title: The impact of depressive symptoms on utilization of home care by the elderly: Longitudinal results from the AgeMooDe study.
abstract: Depression is the most common psychiatric disease in older people, often accompanied by co-morbidities and functional limitations. In cross-sectional studies, depression is associated with an increased use of health care resources, including informal care and home care. Longitudinal data are needed to better understand the causal links between depression, functional impairments, and health care utilization.
  
  
  
  Data were obtained at baseline and follow-up of the multicenter, prospective cohort study "Late life depression in primary care: needs, health care utilization and costs" (AgeMooDe). A sample of 955 primary care patients aged 75 years and older was interviewed twice. The primary outcomes were the average respective amounts of time spent utilizing home care, professional nursing care, domestic help and informal care. These outcomes were analyzed with Generalized Linear Mixed Models (GLMM).
  
  
  
  GLMM analysis revealed that the amount of time utilizing home care over the study period was positively associated with depression, higher age, and functional and cognitive impairments, but negatively associated with living alone. In-depth analyses revealed that these associations were particularly obvious for the utilization of informal care.
  
  
  
  The generalizability of our findings may be limited due to use of a dimensional instrument to determine depressive symptoms.
  
  
  
  Over the study period, the average amount of time receiving home care and especially informal care increased in the group of patients with depression only. People with depressive symptoms experience a growing number of functional limitations over time, increasing their dependency on others. Functional limitations, depression and dependency appear to form a vicious cycle.
authors.affiliation: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany. Electronic address: Andreas.Hoell@zi-mannheim.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hoell
authors.affiliation: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Weyerer
authors.affiliation: Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.affiliation: Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.affiliation: Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Stark
authors.affiliation: Institute of General Practice, Medical Faculty, Kiel University, Kiel, Germany.
authors.forename: Hanna
authors.initials: H
authors.lastname: Kaduszkiewicz
authors.affiliation: Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany.
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
authors.forename: Jens-Oliver
authors.initials: JO
authors.lastname: Bock
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Stein
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany.
authors.forename: Steffi G
authors.initials: SG
authors.lastname: Riedel-Heller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000523:psychology*; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care; D011446:Prospective Studies
keywords: Depression; Elderly population; Health services research; Home care; Informal care