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Depression Predicts Functional Outcome in Geriatric Inpatient Rehabilitation

  • Author Footnotes
    ∗ Shahab and Nicolici contributed equally to this work.
    Saba Shahab
    Footnotes
    ∗ Shahab and Nicolici contributed equally to this work.
    Affiliations
    Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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  • Author Footnotes
    ∗ Shahab and Nicolici contributed equally to this work.
    Diana-Felicia Nicolici
    Footnotes
    ∗ Shahab and Nicolici contributed equally to this work.
    Affiliations
    Division of Geriatric Psychiatry, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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  • Alva Tang
    Affiliations
    Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
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  • Paul Katz
    Affiliations
    Department of Geriatrics, College of Medicine, Florida State University, Tallahassee, FL, United States
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  • Linda Mah
    Correspondence
    Corresponding author Linda Mah, MD, MHS, FRCPC, Rotman Research Institute, Baycrest Division of Geriatric Psychiatry, University of Toronto Faculty of Medicine, BHC 738, 3560 Bathurst St., Toronto, ON M6A 2E1, Canada.
    Affiliations
    Division of Geriatric Psychiatry, Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Rotman Research Institute, Baycrest, Toronto, ON, Canada

    Baycrest Health Sciences Centre, Toronto, ON, Canada
    Search for articles by this author
  • Author Footnotes
    ∗ Shahab and Nicolici contributed equally to this work.
Published:August 13, 2016DOI:https://doi.org/10.1016/j.apmr.2016.07.014

      Abstract

      Objective

      To evaluate the effect of depression on functional recovery in geriatric patients who have completed an inpatient rehabilitation program.

      Design

      Prospective cohort study.

      Setting

      Inpatient rehabilitation unit of a university-affiliated geriatric hospital.

      Participants

      Convenience sample of patients (N=65; mean age, 81.6y; 25 men) admitted to rehabilitation over a 10-month period. Patients >60 years of age who were proficient in English and capable of providing informed consent were eligible to participate in the study.

      Interventions

      Depression was assessed using both the Geriatric Depression Scale-short form (GDS-15) and the Patient Health Questionnaire (9-item screen for depression) (PHQ-9). Measures of well-established predictors of rehabilitation outcome, which may interact with depression, were also obtained, and multiple regression linear modeling was used to evaluate the relation between depression and functional outcome over and above the contribution of these other factors.

      Main Outcome Measure

      FIM (Functional Independence Measure) at discharge from the rehabilitation program.

      Results

      Depression, as assessed by the GDS-15, but not the PHQ-9, was predictive of functional outcome (standardized beta=−.151, P=.030) after controlling for other significant predictors, which included baseline disability, pain, cognition, and educational level. Participation in recreational, but not physio- or occupational, therapy additionally contributed to a small amount of variance in the functional outcome.

      Conclusions

      Our findings suggest that self-report of depression is an independent predictor of functional outcome in high-tolerance, short-duration geriatric rehabilitation. Routine assessment of depressive symptoms in older adults using an instrument (eg, GDS-15) may help identify those at risk for poorer outcomes in rehabilitation.

      Keywords

      List of abbreviations:

      GDS-15 (Geriatric Depression Scale-short form), MoCA (Montreal Cognitive Assessment), OT (occupational therapy), PHQ-9 (Patient Health Questionnaire (9-item screen for depression)), PT (physiotherapy), RT (recreational therapy)
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