Recognition of depression in geriatric ED patients by emergency physicians.
OBJECTIVE
To prospectively evaluate identification of geriatric depression by emergency physicians and to assess the utility of a self-rated depression scale to improve case-finding in geriatric patients presenting to the ED.


METHODS
We conducted an observational survey of geriatric ED patients who presented to an urban, university-affiliated public hospital. A brief self-rated depression scale was administered to 101 patients aged 65 years or older. Emergency physicians, blinded to depression scale scores, prospectively rated the likelihood of depression in these patients. Our main outcome measures were prevalence of depression (in accordance with a predetermined cutoff score for detecting depression) and the emergency physicians' clinical recognition of depression.


RESULTS
Thirty patients (30%; 95% confidence interval [CI], 21% to 39%) met the predetermined criteria for depression. Age, sex, race, and education were not significantly different between depressed and nondepressed patients. Patients who categorized their health as good were less likely to be depressed than those who considered their health poor or fair (18% versus 37%; 95% CI for difference of 19%, 10% to 35%). Recognition of depression by emergency physicians was poor, with a sensitivity of 27% (95% CI; 12% to 46%), specificity of 75% (95% CI, 63% to 84%), and positive predictive value of 32% (95% CI, 27% to 41%). Only 13% (95% CI, 4% to 31%) of depressed patients were referred for further mental health evaluation.


CONCLUSIONS
Depression is common in older ED patients but often goes unrecognized by emergency physicians. Use of a brief depression scale can improve case-finding in this age group, leading to appropriate referral for further management.
Meldon
S W
SW
Department of Emergency Medicine, Case Western Reserve University, Cleveland, OH, USA.
Emerman
C L
CL
Schubert
D S
DS
D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis*; D004522:Educational Status; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005260:Female; D015577:Geriatric Assessment; D006766:Hospitals, County; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D012372:ROC Curve; D012680:Sensitivity and Specificity