Anxiety, Cognitive Impairment, Depression
Conditions
Keywords
Depression, Anxiety, Cognitive Impairment, Emergency medicine, prehospital care
Brief summary
Many older adults have undetected health problems and lack basic prevention measures. Failure to identify and treat these conditions can lead to unnecessary morbidity and mortality and a decreased quality of life. Traditional screening and intervention programs, usually based in primary care providers' offices, have been insufficient, particularly in medically underserved populations. Alternate sites for screening and intervention have begun to receive attention and may hold promise. The emergency department (ED) is the entry point for access to medical and social services for many patients and has the potential to serve as a site to identify older adults with unmet needs. However, we do not know the prevalence of depression and cognitive impairment and how they differ by mode of arrival of the patient to the ED. Second, a question remains as to the validity of screening patients during an acute illness. Upon completion, this study will describe the epidemiology of the population of older adults presenting to the ED.
Detailed description
Many older adults have undetected health problems and lack basic prevention measures. Failure to identify and treat these conditions can lead to unnecessary morbidity and mortality and a decreased quality of life. Traditional screening and intervention programs, usually based in primary care providers' offices, have been insufficient, particularly in medically underserved populations. Alternate sites for screening and intervention have begun to receive attention and may hold promise. The emergency department (ED) is the entry point for access to medical and social services for many patients and has the potential to serve as a site to identify older adults with unmet needs. However, we do not know the prevalence of depression and cognitive impairment and how they differ by mode of arrival of the patient to the ED. Second, a question remains as to the validity of screening patients during an acute illness. This study aims to: 1. Compare the prevalence of depression and cognitive impairment among patients who arrive at the ED by EMS, as compared to those arriving via other means. 2. Evaluate the reliability of screening patients for depression and cognitive impairment during an acute illness and after the illness. 3. To evaluate correlates of depression, anxiety and suicidal ideation. Upon completion, this study will describe the epidemiology of the population of older adults presenting to the ED.
Interventions
None listed
Sponsors
National Institute on Aging (NIA)
University of Rochester
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 60 and older * Arrival at ED
Exclusion criteria
* Institutionalized
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Participants With Depression by Patient Health Questionnaire - 9 | 2 hours | Number of participants with depression as measured by the Patient Health Questionnaire - 9, with a score of greater than or equal to 10. |
| Participants With Cognitive Impairment by Six Item Screener | 2 hours | Number of participants with cogintiive impairment as measured by the Six Item Screener, with greater than 2 questions incorrect |
| Participants With Anxiety by Generalized Anxiety Disorder - 7 | 2 hours | Participants with anxiety as measured by the Generalized Anxiety Disorder - 7, with a score greater than or equal to 10. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Depression and Cognitive Impairment at 2 Weeks | 2 weeks | For the individuals who are able to be contacted in 2 weeks, how many still test positive for depression and cognitive impairment. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Presenting to the ED Patients who present to the ED | 1,206 |
| Total | 1,206 |
Baseline characteristics
| Characteristic | Presenting to the ED |
|---|---|
| Age, Continuous | 71 years |
| Anxiety (>=10 on GAD7) | 119 participants |
| Cognitive Impairment (>2 on SIS) | 106 participants |
| Depression (>=10 on PHQ9) | 177 participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 9 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 1184 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 13 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 178 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 28 Participants |
| Race (NIH/OMB) White | 1000 Participants |
| Region of Enrollment United States | 1206 participants |
| Sex: Female, Male Female | 634 Participants |
| Sex: Female, Male Male | 572 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 1,206 |
| serious Total, serious adverse events | 0 / 1,206 |
Outcome results
Primary
Participants With Anxiety by Generalized Anxiety Disorder - 7
Participants with anxiety as measured by the Generalized Anxiety Disorder - 7, with a score greater than or equal to 10.
Time frame: 2 hours
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Presenting to the ED | Participants With Anxiety by Generalized Anxiety Disorder - 7 | 119 participants |
Primary
Participants With Cognitive Impairment by Six Item Screener
Number of participants with cogintiive impairment as measured by the Six Item Screener, with greater than 2 questions incorrect
Time frame: 2 hours
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Presenting to the ED | Participants With Cognitive Impairment by Six Item Screener | 106 participants |
Primary
Participants With Depression by Patient Health Questionnaire - 9
Number of participants with depression as measured by the Patient Health Questionnaire - 9, with a score of greater than or equal to 10.
Time frame: 2 hours
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Presenting to the ED | Participants With Depression by Patient Health Questionnaire - 9 | 177 participants |
Secondary
Depression and Cognitive Impairment at 2 Weeks
For the individuals who are able to be contacted in 2 weeks, how many still test positive for depression and cognitive impairment.
Time frame: 2 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Presenting to the ED | Depression and Cognitive Impairment at 2 Weeks | 27 participants |
| Cognitively Impaired in the ED | Depression and Cognitive Impairment at 2 Weeks | 5 participants |