title: The Impact of Cognitive Impairment and Comorbid Depression on Disability, Health Care Utilization, and Costs.
abstract: OBJECTIVE
  This study examined the impact of co-occurring cognitive impairment and depression on functional limitations, hospital and nursing home admissions, and out-of-pocket expenditures (OOPEs) among older adults.
  
  
  METHODS
  Individual mixed-effects regressions were performed to examine the relationship between cognitive impairment and depression and selected outcomes among 18,315 community-dwelling adults ages 50 and over from the Health and Retirement Study from 1998 to 2010.
  
  
  RESULTS
  Cognitive impairment and depression were independently associated with the outcomes of interest, and the estimated effects were largest among individuals with both conditions. Cognitive impairment with comorbid depression predicted limitations in activities of daily living (odds ratio [OR]=3.02) and instrumental activities of daily living (OR=4.18), hospitalizations (OR=1.53), nursing home admissions (OR=3.34), and an increase of $1,150 in annual OOPEs.
  
  
  CONCLUSIONS
  Compared with cognitive impairment or depression alone, cognitive impairment plus depression was associated with substantial functional limitations, health services utilization, and costs.
authors.affiliation: Dr. Xiang is with the School of Social Work and Dr. An is with the Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana (e-mail: xxiang3@illinois.edu ).
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Xiang
authors.affiliation: Dr. Xiang is with the School of Social Work and Dr. An is with the Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana (e-mail: xxiang3@illinois.edu ).
authors.forename: Ruopeng
authors.initials: R
authors.lastname: An
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000150:complications*; D005260:Female; D005102:Health Expenditures; D006707:Homes for the Aged; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires