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

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 

Notes

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.

Supplementary material

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REFERENCES

  1. 1.
    Aronow WS. Heart disease and aging. Med Clin North Am. 2006;90:849–862.PubMedCrossRefGoogle Scholar
  2. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36:1033–1046.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Kuehn BM. Cutting Medicare costs will require multipronged approach. JAMA. 2013;309:1334–1335.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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. 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.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 10.
    Robinson S, Howie-Esquivel J, Vlahov D. Readmission risk factors after hospital discharge among the elderly. Popul Health Manag. 2012;15:338–351.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 17.
    Phelan EA, Borson S, Grothaus L, Balch S, Larson EB. Association of incident dementia with hospitalizations. JAMA. 2012;307:165–172.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 20.
    Health and Retirement Study: Sample sizes and response rates. http://hrsonline.isr.umich.edu/sitedocs/sampleresponse.pdf. Accessed May 22, 2014.
  21. 21.
    Steffick DE. Documentation of affective functioning measures in the Health and Retirement Study. Ann Arbor, Michigan: Survey Research Center; 2000.CrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. 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.Google Scholar
  27. 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.Google Scholar
  28. 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.PubMedCrossRefGoogle Scholar
  29. 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.PubMedCrossRefGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. 31.
  32. 32.
    Rockhill B, Newman B, Weinberg C. Use and misuse of population attributable fractions. Am J Public Health. 1998;88:15–19.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496–509.CrossRefGoogle Scholar
  34. 34.
    Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Katon WJ. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry. 2003;54:216–226.PubMedCrossRefGoogle Scholar
  42. 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.PubMedCrossRefGoogle Scholar
  43. 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.PubMedCrossRefGoogle Scholar
  44. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 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.PubMedCrossRefGoogle Scholar
  46. 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.PubMedCrossRefGoogle Scholar
  47. 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.PubMedCrossRefGoogle Scholar
  48. 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.PubMedCrossRefGoogle Scholar
  49. 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.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 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.PubMedCrossRefGoogle Scholar
  51. 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.PubMedCrossRefGoogle Scholar
  52. 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.PubMedCrossRefGoogle Scholar

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

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