Affective disorders in older inpatients.
BACKGROUND
After dementia the group of depressive disorders is considered to be the second most common psychiatric disorder in the elderly. There is dispute regarding whether depression in the elderly differs from depression in the younger age groups by a longer duration of inpatient treatment, a more frequent occurrence of delusions, more cognitive impairment or by a more frequent co-occurrence of physical disease. This study aimed to compare younger with older inpatients with respect to these aspects.


METHODS
Retrospective chart review of all admissions to the psychiatric department of a General University Hospital (n=9400) and review of the documentation of 15 348 psychiatric consultations in the years 1990-1998. The clinical diagnoses were made according to the ICD-10 criteria.


RESULTS
15.5% of the psychiatric inpatients in this period suffered from depressive episodes (ICD-10 F31.3-31.5,32,33). The proportion of depressive episodes increased with age, making up 5.4% in the age group below 30 years and 37.4% in the age group of 70-79 years. On the basis of the ICD-10 criteria for the severity of depressive episodes no significant differences could be demonstrated between the younger (< 65 years) and the older inpatients (>/= 65 years). In particular, no higher frequency of psychotic symptoms with increasing age could be found. The length of inpatient treatment did not significantly differ between both age groups. The elder patients showed less suicidal attempts prior to admission and less psychiatric comorbidity, but a significantly higher rate of concurrent physical illness. In 923 inpatients a psychiatrist was consulted by the other medical departments because of a co-occurrence of physical with affective disorders, making up 8.6% of the total seen by the psychiatric consultation service. Here again, the proportion of depressive episodes increased with age. The pattern of the depressive episodes in these patients did not differ from that seen in the psychiatric inpatients.


CONCLUSIONS
Only clinical diagnoses made by experienced psychiatrists were evaluated.


CONCLUSIONS
According to our results older depressive inpatients differ from younger ones only with regard to concurrent comorbidity but not with respect to the duration of inpatient treatment or the pattern or severity of depressive symptoms. They more frequently suffered from physical illness but less often showed concurrent psychiatric comorbidity.
Wetterling
Tilman
T
Department of Psychiatry and Psychotherapy/Gerontopsychiatry, Vivantes Klinikum Hellersdorf, Myslowitzer Strasse 45, 12621 Berlin, Germany. tilman.wetterling@vivantes.de
Junghanns
Klaus
K
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology*; D010359:Patient Readmission / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D013406:Suicide, Attempted / Q000706:statistics & numerical data