Elderly medical inpatients experience major depression five times as often as the elderly in the community, yet less than 1% of inpatients receive treatment in the hospital. Depressive symptoms and diagnoses evolve during an acute illness and hospitalization with many apparent major affective disorders becoming adjustment disorders or disturbances of mood by discharge, or on outpatient follow-up four to five weeks later. Therefore, without prospective data on the course of depressive illness in the medically ill, it remains uncertain who should and should not be treated and at what point treatment should be initiated, e.g., before or after discharge. It is essential to identify during hospitalization those elderly at risk for affective disorders that persist into the ambulatory setting. The probability of identification and treatment of depression in the elderly is low post discharge. The study prospectively examines the course of untreated episodes of depressive illness after a medical hospitalization and post discharge medical resource use. The hypotheses are: 1) 50% of the elderly identified as depressed at hospital discharge, and 10% of the non- depressed controls will be depressed 4 or 28 weeks later; 2) The elderly depressed at discharge have higher rates of health services utilization, (e.g., medical office visits, psychiatric visits, home care, hospital readmission(s), etc.) for the 4 or 28 week follow-up periods compared to controls; and, 3) Elderly depressed at 4 or 28 weeks post discharge use more health services than the non-depressed at 4 or 28 week follow-up. At discharge, depressed elderly inpatients with a common medical diagnosis (congestive heart failure) and non-depressed frequency matched (Age/Sex/Race/Activity of Daily Living/Severity-of-illness) controls will be evaluated. The subjects will be 58% Female, and 52% White, 20% Black, and 27% Hispanic. Studies to date are limited by small sample size, heterogeneous medical disorders, restriction to male veterans, no reevaluation of depression status, or indirect source reports on health services use. This data will provide information regarding the critical issues involved in linking - """"""""bundling"""""""" - the hospital and post discharge treatment plans, as proposed in new guidelines by Medicare.
|Fulop, George; Strain, James J; Stettin, Glen (2003) Congestive heart failure and depression in older adults: clinical course and health services use 6 months after hospitalization. Psychosomatics 44:367-73|