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Depression in patients with advanced illness: An examination of Ontario complex continuing care using the Minimum Data Set 2.0

Published online by Cambridge University Press:  07 December 2005

ANDREA GRUNEIR ,
TREVOR FRISE SMITH ,
JOHN HIRDES  and
ROY CAMERON
ANDREA GRUNEIR
Affiliation:
Department of Community Health, Brown University, Providence, Rhode Island
TREVOR FRISE SMITH
Affiliation:
Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada
JOHN HIRDES
Affiliation:
Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada Homewood Research Institute, Homewood Health Center, Guelph, Ontario, Canada
ROY CAMERON
Affiliation:
Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada Centre for Behavioural Research and Program Evolution, Canadian Cancer Society, National Cancer Institute of Canada
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Abstract

Objective: In this study, we examined the prevalence of depression, its recognition, and its treatment in continuing care patients with advanced illness (AI).

Methods: All data were obtained from the Ontario (Canada) provincially-mandated MDS 2.0 form for chronic care. Of 3,801 patients, 524 met our empiric definition of AI, which was predicated on a previously validated algorithm. The MDS-embedded Depression Rating Scale (DRS) was used to measure psychological well-being and a score of 3 or greater indicated potential depression.

Results: Twenty-nine percent of patients with AI scored greater than 3, making them nearly twice as likely to be potentially depressed as other patients (OR 1.8, 95% CI 1.5–2.2). Despite this patients with AI were less likely to have received antidepressants (28.9% vs. 38.2%), even among those with a diagnosis (45.3% vs. 58.4%). Using logistic regression, correlates of potential depression were identified and surprisingly patients with cancer were substantially less likely to be depressed (AOR 0.37, 95% CI 0.2–0.6). Further investigation revealed that cancer patients were more likely to be treated for depression and to be recognized as being within the terminal phase of illness.

Significance of results: These findings suggest that a high proportion of terminally ill patients had unmet needs for psychological support. As well, they suggest that cancer patients received better targeted end-of-life care, which resulted in an overall decrease in psychological distress when compared to other patients with similarly advanced illness.

Keywords

End-of-lifeDepressionMinimum Data Set 2.0
Type
Research Article
Information
Palliative & Supportive Care , Volume 3 , Issue 2 , June 2005 , pp. 99 - 105
Copyright
© 2005 Cambridge University Press

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References

REFERENCES

Anderson, D.N. (2001). Treating depression in old age: The reasons to be positive. Age and Ageing, 30, 13–17.Google Scholar
Austin, M.P., Ross, M., Murray, C., et al. (1992). Cognitive function in major depression. Journal of Affective Disorders, 25, 21–30.Google Scholar
Beck, D.A., Koenig, & H.G., Beck J.S. (1998). Depression. Clinics in Geriatric Medicine, 14(4), 765–786.Google Scholar
Billings, J.A. (1995). Depression. Journal of Palliative Care, 11(1), 48–54.Google Scholar
Bortz, W.M. (1990). The trajectory of dying. Functional status in the last year of life. Journal of the American Geriatrics Society, 38, 1300–1306.Google Scholar
Brand, A.N., Jolles, J., & Gispen-de Wied, C. (1992). Recall and recognition memory deficits in depression. Journal of Affective Disorders, 25, 77–86.Google Scholar
Breitbart, W. & Jacobsen, P.B. (1996). Psychiatric symptom management in terminal care. Clinics in Geriatric Medicine, 12(2), 329–347.Google Scholar
Breitbart, W., Rosenfeld, B., Pessin, H., et al. (2000). Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA, 284(22), 2907–2911.Google Scholar
Bruce, M.L. (2002). Psychosocial risk factors for depression in late life. Biological Psychiatry, 52(3), 175–184.Google Scholar
Burrows, A.B., Morris, J.N., Simon, S.E., et al. (2000). Development of a Minimum Data Set-based depression rating scale for use in nursing homes. Age and Ageing, 29, 165–172.Google Scholar
Cassel, C.K. & Foley, K.M. (1999). Principles for care of patients at the end of life: An emerging consensus among the specialties of medicine. New York: Millbank Memorial Fund.
Chochinov, H.M. (2000). Psychiatry and terminal illness. Canadian Journal of Psychiatry, 45(2), 143–150.Google Scholar
Chochinov, H.M., Wilson, K.G., Enns, M., et al. (1995). Desire for death in the terminally ill. American Journal of Psychiatry, 152(8), 1185–1191.Google Scholar
Clary, G.L., Palmer, S.M., & Doraiswamy, M. (2002). Mood disorders and chronic obstructive pulmonary disease: Current research and future needs. Current Psychiatry Reports, 4, 213–221.Google Scholar
Dein, S. (2000). The management of psychological distress in terminal illness. Primary Care Psychiatry, 6(3), 123–126.Google Scholar
Fries, B.E., Simon, S.E., Morris, J.N., et al. (2001). Pain in U.S. nursing homes: Validating a pain scale for the Minimum Data Set. The Gerontologist, 41(2), 173–179.Google Scholar
Gallasi, R., Morreale, A., & Pagni, P. (2001). The relationship between depression and cognition. Archives of Gerontology and Geriatrics, S7, 163–171.Google Scholar
Ganzini, L., Smith, D.M., Fenn, D.S., et al. (1997). Depression and mortality in medically ill older adults. JAGS, 45(3), 307–312.Google Scholar
Geerlings, S.W., Twisk, J.W.R., Beekman, A.T.F., et al. (2002). Longitudinal relationship between pain and depression in older adults: Sex, age, and physical disability. Social Psychiatry and Psychiatric Epidemiology, 37, 23–30.Google Scholar
Harrington, C. (2002). Depression in the medically ill. Medicine and Health/Rhode Island, 85(9), 273–277.Google Scholar
Hodges, E.P., Mast, B., Lichtenberg, P.A., et al. (1998). Disease and depression in older medical patients. Psychological Reports, 83, 1081–1082.Google Scholar
Hirdes, J.P., Fritjers, D.H., & Teare, G.F. (2003). The MDS-CHESS scale: A new measure to predict mortality in institutionalized older people. Journal of the American Geriatrics Society, 51(1), 1–5.Google Scholar
Hirdes, J.P., Ikegami, N., Jónsson, P.V., et al. (2000). Cross-national comparisons of antidepressant use among institutionalized older persons based on the Minimum Data Set (MDS). Canadian Journal on Ageing, 19(S2), 18–37.Google Scholar
Hooper, S.C., Vaughan, K.J., Tennant, C.C., et al. (1997). Preferences for voluntary euthanasia during major depression and following improvement in an elderly population. Australian Journal on Ageing, 16(1), 3–7.Google Scholar
Hotopf, M., Addington-Hall, J., Chidgey, J., et al. (2002). Depression in advanced disease: A systematic review. Part 1. Prevalence and case findings. Palliative Medicine, 16, 81–97.Google Scholar
Jiang, W., Krishnan, R.R.K., & O'Connor, C.M. (2002). Depression and heart disease: Evidence of a link and its therapeutic implications. CNS Drugs, 16(2), 111–127.Google Scholar
Kinzbrunner, B.M. (2002). Predicting prognosis: How to decide when end-of-life care is needed. In 20 Common Problems in End-of-Life, Kinzbrunner, B.M., Weinreb, N.J. & Policzer, J.S. (eds.), New York: McGraw Hill.
Knaus, W.A., Harrell Jr., F.E., Lynn, J., et al. (1995). The SUPPORT prognostic model: Objective estimates of survival for seriously ill hospitalized adults. Annals of Internal Medicine, 122(3), 191–203.Google Scholar
Krishnan, K.R.R., Delong, M., Kraemer, H., et al. (2002). Comorbidity of depression with other medical diseases in the elderly. Biological Psychiatry, 52, 559–588.Google Scholar
Kugaya, A., Akechi, T., Nakano, T., et al. (1999). Successful antidepressant treatment for five terminally ill cancer patients with major depression, suicidal ideation and a desire for hastened death. Supportive Care in Cancer, 7, 432–436.Google Scholar
Lander, M., Wilson, K., & Chochinov, H.M. (2000). Depression and the dying older patient. Clinics in Geriatric Medicine, 16(2), 335–356.Google Scholar
Lloyd-Williams, M., Friedman, T., & Rudd, N. (1999). A survey of antidepressant prescribing in the terminally ill. Palliative Medicine, 13, 243–248.Google Scholar
Martin, A.C. & Jackson, K.C. (1999). Depression in palliative care patients. Journal of Pharmaceutical Care in Pain & Symptom Control, 7(4), 71–89.Google Scholar
Morris, J.N., Fries, B.E., Mehr, D.R., et al. (1994). MDS Cognitive Performance Scale. Journal of Gerontology: Medical Sciences, 49(4), M174–M182.Google Scholar
Morris, J.N., Fries, B.E., & Morris, S.A. (1999). Scaling ADLs within the MDS. Journal of Gerontology, 7, 34–40.Google Scholar
Newman, S.C. & Hassan, A.I. (1999). Antidepressant use in the elderly population in Canada: Results from a national survey. Journal of Gerontology: Medical Sciences, 54A(10), M527–M530.Google Scholar
Ostbye, T., Steenhuis, R., Walton, R., et al. (2000). Correlates of dysphoria in Canadian seniors: The Canadian Study of Health and Ageing. Canadian Journal of Public Health, 91(4), 313–317.Google Scholar
Parmalee, P.A., Katz, I.R., & Lawton, M.P. (1992). Incidence of depression in long-term care settings. Journal of Gerontology: Medical Sciences, 47(6), M189–M196.Google Scholar
Stiefel, F., Die Trill, M., Berney, A., et al. (2001). Depression in palliative care: A pragmatic report for the Expert Working Group of the European Association for Palliative Care. Supportive Care in Cancer, 9, 477–488.Google Scholar
Suarez-Almazor, M.E., Newman, C., Hanson, J., et al. (2002). Attitudes of terminally ill cancer patients about euthanasia and assisted suicide: Predominance of psychosocial determinants and beliefs over symptom distress and subsequent survival. Journal of Clinical Oncology, 20(8), 2134–2141.Google Scholar
Sutor, B., Rummans, T.A., Jowsey, S.G., et al. (1998). Major depression in medically ill patients. Mayo Clinic Proceedings, 73, 329–337.Google Scholar
Wilson, K.G., Chochinov, H.M., de Faye, B.J., et al. (2000). Diagnosis and management of depression in palliative care. In Handbook of psychiatry in palliative medicine, Chochinov, H.M. & Breitbart, W. (eds.). New York: Oxford University Press.
Yohannes, A.M., Baldwin, R.C., & Connolly, M.J. (2000). Mood disorders in elderly patients with chronic obstructive pulmonary disease. Reviews in Clinical Gerontology, 10, 193–202.Google Scholar