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
JournalJournal of General Internal Medicine
Volume29
Issue10
Pagination1362-1371
KeywordsHealth Conditions and Status, Healthcare, Other
Abstract

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. 2014 Society of General Internal Medicine.

Notes

Export Date: 6 August 2014 Article in Press

DOI10.1007/s11606-014-2916-8
Endnote Keywords

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

Endnote ID

999999

Citation Key7967
PubMed ID24939712
PubMed Central IDPMC4175651