Outcomes following acute hospital care for stroke or hip fracture: how useful is an assessment of anxiety or depression for older people?

Abstract

Objective: To investigate the association between severe life events and mental health outcomes following acute hospital care for older patients with acute stroke or fractured neck of femur.

Design: Prospective longitudinal survey of stroke and hip fracture patients admitted to hospital from admission to 6-month follow-up.

Setting: Six district general hospitals, three in the North and three in the South of England.

Participants: 642 patients admitted to hospital with an acute stroke (268) or hip fracture (374) resident in a private household at 6 months follow-up.

Main outcome measures: Hospital Anxiety and Depression Scale, cognitive items of the Survey Psychiatric Assessment Scale, Clackmannan Disability Scale, Severe Life Events Inventory, Wenger Social Support Network Typology.

Results: 47% of 6-month survivors of stroke or hip fracture resident in private households had a possible psychiatric illness: dementia (13%), anxiety or depression (41%). 57% had severe or very severe disability and 48% experienced additional life events (17% two or more) after hospital admission. Severe disability was strongly associated with a higher prevalence of anxiety (p < 0.0005) or depression (p < 0.0001). Social contact was associated with a lower prevalence of anxiety (p < 0.01) or depression (p < 0.0001) and social support network type was strongly associated with depression (p < 0.001) but not anxiety (p = 0.096). Number of severe life events was associated with anxiety (p < 0.001) but not depression (p = 0.058).

Conclusion: Disability is probably a more robust outcome measure than assessments of mental health for older people in uncontrolled studies.