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Neuropsychiatric Disorders and Potentially Preventable Hospitalizations in a Prospective Cohort Study of Older Americans

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A Capsule Commentary to this article was published on 04 July 2014

ABSTRACT

BACKGROUND

The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood.

OBJECTIVE(S)

To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI).

DESIGN

Prospective cohort study.

PARTICIPANTS

Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998–2008).

MAIN MEASURES

The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

KEY RESULTS

All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95 % Confidence Interval [95%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.

CONCLUSIONS

Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions.

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REFERENCES

  1. Aronow WS. Heart disease and aging. Med Clin North Am. 2006;90:849–862.

    Article  PubMed  Google Scholar 

  2. Caspersen CJ, Thomas GD, Boseman LA, Beckles GLA, Albright AL. Aging, diabetes, and the public health system in the United States. Am J Public Health. 2012;102:1482–1497.

    Article  PubMed  PubMed Central  Google Scholar 

  3. American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033–1046.

    Article  PubMed Central  Google Scholar 

  4. Kuehn BM. Cutting Medicare costs will require multipronged approach. JAMA. 2013;309:1334–1335.

    Article  PubMed  CAS  Google Scholar 

  5. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–1428.

    Article  PubMed  CAS  Google Scholar 

  6. Centers for Medicare and Medicaid Services. Readmissions Reduction Program. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html Accessed May 23, 2014.

  7. Niefeld MR, Braunstein JB, Wu AW, Saudek CD, Weller WE, Anderson GF. Preventable hospitalizations among elderly Medicare beneficiaries with type 2 diabetes. Diabetes Care. 2003;26:1344–1349.

    Article  PubMed  Google Scholar 

  8. Fry AM, Shay DK, Holman RC, Curns AT, Anderson LJ. Trends in hospitalization for pneumonia among persons aged 65 years or older in the United States, 1988-2002. JAMA. 2005;294:2712–2719.

    Article  PubMed  CAS  Google Scholar 

  9. Yan LL, Daviglus ML, Liu K, et al. Midlife body mass index and hospitalization and mortality in older age. JAMA. 2006;295:190–198.

    Article  PubMed  CAS  Google Scholar 

  10. Robinson S, Howie-Esquivel J, Vlahov D. Readmission risk factors after hospital discharge among the elderly. Popul Health Manag. 2012;15:338–351.

    Article  PubMed  Google Scholar 

  11. Dharmarajan K, Hsieh AF, Lin Z, et al. Diagnoses and timing of 30-day readmissions after hospitalizations for heart failure, acute myocardial infarction, or pneumonia. JAMA. 2013;309:355–363.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  12. Zivin K, Pirraglia PA, McCammon RJ, Langa KM, Vijan S. Trends in Depressive Symptom Burden Among Older Adults in the United States from 1998 to 2008. J Gen Intern Med. 2013;28:1611–1619.

    Article  PubMed  Google Scholar 

  13. Plassman BL, Langa KM, Fisher GG, et al. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2008;148:427–434.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hurd MD, Martorell P, Delavande A, Mullen KJ, Langa KM. Monetary costs of dementia in the United States. N Engl J Med. 2013;368:1326–1334.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  15. Mitchell SE, Paasche-Orlow MK, Forsythe SR, et al. Post-discharge hospital utilization among adult medical inpatients with depressive symptoms. J Hosp Med. 2010;5:378–384.

    Article  PubMed  Google Scholar 

  16. Burke RE, Donzé J, Schnipper JL. Contribution of psychiatric illness and substance abuse to 30-day readmission risk. J Hosp Med. 2013;8:450–455.

    Article  PubMed  Google Scholar 

  17. Phelan EA, Borson S, Grothaus L, Balch S, Larson EB. Association of incident dementia with hospitalizations. JAMA. 2012;307:165–172.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. Davydow DS, Katon WJ, Lin EHB, et al. Depression and risk of hospitalizations for ambulatory care-sensitive conditions in patients with diabetes. J Gen Intern Med. 2013;28:921–929.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the Cardiovascular Health Study. JAMA. 2002;288:1475–1483.

    Article  PubMed  Google Scholar 

  20. Health and Retirement Study: Sample sizes and response rates. http://hrsonline.isr.umich.edu/sitedocs/sampleresponse.pdf. Accessed May 22, 2014.

  21. Steffick DE. Documentation of affective functioning measures in the Health and Retirement Study. Ann Arbor, Michigan: Survey Research Center; 2000.

    Book  Google Scholar 

  22. Langa KM, Valenstein MA, Fendrick AM, Kabeto MA, Vijan S. Extent and cost of informal caregiving for older Americans with symptoms of depression. Am J Psychiatry. 2004;161:857–863.

    Article  PubMed  Google Scholar 

  23. Zivin K, Llewellyn DJ, Lang IA, et al. Depression among older adults in the United States and England. Am J Geriatr Psychiatr. 2010;18:1036–1044.

    Article  Google Scholar 

  24. Crimmins EM, Kim JK, Langa KM, Weir DR. Assessment of cognition using surveys and neuropsychological assessment: the health and retirement study and the aging, demographics, and memory study. J Gerontol B Psychol Sci Soc Sci. 2011;66(Suppl 1):i162–i171.

    Article  PubMed  Google Scholar 

  25. Charlson ME, Pompei P, Ales KL. A new method for classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.

    Article  PubMed  CAS  Google Scholar 

  26. Agency for Healthcare Research and Quality. AHRQ Quality Indicators - Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions. Rockville, MD: Agency for Healthcare Research and Quality, 2001. AHRQ Pub No. 02-R0203.

  27. Coffey R, Barrett M, Houchens R, et al. Methods Applying AHRQ Quality Indicators to Healthcare Cost and Utilization Project (HCUP) Data for the Seventh (2009) National Healthcare Quality Report. HCUP Methods Series Report #2009-01. Rockville, MD: Agency for Healthcare Research and Quality. August 2009.

  28. Aronsky D, Haug PJ, Lagor C, et al. Accuracy of administrative data for identifying patients with pneumonia. Am J Med Qual. 2005;20:319–328.

    Article  PubMed  Google Scholar 

  29. Saczynski JS, Andrade SE, Harrold LR, et al. A systematic review of validated methods for identifying heart failure using administrative data. Pharmacoepidemiol Drug Saf. 2012;21(Suppl 1):129–140.

    Article  PubMed  Google Scholar 

  30. Kiyota Y, Schneeweiss S, Glynn RJ, Cannuscio CC, Avorn J, Solomon DH. Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: estimating positive predictive value on the basis of review of hospital records. Am Heart J. 2004;148:99–104.

    Article  PubMed  Google Scholar 

  31. Allison PD. Survival analysis. http://www.statisticalhorizons.com/wp-content/uploads/2012/01/Allison_SurvivalAnalysis.pdf. Accessed May 22, 2014.

  32. Rockhill B, Newman B, Weinberg C. Use and misuse of population attributable fractions. Am J Public Health. 1998;88:15–19.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  33. Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.

    Article  Google Scholar 

  34. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.

    Article  PubMed  CAS  Google Scholar 

  35. Okura T, Plassman BL, Steffens DC, Llewellyn DJ, Potter GG, Langa KM. Neuropsychiatric symptoms and the risk of institutionalization and death: the Aging, Demographics, and Memory Study. J Am Geriatr Soc. 2011;59:473–481.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Okura T, Langa KM. Caregiver burden and neuropsychiatric symptoms in older adults with cognitive impairment: the Aging, Demographics, and Memory Study. Alzheimer Dis Assoc Disord. 2011;25:116–121.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ehlenbach WJ, Hough CL, Crane PK, et al. Association between acute care and critical illness hospitalization and cognitive function in older adults. JAMA. 2010;303:763–770.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  38. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304:1787–1794.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  39. Wilson RS, Hebert LE, Scherr PA, Dong X, Leurgens SE, Evans DA. Cognitive decline after hospitalization in a community population of older persons. Neurology. 2012;78:950–956.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  40. Davydow DS, Hough CL, Levine DA, Langa KM, Iwashyna TJ. Functional disability, cognitive impairment, and depression after hospitalization for pneumonia. Am J Med. 2013;126:615–624.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Katon WJ. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry. 2003;54:216–226.

    Article  PubMed  Google Scholar 

  42. Penninx BW, Kritchevsky SB, Yaffe K, et al. Inflammatory markers and depressed mood in older persons: results from the Health, Aging and Body Composition study. Biol Psychiatry. 2003;54:566–572.

    Article  PubMed  CAS  Google Scholar 

  43. Bindman AB, Chattopadhay A, Auerback GA. Interruptions in Medicaid coverage and risk for hospitalization for ambulatory care-sensitive conditions. Ann Intern Med. 2008;149:854–860.

    Article  PubMed  Google Scholar 

  44. Ronksley PE, Brien SE, Turner BJ, Mukamal KJ, Ghali WA. Association of alcohol consumption with selected cardiovascular disease outcomes: a systematic review and meta-analysis. BMJ. 2011;342:d671.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Byles J, Young A, Furuya H, Parkinson L. A drink to healthy aging: The association between older women’s use of alcohol and their health-related quality of life. J Am Geriatr Soc. 2006;54:1341–1347.

    Article  PubMed  Google Scholar 

  46. Unützer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288:2836–2845.

    Article  PubMed  Google Scholar 

  47. Katon WJ, Von Korff M, Lin EH, et al. The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry. 2004;61:1042–1049.

    Article  PubMed  Google Scholar 

  48. Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006;166:2314–2321.

    Article  PubMed  Google Scholar 

  49. Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010;363:2611–2620.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  50. Callahan CM, Boustani MA, Unverzagt FW, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA. 2006;295:2148–2157.

    Article  PubMed  CAS  Google Scholar 

  51. Coleman EA, Parry C, Chalmers S, Min SJ. The Care Transitions Intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166:1822–1828.

    Article  PubMed  Google Scholar 

  52. Brock J, Mitchell J, Irby K, et al. Association between quality improvement for care transitions in communities and rehospitalizations among Medicare beneficiaries. JAMA. 2013;309:381–391.

    Article  PubMed  CAS  Google Scholar 

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Acknowlegdements

The Health and Retirement Study was performed at the Institute for Social Research, University of Michigan. We appreciate the expert programming of Laetitia Shapiro at the University of Michigan.

FUNDING

This work was supported by grants KL2 TR000421, K08 HL091249, R01 AG030155, and U01 AG09740 from the National Institutes of Health.

POTENTIAL CONFLICTS OF INTEREST

Dr. Katon has received honorariums for CME lectures from Eli Lilly, Forest, and Pfizer pharmaceutical companies. Drs. Davydow, Zivin, Pontone, Chwastiak, Langa, and Iwashyna have no relevant potential conflicts of interest to disclose.

DISCLAIMER

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the National Institutes of Health, or the US government.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, 1959 NE Pacific St, Seattle, WA, 98195, USA

    Dimitry S. Davydow M.D., M.P.H., Wayne J. Katon M.D. & Lydia Chwastiak M.D., M.P.H.

  2. Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA

    Kara Zivin Ph.D., Kenneth M. Langa M.D., Ph.D. & Theodore J. Iwashyna M.D., Ph.D.

  3. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA

    Kara Zivin Ph.D.

  4. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

    Kara Zivin Ph.D., Kenneth M. Langa M.D., Ph.D. & Theodore J. Iwashyna M.D., Ph.D.

  5. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA

    Gregory M. Pontone M.D.

  6. Department of Medicine, University of Michigan, Ann Arbor, MI, USA

    Kenneth M. Langa M.D., Ph.D. & Theodore J. Iwashyna M.D., Ph.D.

Authors
  1. Dimitry S. Davydow M.D., M.P.H.
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  2. Kara Zivin Ph.D.
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  6. Kenneth M. Langa M.D., Ph.D.
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Corresponding author

Correspondence to Dimitry S. Davydow M.D., M.P.H..

Additional information

Dr. Davydow has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Davydow, D.S., Zivin, K., Katon, W.J. et al. Neuropsychiatric Disorders and Potentially Preventable Hospitalizations in a Prospective Cohort Study of Older Americans. J GEN INTERN MED 29, 1362–1371 (2014). https://doi.org/10.1007/s11606-014-2916-8

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  • DOI: https://doi.org/10.1007/s11606-014-2916-8

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