RELATION BETWEEN SYMPTOMS OF DEPRESSION AND HEALTH-STATUS OUTCOMES INACUTELY ILL HOSPITALIZED OLDER PERSONS

Background: Older patients often have poor health status outcomes afte r hospitalization. Symptoms of depression are common in hospitalized o lder persons and may be a risk factor for these poor outcomes. Objecti ve: To determine whether symptoms of depression predict worse health s tatus outcomes in acutely ill, older medical patients, independent of health status and severity of illness at hospital admission. Design: P rospective cohort study. Setting: Medical service of a teaching hospit al. Patients: 572 hospitalized medical patients older than 70 years of age. Measurements: 15 symptoms of depression, health status, and seve rity of illness were measured at admission. The main outcome was depen dence in basic activities of daily living at discharge and 30 and 90 d ays after discharge. Other outcome measures were dependence in instrum ental activities of daily living, fair or poor global health status, a nd poor global satisfaction with life. Results: The median number of s ymptoms of depression on admission was 4. Patients with 6 or more symp toms on admission (n = 196) were more likely than patients with 0 to 2 symptoms (n = 181) to be dependent in basic activities of daily livin g (odds ratio, 2.47 [95% Cl, 1.58 to 3.86]) after controlling for demo graphic characteristics and severity of illness. At each subsequent ti me point, patients with more symptoms of depression on admission were more likely to be dependent in basic activities of daily living. This association persisted after adjustment for dependence in basic activit ies of daily living, severity of illness, and demographic characterist ics on admission. The odds ratios comparing patients who had 6 or more symptoms with those who had 0 to 2 symptoms were 3.23 (Cl, 1.76 to 5. 95) at discharge, 3.45 (Cl, 1.81 to 6.60) 30 days after discharge, and 2.15 (Cl, 1.15 to 4.03) 90 days after discharge. At each time point, patients with 6 or more symptoms of depression were more likely to hav e more dependence in instrumental activities of daily living, worse gl obal health status, and less satisfaction with life. Conclusions: Symp toms of depression identified a vulnerable group of hospitalized older persons. The health status of patients with more symptoms of depressi on was after hospitalization. This association was not attributable to health status or severity of illness on admission. The temporal seque nce and magnitude of this association, its consistency over time with different measures, and its independence from the severity of the soma tic illness strongly support a relation between symptoms of depression on admission and subsequent health status outcomes.