Research paperAssociation of depression with malnutrition, grip strength and impaired cognitive function among senior trauma patients☆
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 (BASECNr. 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.
References (86)
- et al.
Risk factors for depression following traumatic injury: an epidemiological study from a scandinavian trauma center
Injury
(2017) Linking the biological underpinnings of depression: role of mitochondria interactions with melatonin, inflammation, sirtuins, tryptophan catabolites, DNA repair and oxidative and nitrosative stress, with consequences for classification and cognition
Prog. Neuropsychopharmacol. Biol. Psychiatry
(2018)- et al.
Depression is associated with early postoperative outcomes following total joint arthroplasty: a nationwide database study
J. Arthroplasty
(2014) - et al.
The influence of psychiatric comorbidity on perioperative outcomes following primary total hip and knee arthroplasty; a 17-year analysis of the National Hospital Discharge Survey database
J. Arthroplasty
(2015) - et al.
Prevalence of geriatric conditions: a hospital-wide survey of 455 geriatric inpatients in a tertiary medical center
Arch. Gerontol. Geriatr.
(2011) - et al.
The development of a European curriculum in Geriatric Emergency Medicine
Eur. Geriatr. Med.
(2016) - et al.
Socioeconomic, psychosocial and behavioral characteristics of patients hospitalized with cardiovascular disease
Am. J. Med. Sci.
(2017) - et al.
"Mini-mental state". A practical method for grading the cognitive state of patients for the clinician
J. Psychiatr. Res.
(1975) - et al.
Depressive symptoms and risk for malnutrition among hospitalized elderly people
J. Nutr. Health Aging
(2008) Depression in adults with a chronic physical health problem: treatment and management
Int. J. Nurs. Stud.
(2009)
Effectiveness of multidisciplinary nutritional care on nutritional intake, nutritional status and quality of life in patients with hip fractures: a controlled prospective cohort study
Clin. Nutr.
AIDE-acute illness and depression in elderly patients. Cognitive behavioral group psychotherapy in geriatric patients with comorbid depression: a randomized, controlled trial
J. Am. Med. Dir. Assoc.
Handgrip dynamometry in healthy adults
Clin. Nutr.
The impact of incident depression on medication adherence in patients with type 2 diabetes
Diabetes Metab.
The orthogeriatrics model of care: systematic review of predictors of institutionalization and mortality in post-hip fracture patients and evidence for interventions
J. Am. Med. Dir. Assoc.
Diagnostic validity and added value of the Geriatric Depression Scale for depression in primary care: a meta-analysis of GDS30 and GDS15
J. Affect. Disord.
Clinical diagnosis of depression in primary care: a meta-analysis
Lancet
Late-life depression, mild cognitive impairment, and dementia: possible continuum?
Am. J. Geriatr. Psychiatry
Multimorbidity and depression: a systematic review and meta-analysis
J. Affect. Disord.
Rehabilitation interventions for older individuals with cognitive impairment post-hip fracture: a systematic review
J. Am. Med. Dir. Assoc.
Prevalence of depression: comparisons of different depression definitions in population-based samples of older adults
J. Affect. Disord.
Is pain perception altered in people with depression? A systematic review and meta-analysis of experimental pain research
J. Pain
Strategies to improve the management of depression in primary care
Prim. Care
Influence of psychological factors on grip strength
J. Hand Surg. Am.
Development and validation of a geriatric depression screening scale: a preliminary report
J. Psychiatr. Res.
Pain perception in major depressive disorder: a neurophysiological case-control study
J. Neurol. Sci.
Factors associated with anxiety and depression in hospitalized patients with first episode of acute myocardial infarction
Arch. Med. Sci. Atheroscler. Dis.
Depressive disorders among elderly people in long-term institutional care
Aust. N Z J Psychiatry
Review of community prevalence of depression in later life
Br. J. Psychiatry
Associations between depressive symptoms and 30-day hospital readmission among older adults
J. Depress. Anxiety
Reliability of the mini nutritional assessment (MNA) in institutionalized elderly people
J. Nutr. Health Aging
Risk factors for malnutrition in seniors aged 75+ living in home environment in selected regions of the Czech Republic
Cent. Eur. J. Public Health
The psychiatric sequelae of traumatic injury
Am. J. Psychiatry
Depressive symptoms as a predictor of 6-month outcomes and services utilization in elderly medical inpatients
Arch. Intern. Med.
Depression and risk of developing dementia
Nat. Rev. Neurol.
Recognition of depression by non-psychiatric physicians—a systematic literature review and meta-analysis
J. Gen. Intern. Med.
Risk factors for depression among elderly community subjects: a systematic review and meta-analysis
Am. J. Psychiatry
Mortality and institutionalization following hip fracture
J. Am. Geriatr. Soc.
Depression in orthopaedic trauma patients. Prevalence and severity
J. Bone Joint Surg. Am.
Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people
Cochrane Database Syst. Rev.
Screening, detection and management of depression in elderly primary care attenders. I: the acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions
Fam. Pract.
Accuracy of the 15-item geriatric depression scale (GDS-15) in a community sample of the oldest old
Int. J. Geriatr. Psychiatry
Is the geriatric depression scale a reliable screening tool for depressive symptoms in elderly patients with cognitive impairment?
Int. J. Geriatr. Psychiatry
Cited by (9)
Grip strength and depressive symptoms in a large-scale adult population: The TCLSIH cohort study
2021, Journal of Affective DisordersCitation Excerpt :Decreased grip strength will affect activities of daily living and reduce the quality of life, thereby increasing the risk of depressive symptoms (Blazer, 2003; Hart, 2019). In addition, the protection of muscle strength can safeguard physical function, reduce malnutrition, and reduce potential disability later in life (Szulc et al., 2016; Wiegand et al., 2019). The reduction of these risk factors for depressive symptoms may prevent the occurrence and development of depressive symptoms.
Optimal Management of the Geriatric Trauma Patient
2023, Current Surgery ReportsPerioperative care program: Zurich-POPS Zurich-PeriOperative-care-for-older-patientS
2022, Senior Trauma Patients: An Integrated ApproachRelationship between malnutrition and the presence of symptoms of anxiety and depression in hospitalized cancer patients
2022, Supportive Care in CancerThe handgrip strength and risk of depressive symptoms: a meta-analysis of prospective cohort studies
2021, Quality of Life Research