Hospitalization for major depression among older Americans.
BACKGROUND
The objective of this study was to report the pattern of hospitalization for major depression among older Americans and to examine correlates of those hospitalizations. We sought to investigate the hypothesis that hospitalization for major depression would be more common among those respondents with declining functional status whose ability to adapt to this decline was impaired by inadequate social support systems or economic stressors.


METHODS
The data were taken from Version 5 of the Longitudinal Study on Aging (LSOA), which includes 7,527 subjects who were aged 70 and older in 1984. We identified all subjects with any hospitalizations for which major depression was a discharge diagnosis (ICD9-CM codes 296.2, 296.3, 300.4, and 311), and all subjects for whom depression was the primary discharge diagnosis. Only patients with a first-listed discharge diagnosis of depression were considered to have been hospitalized for major depression.


RESULTS
The yearly incidence of hospitalization for which depression was the primary discharge diagnosis was 0.1%. The mean length of stay was 14.6 days and the mean hospital charge was $6,742. Length of stay and charges did not vary by hospital type (general vs psychiatric), but both charges and length of stay were significantly longer when major depression was the primary discharge diagnosis rather than a secondary diagnosis. Patients with a hospitalization for major depression had more hospitalizations, longer total lengths of stay, and greater total hospital charges over the seven-year period as compared to patients with at least one hospitalization for any other reason. These differences in hospital resource use dissipated when hospitalizations for depression were excluded. Hospitalization for major depression was not associated with gender, race, education, or social support. Hospitalization for major depression was independently associated with a forced residential move, a history of nursing home stays, decline in household activities of daily living, younger age, and perceived health rated as less than excellent.


CONCLUSIONS
One older American per thousand is hospitalized each year with a primary discharge diagnosis of major depression. These individuals did not have evidence of greater total hospital resource use if episodes of hospitalization for depression are eliminated. Hospitalization for major depression was more common among those with a loss of independent living.
Callahan
C M
CM
Department of Medicine, Regenstrief Institute for Health Care, Indiana University School of Medicine, USA.
Wolinsky
F D
FD
D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D005260:Female; D017722:Hospital Charges; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D011584:Psychology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology