Abstract
Depressive disorder is the most prevalent mental health issue among the elderly. Researchers have studied associations between poor outcomes of health and depressive disorder. However, there is limited knowledge on the association of depressive disorder on hospital outcomes of care for patients admitted due to acute health problems. This study utilized a large dataset from the Centers for Medicare and Medicaid Services to examine associations between depressive disorder and (i) length of stay, (ii) hospital mortality, and (iii) hospital-acquired septicemia, for hospitalized Medicare patients 65 years and above. Bivariate analysis was firstly conducted between each one of the outcomes of interest and the depressive disorder variable, and then, to control for demographics, primary diagnosis, and comorbidities, multiple logistic regression was conducted for the binary outcomes (hospital mortality and hospital-acquired septicemia) and multiple linear regression for the continuous outcome, Length of Stay. After adjusting for patient gender, ethnicity, primary diagnosis, and comorbidities, the presence of depressive disorder in elderly Medicare patients was found to be associated with increased odds for hospital death (OR = 1.186, C. I = 1.030—1.365), and a shorter hospital length of stay (b = -.697, p < 0.001). Black race was found to be protective for death for patients with depressive disorder. Since depression has an effect on various behavioral aspects of patients, the increased risk for hospital death underlines the need for a holistic patient care approach for acute patients with depression, including psychologic support, effective patient-therapist communication, and patient empowerment.
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References
Alexopoulos, G., Katz, I., Reynolds, C., Carpenter, D., Docherty, J., & Ross, R. (2001). Pharmacotherapy of depressive disorder in older patients: A summary of the expert consensus guidelines. Journal of Psychiatric Practice, 7(6), 361–376. https://doi.org/10.1097/00131746-200111000-00003
Boswell, E. B., & Stoudemire, A. (1996). Major depressive disorder in the primary care setting. The American Journal of Medicine, 101(6), 3S-9S. https://doi.org/10.1016/S0002-9343(96)00392-0
Brody, J. D., Pratt, L. A., & Hughes, J. P. (2018). Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016. NCHS Data Brief, 303, 1–8.
Bruce, M. L., Ten Have, T. R., Reynolds, C. F., III., Katz, I. I., Schulberg, H. C., et al. (2004). Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: A randomized controlled trial. JAMA, 291, 1081–1091. https://doi.org/10.1001/jama.291.9.1081
Cavanaugh, S. von A., Furlanetto, L.M., Creech, S. D., & Powell, L.H. (2001). Medical Illness, Past Depressive disorder, and Present Depressive disorder: A Predictive Triad for In-Hospital Mortality. American Journal of Psychiatry, 158(1), 43–48. https://doi.org/10.1176/appi.ajp.158.1.43
Centers for Disease Control and Prevention and National Association of Chronic Disease Directors. (2008). The State of Mental Health and Aging in America Issue Brief 1: What do the data tell us? Atlanta, GA: National Association of Chronic Disease Directors. https://www.cdc.gov/aging/pdf/mental_health.pdf.
Centers for Disease Control and Prevention. (2005). Behavioral Risk Factor Surveillance System (BRFSS) operational and user’s guide. Version 3.0. https://www.cdc.gov/brfss/pdf/userguide.pdf.
Centers for Disease Control and Prevention, CDC. (2018). Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016. https://www.cdc.gov/nchs/products/databriefs/db303.htm
Conejero, I., Olié, E., Courtet, P., & Calati, R. (2018). Suicide in older adults: Current perspectives. Clinical Interventions in Aging, 13, 691–699. https://doi.org/10.2147/cia.s130670
Cullum, S., Metcalfe, C., Todd, C., & Brayne, C. (2008). Does depressive disorder predict adverse outcomes for older medical inpatients? A prospective cohort study of individuals screened for a trial. Age and Ageing, 37(6), 690–695. https://doi.org/10.1093/ageing/afn193
Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depressive disorder in older adults. Annual Review of Clinical Psychology, 5, 363–389. https://doi.org/10.1146/annurev.clinpsy.032408.153621
Gallo, J.J., Morales, K.H., Bogner, H.R., Raue, P.J., Zee, J., Bruce, M.L., & Reynolds, C.F. (2013). Long term effect of depressive disorder care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care. BMJ: British Medical Journal, 346, f2570. https://doi.org/10.1136/bmj.f2570
HCUP-US: Statistical Briefs. (2015). Depression, drug abuse, and eating disorders. https://www.hcupus.ahrq.gov/reports/statbriefs/sb_mhsa.jsp
Kalibatseva, Z., & Leong, F.T.L. (2011). Depressive disorder among Asian Americans: Review and Recommendations. Depressive disorder Research and Treatment, ID: 320902. 320902 https://doi.org/10.1155/2011/320902
Katon, W. J., Lin, E., Russo, J., & Unützer, J. (2003). Increased Medical Costs of a Population-Based Sample of Depressed Elderly Patients. Archives of General Psychiatry, 60(9), 897–903. https://doi.org/10.1001/archpsyc.60.9.897
Kucharska-Newton, A. M., Heiss, G., Ni, H., Stearns, S. C., Puccinelli-Ortega, N., Wruck, L. M., & Chambless, L. (2016). Identification of Heart Failure Events in Medicare Claims: The Atherosclerosis Risk in Communities (ARIC) Study. Journal of Cardiac Failure, 22, 48–55. https://doi.org/10.1016/j.cardfail.2015.07.013
Larsen, K., Schroll, M., & Avlund, K. (2006). Depressive symptomatology at age 75 and subsequent use of health and social services. Archives of Gerontology and Geriatrics, 42(2), 125–139. https://doi.org/10.1016/j.archger.2005.06.004
Lin, E. H., Katon, W., Von Korff, M., Tang, L., Williams, Jr., J. W., et al. (2003). Effect of improving depressive disorder care on pain and functional outcomes among older adults with arthritis: A randomized controlled trial. JAMA, 290, 2428–2429. https://doi.org/10.1001/jama.290.18.2428
Mental Health America. (2019). Depression in older adults: More facts. Mental Health America. https://www.mentalhealthamerica.net/conditions/depression-older-adults-more-facts.
Penninx, B.W.J.H, Guralnik, J.M., Havlik, R.J., Pahor, M., Ferrucci, L., Cerhan, J.R., & Wallace, R.B. (1998). Chronically Depressed Mood and Cancer Risk in Older Persons. JNCI: Journal of the National Cancer Institute, 90(24), 1888–1893. https://doi.org/10.1093/jnci/90.24.1888
Prina, A. M., Cosco, T. D., Dening, T., Beekman, A., Brayne, C., & Huisman, M. (2015). The association between depressive symptoms in the community, non-psychiatric hospital admission and hospital outcomes: A systematic review. Journal of Psychosomatic Research, 78(1), 25–33. https://doi.org/10.1016/j.jpsychores.2014.11.002
Prina, A. M., Deeg, D., Brayne, C., Beekman, A., & Huisman, M. (2012). The Association between Depressive Symptoms and Non-Psychiatric Hospitalization in Older Adults. PLoS ONE, 7(4), e34821. https://doi.org/10.1371/journal.pone.0034821
Prina, A.M., Huisman, M., Yeap, B.B., Hankey, G.J., Flicker, L., Brayne, C., & Almeida, O.P. (2013). Association between depression and hospital outcomes among older men. CMAJ: Canadian Medical Association Journal = Journal de l’Association Medicale Canadienne, 85(2), 117–123. https://doi.org/10.1503/cmaj.121171
Rostomyan, L., Daly, A. F., Petrossians, P., Nachev, E., Lila, A. R., Lecoq, A.-L., Lecumberri, B., Trivellin, G., Salvatori, R., Moraitis, A. G., et al. (2015). Clinical and genetic characterization of pituitary gigantism: An international collaborative study in 208 patients. Endocrine-Related Cancer, 22, 745–757. https://doi.org/10.1530/erc-15-0320
Rowan, P. J., Davidson, K., Campbell, J. A., Dobrez, D. G., & MacLean, D. R. (2002). Depressive symptoms predict medical care utilization in a population-based sample. Psychological Medicine, 32(5), 903–908. https://doi.org/10.1017/s0033291702005767
Sadovsky, R. (1998). Prevalence and recognition of depressive disorder in elderly patients. American Family Physician, 57(5), 1096–1098.
Sayers, S. L., Hanrahan, N., Kutney, A., Clarke, S. P., Reis, B. F., & Riegel, B. (2007). Psychiatric Comorbidity and Greater Hospitalization Risk, Longer Length of Stay, and Higher Hospitalization Costs in Older Adults with Heart Failure. Journal of the American Geriatrics Society, 55(10), 1585–1591. https://doi.org/10.1111/j.1532-5415.2007.01368.x
Schulz, R., Beach, S. R., Ives, D. G., Martire, L. M., Ariyo, A. A., & Kop, W. J. (2000). Association between Depressive disorder and Mortality in Older Adults: The Cardiovascular Health Study. JAMA Internal Medicine, 160(12), 1761–1768. https://doi.org/10.1001/archinte.160.12.1761
Unutzer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr., Hunkeler, E., et al. (2002). Collaborative care management of late-life depressive disorder in the primary care setting: A randomized controlled trial. JAMA, 288, 2836–2845. https://doi.org/10.1001/jama.288.22.2836
Unützer, J., Schoenbaum, M., Katon, W. J., Fan, M. Y., Pincus, H. A., Hogan, D., & Taylor, J. (2009). Healthcare Costs Associated with Depression in Medically Ill Fee-for-Service Medicare Participants. Journal of the American Geriatrics Society, 57(3), 506–510. https://doi.org/10.1111/j.1532-5415.2008.02134.x
Wong, S. Y., Mercer, S. M., Leung, J., & Woo, J. (2009). The relationship between clinically relevant depressive symptoms and episodes and duration of all cause hospitalization in Southern Chinese elderly. Journal of Affective Disorders, 113(3), 272–278. https://doi.org/10.1016/j.jad.2008.06.008
Zikos, D., Shrestha, A., Colotti, T., & Fegaras, L. (2019). A Supervised Pattern Analysis of the Length of Stay for Hip Replacement Admissions. Healthcare, 7(2), 58. https://doi.org/10.3390/2Fhealthcare7020058
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DZ designed the research, conducted the statistical analysis, and wrote the methods, and results portions of the paper, contributing to the introduction and discussion. OO wrote the introduction section and portion of the discussion and contributed to data preparation for the statistical analysis.
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The research does not involve human participants and/or Animals, since it was conducted with the use of secondary medical claims data purchased from the Centers for Medicare and Medicaid services with the intent to use for research regarding quality of care.
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Zikos, D., Afolayan-Oloye, O. Association between Depressive disorder and hospital outcomes of care for elderly hospitalized patients. Ageing Int 48, 180–193 (2023). https://doi.org/10.1007/s12126-021-09455-5
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DOI: https://doi.org/10.1007/s12126-021-09455-5