|Title||Neuropsychiatric disorders and potentially preventable hospitalizations in a prospective cohort study of older Americans.|
|Publication Type||Journal Article|
|Year of Publication||2014|
|Authors||Davydow, DS, Zivin, K, Katon, WJ, Pontone, GM, Chwastiak, L, Langa, KM, Iwashyna, TJ|
|Journal||J Gen Intern Med|
|Date Published||2014 Oct|
|Keywords||Aged, Aged, 80 and over, Cognition Disorders, Cohort Studies, Dementia, depression, Female, Hospitalization, Humans, Male, Mental Disorders, Prospective Studies, Risk Factors, United States|
BACKGROUND: The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood.
OBJECTIVE(S): To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI).
DESIGN: Prospective cohort study.
PARTICIPANTS: Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998-2008).
MAIN MEASURES: The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.
KEY RESULTS: All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95% Confidence Interval [95%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI.
CONCLUSIONS: Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions.
Export Date: 6 August 2014 Article in Press
|User Guide Notes|
|Endnote Keywords|| |
depression/dementia/ambulatory care-sensitive/condition/hospitalization/rehospitalization/cognitive impairment
|Endnote ID|| |
|Alternate Journal||J Gen Intern Med|
|PubMed Central ID||PMC4175651|
|Grant List||U01 AG009740 / AG / NIA NIH HHS / United States |
P30 DK092926 / DK / NIDDK NIH HHS / United States
R01 AG030155 / AG / NIA NIH HHS / United States
U01 AG09740 / AG / NIA NIH HHS / United States
KL2 TR000421 / TR / NCATS NIH HHS / United States
UL1 TR000423 / TR / NCATS NIH HHS / United States
K08 HL091249 / HL / NHLBI NIH HHS / United States