title: The course of depression in late life as measured by the Montgomery and Asberg Depression Rating Scale in an observational study of hospitalized patients.
abstract: BACKGROUND
  Depression and depressive symptoms are highly prevalent in old persons but are potentially reversible. Full recovery is the main goal in the treatment of depressive episodes. Compared to clinical trials, observational studies of patients with depression in late life (DLL) show poorer prognoses in terms of response and remission. However, observational studies on the course of DLL are scarce. The aims of this study were to examine the course of DLL in terms of response, remission and symptom-specific changes as measured by the Montgomery and Asberg Depression Rating Scale (MADRS), and to explore which clinical variables were associated with the response and remission.
  
  
  METHODS
  This is an observational, multicenter and prospective study of patients aged 60 years and older who were referred to treatment of depression in the department of old-age psychiatry at specialist health care services in Norway. The patients were evaluated with the MADRS at admission to and discharge from hospital. The mean, median, minimum and maximum values for days stayed in hospital were 68, 53, 16 and 301, respectively. Effect size (ES) was calculated to determine which MADRS symptoms changed most during the treatment. To assess the predictors for change in the MADRS score (continuous variable) and for remission and response (both dichotomous variables), regression models adjusting for cluster effects within center were estimated.
  
  
  RESULTS
  Of 145 inpatients, 99 (68.3 %) had a response to treatment (50 % or more improvement of the MADRS score). Remission (MADRS score ≤9 at discharge) was experienced in 74 (51.0 %) of the patients. Of the individual MADRS items, "reported sadness" (ES =0.88) and "lassitude" (ES = 0.80) showed the greatest amount of improvement, and "concentration difficulties" (ES = 0.50) showed the least amount of improvement during treatment. Having a diagnosis of dementia was associated with a lower remission rate and less improvement in the MADRS score during the treatment. Poorer physical health was associated with a lower response rate. Having experienced previous episode(s) of depression was associated with a lower remission rate.
  
  
  CONCLUSIONS
  Recurrent episodes of depression, poor somatic health and a diagnosis of dementia were found to be negative prognostic factors for the course of DLL. Clinicians should therefore pay close attention to these factors when evaluating treatment.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01952366.
authors.affiliation: Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Sanderud, PO Box 68, 2312, Ottestad, Norway. tom.borza@sykehuset-innlandet.no.|Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. tom.borza@sykehuset-innlandet.no.
authors.forename: Tom
authors.initials: T
authors.lastname: Borza
authors.affiliation: Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. knut.engedal@aldringoghelse.no.
authors.forename: Knut
authors.initials: K
authors.lastname: Engedal
authors.affiliation: Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Sanderud, PO Box 68, 2312, Ottestad, Norway. sverre.bergh@sykehuset-innlandet.no.
authors.forename: Sverre
authors.initials: S
authors.lastname: Bergh
authors.affiliation: Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Sanderud, PO Box 68, 2312, Ottestad, Norway. jurate.saltyte-benth@medisin.uio.no.|Institute of Clinical Medicine, Campus AHUS, University of Oslo, Oslo, Norway. jurate.saltyte-benth@medisin.uio.no.|HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway. jurate.saltyte-benth@medisin.uio.no.
authors.forename: Jūratė Šaltytė
authors.initials: JŠ
authors.lastname: Benth
authors.affiliation: Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Sanderud, PO Box 68, 2312, Ottestad, Norway. geir.selbaek@aldringoghelse.no.|Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. geir.selbaek@aldringoghelse.no.|Institute of Clinical Medicine, Campus AHUS, University of Oslo, Oslo, Norway. geir.selbaek@aldringoghelse.no.
authors.forename: Geir
authors.initials: G
authors.lastname: Selbæk
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging / Q000523:psychology*; D003704:Dementia / Q000150:complications / Q000175:diagnosis; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D000067562:Late Onset Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales