Comorbid medical conditions among depressed elderly patients discharged home after acute psychiatric care.
OBJECTIVE
The authors examined physical illness among elderly patients hospitalized for treatment of major depression, the impact of comorbidity on functional status, and the burden of comorbidity on post-discharge service needs.


METHODS
Data for this cross-sectional study were derived from patient interviews and abstracted from hospital charts. The sample comprised 195 older adults hospitalized for treatment of depression on the geropsychiatric unit of a large urban teaching hospital and discharged to home. Medical comorbidity was measured with the Cumulative Illness Rating Scale for Geriatrics. A psychiatrist confirmed DSM-IV for Axis I diagnosis of depression, and the Geriatric Depression Scale measured depression severity. Unit nurses administered the Mini-Mental State Exam. They assessed functional dependency via the OARS Multidimensional Functional Assessment Questionnaire. Service needs post-discharge were measured from physician discharge orders and patient scores on standardized tests.


RESULTS
Almost three-fourths of depressed elderly patients had at least one comorbid condition requiring first-line treatment; nearly half had two, and one-fourth had three or more. Comorbid physical illness and cognitive impairment was significantly and negatively associated with elderly patients' functional impairment at discharge. Depressed patients with higher medical comorbidity had significantly more needs for services after they left acute care.


CONCLUSIONS
Medical comorbidity needs to be assessed and considered in planning for post-acute care for depressed elderly patients discharged home.
George Warren Brown School of Social Work, Center of Mental Health Services Research, Washington University, One Brookings Drive, Campus Box 1196, St. Louis, MO, USA. ekp@gwbmail.wustl.edu
Enola K
EK
Proctor
Nancy L
NL
Morrow-Howell
Peter
P
Doré
Joan
J
Wentz
Eugene H
EH
Rubin
Sana
S
Thompson
Hong
H
Li
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006301:Health Services Needs and Demand; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000600:supply & distribution*; D008875:Middle Aged; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires