Background
Methods
Study sample
Measures
InterRAI PC depression rating scale (DRS)
Other interRAI PC scales
InterRAI PC items
Statistical analysis
Item | Categories | Unadjusted OR (95% CI)a
| All patients (%) nbN = 5144 | DRS < 3% (n) N = 4339 | DRS ≥ 3% (n) N = 448h
| p value for χ
2test of Significance | % (n) missingi
|
---|---|---|---|---|---|---|---|
Age | 18-64 | 1.8 (1.3, 2.5) | 34.0% (1626) | 33.0% (1432) | 43.3% (194) | <0.0001 | 0.0% (0) |
65-74 | 1.3 (0.9, 1.9) | 25.5% (1219) | 25.5% (1107) | 25.0% (112) | |||
75-84 | 1.1 (0.7,1.5) | 28.7% (1375) | 29.3% (1273) | 22.8% (102) | |||
85+ | Reference | 11.8% (567) | 12.2% (527) | 8.9% (40) | |||
Gender | Female | 1.2 (1.0,1.5) | 50.9% (2422) | 50.4% (2175) | 55.6% (247) | 0.0369 | 0.6% (30) |
Male | Reference | 49.1% (2335) | 49.6% (2138) | 44.4% (197) | |||
Marital status | No partner | 1.0 (0.8. 1.2) | 38.7% (1785) | 38.8% (1622) | 38.3% (163) | 0.8359 | 3.7% (178) |
Married or have partner | Reference | 61.3% (2824) | 61.2% (2561) | 61.7% (263) | |||
Sitec windsor | Site 1 | 0.6 (0.3,1.1) | 3.6% (174) | 3.7% (161) | 2.9% (13) | 0.1079 | 0.0% (0) |
Site 2 | 0.7 (0.4, 1.0) | 64.4% (3083) | 64.8% (2812) | 60.5% (271) | |||
Site 3 | 0.7 (0.5, 1.2) | 16.8% (802) | 16.7% (726) | 17.0% (76) | |||
Site 4 | 0.9 (0.5, 1.5) | 8.3% (397) | 8.1% (352) | 10.0% (45) | |||
Site 5 | 1.1 (0.6, 2.2) | 2.4% (116) | 2.3% (100) | 3.6% (116) | |||
Site 6 | Reference | 4.5% (215) | 4.3% (188) | 6.0% (27) | |||
Co-morbidities (#)d C | 5+ | 1.8 (1.3, 2.4) | 9.6% (458) | 9.1% (395) | 14.1% (63) | 0.0003 | 0.0% (0) |
3-4 | 1.3 (1.0,1.6) | 32.7% (1564) | 32.4% (1405) | 35.5% (159) | |||
0-2 | Reference | 57.8% (2765) | 58.5% (2539) | 50.5% (226) | |||
Diagnosis prima | Cancer | 0.8 (0.5, 1.1) | 86.5% (4141) | 91.6% (3791) | 8.4% (350) | 0.3094 | 0.0% (0) |
Cardiovascular | 0.7 (0.4, 1.1) | 4.6% (220) | 92.6% (204) | 7.4% (16) | |||
COPD | 0.7 (0.3, 1.5) | 1.7% (81) | 92.6% (75) | 7.4% (6) | |||
Other | Reference | 7.2% (345) | 89.1% (307) | 10.9% (38) | |||
Prognosis | Death imminent (days) - < 6 wks | 2.7 (2.0,3.8) | 8.6% (358) | 7.9% (295) | 14.9% (74) | <0.0001 | 12.8% (615) |
>6 wks - < 6 mths | 1.6 (1.3, 2.1) | 47.6% (1987) | 47.0% (1760) | 53.7% (227) | |||
6+ mths | Reference | 42.8% (1827) | 45.2% (1694) | 31.4% (133) | |||
CHESSe
| Moderate, Severe (2+) | 3.3 (2.2, 4.8) | 83.0% (3770) | 81.9% (3359) | 93.6% (412) | <0.0001 | 5.1% (247) |
None, Minimal (0,1) | Reference | 17.0% (770) | 18.1% (742) | 6.4% (28) | |||
Awareness of prognosis | No | 1.4 (1.1, 1.8) | 45.8% (924) | 44.2% (786) | 52.5% (138) | 0.0122 | 13.0%j (305) |
Yes | Reference | 54.7% (1116) | 55.8% (991) | 47.5% (125) | |||
Pain scale | Moderate-Severe ((2+) | 2.4 (1.9, 3.0) | 64.1% (3034) | 62.6% (2680) | 79.7% (354) | <0.0001 | 1.2% (59) |
None, Minimal (0,1) | Reference | 35.8% (1694) | 37.4% (1604) | 20.3% (90) | |||
CPSf
| Moderate-high impairment (2+) | 2.1 (1.7, 2.6) | 16.6% (796) | 15.5% (671) | 27.9% (125) | <0.0001 | 0.0% (0) |
None, Low impairment (0,1) | Reference | 83.4% (3991) | 84.5% (3668) | 72.1% (323) | |||
ADL SHSg
| Limited, Extensive (2+) | 1.4 (1.1, 1.7) | 37.4% (1752) | 36.7% (1560) | 44.0% (192) | 0.0027 | 2.2% (103) |
Independent (0,1) | Reference | 62.6% (2932) | 63.3% (2688) | 56.0% (244) | |||
Communication disorders | Yes | 1.2 (1.1, 1.6) | 29.0% (1374) | 28.5% (1223) | 33.9% (151) | 0.0171 | 1.0% (46) |
No | Reference | 71.0% (3367) | 71.5% (3072) | 66.1% (295) | |||
Sleep disorders | Severe | 3.5 (2.8, 4.4) | 27.0% (1245) | 24.9% (1039) | 48.1% (206) | <0.0001 | 3.7% (178) |
Moderate | 2.1 (1.6, 2.8) | 17.5% (808) | 17.3% (723) | 19.9% (85) | |||
Minimal | Reference | 55.5% (2556) | 57.9% (2419) | 32.0% (137) | |||
Appetite | Poor | 1.7 (1.3, 2.1) | 22.5% (1038) | 21.5% (898) | 31.8% (140) | <0.0001 | 3.5% (166) |
Good | Reference | 77.5% (3583) | 78.5% (3283) | 68.2% (300) | |||
Dyspnea | Severe | 1.4 (1.1, 1.8) | 15.8% (750) | 15.4% (662) | 19.8% (88) | 0.0301 | 1.1% (51) |
Moderate | 1.2 (0.9, 1.4) | 29.2% (1383) | 29.1% (1250) | 30.0% (133) | |||
Minimal | Reference | 55.0% (2603) | 55.5% (2380) | 50.2% (223) | |||
Gastrointestinal symptoms | Moderate-severe | 1.9 (1.5, 2.3) | 45.2%% (2037) | 43.7% (1785) | 59.0% (252) | <0.0001 | 5.8% (277) |
Minimal | Reference | 54.8% (2473) | 56.3% (2298) | 41.0% (175) | |||
Life satisfaction | Low life-satisfaction | 2.8 (2.3, 3.5) | 41.0% (1846) | 38.6% (1574) | 64.0% (272) | <0.0001 | 6.0% (287) |
High life-satisfaction | Reference | 59.0% (2654) | 61.4% (2501) | 36.0% (153) | |||
Living alone | Living alone | 1.3 (1.0, 1.7Q) | 19.3% (892) | 19.6% (822) | 16.0% (70) | 0.0670 | 3.3% (157) |
Living with others | Reference | 80.7% (3738) | 80.4% (3370) | 84.0% (368) | |||
Supportive family | No strong family support | 1.6 (1.1, 2.4) | 4.7% (222) | 4.5% (191) | 7.0% (31) | 0.0170 | 1.1% (53) |
Strong, supportive family | Reference | 95.3% (4512) | 95.6% (4098) | 93.0% (414) | |||
Caregiver distress | Caregiver exhibits signs of distress | 2.7 (2.2, 3.3) | 23.3% (1063) | 21.3% (878) | 42.2% (185) | <0.0001 | 4.7% (227) |
Caregiver does not exhibit signs of distress | Reference | 76.7% (3497) | 78.7% (3244) | 57.8% (253) |
-
prognosis with the CHESS score;
-
prognosis and the CHESS score with the ADL SHS score and appetite problems;
-
the CHESS score with dyspnea;
-
the CPS score with communication problems and the ADL SHS score; and
-
marital status with living alone.
Results
Sample characteristics
Independent variables for logistic regression
Risk factors associated with depressive symptoms
Independent variable | Complete case analysis (n = 3734) Adjusted odds ratio (95% confidence limit) | Multiple imputation (n = 5144) Pooled odds ratios (Pooled 95% confidence limit) |
---|---|---|
Life satisfaction
a
| ||
Low | 3.070 (2.37-3.98) | 3.01 (2.37-3.82) |
High | Reference | Reference |
CHESS
b
| ||
2+ | 2.88 (1.79-4.62) | 2.122 (1.42-3.18) |
0-1 | Reference | Reference |
Sleep disorders
c
| ||
Severe | 2.78 (2.14-3.60) | 2.56 (2.05-3.19) |
Moderate | 1.52 (1.10-2.11) | 1.56 (1.18-2.06) |
Minimal | Reference | Reference |
Pain scale
| ||
2+ | 2.18 (1.64-2.89) | 1.73 (1.35-2.22) |
0-1 | Reference | Reference |
Signs of caregiver distress
| ||
Yes | 1.93 (1.51-2.45) | 2.01 (1.62-2.51) |
No | Reference | Reference |
Gender
| ||
Female | 1.42 (1.13-1.79) | 1.37 (1.11-1.68) |
Male | Reference | Reference |
Cognitive impairment
| ||
CPSd 2+ | N/Se
| 1.45 (1.13-1.87) |
0-1 | Reference | |
Gastrointestinal symptoms
| ||
Moderate-severe | N/Se
| 1.27 (1.03-1.55) |
Minimal | Reference | |
Goodness of fit
| ||
C statistic | 0.77 | 0.77 (0.75-0.77)f
|
Hosmer & Lemeshow -χ
2
| 6.97 | 5.27(1.5-14.1)f
|
-p | 0.54 | 0.73 (0.08-0.99)f
|
-df | 8 | 8 (8-8)f
|
Independent variable | Model with CHESSb(n = 5144) Pooled odds ratio (Pooled 95% confidence limit) | Model with Prognosis (n = 5144) Pooled odds ratios (Pooled 95% confidence limit) | Model with CHESSband prognostic awareness (n = 2547) Pooled odds ratios (Pooled 95% confidence limit) |
---|---|---|---|
Life satisfaction
a
| |||
Low | 3.01 (2.37-3.82) | 2.58 (1.95-3.42) | 3.62 (2.70-4.85) |
High | Reference | Reference | Reference |
CHESS
b
or Prognosis
| |||
- Imminent (days) | - | 1.97 (1.32-2.94) | - |
2+ - < 6 weeks | 2.122 (1.42-3.18) | 1.47 (1.13-1.91) | 1.71 (1.05-2.80)g
|
0-1 -6 + weeks, < 6mths | Reference | Reference | Reference |
Sleep disorders
c
| |||
Severe | 2.56 (2.05-3.19) | 2.67 (2.03-3.52) | 2.56 (1.93-3.39) |
Moderate | 1.56 (2.06-1.18) | 1.82 (1.31-2.53) | 1.35 (0.94-1.96) |
Minimal | Reference | Reference | Reference |
Pain scale
| |||
2+ | 1.73 (1.35-2.22) | 1.69 (1.25-2.28) | 2.09 (1.52-2.87) |
0-1 | Reference | Reference | Reference |
Signs of caregiver distress
| |||
Yes | 2.01 (1.62-2.51) | 1.71 (1.29-2.26) | 1.41 (1.08-1.85) |
No | Reference | Reference | Reference |
Gender
| |||
Female | 1.37 (1.11-1.68) | 1.47 (1.14-1.90) | 1.41 (1.09-1.81) |
Male | Reference | Reference | Reference |
Cognitive impairment
| |||
CPSd 2+ | 1.45 (1.13-1.87) | 1.71 (1.12-2.62) | 1.39 (1.04-1.85) |
0-1 | Reference | Reference | Reference |
Gastrointestinal symptoms
| |||
Moderate-Severe | 1.27 (1.03-1.55) | 1.37 (1.06-1.76) | N/Se
|
Minimal | Reference | Reference | |
# Co-morbidities
| |||
5+ | N/Se
| 1.79 (1.24-2.59) | N/Se
|
3-4 | 1.17 (0.90-1.51) | ||
0-2 | Reference | ||
Supportive family
| |||
No strong family support | N/Se
| N/Se
| 1.99 (1.20-3.30) |
Strong family support | Reference | ||
Goodness of fit
| |||
C statistic (ROC curve) | 0.77 (0.75-0.77)f
| 0.75 (0.74-0.76)f
| 0.76 (0.75-0.76)f
|
Hosmer & Lemeshow -χ
2
| 5.27(1.5-14.1)f
| 7.89 (2.2-16.9)f
| 9.25 (3.0-16.9)f
|
-p | 0.73 (0.08-0.99)f
| 0.49 (0.03-0.98)f
| 0.37 (0.03-0.93)f
|
-df | 8 (8-8)f
| 8 (8-8)f
| 8 (8-8)f
|