title: 13 year follow up of morbidity, mortality and use of health services among elderly depressed patients and general elderly populations.
abstract: OBJECTIVE
  The aim of this study was to establish the predictive value of an ICD-10 diagnosis of depressive disorder or dysthymia (depressive patients) among 70 years + frail rural community living patients by measuring morbidity, mortality and use of health services. Identical measures were studied over time in general elderly populations.
  
  
  METHODS
  
  
  
  METHODS
  morbidity, mortality and use of health services were registered over 13 years in: (i) a clinical cohort of frail community-living depressive patients (n = 38), a frail control group (n = 116) and non-frail elderly people (n = 575), all living in the same municipality, and (ii) register-based samples of general rural (n = 4 115) and capital living (n = 54 977) elderly populations. The outcome measures were compared using data from Danish national health registers.
  
  
  RESULTS
  Every one of the clinical cohort of depressive patients had died at the end of the study. Compared with both the frail control group and the non-frail elderly people, the depressive patients had significantly more psychiatric hospital days, outpatient home visits, antidepressant use, antipsychotic use, GP service use and more psychiatric diagnoses with higher morbidity. However, greater use of somatic hospital services or more somatic diagnoses among the depressive elderly patients were not observed. The general elderly population living in the capital had, compared with rural equals, significantly more somatic and psychiatric diagnoses, larger use of somatic hospital services, psychiatric hospital days, antipsychotics and anxiolytics, but less use of antidepressants, psychiatric outpatient home visits and GP services.
  
  
  CONCLUSIONS
  An ICD-10 diagnosis of depressive disorder or dysthymia predicted increased use of psychiatric services, more psychiatric diagnoses and increased mortality, indicating poor late-life psychiatric outcome. Contrasting with other studies, depression did not predict increased use of somatic hospital services or more somatic diagnoses. The differences in health care status and use between elderly living in the capital and in rural areas elderly are novel findings.
authors.affiliation: Department of Old Age Psychiatry, Brønderslev Psychiatric Hospital, Hjørringvej 180, Brønderslev, Denmark. jensdjernes@webspeed.dk
authors.forename: Jens Kronborg
authors.initials: JK
authors.lastname: Djernes
authors.forename: Nils Christian
authors.initials: NC
authors.lastname: Gulmann
authors.forename: Leslie
authors.initials: L
authors.lastname: Foldager
authors.forename: Frede
authors.initials: F
authors.lastname: Olesen
authors.forename: Povl
authors.initials: P
authors.lastname: Munk-Jørgensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003866:Depressive Disorder / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D012042:Registries