How do advancing age and dementia affect depression in patients with hip fracture surgery?

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Depression in patients after hip fracture has adverse effect on patient outcomes.(1) The risk for developing depression is particularly high in the first 2 weeks after hip fracture(2), when patients may suffer from pain, sleep disturbance, immobilization, unpredictable prognosis and functional disability. Detecting depressive symptoms allow early interventions to optimise rehabilitation outcomes.(3) Understanding relevant patient factors would help to identify patients at risk of late-life depression.

BACKGROUND  

OBJECTIVES  

RESULTS  

-  Depression was present in 18.3% of 1127 patients within two weeks after hip fracture. Mean age was 81.2 years.

-  Prevalence of perioperative depression was highest in the old-old (24.1%) and in patients with dementia (64.8%).

-  Advancing age, pre-fracture institutionalisation, use of gait aid, poor physical status, and dementia but not gender or perioperative delirium were associated with higher GDS scores.

Age, Dementia & Depression -  Mean GDS was higher in patients with dementia comparing with

patients without dementia (GDS 4.5 v 1.6, P<0.001). -  GDS increased by 0.01 point for each year increase in age in all

patients (adjusted beta=0.01, P=0.03). -  The association of increasing depressive symptoms and

advancing age was significant in patients without dementia (r=0.19, P<0.001) but not in patients with dementia (r=-0.06, P=0.36). (Figure 1)

Figure 1. Relationship of age and depression score in 1127 patients with emergency hip fracture surgery with and without dementia

CONCLUSIONS  

-  Depressive symptoms were common during peri-operative care for hip surgery.

-  Depression was highly prevalent in patients with dementia after hip fracture regardless of their age.

-  Pre-morbid patient factors may help to identify patients at risk for depression who would benefit from screening and management.

REFERENCES  

1.  Feng L, Scherer SC, Tan BY, Chan G, Fong NP, Ng TP. Comorbid cognitive impairment and depression is a significant predictor of poor outcomes in hip fracture rehabilitation. Int Psychogeriatr. 2010 Mar;22(2):246-53.

2.  Kennedy GJ, Kelman HR, Thomas C. The emergence of depressive symptoms in late life: the importance of declining health and increasing disability. Journal of community health. 1990 Apr;15(2):93-104.

3.  Romeo R, Knapp M, Banerjee S, Morris J, Baldwin R, Tarrier N, et al. Treatment and prevention of depression after surgery for hip fracture in older people: cost-effectiveness analysis. Journal of affective disorders. 2011 Feb;128(3):211-9.

4.  Brown LM, Schinka JA. Development and initial validation of a 15-item informant version of the Geriatric Depression Scale. International journal of geriatric psychiatry. 2005 Oct;20(10):911-8.

Contact: Dr Michelle Lai Lecturer, Consultant Geriatrician & Clinical Epidemiologist E: [email protected]

1)  determine the prevalence of perioperative depression 2)  examine potential factors associated with depressive symptoms 3)  whether dementia modify the association between depression

and potential factors

1Eastern  Health  Clinical  School,  Monash  University,  2Department  of  Aged  Care,  Caulfield  Hospital,  Alfred  Health,  Melbourne,  Victoria,  3Department  of  Geriatric  Medicine,  Royal  Perth  Hospital,  Perth,  WA,  4Department  of  Rheumatology,  Eastern  Health,  

Box  Hill,  Victoria,  5Department  of  Psychiatry,  Royal  Perth  Hospital,  Perth,  WA,  Australia    

Michelle  M.  Y.  Lai  1,  2,  Noreen  Mughal  3,  Christopher  Fong  1,4,  Stephen  Fenner  5    

PERIOPERATIVE  DEPRESSION  IN  OLDER  PATIENTS  WITH  EMERGENCY  HIP  FRACTURE  SURGERY:  IMPLICATIONS  OF  AGE  AND  DEMENTIA    

METHODS  

-  In a cross-sectional study, 1127 hip fracture survivors were able to complete assessments within two weeks after hip fracture in an orthogeriatric unit in Western Australia, from 2005 to 2008.

-  Measurements included age, gender, pre-fracture residence, mobility, American Society of Anesthesiologists (ASA) physical status score, pre-existing dementia, perioperative delirium, 15-item Geriatric Depression Scale (GDS 15).(4)

-  Clinical depression was defined as Geriatric Depression Scale (GDS) score was five or above.

-  Linear regression analysed the association of age and GDS. Modifying effect of dementia was examined using likelihood ratio test. All data were analysed using Stata v11.

Table 1. Prevalence of depression in 1127 patients after hip fracture by age and gender, using GDS-15

GDS, Geriatric Depression Scale † Chi-square linear by linear association Comparisons between men and women across all age groups were insignificant

!

Variables Men

(n=318)

Women

(n=809)

All

(n=1127)

GDS ≥ 5, n (%) 57 (17.9) 149 (18.4) 206 (18.3)

Age Group (years)

<75, n (%) 10 (10.1) 7 (4.9) 17 (7.1)

75 – 84, n (%) 19 (16.6) 57 (18.8) 76 (18.2)

≥ 85, n (%) 28 (26.7) 85 (23.4) 113 (24.1)

P value for trend† 0.002 <0.001 <0.001

RESULTS  

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