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Major depression and refusal of life-sustaining medical treatment in the elderly
S C Hooper1, K J Vaughan, C C Tennant
1Department of Mental Health, Hornsby Ku-Ring-Gai Hospital, Sydney, NSW.
Objective:
To examine the effect of improvement or recovery from major depression in elderly patients on their desire for life-sustaining treatments.
Design:
Prospective case survey.
Setting:
Psychogeriatric Service of Hornsby Ku-ring-gai Hospital & Community Health Services and Ryde Hospital & Community Health Services (a community-based service serving an urban population with over 29,000 elderly people).
Subjects:
All patients referred with major depression (diagnosed by DSM-IV criteria) and no significant cognitive impairment between October 1994 and January 1995.
Outcome Measures:
Number of life-sustaining treatments desired before and after treatment of depression in two hypothetical acute life-threatening illnesses (one with a good and the other with an uncertain prognosis), and intensity of depression on the Geriatric Depression Scale (GDS).
Results:
22 subjects completed both stages of the study. Initial depression was severe in five, moderate in 16 and mild in one. GDS scores decreased in 18 subjects after treatment. Mean number of life-sustaining treatments desired by these patients increased significantly from 4.0 to 6.1 (out of seven possible treatments) in the "good prognosis" illness and from 6.4 to to 9.6 (out of 14) overall. The increase in the "uncertain prognosis" illness (2.3 to 3.4) was not significant.
Conclusions:
Moderate or severe major depression in the elderly is associated with a high degree of refusal of life-sustaining treatments. Treatment of the depression leads to increased acceptance of these treatments, particularly if prognosis is good.