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Screening for depression in older adults on an acute medical ward: the validity of NICE guidance in using two questions
- Authors:
- ESIWE Collins, et al
- Journal article citation:
- Age and Ageing, 44(5), 2015, pp.771-775.
- Publisher:
- Oxford University Press
Background: Depression is common in older people in general hospital settings and associated with poor outcomes. This study aimed to evaluate the validity of two screening questions recommended by the UK National Institute for Health and Clinical Excellence (NICE). Methods: One hundred and eighteen patients aged over 65 years, admitted to acute medical wards at a teaching hospital, were interviewed in a standardised manner using relevant sections of the Present State Examination—Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to ICD-10 criteria. Subsequently, participants completed the two depression screening questions and the 15-item version of the Geriatric Depression Scale (GDS-15). Results: A threshold of one or more positive responses to the two NICE depression screening questions gave a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 49% and negative predictive value (NPV) of 100%. The GDS-15 optimal cut-off was 6/7 with a sensitivity of 80%, specificity of 86%, PPV of 62% and NPV of 94%. A two-stage screening process utilising the NICE two questions followed by the GDS-15 with these cut-offs gave a sensitivity of 80%, specificity of 91%, PPV of 71% and NPV of 94%. Conclusion: The two depression questions perform well as an initial screening process for non-cognitively impaired older people in the acute medical setting. A positive response to either question would indicate that further assessment is required by a clinician competent in diagnosing depression in this population, or the possible use of a more detailed instrument such as the GDS-15 to reduce the number of false-positive cases. (Publisher abstract)
Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings
- Authors:
- SCOTT Vicky, et al
- Journal article citation:
- Age and Ageing, 36(2), 2007, pp.130-139.
- Publisher:
- Oxford University Press
This review focuses on studies that use prospective validation in examining the predictive value of fall assessment tools applied to people over 65. Thirty four studies reporting the testing of thirty eight tools are included, and cover community settings (14 studies, 23 tools); acute settings (12 studies, 8 tools); long term care (6 studies, 10 tools); and home support (4 studies, 4 tools). Eleven of the tools are multifactorial assessment tools covering a wide range of fall risk factors, and 27 are functional mobility assessment tools involving measures of physical activity related to gait, strength or balance. A number of tools were found to have moderate to good validity and reliability but few have been tested more than once, or in more than one setting. Thus no single tool can be recommended for implementation in all settings or with all sub-populations.
A systematic review of the utility of self-report alcohol screening instruments in the elderly
- Authors:
- O'CONNELL Henry, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(11), November 2004, pp.1074-1086.
- Publisher:
- Wiley
Alcohol use disorders (AUDs) can cause significant physical, psychological and social problems in the elderly population, and therefore effective screening instruments may be beneficial both at an individual and population level to direct public health initiatives. This review identifies instruments which have been used to screen elderly populations, describes the instruments and assesses their effectiveness in this population. The CAGE was the most widely studied instrument, followed by MAST or its variations, AUDIT or its variations, and others. Sensitivity and specificity of the instruments varied widely depending on the prevalence of AUDs and clinical characteristics of the populations. No study focused on elderly people with cognitive impairment. Ease of use, patient acceptability, specificity, sensitivity, prevalence of AUDs and clinical characteristics of the population must all be taken into account when selecting alcohol screening instruments for this population.
Single screening questions for cognitive impairment in older people: a systematic review
- Authors:
- HENDRY Kirsty, et al
- Journal article citation:
- Age and Ageing, 44(2), 2015, pp.322-326.
- Publisher:
- Oxford University Press
Background and objective: Single-item screening questions may be a practical first step in screening for cognitive problems in older people. A form of single-item cognitive assessment is proposed in the NHS England and Wales dementia strategy. The authors aim to provide a review and synthesis of the evidence regarding the performance of single-item tests for detection of cognitive impairment. Design: This review used Cochrane diagnostic test accuracy procedures. Two independent researchers searched for relevant papers across multiple, cross-disciplinary electronic databases using previously validated search strings. The index test was any single screening question for cognitive impairment, including factor analysis of multi-item tools. Reference standards included clinical diagnosis and multi-domain cognitive assessments. Results: From 884 titles, 11 studies were identified as eligible for inclusion. Four studies were graded low risk of bias and recruited a representative patient sample. Five papers described a single screening question for cognitive impairment with each using a different question. Sensitivity ranged from 26 to 96% and specificity from 45 to 100%. Six papers described the component analysis of multiple item tools with broadly worded single questions (‘decline in memory function’, ‘changes in ability to think and reason’ or ‘learning new things’) performing best. Conclusion: Informant-based, single-item screening questions show promise for detecting cognitive impairment. However, there was substantial heterogeneity in format and application of single-item screens, and several studies were of poor methodological quality. Currently, there is insufficient evidence to support routine screening using a single-item approach. (Edited publisher abstract)
Effect of community-based intervention using depression screening on elderly suicide risk: a meta-analysis of the evidence from Japan
- Authors:
- OYAMA Hirofumi, et al
- Journal article citation:
- Community Mental Health Journal, 44(5), October 2008, pp.311-320.
- Publisher:
- Springer
A systematic review was undertaken to quantify the effect of community-based depression screening (CDS) with follow-up on the completed suicide risk for residents aged 65 and over. Five quasi-experimental studies in Japanese regions with high suicide rates were included in the meta-analysis. Combined incidence rate ratios (95% confidence intervals) by the Mantel–Haenszel method and by the DerSimonian–Laird method in two homogenous studies implementing the follow-up conducted by psychiatrists were 0.30 (0.13–0.68) and 0.33 (0.14–0.80) in men, and 0.33 (0.19–0.58) and 0.33 (0.19–0.60) in women, respectively; and those in three homogenous studies implementing the follow-up conducted by general practitioners were 0.73 (0.45–1.18) and 0.74 (0.45–1.23) in men, and 0.36 (0.21–0.60) and 0.39 (0.22–0.66) in women, respectively. There are very few studies included, however, to demonstrate an association between CDS and the reduced risk, suggesting gender difference in the effectiveness.
The criterion validity of the Geriatric Depression Scale: a systematic review
- Authors:
- WANCATA J., et al
- Journal article citation:
- Acta Psychiatrica Scandinavica, 114(6), December 2006, pp.398-410.
- Publisher:
- Blackwell Publishing
Among many of the 42 studies included in this review, important aspects of research design such as sampling methods and blinding of researchers were not reported. This limits the usefulness of the pooled findings, despite the relatively large number of studies available for review. Sensitivity and specificity values were similar for the 30-item GDS and the shorter GDS-15 designed for use with people who have greater cognitive or concentration difficulties. In comparison with the Yale-1-question screening instrument, the GDS performed significantly better, while its criterion validity was on a par with that of the Center for Epidemiological Studies Depression scale (CES-D). The firmest conclusion that can be drawn is that the GDS should not be used with people who have marked cognitive impairment.
Primary care-based interventions addressing social isolation and loneliness in older people: a scoping review
- Authors:
- GALVEZ-HERNANDEZ Pablo, PAZ Luis Gonzalez-de, MUNTANER Carles
- Journal article citation:
- BMJ Open, 12(2), 2022, Online only
- Publisher:
- BMJ Publishing Group
Objectives: Primary care is well positioned to identify and address loneliness and social isolation in older adults, given its gatekeeper function in many healthcare systems. This study aimed to identify and characterise loneliness and social isolation interventions and detect factors influencing implementation in primary care. Design: Scoping review using the five-step Arksey and O’Malley Framework. Data sources: MEDLINE, CINAHL, EMBASE, COCHRANE databases and grey literature were searched from inception to June 2021. Eligibility criteria: Empirical studies in English and Spanish focusing on interventions addressing social isolation and loneliness in older adults involving primary care services or professionals. Data extraction and synthesis: The researchers extracted data on loneliness and social isolation identification strategies and the professionals involved, networks and characteristics of the interventions and barriers to and facilitators of implementation. This study conducted a thematic content analysis to integrate the information extracted. Results:32 documents were included in the review. Only seven articles (22%) reported primary care professionals screening of older adults’ loneliness or social isolation, mainly through questionnaires. Several interventions showed networks between primary care, health and non-healthcare sectors, with a dominance of referral pathways (n=17). Two-thirds of reports did not provide clear theoretical frameworks, and one-third described lengths under 6 months. Workload, lack of interest and ageing-related barriers affected implementation outcomes. In contrast, well-defined pathways, collaborative designs, long-lasting and accessible interventions acted as facilitators. Conclusions: There is an apparent lack of consistency in strategies to identify lonely and socially isolated older adults. This might lead to conflicts between intervention content and participant needs. This study also identified a predominance of schemes linking primary care and non-healthcare sectors. However, although professionals and participants reported the need for long-lasting interventions to create meaningful social networks, durable interventions were scarce. Sustainability should be a core outcome when implementing loneliness and social isolation interventions in primary care. (Edited publisher abstract)
Screening for depression in older adults with cognitive impairment in the homecare setting: a systematic review
- Authors:
- NICULESCU Iulia, ARORA Twinkle, IABONI Andrea
- Journal article citation:
- Aging and Mental Health, 25(9), 2021, pp.1585-1594.
- Publisher:
- Taylor and Francis
Objective: Previous systematic reviews have examined depression screening in older adults with cognitive impairment (CI) in outpatient and inpatient clinics, nursing homes, and residential care. Despite an increasing number of older adults with CI receiving care in their homes, less is known about best depression screening practices in homecare. The objective of this review is to identify evidence-based practices for depression screening for individuals with CI receiving homecare by assessing tool performance and establishing the current evidence for screening practices in this setting. Methods: This review is registered under PROSPERO (ID: CRD42018110243). A systematic search was conducted using MEDLINE, EMBASE, Health and Psychosocial Abstracts, PsycINFO and CINAHL. The following criteria were used: assessment of depression at home in older adults (>55 years) with CI, where performance outcomes of the depression screening tool were reported. Results: Of 5,453 studies, only three met eligibility criteria. These studies evaluated the Patient Health Questionnaire (n = 236), the Geriatric Depression Scale (n = 79) and the Mental Health Index (n = 1,444) in older adults at home with and without CI. Psychometric evaluation demonstrated moderate performance in the subsamples of people with CI. Conclusion: At present, there is insufficient evidence to support best practices in screening for depression in people with CI in homecare. (Edited publisher abstract)
The diagnostic accuracy of brief versions of the Geriatric Depression Scale: a systematic review and meta-analysis
- Authors:
- POCKLINGTON Clarie, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(8), 2016, pp.837-857.
- Publisher:
- Wiley
Background: Depression in older adults is often under recognised despite it being the most common mental health illness in this age group. An increasing older adult population highlights the need for improved diagnostic rates. Brief versions (15 items or less) of the Geriatric Depression Scale (GDS), which are suitable for busy clinical practice, could improve detection rates. Objective: This study aimed to establish the diagnostic accuracy of brief versions of the GDS. Methods: Twelve electronic databases of published and unpublished literature were searched. Study selection was in accordance with predefined inclusion and exclusion criteria. A recognised gold-standard diagnostic instrument was used as a comparator against data pertaining to the use of a brief version of the GDS in an older adult population. The QUADAS-II was utilised for quality assessment. Narrative analysis and, where possible, meta-analysis were performed. Results: Thirty-two studies were identified that provided diagnostic data regarding seven brief versions of the GDS (1, 4, 5, 7 8, 10 and 15-item versions). Pooled sensitivity was 0.89 (95% confidence interval (CI) 0.80–0.94), and specificity was 0.77 (95% CI 0.65–0.86) for the GDS-15 at the recommended cut-off score of 5. Meta-analysis of other brief versions was not possible because of an insufficient number of studies with standardised items. Conclusions: Results suggest the possibility of selective reporting of cut-off scores, and therefore, findings should be approached cautiously. Studies should report all cut-off scores, and all brief GDS versions should be compiled of standardised items. (Edited publisher abstract)
Screening for dementia in general hospital inpatients: a systematic review and meta-analysis of available instruments
- Authors:
- JACKSON Thomas A., NAQVI Syeda Huma, SHEEHAN Bart
- Journal article citation:
- Age and Ageing, 42(6), 2013, pp.689-695.
- Publisher:
- Oxford University Press
Objective: Dementia is common and often undiagnosed. Improving rates of diagnosis has become a key part of current dementia guidelines. Older people admitted to hospital are a potential target population for screening for dementia. The objective was to report whether instruments advocated in screening for dementia had been validated in hospital inpatients and to make recommendations on evidence-based screening for dementia in this population. Design: A systematic review was performed by an initial electronic database search using three key search criteria. Studies were then selected in a systematic fashion using specific predetermined criteria. Pooled meta-analysis was performed. Inclusion criteria were studies where the study group were inpatients in general hospitals, including a clearly defined group of older people (60 or older), they used a recognised screening instrument compared with a reference standard, and included at least 10 cases of dementia. Demographic data as well as sensitivity and specificity were recorded from the selected studies. Results: In total nine studies describing validation of six discreet instruments satisfied all our criteria and we were able to perform meta-analysis with one instrument, the Abbreviated Mental Test Score (AMTS). With a cut-off of <7, pooled analysis of the AMTS showed a sensitivity of 81%, a specificity of 84% and an area under the curve (AUC) of 0.88. Conclusion: A small number of instruments have been validated for screening for dementia in general hospital. Understanding strengths and weaknesses of currently available instruments allows informed decisions about screening in this setting. (Publisher abstract)