Depressive symptoms as a predictor of 6-month outcomes and services utilization in elderly medical inpatients

Background: Depressive symptoms have been associated with higher mortality in hospitalized elderly persons, but few data are available associating dep ressive symptoms with other outcomes. Objective: To determine the association between depressive symptoms and the risk of hospital readmission, nursing home admission, and death as well as inpatient services utilization during a 6-month follow-up period in a coho rt of elderly medical inpatients. Methods: We enrolled 401 patients, 75 years and older, admitted to the inte rnal medicine service of an academic hospital in Lausanne, Switzerland. Dat a on demographic, medical, physical, social, and mental status were collect ed on admission. Depressive symptoms were defined as a score of 6 or higher on the Geriatric Depression Scale short form. Follow-up data were gathered from the centralized billing system (hospital and nursing home admissions) and from proxies (in cases of death). Results: In bivariate analysis, depressive symptoms were associated with an increased risk of hospital readmission, nursing home placement, and death. After adjustment for demographic, socioeconomic, and functional status and comorbidity, depressive symptoms remained associated with an increased ris k of hospital readmission (adjusted hazard ratio, 1.50; 95% confidence inte rval, 1.03-2.17; P=.03). In addition, depressive symptoms were associated w ith increased average costs of both acute and rehabilitation services, resu lting in higher overall costs of inpatient services. ($175.70 vs $126.00; P < .001). This association remained after adjusting for differences in func tional status, comorbidity, and living, situation, although it was just sho rt of statistical significance (P=.07). Conclusions: Elderly medical inpatients with depressive symptoms were more likely than those without to be readmitted and had higher inpatient service s utilization during the follow-up period, independent of functional and he alth status. These results emphasize the need for interventions directed at improving management of depressive symptoms, given the low recognition and treatment rates of this problem in elderly populations.