Elsevier

Journal of Affective Disorders

Volume 247, 15 March 2019, Pages 175-182
Journal of Affective Disorders

Research paper
Association of depression with malnutrition, grip strength and impaired cognitive function among senior trauma patients

https://doi.org/10.1016/j.jad.2019.01.013Get rights and content

Highlights

  • 19% of acute trauma patients (≥70 years) had Geriatric Depression Score ≥5.

  • Seniors with depressive symptoms were more likely to be at risk for malnutrition.

  • Seniors with depressive symptoms were more likely to have lower MMSE scores.

  • Women with depressive symptoms had lower grip strength.

  • Having depressive symptoms was associated with transfer to geriatric care.

Abstract

Background

Depression is common among senior adults, yet understudied among trauma patients. The purpose of this study was to assess the prevalence of depressive symptoms among seniors hospitalized in acute trauma care, to compare patients with depressive symptoms vs. those without, and to evaluate whether depression symptoms affects discharge destination.

Methods

This cross-sectional and prospective analysis was conducted among community-dwelling patients ≥70 years old, hospitalized at the Senior Trauma Center of the University Hospital Zurich, Switzerland. We used the Geriatric Depression Scale (GDS-15) to assess presence of depressive symptoms. Using a cutoff value of 5 points, we compared age- and gender-adjusted characteristics of patients with and without depressive symptoms. Multinomial logistic regression models were used to estimate the odds of returning home vs. not adjusting for age, gender, nutritional status, cognitive function and others.

Results

Of the 273 seniors enrolled, 104 (38.1%) were men and the mean age was 79.4 (SD = 6.5) years. We identified 52 (19.0%) patients with depressive symptoms. These patients were more likely to be older (p= 0.04), at risk for malnutrition (p<0.0001), at least pre-frail (p= 0.005), and have decreased cognitive function (p= 0.001). They were also more than twice as likely to be discharged to acute geriatric care compared to home (OR = 2.28 (CI = 1.12–4.68)).

Limitations

Depressive symptoms were assessed during acute care without data before hospitalization.

Conclusions

Senior trauma patients with depressive symptoms during acute care were more likely to be at higher risk of malnutrition, have cognitive decline and are more likely to receive additional geriatric care.

Introduction

The prevalence of geriatric depression varies largely across studies, ranging between 4.2 and 10.6% in the general senior population (Sjoberg et al., 2017). Among trauma patients the prevalence of symptoms of depression is even higher, ranging between 9% and 29% pre-admission (McRae et al., 2013) to 30% during hospitalization (Chen et al., 2011). This number increases up to 80% in patients with a chronic medical condition (Haddad, 2009). Yet, depression is often underdiagnosed and undertreated (Cepoiu et al., 2008, Kok and Reynolds, 2017, Mitchell et al., 2009, Morichi et al., 2015).

Depression is associated with several negative outcomes in seniors, including falls (Gostynski et al., 2001), malnutrition (Brabcova et al., 2016) and cognitive impairment (Panza et al., 2010). Conversely, readmission rates, mobility and autonomy after orthopedic trauma, total joint arthroplasty, spinal surgery or shoulder arthroplasty are strongly influenced by depression (Berges et al., 2015, Browne et al., 2014, Buller et al., 2015, Hummel et al., 2017, Lavernia et al., 2015, Menendez et al., 2013, Mollon et al., 2016, Morghen et al., 2011). Several risk factors for depression are known, including age, gender and socioeconomic conditions (Ames, 1993, Beekman et al., 1999, Djernes, 2006, Muller et al., 2017). Moreover, gender differences exist regarding prevalence, symptomatology, risk and influencing factors of depression (Lyu and Kim, 2018), muscle strength (Luna-Heredia et al., 2005), as well as recovery after hip fracture (Cree et al., 2000). Characteristics associated with depression among hospitalized patients has been mostly studied in regards to internal medicine wards but have not been thoroughly studied in acute trauma care (Alexandri et al., 2017, Dupre et al., 2017).

Despite the extensive research on association between depression and adverse health events after hospitalization, few studies have evaluated the factors associated with depressive symptoms during acute trauma care. It is in acute trauma care where important risk factors for institutionalization should be identified and treated (Martinez-Reig et al., 2012). Since appropriate care management has shown to improve outcomes for depressed seniors in primary care settings (Unutzer and Park, 2012), understanding depression in this large population offers the potential for targeted interventions to improve patient outcomes. Therefore, we aimed evaluate the prevalence of depressive symptoms among patients hospitalized in acute trauma care and to evaluate the characteristics of depressed patients vs. those who did not report depressive symptoms. In addition, we aimed to evaluate whether depression influences discharge destination of seniors after a physical trauma. Our primary hypothesis is that hospitalized trauma patients with depression are more likely to be discharged to another care facility rather return home.

Section snippets

Subjects and study design

This cross-sectional and prospective analysis was conducted at the Centre on Aging and Mobility at the University Hospital Zurich among patients ≥70 years of age, hospitalized at the Senior Trauma Center of the University Hospital Zurich, Switzerland during three different time periods (March 2016 to February 2017). Only community-dwelling patients who were physically able to completely fulfill the Mini-Mental State Examination (MMSE) were considered for this study (Fig. 1). Exclusion criteria

Results

Baseline characteristics of the 273 seniors included in this study are presented in Table 1. Mean age of all patients was 79.4 (SD = 6.5) years including 38% men and 62% women. Women (80.3 (SD = 6.7) years) were significantly older (77.8 (SD = 5.8) years, p = 0.001). The mean GDS-15 score was higher (p= 0.01) for women and they were more likely to be at risk for malnutrition (p = 0.01). Men were more likely to be married (p < 0.0001), have higher BMI (p = 0.0001) and stronger grip strength (p

Discussion

In this study conducted among community-dwelling seniors hospitalized in acute trauma care, we found a prevalence of possible depression cases higher than some previous studies among orthopedic surgery patients (Menendez et al., 2013), but lower than others (Bula et al., 2001, Crichlow et al., 2006). However, differences in prevalence of depression symptoms can be attributed to the use of different tools and definitions.

While there is no definitive biological explanation for the association

Limitiations

Our study has several limitations. First, while the GDS-15 is a well validated depression screening tool (D'Ath et al., 1994, de Craen et al., 2003, Fountoulakis et al., 1999, Mitchell et al., 2010, Nyunt et al., 2009), it is not equivalent to a depression diagnosis verified by a professional. Most patients showed a score for no or mild depression, which is a realistic reflection of the senior patients in a trauma department (Bryant et al., 2010). Regardless, our findings would need to be

Conclusion

In summary, symptoms of depression are frequent among seniors trauma patients and are associated with other geriatric syndromes, such as low cognitive function, malnutrition, low muscle strength and frailty. We also show that symptoms of depression trigger specialized geriatric care and reduce the chance of immediate discharge back home after acute trauma care. Diagnosing depression at the beginning of hospitalization among senior trauma patients may help to effectively plan extended care,

Ethical statement

This study was approved by the Ethics Committee Zurich (BASECsingle bondNr. 2018–00743).

Conflict of interest

All authors declare no conflict of interests.

Author contributions

AW, AZ and RDS, wrote the first draft of the manuscript with input from PCB, HBF and all coauthors. PCB and HBF designed the study, statistical analysis was conducted by PCB, RDS, AW and AZ with input from HBF. Data collection according to GCP were conducted under supervision of AE, GF and HBF. All authors contributed to and have approved the final manuscript. HBF bears responsibility for the study process.

Acknowledgments

Funding: Baugarten Centre Grant for the Centre on Aging and Mobility.

The funding sources had no influence of the study design; data collection; analysis and interpretation; writing of the report or decision to submit the article for publication.

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