HOSPITALIZATION FOR MAJOR DEPRESSION AMONG OLDER AMERICANS

Background. The objective of this study was to report the pattern of h ospitalization for major depression among older Americans and to exami ne correlates of those hospitalizations. We sought to investigate the hypothesis that hospitalization for major depression would be more com mon among those respondents with declining functional status whose abi lity to adapt to this decline was impaired by inadequate social suppor t systems or economic stressors. Methods. The data were taken from Ver sion 5 of the Longitudinal Study on Aging (LSOA), which includes 7,527 subjects who were aged 70 and older in 1984. We identified all subjec ts with any hospitalizations for which major depression was a discharg e diagnosis (ICD9-CM codes 296.2, 296.3, 300.4, and 311), and all subj ects for whom depression was the primary discharge diagnosis. Only pat ients with a first-listed discharge diagnosis of depression were consi dered to have been hospitalized for major depression. Results. The yea rly incidence of hospitalization for which depression was the primary discharge diagnosis was 0.1%. The mean length of stay was 14.6 days an d the mean hospital charge was $6,742. Length of stay and charges did not vary by hospital type (general vs psychiatric), but both charges a nd length of stay were significantly longer when major depression was the primary discharge diagnosis rather than a secondary diagnosis. Pat ients with a hospitalization for major depression had more hospitaliza tions, longer total lengths of stay, and greater total hospital charge s over the seven-year period as compared to patients with at least one hospitalization for any other reason. These differences in hospital r esource use dissipated when hospitalizations for depression were exclu ded. Hospitalization for major depression was not associated with gend er, race, education, or social support. Hospitalization for major depr ession was independently associated with a forced residential move, a history of nursing home stays, decline in household activities of dail y living, younger age, and perceived health rated as less than excelle nt. Conclusions, One older American per thousand is hospitalized each year with a primary discharge diagnosis of major depression. These ind ividuals did not have evidence of greater total hospital resource use if episodes of hospitalization for depression are eliminated. Hospital ization for major depression was more common among those with a loss o f independent living.