Depression in elderly outpatients with disabling chronic obstructive pulmonary disease

Age and Ageing, March, 1998 by Abebw M. Yohannes, Jamal Roomi, Robert C. Baldwin, Martin J. Connolly

Instruments

BASDEC

The BASDEC scale has demonstrated good response when tested against the Geriatric Depression Score (GDS) [14] which is recommended as an assessment scale for elderly people by the British Geriatrics Society and the Royal College of Physicians [15]. It consists of a 19-item deck of cards, to elicit a response of `true', `false' or `I do not know'. Two items are weighted to give two points, with a maximum score of 21. A score of seven or above suggests a `case' of depression, i.e. depressive symptoms of sufficient severity to warrant intervention. BASDEC is user-friendly and can be administered by non-medical staff at the bedside.

6-min walking test

Exercise tolerance was evaluated by a 6-min walking test [12] which was performed in a level, enclosed, warm (22-24 [degrees] C) hospital corridor 29 m long with vinyl flooring. Before the test, subjects sat for 30 min after performing the respiratory function tests. They were transported to the start of the course by wheelchair. They were asked to walk as far as possible in 6 min at their own pace using any walking aid they usually used. The researcher acted as a time-keeper and followed the patient. No encouragement was given during the test. The 6-min walk test is reproducible and responsive in COPD subjects in this age group [12].

CRQ

The CRQ disease-specific quality of life questionnaire is valid, responsive and reproducible in young COPD subjects [16, 17]. It comprises 20 items and measures four domains: dyspnoea (five items), fatigue (seven items), emotion (four items) and mastery (the level to which a subject feels control over the disease; four items). The domains, which are scored separately, result in a total score of between 20 and 140. Low scores signify reduced quality of life and high scores correspond to good quality of life. Subjects rate their responses using a Likert 7-point category scale: for example, 1 = `extremely short of breath', 7 = `not at all short of breath'.

NEADL

The NEADL consists of 21 activities of daily living, self-report questions, which are divided into four categories with subsections of mobility (six activities), kitchen (five activities), domestic (four activities) and leisure (six activities). It has been used as a postal questionnaire to monitor the progress of improvement or deterioration in stroke patients who live at home [10].

Statistical analysis

Analysis were performed using EcStatic program (SomeWare in Vermont, VT, USA). Comparison between means was by Student's t-test. The [X.sup.2] test was used to examine differences in prevalence of depressive symptoms between groups. To identify the variables most predictive of depressive symptoms, multiple regression analysis was performed using BASDEC as the dependent variable in COPD subjects. Significance was defined at the 5% level.

Results

Table 1 shows demographic data, spirometry, walk test, activities of daily living and quality of life.

Table 1. Characteristics of the 96 subjects with chronic obstructive pulmonary disease (COPD), 55 normal controls (NC) and 53 disabled controls (DC)