Perioperative Anxiety and Depression in Older Adults: Epidemiology and Treatment

Srifuengfung, Maytinee; Abraham, Joanna; Avidan, Michael S.; Lenze, Eric J.

doi:10.1016/j.jagp.2023.07.002

Cited by 5 publications

(7 citation statements)

References 122 publications

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“…If replicated, these findings suggest the need for optimizing depression symptom burden in older adults, separately or as part of established multicomponent delirium bundles. For example, despite consistency in our findings across hospitalization settings (Supplemental Figure 2), there is a window of opportunity before major surgery to intervene, 9 given that delirium is growing in an aging population with exponential increases in surgical needs. 31 Whether these results point to a causal role or an unmasking of cognitive vulnerability is unclear.…”

Section: Discussionmentioning

confidence: 64%

“…28 While all components/questions drove these results, interestingly, tenseness/restlessness and tiredness/lethargy were most strongly associated with delirium in the final models, suggesting that the full spectrum of depression and anxiety-related symptoms reported should be considered. 9 The simplicity of the assessment questions captured responses on a large scale, allowing for repeated measures and examining symptom trajectory. Consistent results across two separate time points and the additional risk from worsening symptoms support the idea that depression may increase neurocognitive vulnerability to stressors such as illness, surgery, or hospitalization rather than simply being comorbid with delirium.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 In older hospitalized patients, depression symptoms can be present in up to half, depending on the population (medical vs. surgical) and measurement tools. 8,9 Some evidence suggests that depression may be a risk factor for delirium. 10,11 Yet, uncertainty remains regarding the longterm relationship between depression symptoms and delirium, 12,13 particularly in larger population-based cohorts across therapeutic settings (e.g., general medical vs. postoperative) and age groups.…”

Section: Background and Objectivesmentioning

confidence: 99%

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Associations between depression symptom burden and delirium risk: a prospective cohort study

Gaba,

Li,

Zheng

et al. 2023

Preprint

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BACKGROUND AND OBJECTIVES: Delirium and depression are increasingly common in aging. There is considerable clinical overlap, including shared symptoms and comorbid conditions, including Alzheimer disease (AD), functional decline, and mortality. Despite this, the long–term relationship between depression and delirium remains unclear. This study assessed the associations of depression symptom burden and its trajectory with delirium risk in a 12–year prospective study of older individuals during hospitalization. RESEARCH DESIGN AND METHODS: 319,141 UK biobank participants between 2006–2010 (mean 58y [range 37–74, SD=8], 54% female) reported frequency (0–3) of four depressive symptoms (mood, disinterest, tenseness, or lethargy) in the preceding 2 weeks, and aggregated into a depressive symptom burden score (0–12). New–onset delirium was obtained from hospitalization records during 12y median follow–up. 40,451 (mean age 57 ± 8; range 40–74y) had repeat assessment on average 8y after their first. Cox proportional hazard models examined whether depression symptom burden and trajectory predicted incident delirium during hospitalization. RESULTS: 5,753 (15 per 1000) newly developed delirium during follow–up. Increased risk for delirium was seen for mild (aggregated scores 1–2, hazards ratio, HR=1.16, [95% confidence interval 1.08–1.25], p<0.001), modest (scores 3–5, 1.30 [1.19 –1.43], p<0.001) and severe (scores ≥ 5, 1.38 [1.24 –1.55], p<0.001) depressive symptoms, versus none in the fully adjusted model. These findings were independent of the number of hospitalizations and consistent across hospitalization settings (e.g., surgical, medical, or critical care) and specialty (e.g., neuropsychiatric, cardiorespiratory or other). Worsening depression symptoms (≥1 point increase), compared to no change/improved score, were associated with an additional 39% increased risk (1.39 [1.03–1.88], p=0.03) independent of baseline depression burden. The association was strongest in those over 65y at baseline (p for interaction <0.001). DISCUSSION AND IMPLICATIONS: Depression symptom burden and worsening trajectory predicted delirium risk during hospitalization. Increased awareness of subclinical depression symptoms may be warranted for delirium prevention.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Background and Objectivesmentioning

confidence: 99%

See 1 more Smart Citation

Associations between depression symptom burden and delirium risk: a prospective cohort study

Gaba,

Li,

Zheng

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Dysphoric mood and hopelessness, as components of depression symptoms, also increased the risk for delirium ( 33 ). Although all components/questions drove these results, interestingly, tenseness/restlessness and tiredness/lethargy were most strongly associated with delirium in the final models, suggesting that the full spectrum of depression and anxiety-related symptoms reported should be considered ( 9 ). The simplicity of the assessment questions captured responses on a large scale, allowing for repeated measures and examining symptom trajectory.…”

Section: Discussionmentioning

confidence: 99%

“…In older hospitalized patients, depression symptoms can be present in up to half, depending on the population (medical vs surgical) and measurement tools ( 8 , 9 ). Some evidence suggests that depression may be a risk factor for delirium ( 10 , 11 ).…”

Section: Background and Objectivesmentioning

confidence: 99%

Associations Between Depression Symptom Burden and Delirium Risk: A Prospective Cohort Study

Gaba,

Li,

Zheng

et al. 2024

Innovation in Aging

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BACKGROUND AND OBJECTIVES Delirium and depression are prevalent in aging. There is considerable clinical overlap, including shared symptoms and comorbid conditions, including Alzheimer’s disease, functional decline, and mortality. Despite this, the long-term relationship between depression and delirium remains unclear. This study assessed the associations of depression symptom burden and its trajectory with delirium risk in a 12-year prospective study of older hospitalized individuals. RESEARCH DESIGN AND METHODS 319,141 UK biobank participants between 2006-2010 (mean 58y [range 37-74, SD=8], 54% female) reported frequency (0-3) of four depressive symptoms (mood, disinterest, tenseness, or lethargy) in the preceding 2 weeks prior to initial assessment visit and aggregated into a depressive symptom burden score (0-12). New-onset delirium was obtained from hospitalization records during 12y median follow-up. 40,451 (mean age 57±8; range 40-74y) had repeat assessment on average 8y after their first visit. Cox proportional hazard models examined whether depression symptom burden and trajectory predicted incident delirium. RESULTS 5,753 (15 per 1000) newly developed delirium during follow-up. Increased risk for delirium was seen for mild (aggregated scores 1-2, hazards ratio, HR=1.16, [95% confidence interval 1.08–1.25], p<0.001), modest (scores 3-5, 1.30 [1.19–1.43], p<0.001) and severe (scores ≥ 5, 1.38 [1.24–1.55], p<0.001) depressive symptoms, versus none in the fully adjusted model. These findings were independent of the number of hospitalizations and consistent across setting (e.g., surgical, medical, or critical care) and specialty (e.g., neuropsychiatric, cardiorespiratory or other). Worsening depression symptoms (≥1 point increase), compared to no change/improved score, were associated with an additional 39% increased risk (1.39 [1.03–1.88], p=0.03) independent of baseline depression burden. The association was strongest in those over 65y at baseline (p for interaction <0.001). DISCUSSION AND IMPLICATIONS Depression symptom burden and worsening trajectory predicted delirium risk during hospitalization. Increased awareness of subclinical depression symptoms may aid delirium prevention.

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Efficacy and safety of esketamine for perioperative depression in patients undergoing elective surgery: A meta-analysis of randomized controlled trials

Lou,

Qiu,

Ren

et al. 2024

Asian Journal of Psychiatry

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Perioperative Anxiety and Depression in Older Adults: Epidemiology and Treatment

Cited by 5 publications

References 122 publications

Associations between depression symptom burden and delirium risk: a prospective cohort study

Associations between depression symptom burden and delirium risk: a prospective cohort study

Associations Between Depression Symptom Burden and Delirium Risk: A Prospective Cohort Study

Efficacy and safety of esketamine for perioperative depression in patients undergoing elective surgery: A meta-analysis of randomized controlled trials

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