Predictors of Improvement in Health-Related Quality of Life Among Elderly Patients With Depression

Abstract

Background: Depression is the most prevalent disabling psychiatric syndrome of aging and may lead to important decrements in the elderly depressed patient's health-related quality of life (HRQL). The goal of this study was to determine whether severity of chronic illness at admission, severity of depressive symptoms at admission, or living alone before admission was associated with lack of improvement in HRQL at 3 months postdischarge among elderly depressed inpatients. Methods: Subjects were 100 consecutive patients admitted to a 26-bed inpatient geriatric psychiatry unit from 1994 through 1997, who were residing in the community and were not demented. At admission, severity of depressive symptoms was assessed using the Geriatric Depression Scale and severity of chronic physical illness was measured using the Cumulative Illness Rating Scale (Geriatrics). HRQL was assessed at admission and again at 3 months postdischarge using the Medical Outcomes Study (MOS) 6-Item General Health Survey. Results: This study found large improvements in all MOS items between admission and 3 months postdischarge. Severity of chronic physical disease was negatively associated with the probability of improvement in three MOS items (role functioning, psychological functioning, and general health perceptions) whereas the severity of depressive symptoms on admission was negatively associated with the probability of improvement in role functioning, social functioning, and bodily pain. Living alone was negatively associated with social functioning but not with any of the other MOS items. Conclusion: The results of this study suggest that the inpatient treatment of depression in the elderly brings about improvements in quality of life that persist for at least 3 months follwing discharge. The patient's initial level of depression and initial level of physical health may be important factors to be considered when evaluating a patient's prognosis.

Depression and Quality of Life in Older Persons: A Review

“…In all, 45 studies reported that they excluded individuals with cognitive impairment or a diagnosis of dementia, of which 30 were cross-sectional studies (58.8%) [11,12,17,19,24,30,31,32,33,37,58,59,60,62,63,64,65,66,69,72,73,75,76,77,78,88,89,90,91,92] and 15 were longitudinal studies (68.2%) [2,3,4,8,10,18,20,21,25,26,34,45,46,48,49]. Cognitive function was equally assessed in clinical studies (n = 11) and in community-based studies (n = 12).…”

“…Generally, most of the generic HQOL domains were affected in a negative way by a depressive disorder or a severe degree of depressive symptoms, except for physical functioning (role limitations due to physical health) and in the mental domain (emotional, psychological functioning) [3,10,21,25,45,82]. Two studies found that general health and vitality (and energy level) were not affected by depression [2,21] while spiritual, body pain, and satisfaction with living arrangements domains were not affected by depression in 1 study each [2,25,45].…”

“…Depression in older persons (≥60 years) is prevalent in community living settings [2,3,4,5,6,7,8] and even more prevalent among older individuals who have been hospitalized due to serious physical diseases or institutionalized due to reduced physical and/or cognitive functioning [9,10,11,12]. Known risk factors for depression are female gender [1,13], older age [14,15], poorer coping abilities [16], physical morbidity [2,4,9,17,18,19,20,21,22], impaired level of functioning [2,5,6,9,13,18,23,24,25,26,27,28,29], reduced cognition [2,3,8,20,30,31,32,33,34,35], and bereavement [13,36]. Depression has been associated with an increased risk of mortality [2,37], and poorer outcome of treatment of physical disorders [4,10].…”

“…The wide range of definitions of QOL complicates the research field and may make comparisons between studies difficult. Furthermore, the wide variety of assessment instruments for both depression/depressive symptoms and QOL [2,3,4,5,6,7,8,10,18,20,21,25,26,34,44,45,46,47,48,49,50,51] increases the need for a review of the existing research. Given these challenges, the aim of the present study was to review the literature on the association between depression and QOL in older persons.…”

Racial Differences in Tobacco Cessation and Treatment Usage After Lung Screening: An Examination of the National Lung Screening Trial

“…Higher FTND scores were associated with a lower probability of a quit attempt, supporting the conclusion that higher levels of nicotine addiction hinder attempts at smoking cessation. The only factor significantly associated with sustained smoking cessation was a positive screening result, suggesting that lung cancer screening using recently published guidelines [48] could represent a unique opportunity to counsel patients about smoking cessation. This is in keeping with previously published studies examining the relationship of CT screening and screening results with smoking behavior [48][49][50].…”