Depressive Symptoms in Older People Predict Nursing Home Admission

Authors

  • Yael Harris PhD, MHS,

    1. From the *Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, MarylandDepartment of Medicine, School of Medicine, George Washington University, Washington, DC.
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  • James K. Cooper MD

    1. From the *Office of Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Baltimore, MarylandDepartment of Medicine, School of Medicine, George Washington University, Washington, DC.
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Address correspondence to Yael Harris, PhD, MHS, Centers for Medicare and Medicaid Services, 7500 Security Boulevard, Mailstop S3-02–01, Baltimore, MD 21244. E-mail: yharris@cms.hhs.gov

Abstract

OBJECTIVES: To evaluate the power of several self-reported depressive symptoms to predict nursing home admission (NHA).

DESIGN: A Cox proportional hazards model was used to estimate the risk of NHA.

SETTING: Data were from the Health Outcomes Survey (a national random sample of 137,000 Medicare + Choice enrollees aged 65 and older), the Nursing Home Minimum Data Set, and the Medicare Enrollment Database.

PARTICIPANTS: Medicare beneficiaries aged 65 and older enrolled in a Medicare Managed Care Plan who were self-respondents to the questionnaire and were not institutionalized at the time of the survey.

MEASUREMENTS: Variables were self-reported functional status, chronic health conditions, demographics, and several mood-related questions.

RESULTS: After controlling for age, race, sex, marital status, home ownership, functional status, and comorbid conditions, individuals who identified themselves as feeling sad or depressed much of the time over the previous year were at significantly higher risk of NHA.

CONCLUSION: A single question about depressive symptoms can be used to identify individuals at higher risk of NHA. There may be benefit from better screening and treatment of depression in community-based older people. Depression and social support may be linked. This study was targeted and did not attempt to explain everything that affects NHA. Investigation of the relationship between social support, depression, and NHA should be considered in future research.

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