title: The association between stroke, depression, and 5-year mortality among very old people.
abstract: OBJECTIVE
  Depression after stroke has been associated with increased mortality, but little is known about this association among very old people.
  
  
  METHODS
  A population-based study among people ≥85 years of age was conducted in northern Sweden and Finland, comprising cross-sectional assessments and subsequent survival data. The 452 individuals who had completed the Geriatric Depression Scale-15 assessment were selected. Depression was defined as a score of ≥5 on the geriatric depression scale.
  
  
  RESULTS
  Of those with a history of stroke, 38 of 88 (43.2%) people were depressed, and 11 of the 38 (28.9%) were treated with antidepressants, compared with 91 of 364 (25.0%) depressed (P=0.001) and 17 of 91 (18.7%) treated with antidepressants among those without stroke. Having a history of stroke and ongoing depression was associated with increased 5-year mortality compared with having only stroke (hazard ratio, 1.90; confidence interval, 1.15-3.13), having only depression (hazard ratio, 1.59; confidence interval, 1.03-2.45), and compared with having neither stroke nor depression (hazard ratio, 2.50; confidence interval, 1.69-3.69). Having only stroke without depression did not increase mortality compared with having neither stroke nor depression.
  
  
  CONCLUSIONS
  A history of stroke was associated with increased mortality among very old people but only among those who were also depressed. Depression seemed to be underdiagnosed and undertreated.
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden. carl.hornsten@germed.umu.se
authors.forename: Carl
authors.initials: C
authors.lastname: Hornsten
authors.forename: Hugo
authors.initials: H
authors.lastname: Lövheim
authors.forename: Yngve
authors.initials: Y
authors.lastname: Gustafson
mesh_terms: D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005387:Finland / Q000453:epidemiology; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D020521:Stroke / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents
keywords: cerebrovascular disorders; depression; epidemiology; mortality; stroke; very old