Depressive symptoms as a predictor of 6-month outcomes and services utilization in elderly medical inpatients.
BACKGROUND
Depressive symptoms have been associated with higher mortality in hospitalized elderly persons, but few data are available associating depressive symptoms with other outcomes.


OBJECTIVE
To determine the association between depressive symptoms and the risk of hospital readmission, nursing home admission, and death as well as inpatient services utilization during a 6-month follow-up period in a cohort of elderly medical inpatients.


METHODS
We enrolled 401 patients, 75 years and older, admitted to the internal medicine service of an academic hospital in Lausanne, Switzerland. Data on demographic, medical, physical, social, and mental status were collected on admission. Depressive symptoms were defined as a score of 6 or higher on the Geriatric Depression Scale short form. Follow-up data were gathered from the centralized billing system (hospital and nursing home admissions) and from proxies (in cases of death).


RESULTS
In bivariate analysis, depressive symptoms were associated with an increased risk of hospital readmission, nursing home placement, and death. After adjustment for demographic, socioeconomic, and functional status and comorbidity, depressive symptoms remained associated with an increased risk of hospital readmission (adjusted hazard ratio, 1.50; 95% confidence interval, 1.03-2.17; P =.03). In addition, depressive symptoms were associated with increased average costs of both acute and rehabilitation services, resulting in higher overall costs of inpatient services. ($175.70 vs $126.00; P<.001). This association remained after adjusting for differences in functional status, comorbidity, and living situation, although it was just short of statistical significance (P =.07).


CONCLUSIONS
Elderly medical inpatients with depressive symptoms were more likely than those without to be readmitted and had higher inpatient services utilization during the follow-up period, independent of functional and health status. These results emphasize the need for interventions directed at improving management of depressive symptoms, given the low recognition and treatment rates of this problem in elderly populations.
Büla
C J
CJ
CUTR Sylvana, Ch de Sylvana 10, 1066 Epalinges, Switzerland. Christophe.Bula@chuv.hospvd.ch
Wietlisbach
V
V
Burnand
B
B
Yersin
B
B
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D007902:Length of Stay; D008297:Male; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D010358:Patient Participation; D010359:Patient Readmission; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors