Health care utilization by older patients with coexisting dementia and depression

Objective: Few studies have examined the course of coexisting dementia and depression. The purpose of this study was to compare elderly patients who h ad coexisting dementia and depression with elderly patients who had either disorder alone in terms of their utilization of inpatient and outpatient se rvices. Method: The study group included 7,115 veterans aged 60 years or ol der who had been discharged from Department of Veterans Affairs inpatient u nits in 1992 with diagnoses of major depression, dementia, or both. Outcome measures were analyzed for a 2-year period following the index hospitaliza tion for each diagnostic study group. Results: Patients with coexisting dem entia and depression had significantly more psychiatric inpatient days than the other two study groups and more medical inpatient days and nursing hom e readmissions than patients with depression alone. Patients with coexistin g dementia and depression had significantly more total inpatient days than the other two groups. Notably, patients with coexisting dementia and depres sion did not utilize more outpatient resources than the other study groups; in fact, they had significantly fewer medical, psychiatric, and total visi ts than patients with depression alone. Conclusions: The findings suggest t hat patients with coexisting dementia and depression are high utilizers of inpatient services, with a course of illness that may resemble dementia in terms of nursing home and inpatient medical care utilization and depression in terms of inpatient psychiatric care utilization; however, these patient s utilized significantly fewer outpatient resources than the group with dep ression alone. Aggressive outpatient treatment approaches might reduce util ization of inpatient care for patients with coexisting depression and demen tia.