The relationship between clinically relevant depressive symptoms and episodes and duration of all cause hospitalisation in Southern Chinese elderly
ABSTRACT Identification of depression as an independent factor for increased hospital service utilization, or as part of other factors, is important for primary healthcare in possibly preventing use of hospitals. The objective of this study was to study the effects of having clinically relevant depressive symptoms in community dwelling elderly on all cause hospitalization in the elderly.
We administered the validated Chinese version of Geriatric Depression Scale on 3770 men and women aged 65 years and over. Duration and episodes of hospitalization were assessed using 4-monthly telephone interviews and database from the Hospital Authority over a 4-year period. The associations between the presence of clinically relevant depressive symptoms and the number of hospitalizations and duration of hospitalization were studied by multiple Poisson regression analysis.
The presence of clinically relevant depressive symptoms was independently associated with increased episodes (RR: 1.29; CI: 1.16-1.43) and increased length of stay (RR: 1.18; CI: 1.10-1.25) for all cause hospitalization in those with and without chronic conditions at baseline.
Our study relied on self report of chronic medical conditions. As a result, under-diagnosis of diseases and misclassification of disease status could not be excluded.
It was shown that clinically relevant depressive symptoms are independently associated with inpatient utilization over a 4-year period after adjustment for socioeconomic and health status in these elderly subjects. Identification and effective management of depression in primary care may be one way to reduce hospital service utilization in the elderly in China.
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- "However, after full adjustment the association they reported remained statistically significant only among men aged 75 and over (RR = 3.43, 95% CI: 1.33–8.9). Of the other seven studies, four reported an independent effect of depressive symptoms on hospitalisation    , whereas the other four     reported wide 95% CI confidence intervals after adjustment for potential confounders (Table 3). Only one study  "
ABSTRACT: Objectives This paper aims to systematically review observational studies that have analysed whether depressive symptoms in the community are associated with higher general hospital admissions, longer hospital stays and increased risk of re-admission. Methods We identified prospective studies that looked at depressive symptoms in the community as a risk factor for non-psychiatric general hospital admissions, length of stay or risk of re-admission. The search was carried out on MEDLINE, PsycINFO, Cochrane Library Database, and followed up with contact with authors and scanning of reference lists. Results Eleven studies fulfilled our inclusion and exclusion criteria, and all were deemed to be of moderate to high quality. Meta-analysis of seven studies with relevant data suggested that depressive symptoms may be a predictor of subsequent admission to a general hospital in unadjusted analyses (RR = 1.36, 95% CI: 1.28–1.44), but findings after adjustment for confounding variables were inconsistent. The narrative synthesis also reported depressive symptoms to be independently associated with longer length of stay, and higher re-admission risk. Conclusions Depressive symptoms are associated with a higher risk of hospitalisation, longer length of stay and a higher re-admission risk. Some of these associations may be mediated by other factors, and should be explored in more details.Journal of psychosomatic research 11/2014; DOI:10.1016/j.jpsychores.2014.11.002 · 2.84 Impact Factor
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ABSTRACT: Depression is frequently encountered in hospitalized elderly persons. Studies have found an independent association between depressive symptoms, mortality and functional decline. Only a few studies look specifically at other potential effects of depressive symptoms, such as subsequent hospital readmission or nursing home admission. In this study, we aim to investigate the association between the presence of depressive symptoms and nursing home placement, hospital admission and mortality in a group of geriatric outpatients receiving rehabilitation. All community dwelling elderly patients with no history of depression or cognitive impairment who were new attendances of a geriatric day hospital of a regional hospital in Hong Kong were recruited. Baseline demographic data, medical comorbidities, functional status and presence of depressive symptoms defined as a Geriatric Depression Scale score of more than 8 were recorded. Outcome variables were mortality, nursing home admission and unplanned hospital admission rate at 1 year. Two hundred and nine subjects were included with a mean age of 77.4 years (standard deviation, 7.6). There was no statistically significant difference on mortality at 1 year and nursing home admission. However, depressed subjects were found to have increased risk of hospital admission (odds ratio = 2.67, 95% confidence interval = 1.31, 5.32) and have more episodes of unplanned hospital admission (odds ratio = 1.52, 95% confidence interval = 1.1, 2.12). Elderly patients with depressive symptoms are associated with increased risk of hospital admission and greater inpatient service utilization, independent of their functional status. These results emphasize the need to improve the management of depressive symptoms and heighten the recognition and treatment of depression in the elderly population.Geriatrics & Gerontology International 12/2010; 11(2):174-9. DOI:10.1111/j.1447-0594.2010.00665.x · 1.58 Impact Factor
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ABSTRACT: This population-based study examined the relative and combined relationships of chronic medical illness (CMI) and depressive symptoms with health care utilization among older adults in South Korea. A nationally representative sample of 3224 older adults participating in the Korean Longitudinal Study of Ageing (KLoSA) were categorized into four groups based on clinical characteristics: CMI only; depressive symptoms only; CMI and depressive symptoms; and neither CMI nor depressive symptoms. We estimated the use of various health care services by the groups while adjusting for clinical and sociodemographic characteristics. Depressive symptoms, as measured by the short-form Center for Epidemiological Studies-Depression scale (CES-D10), were prevalent, often occurring together with CMI in community-dwelling older adults in South Korea. Having depressive symptoms was positively associated with the use of inpatient services, outpatient physician services, and public health centers. The odds of using health care services were larger among older people with both depressive symptoms and CMI than depressive symptoms only. Self-reported depressive symptoms and self-reported CMI are prevalent among older adults in South Korea, often occurring together and possibly increasing health care utilization. These findings imply a need for chronic disease management targeting older people with complex mental and medical conditions and evaluation of its effects on health outcomes and service use.International Psychogeriatrics 03/2011; 23(8):1285-93. DOI:10.1017/S1041610211000123 · 1.89 Impact Factor