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Depressive Symptoms After Hospitalization in Older Adults: Function and Mortality Outcomes

Authors

  • Edgar Pierluissi MD,

    Corresponding author
    • Division of Geriatrics, University of California at San Francisco, San Francisco, California
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  • Kala M. Mehta DSc, MPH,

    1. Division of Geriatrics, University of California at San Francisco, San Francisco, California
    2. Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California
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  • Katharine A. Kirby MS,

    1. Division of Geriatrics, University of California at San Francisco, San Francisco, California
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  • W. John Boscardin PhD,

    1. Division of Geriatrics, University of California at San Francisco, San Francisco, California
    2. Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California
    3. Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California
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  • Richard H. Fortinsky PhD,

    1. Center on Aging, University of Connecticut, Farmington, Connecticut
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  • Robert M. Palmer MD, MPH,

    1. Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • C. Seth Landefeld MD

    1. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Address correspondence to Edgar Pierluissi, University of California, San Francisco, San Francisco General Hospital, 1001 Potrero Avenue Room 5H17, San Francisco, CA 94110. E-mail: epierluissi@medsfgh.ucsf.edu

Abstract

Objectives

To determine the relationship between depressive symptoms after hospitalization and survival and functional outcomes.

Design

Secondary analysis of a prospective cohort study.

Setting

General medical service of two urban, teaching hospitals in Ohio.

Participants

Hospitalized individuals aged 70 and older.

Measurements

Ten depressive symptoms, instrumental activities of daily living (IADLs), and basic activities of daily living (ADLs) were measured at hospital discharge and 1, 3, 6, and 12 months later. Participant-specific changes in depressive symptoms (slopes) were determined using all data points. Four groups were also defined according to number of depressive symptoms (≤3 symptoms, low; 4–10 symptoms, high) at discharge and follow-up: low–low, low–high, high–low, and high–high. Mortality was measured 3, 6, and 12 months after hospital discharge.

Results

Participant-specific discharge depressive symptoms and change in depressive symptoms over time (slopes) were associated (P < .05) with functional and mortality outcomes. At 1 year, more participants in the low–low depressive symptom group (49%) were alive and independent in IADLs and ADLs than in the low–high group (37%, P = .02), and more participants in the high–low group (39%) were alive and independent in IADLs and ADLs than in the high–high group (19%, P < .001).

Conclusion

Number of depressive symptoms and change in number of depressive symptoms during the year after discharge were associated with functional and mortality outcomes in hospitalized older adults. Fewer participants with persistently high or increasing depressive symptoms after hospitalization were alive and functionally independent 1 year later than participants with decreasing or persistently low symptoms, respectively.

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