Assessment of the decision-making capacity of elderly individuals diagnosed with major depression
DOI:
https://doi.org/10.15448/1980-6108.2017.3.26558Keywords:
major depressive disorder, elderly, autonomy, geriatrics, gerontology.Abstract
*** Assessment of the decision-making capacity of elderly individuals diagnosed with major depression ***
AIMS: To verify if there are changes in the decision-making capacity of elderly patients with major depression.
METHODS: This is a prospective cohort study with an initial cross-sectional analysis conducted between January 2014 and September 2015. Treatment-naïve elderly patients from the Cerebral Aging Outpatient Clinic at PUCRS São Lucas Hospital, in Porto Alegre, Brazil, all diagnosed with major depressive disorder, were selected. The control group was composed of elderly individuals from the same community who had neither depression nor cognitive problems. For evaluation of the decision-making capacity, the Assessment Scale for Decision-Making Capacity was designed and validated in a previous stage of the research. This instrument is divided into four domains: daily activity, financial management, self-management, and well-being. The Geriatric Depression Scale (short version) and the Mini-International Neuropsychiatric Interview (detailed version) were used to evaluate the presence of depression. The Vellore Screening Instrument for Dementia and the Addenbrooke’s Cognitive Examination (revised version) were applied to evaluate cognitive decline. Decision-making capacity was compared between the two groups of elderly individuals. The same evaluation was conducted with elderly patients with depression after six months of psychiatric treatment. The statistical analysis included Student’s t, Pearson’s chi-square, Mann-Whitney, and Wilcoxon tests. Statistical significance was set at p≤0.05.
RESULTS: Forty-eight elderly patients with major depression and 144 elderly individuals from the control group participated in the study. The Assessment Scale for Decision-Making Capacity average score in depression patients was 70.5±17.9, compared to 94.6±9.6 (p<0.001) in the control group, which indicates poorer decision-making capacity among patients with major depression. The domains with the most striking differences in the average scores were self-management (depression patients 65.0±23.3 and control group 97.8±6.2) and well-being (depression patients 52.2±27.1 and control group 91.8±16.7). When comparing patients with depression before and after treatment, regarding both the general score and the four domains of the Assessment Scale for Decision-Making Capacity, the decision-making capacity was higher after the treatment.
CONCLUSIONS: The group of elderly patients with current major depression had a lower decision-making capacity compared to the control group. Their decision-making capacity improved after six months of psychiatric treatment.
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References
Brasil. Instituto Brasileiro de Geografia e Estatística. Projeção da população do Brasil e das Unidades da Federação [Internet]. 2016 [citado 13 de novembro de 2016]. p. 2. Available from: http://www.ibge.gov.br/apps/populacao/projecao/
Frank MH, Rodrigues NL. Depressão, Ansiedade, Outros Transtornos Afetivos e Suicídio. In: Freitas EV, Py L, organizadores. Tratado de Geriatria e Gerontologia. 3ªed. Rio de Janeiro: Guanabara Koogan, 2011.p. 314-26.
Organização Mundial de Saúde. Saúde mental: nova concepção, nova esperança [Internet]. 1aed. The World Health Report. Lisboa; 2002. Available from: http://apps.who.int/iris/bitstream/10665/42390/4/WHR_2001_por.pdf
Blazer DG. Depressão. In: Abrams WB, Berkow R, organizadores. Manual Merck de Geriatria. São Paulo: Roca; 1994. p.1086-96.
Crippa A, Gomes I. Pedidos judiciais relacionados à interdição de idosos. Rev Kairós Gerontol. 2014;17(3):329-42. https://revistas.pucsp.br/index.php/kairos/article/view/23870
Brasil. Lei 10.406 de 10 de janeiro de 2002. Institui o Código Civil. Brasília, 10 de janeiro de 2002.
Brasil. Lei nº 13.146, de 6 de julho de 2015. Institui a Lei Brasileira de Inclusão da Pessoa com Deficiência (Estatuto da Pessoa com Deficiência). Brasília, 2015.
Farias CC, Rosenvald N. Curso de Direito Civil: famílias. 8ªed. Salvador: JusPodivm, 2016.
Brasil. Lei nº 13.105, de 16 de março de 2015. Institui o Código de Processo Civil. Brasília, 2015.
Medeiros MBM. Interdição civil: proteção ou exclusão. São Paulo: Cortez, 2007.
Amorim AMA. Manual de direitos das famílias. Curitiba: Juruá, 2016.
Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1983;17(1):37-49. https://doi.org/10.1016/0022-3956(82)90033-4
Loureiro F, Finger G, Gomes I. Tradução e adaptação cultural para o português brasileiro do instrumento para rastreio cognitivo Vellore. PAJAR - Pan Am J Aging Res. 2015;3(2):47-52. https://doi.org/10.15448/2357-9641.2015.2.22950
Amorin P. Mini International Neuropsychiatric Interview (MINI): validação de entrevista breve para diagnóstico de transtornos mentais. Rev Bras Psiquiatr. 2000;22(3):106-15. https://doi.org/10.1590/S1516-44462000000300003
Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry. 2006;21(11):1078-85. https://doi.org/10.1002/gps.1610
Silva AC. Autonomia do idoso: avaliação da capacidade da tomada de decisão e associação com depressão maior [thesis]. [Porto Alegre]: Pontifícia Universidade Católica do Rio Grande do Sul; 2017. http://hdl.handle.net/10923/10049
Álvaro LC. Competencia: conceptos generales y aplicación en la demencia. Neurología. 2012;27(5):290-300. https://doi.org/10.1016/j.nrl.2011.12.005
Deon RG, Goldim JR. Capacidade para tomada de decisão em idosos institucionalizados e não institucionalizados. Estud Interdiscipl Envelhec. 2016;21(1):123-33.
Sousa LB, Simões MR, Firmino H, Peisah C. Financial and testamentary capacity evaluations: procedures and assessment instruments underneath a functional approach. Int Psychogeriatrics. 2014;26(2):217-28. https://doi.org/10.1017/S1041610213001828
Giroux D, Tétreault S, Landry M-P. Evaluating adult's competency: application of the competency assessment process. Int J Alzheimers Dis. 2015;2015:1-7. https://doi.org/10.1155/2015/753873
Astell H, Lee JH, Sankaran S. Review of capacity assessments and recommendations for examining capacity. N Z Med J. 2013;126(1383):38-48.
Moye J, Marson DC. Assessment of Decision-Making Capacity in Older Adults: An Emerging Area of Practice and Research. J Gerontol B Psychol Sci Soc Sci. 2007;62(1):3-11. https://doi.org/10.1093/geronb/62.1.P3
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