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Depressive Symptoms as a Predictor of 6-Month Outcomes and Services Utilization in Elderly Medical Inpatients
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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