Under‐detection of depressed mood in older inpatients and related over‐prescription of depression‐associated medications

Background: Aging is associated with increased prevalence of depression and with increased use of medications. The aims of this study were to determine the rate of recognition of depressive symptoms and the prevalence of depressed mood among aged inpatients, as well as to assess the use of medications known to enhance depression in this population. Methods: A cross‐sectional study of cognitively intact patients aged 65 and over, in a general medical ward, was undertaken. Depressed mood was identified using the Geriatric Depression Screening Scale. Data on diagnoses, prescribed medications, psychiatry consultations and medication changes were abstracted from medical charts. Two years following the index hospitalization, data on diagnoses during subsequent admissions were abstracted from computerized records. Results: The study sample comprised 183 elderly patients. 27.3% of them displayed depressed mood. None were diagnosed as suffering from depression, referred to psychiatric consultation, or prescribed antidepressant medication. All patients but one received depression‐enhancing medications. Only in four cases were these medications stopped, without attributing the cessation to awareness of the mood disturbance and the potential association with the stopped medication. During the subsequent two years, a state of depression was recorded in only three additional patients. Conclusion: Under‐recognition of depressed mood leads to inappropriate management of aged inpatients. Initiation or continuation of depression‐associated medications, resulting from under‐recognition of depression, may contribute to the prevalence and augment the severity of this disorder.