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Christophe J. Büla, MD; Vincent Wietlisbach, BA; Bernard Burnand, MD; Bertrand Yersin, MD

Arch Intern Med. 2001;161:2609-2615.

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.

From the Division of Geriatric Medicine (Dr Büla) and the Department of Internal Medicine (Drs Büla and Yersin), Centre Hospitalier Universitaire Vaudois; and the Institute of Social and Preventive Medicine, University of Lausanne (Drs Wietlisbach and Burnand), Lausanne, Switzerland.

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