Neuropsychiatric disorders and potentially preventable hospitalizations in a prospective cohort study of older Americans.

TitleNeuropsychiatric disorders and potentially preventable hospitalizations in a prospective cohort study of older Americans.
Publication TypeJournal Article
Year of Publication2014
AuthorsDavydow, DS, Zivin, K, Katon, WJ, Pontone, GM, Chwastiak, L, Langa, KM, Iwashyna, TJ
JournalJ Gen Intern Med
Volume29
Issue10
Pagination1362-71
Date Published2014 Oct
ISSN Number1525-1497
KeywordsAged, Aged, 80 and over, Cognition Disorders, Cohort Studies, Dementia, depression, Female, Hospitalization, Humans, Male, Mental Disorders, Prospective Studies, Risk Factors, United States
Abstract

<p><b>BACKGROUND: </b>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.</p><p><b>OBJECTIVE(S): </b>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).</p><p><b>DESIGN: </b>Prospective cohort study.</p><p><b>PARTICIPANTS: </b>Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998-2008).</p><p><b>MAIN MEASURES: </b>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.</p><p><b>KEY RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>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.</p>

Notes

Export Date: 6 August 2014 Article in Press

DOI10.1007/s11606-014-2916-8
User Guide Notes

http://www.ncbi.nlm.nih.gov/pubmed/24939712?dopt=Abstract

Endnote Keywords

depression/dementia/ambulatory care-sensitive/condition/hospitalization/rehospitalization/cognitive impairment

Endnote ID

999999

Alternate JournalJ Gen Intern Med
Citation Key7967
PubMed ID24939712
PubMed Central IDPMC4175651
Grant ListU01 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