The proposed study addresses service use of depressed elders after acute psychiatric care. Depressed elders are hospitalized for shorter periods and are discharged at higher levels of dependency to a community system of care which they underutilized. Inadequate service after discharge may undermine the effective use of expensive inpatient treatment. Yet the service use of depressed elders following hospitalization has not been examined for its impact on post-acute outcomes. This study addresses the following objectives: to identify factors related to service utilization of depressed elders after psychiatric hospitalization in four sectors of care (specialty mental health, general health, formal aging, and informal services); to assess and identify factors associated with service adequacy. operationalized as the extent to which needs for care are met. and test the relationship between service utilization and service adequacy; and to test the impact of service utilization and service adequacy on outcomes.
These aims will be achieved through a prospective, longitudinal study of 275 elderly patients hospitalized for depression and discharged home. Service utilization in the six months following discharge will be measured through subject report and service provider records. Outcomes of readmission, depressive symptomatology, cognitive status, and health status will be evaluated at six months. Guided by the Andersen model, need, predisposing, and enabling factors associated with service utilization and service adequacy will be identified through regression analysis. Path analysis will be used to determine the effects of utilization and adequacy on post-acute outcomes. The study is unique in its conceptualization of service use in the four sectors of care on which the elderly depend and its empirical derivation of configurations of care representing combinations of services across these four sectors. Further, the study advances the concept of service adequacy, operationalized as the extent to which services meet patient needs for care (mental health, physical.health, and physical dependency needs). Service adequacy is conceptualized as an outcome of utilization and is viewed as a stronger predictor of post-acute outcome than is utilization per se. The study is significant in its focus on post-acute care, which will continue to grow in importance as use of inpatient care is constrained. The study responds to the recognized need for information about the critical interface between acute and community care. Knowledge generated from the study will inform discharge planning practices, home care and extended care programming, and post-hospital care reimbursement policies.
