MEAMS test suggesting an improvement in depressive symptoms with physical recovery and further cognitive decline following 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 during inpatient episodes.