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ABSTRACT: Subjects with depression might request more healthcare services. The aim of this study was to evaluate the association of depressive symptoms with hospitalization and mortality rates in a general unselected older population.
We assessed the association of the 30-items Geriatric Depression Scale (GDS) score with one-year hospitalization and mortality in all 344 subjects aged 75+ living in Tuscania (Italy). This population had been enrolled in a national study of the genetic determinants of health status. Analyses were conducted using continuous, as well as categorical GDS score levels.
After adjusting for potential confounders, depressive symptoms were associated in Cox regression modelling with hospitalization (relative risk, RR = 1.05; 95% confidence interval, CI = 1.01-1.09; p = 0.016), but not with mortality (RR = 1.06; 95% CI = 0.96-1.16; p = 0.246). Increasing GDS score levels were associated with increasing risk of hospitalization (p for trend = 0.033). Up to 39% of hospitalizations might be attributed to depression.
Depressive symptoms are not associated with increased mortality rates in general older populations. However, depressive symptoms represent a potentially reversible determinant of increased hospitalization rates in these subjects, independent of the presence and severity of other medical conditions.
Aging and Mental Health 11/2010; 14(8):955-61. · 1.37 Impact Factor
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ABSTRACT: The metabolic syndrome (MetS) is being increasingly found in older populations. Depressive symptoms are prevalent in elderly populations, and they are associated with adverse outcomes, chiefly cardiovascular. The aim of this study was to evaluate the association of the 30-item geriatric depression scale (GDS) score with MetS, as defined according to the National Cholesterol Education Program's Adult Treatment Panel III (ATP-III) criteria, in all 353 participants aged 75+ years living in Tuscania (Italy). Metabolic syndrome was associated with the GDS score in a multivariable linear regression analysis in women (beta s= 2.14, 95% CI = 0.14 to 4.14; P = .036), but not in men (beta = -.84, 95% CI = -3.17 to 1.49; P = .476), after adjusting. Analysis of the interaction term confirmed (P = .022) that such an association differed according to sex. Metabolic syndrome is independently associated with depressive symptoms in community-dwelling older women. Older women with depression should be prompted to undergo screening for MetS. Conversely, elderly women with MetS should be assessed for affective disorders.
Journal of Geriatric Psychiatry and Neurology 06/2009; 22(4):215-22. · 3.07 Impact Factor
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New England Journal of Medicine 05/2005; 352(17):1817-9; author reply 1817-9. · 53.30 Impact Factor
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ABSTRACT: Objective: To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community.
Design: Randomised study with 1 year follow up.
Setting: Town in northern Italy (Rovereto).
Subjects: 200 older people already receiving conventional community care services.
Intervention: Random allocation to an intervention group receiving integrated social and medical care and case management or to a control group receiving conventional care.
Main outcome measures: Admission to an institution, use and costs of health services, variations in functional status.
Results: Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls (hazard ratio 0.69; 95% confidence interval 0.53 to 0.91). Health services were used to the same extent, but control subjects received more frequent home visits by general practitioners. In the intervention group the estimated financial savings were in the order of £1125 ($1800) per year of follow up. The intervention group had improved physical function (activities of daily living score improved by 5.1% v 13.0% loss in controls; P<0.001). Decline of cognitive status (measured by the short portable mental status questionnaire) was also reduced (3.8% v 9.4%; P<0.05).
Conclusion: Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the community.
Key messages
Responsibility for management of care of elderly people living in the community is poorly definedIntegration of medical and social services together with care management programmes would improve such care in the communityIn a comparison of this option with a traditional and fragmented model of community care the integrated care approach reduced admission to institutions and functional decline in frail elderly people living in the community and also reduced costs
BMJ. 05/1998; 316(7141):1348.
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ABSTRACT: Objective: To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community.
