Journal of General Internal Medicine

, Volume 29, Issue 10, pp 1362–1371 | Cite as

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

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



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.


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).


Prospective cohort study.


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


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.


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.


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.


depression dementia ambulatory care-sensitive condition hospitalization rehospitalization 



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.


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


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.


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.

Supplementary material

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Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Dimitry S. Davydow
    • 1
    Email author
  • 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

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