Predictors of a new depression diagnosis among older adults admitted to complex continuing care: implications for the depression rating scale (DRS).

BACKGROUND depression is a major disabling condition among older adults, where it may be under-diagnosed for a number of reasons, including a different presentation for younger people with depression. The Minimum Data Set 2.0 (MDS 2.0) assessment system provides a measurement scale for depression, the Depression Rating Scale (DRS), in addition to other items that may represent depressive phenomenology. OBJECTIVE the ability of the DRS to predict the presence of new depression diagnoses at follow-up, among hospitalised older adults admitted without depression, is examined. METHODS the study sample consists of all persons aged 65 years or more admitted between 1996 and 2003 to a complex continuing care (CCC) bed in Ontario without a recorded depression diagnosis. The sample was restricted to those who remained in hospital for about 3 months (n = 7,818) in order to obtain follow-up assessment information. Logistic regression was used to explore the relationship between admission characteristics (i.e. DRS scale items, other MDS 2.0 items related to DSM-IV criteria for depression) and receipt of a depression diagnosis on the follow-up assessment. RESULTS a new depression diagnosis at follow-up was present in 7.5% of the individuals. The multivariate model predicting depression diagnosis included only the DRS scale, sadness over past roles, and withdrawal from activities. CONCLUSIONS the DRS score at admission was predictive of receiving a depression diagnosis on a follow-up assessment among older adults admitted to the CCC. Further, the predictive ability of the DRS is only modestly improved by the addition of other items related to DSM-IV criteria.