Elizabeth A Phelan

University of Washington Seattle, Seattle, Washington, United States

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Publications (49)163.66 Total impact

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    ABSTRACT: To conduct a systematic literature review to determine if there were any intervention strategies that had any measurable effect on acute-care hospitalizations among community-dwelling adults with dementia. Studies were identified by a professional research librarian and content experts. Community dwelling. Participants were diagnosed with dementia, severity ranging from mild to severe, and were recruited from health care and community agencies. A study met the inclusion criteria if it: (a) was published in English; (b) included a control or comparison group; (c) published outcome data from the intervention under study; (d) reported hospitalization as one of the outcomes; (e) included community-dwelling older adults; and (f) enrolled participants with dementia. Ten studies met all inclusion criteria. Of the 10 studies included, most assessed health services use (ie, hospitalizations) as a secondary outcome. Participants were recruited from a range of health care and community agencies, and most were diagnosed with dementia with severity ratings ranging from mild to severe. Most intervention strategies consisted of face-to-face assessments of the persons living with dementia, their caregivers, and the development and implementation of a care plan. A significant reduction in hospital admissions was not found in any of the included studies, although 1 study did observe a reduction in hospital days. The majority of studies included hospitalizations as a secondary outcome. Only 1 intervention was found to have an effect on hospitalizations. Future work would benefit from strategies specifically designed to reduce and prevent acute hospitalizations in persons with dementia.
    Medical Care 02/2015; 53(2):207-13. DOI:10.1097/MLR.0000000000000294 · 2.94 Impact Factor
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    ABSTRACT: Objectives To determine the prevalence of clinically relevant falls-related outcomes according to pain status in older adults in the United States.DesignCross-sectional analysis of the 2011 National Health and Aging Trends Study, a sample of Medicare enrollees aged 65 and older (response rate 71.0%).SettingIn-person assessments were conducted in the home or residential care facility of the sampled study participant.ParticipantsIndividuals aged 65 and older (n = 7,601, representing 35.3 million Medicare beneficiaries).MeasurementsParticipants were asked whether they had been “bothered by pain” and the location of pain, as well as questions about balance and coordination, fear of falling, and falls.ResultsFifty-three percent of the participants reported bothersome pain. The prevalence of recurrent falls in the past year (≥2 falls) was 19.5% in participants with pain and 7.4% in those without (age- and sex-adjusted prevalence ratio (PR) = 2.63, 95% confidence interval (CI) = 2.28–3.05). The prevalence of fear of falling that limits activity was 18.0% in those with pain and 4.4% in those without (adjusted PR = 3.98, 95% CI = 3.24–4.87). Prevalence of balance and falls outcomes increased with number of pain sites. For example, prevalence of problems with balance and coordination that limited activity was 6.6% in participants with no pain, 11.6% in those with one site of pain, 17.7% in those with two sites, 25.0% in those with three sites, and 41.4% in those with four or more sites (P < .001 for trend). Associations were robust to adjustment for several potential confounders, including cognitive and physical performance.Conclusion Falls-related outcomes were substantially more common in older adults with pain than in those without. Accordingly, pain management strategies should be developed and evaluated for falls prevention.
    Journal of the American Geriatrics Society 10/2014; 62(10). DOI:10.1111/jgs.13072 · 4.22 Impact Factor
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    ABSTRACT: BACKGROUND Older persons account for the majority of hospitalizations in the United States.1 Identifying risk factors for hospitalization among elders, especially potentially preventable hospitalization, may suggest opportunities to improve primary care. Certain factors—for example, living alone—may increase the risk for hospitalization, and their effect may be greater among persons with dementia and the old-old (aged 85+). OBJECTIVES To determine the association of living alone and risk for hospitalization, and see if the observed effect is greater among persons with dementia or the old-old. DESIGN Retrospective longitudinal cohort study. PARTICIPANTS 2,636 participants in the Adult Changes in Thought (ACT) study, a longitudinal cohort study of dementia incidence. Participants were adults aged 65+ enrolled in an integrated health care system who completed biennial follow-up visits to assess for dementia and living situation. MAIN MEASURES Hospitalization for all causes and for ambulatory care sensitive conditions (ACSCs) were identified using automated data. KEY RESULTS At baseline, the mean age of participants was 75.5 years, 59 % were female and 36 % lived alone. Follow-up time averaged 8.4 years (SD 3.5), yielding 10,431 approximately 2-year periods for analysis. Living alone was positively associated with being aged 85+, female, and having lower reported social support and better physical function, and negatively associated with having dementia. In a regression model adjusted for age, sex, comorbidity burden, physical function and length of follow-up, living alone was not associated with all-cause (OR = 0.93; 95 % CI 0.84, 1.03) or ambulatory care sensitive condition (ACSC) hospitalization (OR = 0.88; 95 % CI 0.73, 1.07). Among participants aged 85+, living alone was associated with a lower risk for all-cause (OR = 0.76; 95 % CI 0.61, 0.94), but not ACSC hospitalization. Dementia did not modify any observed associations. CONCLUSION Living alone in later life did not increase hospitalization risk, and in this population may be a marker of healthy aging in the old-old.
    Journal of General Internal Medicine 06/2014; 29(11). DOI:10.1007/s11606-014-2904-z · 3.42 Impact Factor
  • Journal of Pain 04/2014; 15(4):S8. DOI:10.1016/j.jpain.2014.01.037 · 4.22 Impact Factor
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    ABSTRACT: Purpose of the Study: Optimal mobility is an important element of healthy aging. Yet, older adults' perceptions of mobility and mobility preservation are not well understood. The purposes of our study were to (a) identify studies that report older adults' perceptions of mobility, (b) conduct a standardized methodological quality assessment, and (c) conduct a metasynthesis of the identified studies. We included studies with community-dwelling adults aged ≥65 years, focused on perceptions of mobility pertaining to everyday functioning, used qualitative methods, and were cited in PubMed, Embase, CINAHLPlus, or Geobase databases. Study quality was appraised using the McMaster University Tool. Out of 748 studies identified, 12 met inclusion criteria. Overall quality of the studies was variable. Metasynthesis produced 3 overarching themes: (a) mobility is part of sense of self and feeling whole, (b) assisted mobility is fundamental to living, and (c) adaptability is key to moving forward. Older adults' perceptions of mobility can inform interventions that would involve actively planning for future mobility needs and enhance the acceptance of the changes, both to the older adult and the perceived response to changes by those around them.
    The Gerontologist 03/2014; DOI:10.1093/geront/gnu014 · 2.48 Impact Factor
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    ABSTRACT: This study investigated facilitators and barriers to adoption of an at-scene patient education program by firefighter emergency medical technicians (EMTs) in King County, Washington. We consulted providers of emergency medical services (EMS) to develop a patient education pamphlet in the form of a tear-off sheet that could be attached to the EMT medical incident report. The pamphlet included resources for at-scene patient education on high blood pressure, blood glucose, falls, and social services. The program was launched in 29 fire departments in King County, Washington, on January 1, 2010, and a formal evaluation was conducted in late 2011. We developed a survey based on diffusion theory to assess 1) awareness of the pamphlet, 2) evaluation of the pamphlet attributes, 3) encouragement by peers and superiors for handing out the pamphlet, 4) perceived behavioral norms, and 5) demographic variables associated with self-reported adoption of the at-scene patient education program. The survey was completed by 822 (40.1%) of 2,047 firefighter emergency medical technicians. We conducted bivariate and multivariable analyses to assess associations between independent variables and self-reported adoption of the program. Adoption of the at-scene patient education intervention was significantly associated with positive evaluation of the pamphlet, encouragement from peers and superiors, and perceived behavioral norms. EMS providers reported they were most likely to hand out the pamphlet to patients in private residences who were treated and left at the scene. Attributes of chronic disease prevention programs and encouragement from peers and supervisors are necessary in diffusion of patient education interventions in the prehospital care setting.
    Preventing chronic disease 01/2014; 11:E14. DOI:10.5888/pcd11.130221 · 1.96 Impact Factor
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    ABSTRACT: Little is known about older adults' perceptions of organized programs that support exercise behavior. We conducted semi-structured interviews with 39 older adults residing in King County, Washington, who either declined to join, joined and participated, or joined and then quit a physical activity-oriented program. We sought to explore motivators and barriers to physical activity program participation and to elicit suggestions for marketing strategies to optimize participation. Two programs supporting exercise behavior and targeting older persons were the source of study participants: Enhance(®)Fitness and Physical Activity for a Lifetime of Success. We analyzed interview data using standard qualitative methods. We examined variations in themes by category of program participant (joiner, decliner, quitter) as well as by program and by race. Interview participants were mostly females in their early 70s. Approximately half were non-White, and about half had graduated from college. The most frequently cited personal factors motivating program participation were enjoying being with others while exercising and desiring a routine that promoted accountability. The most frequent environmental motivators were marketing materials, encouragement from a trusted person, lack of program fees, and the location of the program. The most common barriers to participation were already getting enough exercise, not being motivated or ready, and having poor health. Marketing messages focused on both personal benefits (feeling better, social opportunity, enjoyability) and desirable program features (tailored to individual needs), and marketing mechanisms ranged from traditional written materials to highly personalized approaches. These results suggest that organized programs tend to appeal to those who are more socially inclined and seek accountability. Certain program features also influence participation. Thoughtful marketing that involves a variety of messages and mechanisms is essential to successful program recruitment and continued attendance.
    The Journal of Prevention 11/2013; DOI:10.1007/s10935-013-0331-2
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    ABSTRACT: Abstract There is an urgent need to translate science into practice and help enhance the capacity of professionals to deliver evidence-based programming. We describe contributions of the Healthy Aging Research Network in building professional capacity through online modules, issue briefs, monographs, and tools focused on health promotion practice, physical activity, mental health, and environment and policy. We also describe practice partnerships and research activities that helped inform product development and ways these products have been incorporated into real-world practice to illustrate possibilities for future applications. Our work aims to bridge the research-to-practice gap to meet the demands of an aging population.
    American journal of health promotion: AJHP 09/2013; 28(1):2-6. DOI:10.4278/ajhp.121116-CIT-564 · 2.37 Impact Factor
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    ABSTRACT: Optimal mobility, defined as relative ease and freedom of movement in all of its forms, is central to healthy aging. Mobility is a significant consideration for research, practice, and policy in aging and public health. We examined the public health burdens of mobility disability, with a particular focus on leading public health interventions to enhance walking and driving, and the challenges and opportunities for public health action. We propose an integrated mobility agenda, which draws on the lived experience of older adults. New strategies for research, practice, and policy are needed to move beyond categorical promotion programs in walking and driving to establish a comprehensive program to enhance safe mobility in all its forms.
    American Journal of Public Health 06/2012; 102(8):1508-15. DOI:10.2105/AJPH.2011.300631 · 3.93 Impact Factor
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    ABSTRACT: Purpose of the Study:  To examine the components of cost that drive increased total costs after a medical fall over time, stratified by injury severity.   We used 2004-2007 cost and utilization data for persons enrolled in an integrated care delivery system. We used a longitudinal cohort study design, where each individual provides 2-3 years of administrative data grouped into 3-month intervals relative to an index date. We identified 8,969 medical fallers through International Classification of Diseases, 9th Revision, codes and E-Codes and used 8,956 nonfaller controls, identified through age and gender frequency matching. Total costs were partitioned into 7 components: inpatient, outpatient, emergency, radiology, pharmacy, postacute care, and "other."   The large increase in costs after a hospitalized fall is mainly associated with inpatient and postacute care components. The spike in costs after a nonhospitalized fall is attributable to outpatient and "other" (e.g., ambulatory surgery or community health services) components. Hospitalized fallers' inpatient, emergency, postacute care, outpatient, and radiology costs are not always greater than those for nonhospitalized fallers.   Components associated with increased costs after a medical fall vary over time and by injury severity. Future studies should compare if delivering certain acute and postacute health services improve health and reduce cost trajectories after a medical fall more than others. Additionally, since the older adult population and the problem of falls are growing, health care delivery systems should develop standardized methodology to monitor medical fall rates.
    The Gerontologist 03/2012; 52(5):664-75. DOI:10.1093/geront/gnr151 · 2.48 Impact Factor
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    ABSTRACT: Generalized additive models for location, scale, and shape (GAMLSS) are a class of semi-parametric models with potential applicability to health care cost data. We compared the bias, accuracy, and coverage of GAMLSS estimators with two distributions [gamma and generalized inverse gaussian (GIG)] using a log link to the generalized linear model (GLM) with log link and gamma family and the log-transformed OLS. The evaluation using simulated gamma data showed that the GAMLSS and GLM gamma model had similar bias, accuracy, and coverage and outperformed the GAMLSS GIG. When applied to simulated GIG data, the GLM gamma was similar or improved in bias, accuracy, and coverage compared to the GAMLSS GIG and gamma; furthermore, the GAMLSS estimators produced wildly inaccurate or overly-precise results in certain circumstances. Applying all models to empirical data on health care costs after a fall-related injury, all estimators produced similar coefficient estimates, but GAMLSS estimators produced spuriously smaller standard errors. Although no single alternative was best for all simulations, the GLM gamma was the most consistent, so we recommend against using GAMLSS estimators using GIG or gamma to test for differences in mean health care costs. Since GAMLSS offers many other flexible distributions, future work should evaluate whether GAMLSS is useful when predicting health care costs.
    Health Services and Outcomes Research Methodology 03/2012; 13(1). DOI:10.1007/s10742-012-0086-x
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    ABSTRACT: Lack of adequate physical activity among older adults has been widely documented. Although interventions aimed at increasing physical activity that are based on behavioral strategies and theories have been shown to increase activity levels among older adults, little is known about responses to these interventions in different population segments. The Physical Activity for a Lifetime of Success (PALS) program attempted to translate a telephone-based, motivational support program for physical activity, Active Choices, for use by a low-income, ethnically diverse population of older adults living in southeast Seattle. This article describes the evaluation of PALS at the end of the 5-year program. Evaluation data included a data set of participant physical activity assessments; internal study documents; and interviews with key PALS stakeholders, participants, volunteers, and people eligible for PALS who declined to enroll when invited. PALS demonstrated improved physical activity levels among the sedentary older adults who participated in the program, but the PALS model did not appeal widely to a diverse, low-income target population. Extensive recruitment efforts resulted in a low number of participants, and attempts to recruit peer volunteers were largely unsuccessful. Considering the resources required to engage both participants and volunteers, PALS does not appear to be a sustainable model for delivering support for physical activity to community-dwelling minority and low-income older adults.
    Preventing chronic disease 02/2012; 9:E62. DOI:10.5888/pcd9.110071 · 1.96 Impact Factor
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    ABSTRACT: Dementia is associated with increased rates and often poorer outcomes of hospitalization, including worsening cognitive status. New evidence is needed to determine whether some admissions of persons with dementia might be potentially preventable. To determine whether dementia onset is associated with higher rates of or different reasons for hospitalization, particularly for ambulatory care-sensitive conditions (ACSCs), for which proactive outpatient care might prevent the need for a hospital stay. Retrospective analysis of hospitalizations among 3019 participants in Adult Changes in Thought (ACT), a longitudinal cohort study of adults aged 65 years or older enrolled in an integrated health care system. All participants had no dementia at baseline and those who had a dementia diagnosis during biennial screening contributed nondementia hospitalizations until diagnosis. Automated data were used to identify all hospitalizations of all participants from time of enrollment in ACT until death, disenrollment from the health plan, or end of follow-up, whichever came first. The study period spanned February 1, 1994, to December 31, 2007. Hospital admission rates for patients with and without dementia, for all causes, by type of admission, and for ACSCs. Four hundred ninety-four individuals eventually developed dementia and 427 (86%) of these persons were admitted at least once; 2525 remained free of dementia and 1478 (59%) of those were admitted at least once. The unadjusted all-cause admission rate in the dementia group was 419 admissions per 1000 person-years vs 200 admissions per 1000 person-years in the dementia-free group. After adjustment for age, sex, and other potential confounders, the ratio of admission rates for all-cause admissions was 1.41 (95% confidence interval [CI], 1.23-1.61; P < .001), while for ACSCs, the adjusted ratio of admission rates was 1.78 (95% CI, 1.38-2.31; P < .001). Adjusted admission rates classified by body system were significantly higher in the dementia group for most categories. Adjusted admission rates for all types of ACSCs, including bacterial pneumonia, congestive heart failure, dehydration, duodenal ulcer, and urinary tract infection, were significantly higher among those with dementia. Among our cohort aged 65 years or older, incident dementia was significantly associated with increased risk of hospitalization, including hospitalization for ACSCs.
    JAMA The Journal of the American Medical Association 01/2012; 307(2):165-72. DOI:10.1001/jama.2011.1964 · 29.98 Impact Factor
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    ABSTRACT: To determine the safety and feasibility of using Nintendo Wii Fit exergames to improve balance in older adults. Seven older adults aged 84 (5) years with impaired balance (Berg Balance Scale [BBS] score < 52 points) were recruited from 4 continuing care retirement communities to participate in a single group pre- and postevaluation of Wii Fit exergames. Participants received individualized instructions (at least 5 home visits) on playing 4 exergames (basic step, soccer heading, ski slalom, and table tilt) and were asked to play these games in their homes at least 30 minutes 3 times per week for 3 months and received weekly telephone follow-up. They also completed a paper log of their exergame play and rated their enjoyment immediately after each session. Participants completed the BBS, 4-Meter Timed Walk test, and the Physical Activity Enjoyment Scale at baseline and 3 months. Semistructured interviews were conducted at the 3-month evaluation. Participants safely and independently played a mean of 50 sessions, median session duration of 31 minutes. Two of the games were modified to ensure participants' safety. Participants rated high enjoyment immediately after exergame play and expressed experiencing improved balance with daily activities and desire to play exergames with their grandchildren. Berg Balance Scores increased from 49 (2.1) to 53 (1.8) points (P = .017). Walking speed increased from 1.04 (0.2) to 1.33 (0.84) m/s (P = .018). Use of Wii Fit for limited supervised balance training in the home was safe and feasible for a selected sample of older adults. Further research is needed to determine clinical efficacy in a larger, diverse sample and ascertain whether Wii Fit exergames can be integrated into physical therapy practice to promote health in older adults.
    10/2011; 34(4):161-7. DOI:10.1519/JPT.0b013e3182191d98
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    Sharon S Laing, Ilene F Silver, Sally York, Elizabeth A Phelan
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    ABSTRACT: We assessed knowledge, attitude, and provision of recommended fall prevention (FP) practices by employees of senior-serving organization and participation in FP practices by at-risk elders. The Washington State Department of Health administered structured telephone surveys to 50 employees and 101 elders in Washington State. Only 38% of employees felt "very knowledgeable" about FP, and a majority of their organizations did not regularly offer FP services. Almost half (48%) of seniors sustained a fall within the past 12 months; however, one-third perceived falling to be among their least important health concerns, and most had minimal working knowledge of proven FP practices. Seniors who perceived avoiding falls as important to their well-being were more likely to participate in practices about which they had the least knowledge (risk assessment, medication management). Increased awareness and availability of FP services might help engage older adults in FP practices and reduce the adverse effects of falls.
    Journal of aging research 09/2011; 2011:395357. DOI:10.4061/2011/395357
  • Angelena Maria Labella, Susan Eva Merel, Elizabeth Anne Phelan
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    ABSTRACT: Hospitalists care for elderly patients daily, but few have specialized training in geriatric medicine. Elderly patients, and in particular the very old and the frail elderly, are at high risk of functional decline and iatrogenic complications during hospitalization. Other challenges in caring for this patient population include dosing medications safely, preventing delirium and accidental falls, and providing adequate pain control. Ways to improve the care of the hospitalized elderly patient include the following: screening for geriatric syndromes such as delirium, assessing functional status and maintaining mobility, and implementation of interventions that have been shown to prevent delirium, accidental falls, and acute functional decline in the hospital. This article addresses these issues with 10 evidence-based pearls developed to help hospitalists provide optimal care for this expanding population.
    Journal of Hospital Medicine 07/2011; 6(6):351-7. DOI:10.1002/jhm.900 · 2.08 Impact Factor
  • Journal of Hospital Medicine 07/2011; 6(6):350. DOI:10.1002/jhm.965 · 2.08 Impact Factor
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    ABSTRACT: The study of complex, health-related problems is often best addressed by interdisciplinary teams, and yet models for training and mentoring junior investigators in an interdisciplinary mode are not widely available. Here, the authors describe their school's version of the consultancy process, a two-year effort (September 2007 to June 2009) sponsored by the University of Washington's Center for Interdisciplinary Geriatric Research, as a model for short-and long-term, interdisciplinary training and mentoring of junior faculty investigators, and evaluate its effects on establishing productive cross-disciplinary linkages among them. Between September 2007 and December 2008, written feedback was collected from participating faculty after each consultancy session. A brief, Internet-based survey of all attendees was conducted in February 2009 to gather information about longer-term implications and benefits of consultancy participation. Most respondents rated sessions highly, and a majority of the respondents reported increased networking opportunities, access to resources, new research questions, access to expertise beyond their disciplines as a result of the sessions, and a positive impact on cross-disciplinary collaborations. Their responses suggest that the consultancy format may stimulate the formation of new interdisciplinary mentoring relationships and foster cross-disciplinary collaborations.
    Academic Medicine 05/2011; 86(7):866-71. DOI:10.1097/ACM.0b013e31821ddad0 · 3.47 Impact Factor
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    ABSTRACT: Objective. To investigate motivational factors and barriers to participating in fall risk assessment and management programs among diverse, low-income, community-dwelling older adults who had experienced a fall. Methods. Face-to-face interviews with 20 elderly who had accepted and 19 who had not accepted an invitation to an assessment by one of two fall prevention programs. Interviews covered healthy aging, core values, attributions/consequences of the fall, and barriers/benefits of fall prevention strategies and programs. Results. Joiners and nonjoiners of fall prevention programs were similar in their experience of loss associated with aging, core values they expressed, and emotional response to falling. One difference was that those who participated endorsed that they “needed” the program, while those who did not participate expressed a lack of need. Conclusions. Interventions targeted at a high-risk group need to address individual beliefs as well as structural and social factors (transportation issues, social networks) to enhance participation.
    Journal of aging research 05/2011; 2011:867341. DOI:10.4061/2011/867341
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    ABSTRACT: The diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) for assessment of depression in elderly persons in primary care settings in the United States has not been previously addressed. Thus, the purpose of this study was to evaluate the test performance of the PHQ-9 for detecting major and minor depression in elderly patients in primary care. A prospective study of diagnostic accuracy was conducted in two primary care, university-based clinics in the Pacific Northwest of the United States. Seventy-one patients aged 65 years or older participated; all completed the PHQ-9 and the 15-item Geriatric Depression Scale (GDS) and underwent the Structured Clinical Interview for Depression (SCID). Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve, and likelihood ratios (LRs) were calculated for the PHQ-9, the PHQ-2, and the 15-item GDS for major depression alone and the combination of major plus minor depression. Two thirds of participants were female, with a mean age of 78 and two chronic health conditions. Twelve percent met SCID criteria for major depression and 13% minor depression. The PHQ-9 had an area under the curve (AUC) of 0.87 (95% confidence interval [CI], 0.74-1.00) for major depression, while the PHQ-2 and the 15-item GDS each had an AUC of 0.81 (95% CI for PHQ-2, 0.64-0.98, and for 15-item GDS, 0.70-0.91; P = 0.551). For major and minor depression combined, the AUC for the PHQ-9 was 0.85 (95% CI, 0.73-0.96), for the PHQ-2, 0.80 (95% CI, 0.68-0.93), and for the 15-item GDS, 0.71 (95% CI, 0.55-0.87; P = 0.187). Based on AUC values, the PHQ-9 performs comparably to the PHQ-2 and the 15-item GDS in identifying depression among primary care elderly.
    BMC Family Practice 09/2010; 11:63. DOI:10.1186/1471-2296-11-63 · 1.74 Impact Factor

Publication Stats

822 Citations
163.66 Total Impact Points

Institutions

  • 2000–2014
    • University of Washington Seattle
      • • Division of Gerontology and Geriatric Medicine
      • • Department of Health Services
      • • Department of Medicine
      Seattle, Washington, United States
  • 2007
    • Trinity Washington University
      Washington, Washington, D.C., United States