Despite the methodologic limitations of the studies and this meta-analysis, bereavement, sleep disturbance, disability, prior depression, and female gender appear to be important risk factors for depression among elderly community subjects.

Delirium is an independent marker for increased mortality among older medical inpatients during the 12 months after hospital admission. It is a particularly important prognostic marker among patients without dementia.

Exposure to ACH medications is independently and specifically associated with a subsequent increase in delirium symptom severity in elderly medical inpatients with diagnosed delirium.

Research M ajor depression occurs in 10%-30% of older medical inpatients 1-4 and appears to be associated with poor functional status, 5 increased use of hospital services 6,7 and reduced survival, 6,8-10 independent of the severity of physical illness. Despite the apparent benefits of treatment, 11 up to 90% of cases of depression are not detected by attending physicians during the course of usual hospital care, 3,12 and few patients receive optimal treatment in hospital or after discharge.12,13 Because a strategy of systematic detection and treatment has been shown to benefit elderly people with depression living in the community, 14-18we conducted a randomized clinical trial to evaluate whether systematic detection and multidisciplinary treatment of depression could be effective in reducing symptoms of depression and improving mental and physical health status in elderly medical inpatients. Our secondary objective was to determine the effect of the intervention on basic and instrumental activities of daily living, cognitive status, side-effects profile, mortality and health services utilization (length of hospital stay, and number of readmissions and emergency department visits). MethodsWe conducted the study at St. Mary's Hospital Center, a university-affiliated, primary acute care hospital in Montréal. The trial was approved by the hospital's Research Ethics Committee.All patients aged 65 years and over admitted from the emergency department to medical services between Oct. 19, 1999, and Nov. 1, 2002, were screened for eligibility by the research nurse. We excluded patients who (a) were admitted to the intensive care unit or cardiac monitoring unit for more than 48 hours; (b) had an imminently terminal illness; (c) did not speak or understand English or French; and (4) did not live on the Island of Montreal. Eligible patients who scored 4 or less on the Short Portable Mental Status Questionnaire (indicating at most mild cognitive impairment) were assessed using the Diagnostic Interview Schedule.19 Patients who were found to have major depression (as defined by DSM-IV criteria 20) and who consented to participate were enrolled. Enrolled patients were allocated to the intervention or usual-care groups with the use of block-size randomization and an allocation ratio of 1:1. The block size was varied ran- Systematic detection and multidisciplinary care of depression in older medical inpatients: a randomized trialBackground: Major depression is a frequent and serious disorder in older medical inpatients. Because the condition goes undetected and untreated in most of these patients, we conducted a randomized clinical trial to evaluate the effectiveness of a strategy of systematic detection and multidisciplinary treatment of depression in this population. Methods:Consecutive patients aged 65 years or more admitted to general medical services in a primary care hospital between October 1999 and November 2002 were screened for depression with the Diagnostic Interview Schedule (DIS) within 48 hours after admission. ...

OBJECTIVE: Delirium is frequent in elderly hospitalized patients. Many studies have examined its risk factors, but results have been quite variable. Thus, the goal of this study is to identify through systematic literature review the risk factors associated with the development of delirium in hospitalized geriatric patients. MEASUREMENTS AND MAIN RESULTS:First, MEDLINE / CURRENT CONTENTS databases were screened for relevant articles published from 1966 to December 1995, and from bibliographies of identified articles additional reports were selected. Second, the reports were screened by two different investigators and retained only if meeting the five following criteria: (1) original research in French or English; (2) prospective study; (3) patients over age 50; (4) minimum of one risk factor examined; (5) acceptable definition of delirium. Third, the methodology of each study was graded according to specific criteria for risk factor studies. Fourth, risk factors were identified and tabulated, unadjusted odds ratios (ORs) were computed, and where appropriate a combined OR with the Mantel-Haenszel estimator was calculated. Twenty-seven articles were retained meeting all of the above criteria. Among these studies, 11 were done on medical patients, 9 on surgical patients, 2 on medical and surgical patients, and 5 on psychiatric patients. In total 1,365 subjects with delirium were studied. Sixty-one different risk factors were examined, the five most common being dementia, medication, medical illness, age, and male gender. Mantel-Haenszel estimator was calculated for 10 risk factors, the most strongly associated being dementia (OR 5.2; 95% confidence interval [CI] 4.2, 6.3), medical illness (OR 3.8; 95% CI 2.2, 6.4), alcohol abuse (OR 3.3; 95% CI 1.9, 5.5), and depression (OR 1.9; 95% CI 1.3, 2.6). Methodologic weaknesses were present in many studies.

SSD in elderly medical inpatients appears to be a clinically important syndrome that falls on a continuum between no symptoms and DSM-defined delirium.

The accuracy of depression recognition by non-psychiatrist physicians is low. Further research should focus on developing standardized methods of documenting non-psychiatric physicians' recognition of depression.

Among patients with and without dementia, symptoms of delirium persist up to 12 months after diagnosis. Quicker in-hospital recovery is associated with better outcomes.