Journal of General Internal Medicine

, Volume 29, Issue 10, pp 1362–1371

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

  • Dimitry S. Davydow
  • Kara Zivin
  • Wayne J. Katon
  • Gregory M. Pontone
  • Lydia Chwastiak
  • Kenneth M. Langa
  • Theodore J. Iwashyna
Original Research

DOI: 10.1007/s11606-014-2916-8

Cite this article as:
Davydow, D.S., Zivin, K., Katon, W.J. et al. J GEN INTERN MED (2014) 29: 1362. doi:10.1007/s11606-014-2916-8

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.

KEY WORDS

depression dementia ambulatory care-sensitive condition hospitalization rehospitalization 

Supplementary material

11606_2014_2916_MOESM1_ESM.docx (89 kb)
ESM 1(DOCX 89 kb)
11606_2014_2916_MOESM2_ESM.docx (19 kb)
ESM 1(DOCX 18 kb)
11606_2014_2916_MOESM3_ESM.docx (20 kb)
ESM 1(DOCX 20 kb)
11606_2014_2916_MOESM4_ESM.docx (19 kb)
ESM 1(DOCX 18 kb)
11606_2014_2916_MOESM5_ESM.docx (52 kb)
ESM 1(DOCX 51 kb)
11606_2014_2916_MOESM6_ESM.docx (48 kb)
ESM 1(DOCX 48 kb)

Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Dimitry S. Davydow
    • 1
  • Kara Zivin
    • 2
    • 3
    • 4
  • Wayne J. Katon
    • 1
  • Gregory M. Pontone
    • 5
  • Lydia Chwastiak
    • 1
  • Kenneth M. Langa
    • 2
    • 4
    • 6
  • Theodore J. Iwashyna
    • 2
    • 4
    • 6
  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA
  2. 2.Ann Arbor Veterans Affairs Center for Clinical Management ResearchAnn ArborUSA
  3. 3.Department of PsychiatryUniversity of MichiganAnn ArborUSA
  4. 4.Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  5. 5.Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreUSA
  6. 6.Department of MedicineUniversity of MichiganAnn ArborUSA

Personalised recommendations