FEATURE
Occurrence of Depressive Symptoms Among Older Adults after a Stroke in the Nursing Home Facility ska-Gieracha1, PhD, Joanna Joanna Kowalska1, PhD, Ewa Bojko2, Msc, Joanna Szczepan 3 1,2 _ Rymaszewska , MD, PhD & Krystyna Rozek-Piechura , PhD 1 Department of Physiotherapy, University School of Physical Education, Wroclaw, Poland 2 Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland 3 Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
Keywords
Abstract
Depressive symptoms; stroke; nursing home. Correspondence Joanna Kowalska, Department of Physiotherapy, University School of Physical Education, al. J.Paderewskiego 35, Wroclaw 51-612, Poland. E-mail: [email protected] Accepted January 19, 2015. doi: 10.1002/rnj.203
Purpose: The aim of the study was to analyze the prevalence of depressive symptoms among older adults after stroke in a nursing home (NH). Design: The study was conducted in a NH and included 50 patients after stroke with a mean age of 74.62 (8.2). Method: The Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Acceptance Illness Scale (AIS) and Barthel Index (BI) were used. Findings: Mean GDS was 7.60 (2.75); 74% of patients had depressive symptoms. The study showed a significant relationship between GDS and marital status (p = .043). A negative correlations between GDS and MMSE (p = .029), GDS and BI (p = .049), and GDS and AIS (p < .0001) were found. Conclusion: The occurrence of depressive symptoms in older adults after stroke depends on their mental and functional status, degree of acceptance of illness, and marital status. Clinical Relevance: Early detection of depressive symptoms in stroke patients allows rehabilitation nurses to optimize the therapeutic effects.
Introduction One of the most common brain injuries is a stroke (Rykała & Kwolek, 2009). The number of people worldwide who have suffered a stroke is over 55 million. In the United States, the number of new and repeat strokes is 750,000 a year (Spetruk & Opala, 2005). In Poland, 60,000 people a year suffer a stroke, among which the ratio is 177 men and 125 women per 100,000 people. These figures do not diverge from the average number of cases in Europe. Unfortunately, the mortality rates in Poland are one of the highest. Among 100,000 patients, as many as 106 men and 79 women do not survive the stroke (Brola, Fudala, Przybylski, & Czernicki, 2008). In 72% of people, after a stroke, there occurs at least one late complication within a
112
year, while in 42% there are a greater number of complications. The most common complication after a stroke is depression (38%). The remaining complications include falls and their consequences (35%), urinary tract infections (24%), pain and swelling in paretic limbs (15%), and cognitive disorders (12%; Brola et al., 2008). Poststroke depression may have both an organic background (damage to the brain structures responsible for experiencing emotions) as well as psychosocial (disability and loss of independence, pain, inactivity, social isolation, changing social situation, fear of the future, etc.; De Ryck et al., 2014). Most often several reasons overlap, making treatment and therapy difficult. Depressive disorders that occur after a stroke last an average of 7–9 months, sometimes subsiding on their own. Unfortunately, in about
© 2015 Association of Rehabilitation Nurses Rehabilitation Nursing 2016, 41, 112–119
J. Kowalska et al.
30% of patients they last 2–3 years or even up to 7 years (Zi ołkowska-Kochan & Pracka, 2003). About 40% to nearly 80% of patients require antidepressant treatment (Paradiso, Tranel, Kosier, & Robinson, 2008). Detecting depression in older adults is difficult, since they and their families pay more attention to the somatic ailments than the psychological ones. They treat depressive symptoms as a natural sign of aging, and usually do not seek specialist help in this regard. Therefore, the detection of depression in basic health care facilities among the elderly is low at 41% (Dr oz_ d_z et al., 2007). Depressive disorders may either precede a somatic illness or can be the consequence of it, which further complicates the detection. Left untreated, depression worsens the course of somatic diseases, hinders the process of physiotherapy, and in extreme cases, can be a cause of suicide (Dr oz_ d_z et al., 2007). The problem of depressive disorders particularly concerns residents of long-term care facilities such as nursing homes (NH). In such cases, the patient’s mental condition further deteriorates through problems with adapting to new conditions and isolation from loved ones. At the same time, many authors emphasize that the presence of depression has a negative impact on the functional status —it limits independence of patients, reduces their quality of life, and delays recovery (Dafer, Rao, Shareef, & Sharma, 2008; De Ryck et al., 2014), as well as increases the risk of death (Eng & Reime, 2014; Robinson & Spalletta, 2010). Depressive symptoms also significantly complicate the process of rehabilitation (De Ryck et al., 2014; Saxena, Ng, Koh, Yong, & Fong, 2007). The symptoms of depression, which hinder the course of physiotherapy, include pessimism, lack of motivation, feelings of energy shortage, increased sensitivity to pain, and somatic complaints, as well as emotional lability and irritability. Unfortunately, these symptoms often evoke negative emotions on the part of caregivers and healthcare professionals, including physiotherapists, thereby worsening relations and hampering cooperation (Szczepa nska, Kowalska, Gre n, & Wozniewski, 2006). This definitely lengthens the patient’s stay at the long-term care unit (Kowalska, Szczepa nskaGieracha, & Piaz tek, 2010a). Due to a small amount of research performed concerning the groups of residents of NH in Poland, the objective of this study focused on analyzing the prevalence of depressive symptoms among older adults who had a stroke and who were undergoing physiotherapy at the NH. Additionally, attempts were made to answer the question: What is the association between sociodemographic (age, gender, © 2015 Association of Rehabilitation Nurses Rehabilitation Nursing 2016, 41, 112–119
Occurrence of Depressive Symptoms Among Older Adults
marital status) and clinical factors (the type and location of stroke, the number of comorbid diseases, the functional and cognitive status, the degree of acceptance of disease) and the prevalence of depressive symptoms in stroke patients? Materials and Methods Study Methodology The study group consisted of consecutively admitted patients (newly admitted) to NH who met the following inclusion criteria: patient’s consent to participate in the study, age over 60, first stroke, and stroke being the main reason for rehabilitation at the center. Criteria for exclusion from the study included: aphasia, severe loss of vision or hearing preventing the patient from performing tests, presence of mental retardation and other serious mental disorders, and patient’s refusal at each stage of research. We examined 71 patients in the period from April to September 2010. Patients were graded as to their cognitive functioning using the Mini Mental State Examination (MMSE) scale. It is a widely used screening test that assesses orientation in time and place, memory, attention and counting, language functions, and visual-spatial orientation (Folstein, Folstein, & McHugh, 1975). The sensitivity of the MMSE, according to many authors, is 87%–90% and the specificity 80%–82%. The Polish version of the MMSE scale developed by Sta nczak is characterized by high accuracy and reliability (Cronbach’s coefficient a at 0.88 for a clinical trial and 0.82 for healthy people; Sta nczak, 2010). The obtained results have been calculated taking into consideration the age and education according to the formula by Mungas, Marshall, Weldon, and Reed (1996), verified with Polish circumstances by J ozwiak, Wisniewska, and Wieczorkowska-Tobis (2000). Only patients who achieved a score of MMSE >15 were included in the subsequent studies (McGivney, Mulvihill & Taylor, 1994; Snowdon & Lane, 1999). In these patients, the following assessments were made:
• assessment • •
of mood using the Geriatric Depression Scale (GDS) functional status using the Barthel Index (BI) degree of acceptance of the disease using the Acceptance of Illness Scale (AIS).
The GDS assesses the subject’s mood, his or her subjective satisfaction with the quality of life, mood and
113
Occurrence of Depressive Symptoms Among Older Adults
feelings of happiness, or lack thereof. In the 15-question version, a score between 0 and 5 points indicates no depression, 6 points and above indicates increased severity of depression. GDS is considered a satisfactory screening tool of poststroke depression. Cronbach’s reliability coefficient is a = 0.94, an identical value of the coefficient (r = .94) was achieved in the measurement of split-half reliability of this tool. The sensitivity and specificity of the GDS is respectively 84% and 95% (Albi nski, Kleszczewska-Albi nska, & Bedy nska, 2011; Yesavage et al., 1983). Assuming that MMSE >15, the sensitivity scale is 84%, and specificity 91% (McGivney et al., 1994; Snowdon & Lane, 1999). The GDS scale has been translated into Polish and its psychometric parameters evaluated by Bidzan, Łapin, Sołtys, & Turczy nski (2002). The BI is the most common method of assessing the functional status of elderly and stroke patients (Mahoney & Barthel, 1965). Psychometric properties of the BI scale are very good. The BI shows acceptable distribution, high internal consistency (a coefficient > 0.84) (Hsueh, Lin, Jeng, & Hsieh, 2002). It has been used in Poland for over 40 years. The scale is completed by medical personnel on the basis of patient observations, assessing the capacity to independently carry out basic activities of daily living. The AIS scale is used to assess the degree of acceptance of the disease. The AIS constructed by Felton et al. (1984), has been adapted to Polish circumstances by Juczy nski (2001). Psychometric properties of the AIS are satisfactory. Cronbach’s a reliability index used in studies of the Polish version is 0.85 and is close to the reliability of the original version, for which Cronbach’s a is 0.82. The respondent can score from 8 to 40 points. A low score indicates a lack of acceptance of the disease and a strong sense of psychological discomfort, while a high score indicates adaptation to illness and discomfort associated with it (Juczy nski, 2001). The above studies were carried out at the beginning of the second week after patient’s admission to NH. Finally, the research group consisted of 50 people after brain stroke, including 39 women and 11 men aged 61– 88 years. Mean age was 74.62 (8.2). The most numerous group was single people and those with primary education or vocational training. The average number of comorbidities per one person was 3.74 (1.7), and the mean time from the onset of illness was 6.4 (7.4) months. Right hemisphere stroke occurred in 36 patients, and left hemisphere stroke in 14 patients. Ischemic stroke
114
J. Kowalska et al.
Table 1 Baseline characteristics of the patients Patients (%) (n = 50)
Baseline Characteristics Age Mean (SD) Range Gender Women Men Education Primary and vocational Secondary Higher Marital status Married Single people (widow(er), unmarried) Place of residence Town Village Family care Total or partial lack of care capacity Full caring capacity Stroke type Hemorrhagic Ischemic Lesion location Right hemispheric stroke Left hemispheric stroke Time since stroke (months) Mean (SD) Number of comorbidities Mean (SD) Range
74.6 (8.2) 61–88 39 (78) 11 (22) 30 (60) 14 (28) 6 (12) 18 (36) 32 (64) 43 (86) 7 (14) 31 (62) 19 (38) 12 (24) 38 (76) 36 (72) 14 (28) 6.4 (7.4) 3.7 (1.7) 1–7
affected 38 patients and hemorrhagic stroke 12 patients. All respondents tested were right-handed. The characteristics of the patients are described in Table 1. Statistical Analysis The characteristics of the study group were made using descriptive statistics such as mean, standard deviation, median, lower and upper quartile, minimum and maximum value, and, in the case of qualitative variables, numbers and percentages. The Shapiro–Wilk test was used to check for normal distribution of the data. Due to the rejection of the hypothesis of a normal distribution a Mann–Whitney test was applied to assess the significance of differences between two groups. To determine the strength of the relationship between the two variables a Spearman’s rank coefficient was used. Statistical tests were © 2015 Association of Rehabilitation Nurses Rehabilitation Nursing 2016, 41, 112–119
J. Kowalska et al.
Occurrence of Depressive Symptoms Among Older Adults
verified at the 0.05 level of significance. Statistica Version 7.0 of Statsoft Poland was used.
Table 3 Characteristics of the study group by gender
Results
Variables
In the study group (n = 50) an assessment of mood (GDS), functional status (BI) and the degree of acceptance of the disease (AIS) were performed. Average functional status of patients (BI) was 39.40 (21.96) and cognitive status (MMSE) 21.60 (3.74), whereas the degree of acceptance of the disease (AIS) was 16.12 (6.86). Depressive symptoms at admission to the unit (GDS> 5) were found in 74% of patients after stroke. Average score of the severity of depressive symptoms (GDS) in the studied group was 7.60 (2.75). Reduced mood was detected in 84% of patients hospitalized with hemorrhagic stroke, and in 93% of patients with left hemisphere stroke. A high percentage of the symptoms of depression were found in both men and women groups (63.6% vs. 74.4%). Further analysis indicated no statistically significant differences between a group of patients with hemorrhagic stroke and a group of patients after ischemic stroke. Furthermore, taking into account the effect of location of the stroke (left or right hemisphere stroke), there were no significant differences between groups. The results are presented in Table 2. Comparing the two groups of men and women it was observed that they did not differ significantly in terms of the time of onset of stroke, the number of existing comorbidities and in terms of intellectual, emotional and functional status. A factor differentiating these two groups was age (p = .005). Women were older than men (Table 3). However, a statistically significant difference had shown in age and the presence of depressive symptoms, under a division of respondents as to marital status (p = .002 and .043). Patients who were single were older
Age Time after stroke (months) Number of comorbidities MMSE GDS BI AIS
Table 2 Occurrence of depressive symptoms in subgroups by gender, type, and localization of stroke
Subgroup
n
GDS Mean (SD)
Women Men Hemorrhagic stroke Ischemic stroke Left hemispheric stroke Right hemispheric stroke
39 11 12 38 14 36
7.74 7.09 8.75 7.24 7.57 7.61
© 2015 Association of Rehabilitation Nurses Rehabilitation Nursing 2016, 41, 112–119
(2.90) (2.16) (2.63) (2.72) (1.69) (3.09)
Women n = 39 Mean (SD)
Men n = 11 Mean (SD)
p-Value
76.30 (7.43) 7.08 (8.04)
68.63 (8.31) 4.07 (4.20)
.0054 .3187
3.87 (1.59)
3.27 (2.00)
.2651
21.67 (3.94) 7.74 (2.90) 38.59 (21.15) 16.51 (6.96)
21.36 (3.04) 7.09 (2.16) 42.27 (25.53) 14.72 (6.60)
.9081 .4590 .6607 .4177
Table 4 Spearman0 s correlation of variables in the study group (n = 50) Pair of Variables GDS & age GDS & time after stroke GDS & number of coexisting diseases GDS & MMSE GDS & BI GDS & AIS AIS & BI
R Spearman
t (N2)
0.0758 0.2495
0.5269 1.7851
0.6006 0.0805
0.2296
1.6344
0.1087
0.3087 0.2782 0.5409 0.3108
2.2489 2.0067 4.4550 2.2655
0.0291 0.0494
Occurrence of Depressive Symptoms Among Older Adults after a Stroke in the Nursing Home Facility ska-Gieracha1, PhD, Joanna Joanna Kowalska1, PhD, Ewa Bojko2, Msc, Joanna Szczepan 3 1,2 _ Rymaszewska , MD, PhD & Krystyna Rozek-Piechura , PhD 1 Department of Physiotherapy, University School of Physical Education, Wroclaw, Poland 2 Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland 3 Division of Consultation Psychiatry and Neuroscience, Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
Keywords
Abstract
Depressive symptoms; stroke; nursing home. Correspondence Joanna Kowalska, Department of Physiotherapy, University School of Physical Education, al. J.Paderewskiego 35, Wroclaw 51-612, Poland. E-mail: [email protected] Accepted January 19, 2015. doi: 10.1002/rnj.203
Purpose: The aim of the study was to analyze the prevalence of depressive symptoms among older adults after stroke in a nursing home (NH). Design: The study was conducted in a NH and included 50 patients after stroke with a mean age of 74.62 (8.2). Method: The Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Acceptance Illness Scale (AIS) and Barthel Index (BI) were used. Findings: Mean GDS was 7.60 (2.75); 74% of patients had depressive symptoms. The study showed a significant relationship between GDS and marital status (p = .043). A negative correlations between GDS and MMSE (p = .029), GDS and BI (p = .049), and GDS and AIS (p < .0001) were found. Conclusion: The occurrence of depressive symptoms in older adults after stroke depends on their mental and functional status, degree of acceptance of illness, and marital status. Clinical Relevance: Early detection of depressive symptoms in stroke patients allows rehabilitation nurses to optimize the therapeutic effects.
Introduction One of the most common brain injuries is a stroke (Rykała & Kwolek, 2009). The number of people worldwide who have suffered a stroke is over 55 million. In the United States, the number of new and repeat strokes is 750,000 a year (Spetruk & Opala, 2005). In Poland, 60,000 people a year suffer a stroke, among which the ratio is 177 men and 125 women per 100,000 people. These figures do not diverge from the average number of cases in Europe. Unfortunately, the mortality rates in Poland are one of the highest. Among 100,000 patients, as many as 106 men and 79 women do not survive the stroke (Brola, Fudala, Przybylski, & Czernicki, 2008). In 72% of people, after a stroke, there occurs at least one late complication within a
112
year, while in 42% there are a greater number of complications. The most common complication after a stroke is depression (38%). The remaining complications include falls and their consequences (35%), urinary tract infections (24%), pain and swelling in paretic limbs (15%), and cognitive disorders (12%; Brola et al., 2008). Poststroke depression may have both an organic background (damage to the brain structures responsible for experiencing emotions) as well as psychosocial (disability and loss of independence, pain, inactivity, social isolation, changing social situation, fear of the future, etc.; De Ryck et al., 2014). Most often several reasons overlap, making treatment and therapy difficult. Depressive disorders that occur after a stroke last an average of 7–9 months, sometimes subsiding on their own. Unfortunately, in about
© 2015 Association of Rehabilitation Nurses Rehabilitation Nursing 2016, 41, 112–119
J. Kowalska et al.
30% of patients they last 2–3 years or even up to 7 years (Zi ołkowska-Kochan & Pracka, 2003). About 40% to nearly 80% of patients require antidepressant treatment (Paradiso, Tranel, Kosier, & Robinson, 2008). Detecting depression in older adults is difficult, since they and their families pay more attention to the somatic ailments than the psychological ones. They treat depressive symptoms as a natural sign of aging, and usually do not seek specialist help in this regard. Therefore, the detection of depression in basic health care facilities among the elderly is low at 41% (Dr oz_ d_z et al., 2007). Depressive disorders may either precede a somatic illness or can be the consequence of it, which further complicates the detection. Left untreated, depression worsens the course of somatic diseases, hinders the process of physiotherapy, and in extreme cases, can be a cause of suicide (Dr oz_ d_z et al., 2007). The problem of depressive disorders particularly concerns residents of long-term care facilities such as nursing homes (NH). In such cases, the patient’s mental condition further deteriorates through problems with adapting to new conditions and isolation from loved ones. At the same time, many authors emphasize that the presence of depression has a negative impact on the functional status —it limits independence of patients, reduces their quality of life, and delays recovery (Dafer, Rao, Shareef, & Sharma, 2008; De Ryck et al., 2014), as well as increases the risk of death (Eng & Reime, 2014; Robinson & Spalletta, 2010). Depressive symptoms also significantly complicate the process of rehabilitation (De Ryck et al., 2014; Saxena, Ng, Koh, Yong, & Fong, 2007). The symptoms of depression, which hinder the course of physiotherapy, include pessimism, lack of motivation, feelings of energy shortage, increased sensitivity to pain, and somatic complaints, as well as emotional lability and irritability. Unfortunately, these symptoms often evoke negative emotions on the part of caregivers and healthcare professionals, including physiotherapists, thereby worsening relations and hampering cooperation (Szczepa nska, Kowalska, Gre n, & Wozniewski, 2006). This definitely lengthens the patient’s stay at the long-term care unit (Kowalska, Szczepa nskaGieracha, & Piaz tek, 2010a). Due to a small amount of research performed concerning the groups of residents of NH in Poland, the objective of this study focused on analyzing the prevalence of depressive symptoms among older adults who had a stroke and who were undergoing physiotherapy at the NH. Additionally, attempts were made to answer the question: What is the association between sociodemographic (age, gender, © 2015 Association of Rehabilitation Nurses Rehabilitation Nursing 2016, 41, 112–119
Occurrence of Depressive Symptoms Among Older Adults
marital status) and clinical factors (the type and location of stroke, the number of comorbid diseases, the functional and cognitive status, the degree of acceptance of disease) and the prevalence of depressive symptoms in stroke patients? Materials and Methods Study Methodology The study group consisted of consecutively admitted patients (newly admitted) to NH who met the following inclusion criteria: patient’s consent to participate in the study, age over 60, first stroke, and stroke being the main reason for rehabilitation at the center. Criteria for exclusion from the study included: aphasia, severe loss of vision or hearing preventing the patient from performing tests, presence of mental retardation and other serious mental disorders, and patient’s refusal at each stage of research. We examined 71 patients in the period from April to September 2010. Patients were graded as to their cognitive functioning using the Mini Mental State Examination (MMSE) scale. It is a widely used screening test that assesses orientation in time and place, memory, attention and counting, language functions, and visual-spatial orientation (Folstein, Folstein, & McHugh, 1975). The sensitivity of the MMSE, according to many authors, is 87%–90% and the specificity 80%–82%. The Polish version of the MMSE scale developed by Sta nczak is characterized by high accuracy and reliability (Cronbach’s coefficient a at 0.88 for a clinical trial and 0.82 for healthy people; Sta nczak, 2010). The obtained results have been calculated taking into consideration the age and education according to the formula by Mungas, Marshall, Weldon, and Reed (1996), verified with Polish circumstances by J ozwiak, Wisniewska, and Wieczorkowska-Tobis (2000). Only patients who achieved a score of MMSE >15 were included in the subsequent studies (McGivney, Mulvihill & Taylor, 1994; Snowdon & Lane, 1999). In these patients, the following assessments were made:
• assessment • •
of mood using the Geriatric Depression Scale (GDS) functional status using the Barthel Index (BI) degree of acceptance of the disease using the Acceptance of Illness Scale (AIS).
The GDS assesses the subject’s mood, his or her subjective satisfaction with the quality of life, mood and
113
Occurrence of Depressive Symptoms Among Older Adults
feelings of happiness, or lack thereof. In the 15-question version, a score between 0 and 5 points indicates no depression, 6 points and above indicates increased severity of depression. GDS is considered a satisfactory screening tool of poststroke depression. Cronbach’s reliability coefficient is a = 0.94, an identical value of the coefficient (r = .94) was achieved in the measurement of split-half reliability of this tool. The sensitivity and specificity of the GDS is respectively 84% and 95% (Albi nski, Kleszczewska-Albi nska, & Bedy nska, 2011; Yesavage et al., 1983). Assuming that MMSE >15, the sensitivity scale is 84%, and specificity 91% (McGivney et al., 1994; Snowdon & Lane, 1999). The GDS scale has been translated into Polish and its psychometric parameters evaluated by Bidzan, Łapin, Sołtys, & Turczy nski (2002). The BI is the most common method of assessing the functional status of elderly and stroke patients (Mahoney & Barthel, 1965). Psychometric properties of the BI scale are very good. The BI shows acceptable distribution, high internal consistency (a coefficient > 0.84) (Hsueh, Lin, Jeng, & Hsieh, 2002). It has been used in Poland for over 40 years. The scale is completed by medical personnel on the basis of patient observations, assessing the capacity to independently carry out basic activities of daily living. The AIS scale is used to assess the degree of acceptance of the disease. The AIS constructed by Felton et al. (1984), has been adapted to Polish circumstances by Juczy nski (2001). Psychometric properties of the AIS are satisfactory. Cronbach’s a reliability index used in studies of the Polish version is 0.85 and is close to the reliability of the original version, for which Cronbach’s a is 0.82. The respondent can score from 8 to 40 points. A low score indicates a lack of acceptance of the disease and a strong sense of psychological discomfort, while a high score indicates adaptation to illness and discomfort associated with it (Juczy nski, 2001). The above studies were carried out at the beginning of the second week after patient’s admission to NH. Finally, the research group consisted of 50 people after brain stroke, including 39 women and 11 men aged 61– 88 years. Mean age was 74.62 (8.2). The most numerous group was single people and those with primary education or vocational training. The average number of comorbidities per one person was 3.74 (1.7), and the mean time from the onset of illness was 6.4 (7.4) months. Right hemisphere stroke occurred in 36 patients, and left hemisphere stroke in 14 patients. Ischemic stroke
114
J. Kowalska et al.
Table 1 Baseline characteristics of the patients Patients (%) (n = 50)
Baseline Characteristics Age Mean (SD) Range Gender Women Men Education Primary and vocational Secondary Higher Marital status Married Single people (widow(er), unmarried) Place of residence Town Village Family care Total or partial lack of care capacity Full caring capacity Stroke type Hemorrhagic Ischemic Lesion location Right hemispheric stroke Left hemispheric stroke Time since stroke (months) Mean (SD) Number of comorbidities Mean (SD) Range
74.6 (8.2) 61–88 39 (78) 11 (22) 30 (60) 14 (28) 6 (12) 18 (36) 32 (64) 43 (86) 7 (14) 31 (62) 19 (38) 12 (24) 38 (76) 36 (72) 14 (28) 6.4 (7.4) 3.7 (1.7) 1–7
affected 38 patients and hemorrhagic stroke 12 patients. All respondents tested were right-handed. The characteristics of the patients are described in Table 1. Statistical Analysis The characteristics of the study group were made using descriptive statistics such as mean, standard deviation, median, lower and upper quartile, minimum and maximum value, and, in the case of qualitative variables, numbers and percentages. The Shapiro–Wilk test was used to check for normal distribution of the data. Due to the rejection of the hypothesis of a normal distribution a Mann–Whitney test was applied to assess the significance of differences between two groups. To determine the strength of the relationship between the two variables a Spearman’s rank coefficient was used. Statistical tests were © 2015 Association of Rehabilitation Nurses Rehabilitation Nursing 2016, 41, 112–119
J. Kowalska et al.
Occurrence of Depressive Symptoms Among Older Adults
verified at the 0.05 level of significance. Statistica Version 7.0 of Statsoft Poland was used.
Table 3 Characteristics of the study group by gender
Results
Variables
In the study group (n = 50) an assessment of mood (GDS), functional status (BI) and the degree of acceptance of the disease (AIS) were performed. Average functional status of patients (BI) was 39.40 (21.96) and cognitive status (MMSE) 21.60 (3.74), whereas the degree of acceptance of the disease (AIS) was 16.12 (6.86). Depressive symptoms at admission to the unit (GDS> 5) were found in 74% of patients after stroke. Average score of the severity of depressive symptoms (GDS) in the studied group was 7.60 (2.75). Reduced mood was detected in 84% of patients hospitalized with hemorrhagic stroke, and in 93% of patients with left hemisphere stroke. A high percentage of the symptoms of depression were found in both men and women groups (63.6% vs. 74.4%). Further analysis indicated no statistically significant differences between a group of patients with hemorrhagic stroke and a group of patients after ischemic stroke. Furthermore, taking into account the effect of location of the stroke (left or right hemisphere stroke), there were no significant differences between groups. The results are presented in Table 2. Comparing the two groups of men and women it was observed that they did not differ significantly in terms of the time of onset of stroke, the number of existing comorbidities and in terms of intellectual, emotional and functional status. A factor differentiating these two groups was age (p = .005). Women were older than men (Table 3). However, a statistically significant difference had shown in age and the presence of depressive symptoms, under a division of respondents as to marital status (p = .002 and .043). Patients who were single were older
Age Time after stroke (months) Number of comorbidities MMSE GDS BI AIS
Table 2 Occurrence of depressive symptoms in subgroups by gender, type, and localization of stroke
Subgroup
n
GDS Mean (SD)
Women Men Hemorrhagic stroke Ischemic stroke Left hemispheric stroke Right hemispheric stroke
39 11 12 38 14 36
7.74 7.09 8.75 7.24 7.57 7.61
© 2015 Association of Rehabilitation Nurses Rehabilitation Nursing 2016, 41, 112–119
(2.90) (2.16) (2.63) (2.72) (1.69) (3.09)
Women n = 39 Mean (SD)
Men n = 11 Mean (SD)
p-Value
76.30 (7.43) 7.08 (8.04)
68.63 (8.31) 4.07 (4.20)
.0054 .3187
3.87 (1.59)
3.27 (2.00)
.2651
21.67 (3.94) 7.74 (2.90) 38.59 (21.15) 16.51 (6.96)
21.36 (3.04) 7.09 (2.16) 42.27 (25.53) 14.72 (6.60)
.9081 .4590 .6607 .4177
Table 4 Spearman0 s correlation of variables in the study group (n = 50) Pair of Variables GDS & age GDS & time after stroke GDS & number of coexisting diseases GDS & MMSE GDS & BI GDS & AIS AIS & BI
R Spearman
t (N2)
0.0758 0.2495
0.5269 1.7851
0.6006 0.0805
0.2296
1.6344
0.1087
0.3087 0.2782 0.5409 0.3108
2.2489 2.0067 4.4550 2.2655
0.0291 0.0494
