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ABSTRACT
Levels of awareness and treatment of depression in older adults admitted to acute hospitals are unclear. This study aims to examine the proportion of older adults diagnosed with depression in acute hospitals, treatment, referral, and communication between secondary and primary healthcare services following discharge. Retrospective examination of records of 766 older adults admitted to 27 acute hospitals in England was carried out. Ninety-eight (12.7%, 95% confidence interval (CI) = 10.6-15.3) records included a diagnosis of depression of which eight (1.0%, 95% CI = 0.5-2.0) had a new diagnosis made during their hospital admission. All newly diagnosed and 76 (84.4%, 95% CI = 75.5-90.5) of those with an existing diagnosis of depression were prescribed antidepressant medication. Six (75.0%, 95% CI = 40.9-92.8) of those with a new diagnosis, and 21 (23.3%, 95% CI = 15.8-33.0) with an existing diagnosis of depression were referred to liaison psychiatry. References to mental health were made in 50 (51.0%, 95% CI = 41.2-60.6) discharge letters sent to primary care. Very few older adults admitted to acute hospitals in this study were diagnosed with depression during their inpatient stay. Opportunities for improving the mental and physical health of such patients appear to be being missed.
KEYWORDS: Depression, older adults
Introduction
Depression is common among older adults in acute hospitals. Data collected from 14,632 patients in 47 studies indicates a prevalence of 29%.1 Inpatients with depression have increased mortality during their admission2 and following their discharge from hospital.3,4 In addition to emotional distress and reduced quality of life that older adults with depression experience, inpatients with depression have longer lengths of stay in hospital and higher rates of readmission.4
It has been argued that an admission to hospital provides an important opportunity to review people's mental health and initiate treatment. NHS Scotland's Care of older people in hospital standards5 recommend that for patients with confirmed or possible depression, information about mental health is recorded in clinical records, a care plan is agreed and referral to psychiatric liaison or community mental health services is considered. The Royal College of Psychiatrists (RCPsych) recommends that mental health of all older adults admitted to acute hospitals should be routinely assessed and that all acute hospitals have an older adult psychiatric liaison team distinct from...