Psychiatric morbidity and outcome in elderly patients undergoing emergency hip surgery: A one‐year follow‐up study

Abstract

Fifty consecutive elderly patients undergoing emergency hip surgery were assessed shortly after operation and again one year later. Depressive symptoms, cognitive impairment, global physical ill-health and activity of daily living (ADL) function were assessed and their predictive effect on outcome investigated. Mortality was predicted by the presence of both depression and dementia as well as by physical ill-health. The effect of depression on mortality was independent of concurrent physical illness. Mortality was particularly high in subjects with both depression and dementia. Length of hospital stay was predicted by age and physical ill-health but not by psychiatric morbidity. ADL functioning at one year was predicted by increased age and the presence of dementia. Psychiatric evaluation may thus be relevant to the postoperative management of elderly patients undergoing emergency hip surgery.

Suicidal ideation in acutely medically ill elderly inpatients: prevalence, correlates and longitudinal stability

“…However, they were higher than the prevalence of 1±20% reported in a mixture of studies in the community, primary care, memory clinic and stroke patients (Paykel et al, 1974;Rao et al, 1997;Forsell et al, 1997;Skoog et al, 1996;Callaghan et al, 1996;Draper et al, 1998;Kishi et al, 1996a,b). Only one other study has used the BSSI scale for measuring suicidal ideation (Rao et al, 1997).…”

“…The BAS was chosen as the`gold standard' because it is a semi-structured interview and it was conducted by appropriately trained interviewers. Moreover, it has been successfully utilised in identifying depression in acutely ill (Ramsey et al, 1991;Shah et al, 1997Shah et al, , 1998b) and continuing care (Shah et al, 1992) geriatric inpatients, elderly patients attending casualty departments (Walker et al, 1995) and elderly patients with hip fractures (Shamash et al, 1992). It consists of an organic brain syndrome scale (BAS-OBS) with a scoring range of 0±8 and a depression scale (BAS-DEP) with a scoring range of 0±24.…”

“…Dierent age groups between 60 and 85 years have been examined in dierent studies (Paykel et al, 1974;Jorm et al, 1995;Skoog et al, 1996;Rao et al, 1997). The relevant items on the Hamilton Depression Rating Scale (Callaghan et al, 1996;Draper et al, 1998), Comprehensive Psychiatric Rating Scale (Skoog et al, 1996;Forsell et al, 1997), Brief Assessment Schedule (Ashby et al, 1991;Shah et al, 1998a), Present State Examination (Kishi et al, 1996a,b), Beck Suicidal Ideation Scale (Rao et al, 1997), Diagnostic Interview Schedule (Flint et al, 1998) and Geriatric Mental State (Dewey et al, 1993) have been used to measure suicidal ideation. The time interval for the presence of suicidal ideation has varied from 2 weeks (Jorm et al, 1995) to 2 years (Rao et al, 1997).…”

“…Overtly reported suicidal ideation has been examined in the community (Paykel et al, 1974;Dewey et al, 1993;Jorm et al, 1995;Forsell et al, 1997;Skoog et al, 1996), residential homes (Ashby et al, 1991), primary care (Callaghan et al, 1996), memory clinics (Draper et al, 1998), acute and continuing care geriatric wards (Shah et al, 1998a) and acute psychogeriatric wards (Bell and Shah, 1999). Study samples have included high risk groups of depressed men with a family history of suicide (Flint et al, 1998), undierentiated dementias (Rao et al, 1997;Draper et al, 1998), Alzheimer's disease (Rao et al, 1997;Draper et al, 1998), 85-year-olds without dementia (Skoog et al, 1996), stroke patients (Kishi et al, 1996a,b) and medically ill patients (Callaghan et al, 1996;Shah et al, 1998a).…”

Psychiatric illness and length of stay in elderly patients with hip fracture

“…The presence of confusion and depressive illness increases the associated morbidity and mortality and is said to increase length of stay (Billiget al, 1986;Mossey et al, 1989;Magaziner et al, 1990;Strain et al, 1991;Shamash et al, 1992).…”