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 65years 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 3months (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.