Depression Linked to Hospital Admissions of Elderly Men
Depressed elderly men found to use hospital services longer and more frequently.
-- by Alexia Severson
Elderly men who are depressed have a significantly higher risk of being admitted to a hospital and staying twice as long, found a new study published in the Canadian Medical Association Journal.
In this study, the presence of clinically significant symptoms of depression in older men was associated with increased risk of hospital admission, higher number of readmissions, and longer use of services.
Researchers from Australia, the UK, and the Netherlands conducted a study of 5,411 men aged 69 years and older in Perth, Western Australia, to determine whether hospital admissions were higher for men with depressive symptoms than for those without.
Based on a 15-item Geriatric Depression Scale, 6.3 percent of all participants had a score that indicated moderate to severe depression. And almost half of the depressed men had at least one hospital emergency admission, compared with just 23 percent of the non-depressed men. Depressed elderly men also had higher overnight admissions and deaths in hospitals. They were also less educated, had more illnesses, and more likely to smoke.
The Expert Take
“Some studies had identified a connection between depression and hospital admissions but were let down by limiting the studies to specific clinical populations or by using weak methodologies,” said study author Matthew Prina of Cambridge University. “We wanted to address this in order to understand whether depressed men living in the community were at higher risk of emergency admissions and worse hospital outcomes.”
Researchers have come up with several theories to explain their findings. For example, patients with depression are less likely to adhere to treatment plans, causing them to arrive at the hospital at more severe stages of their illness and increasing their length of stay and risk of death. Patients suffering from depression are also less likely to effectively communicate with their doctors, which could delay a potential diagnosis and treatment and subsequently cause them to use hospital services for longer.
“We need to understand whether treating depression symptoms will result in lower hospital admissions and better clinical outcomes,” Prina said. “Future research will hopefully be able to identify whether that is the case.”
Source and Method
A large community-based sample of 5,411 men enrolled in the Health in Men Study was assessed at baseline for depressive symptoms, defined as a score of seven or higher on a 15-item Geriatric Depression Scale. Participants were followed for two years for occurrence and number of hospital admissions, type of hospital admission, length of hospital stay, and inpatient death as recorded in the Western Australian Data Linkage System.
According to study authors, older people are the most frequent users of health services, and the progressive aging of the world’s population may lead to a saturation of available services. Therefore, it is important that we are able to identify factors associated with hospital admission and longer length of stay in order to help reduce admissions.
Prina said this research also highlights the burden associated with depression.
“The study of depression in older age has often been neglected and should be on top of the agenda of research funding bodies and policy makers,” he said.
According to study authors, little research investigates the effect of clinically significant depressive symptoms on hospital admission and outcomes in people living in the community. However, several studies have looked at depression and its link to the elderly from various perspectives.
In a study published in 2002 in BMJ, researchers studied the association between physical illness and suicide in elderly people. They found that increased risk of suicide in elderly men could be linked to visual impairment, neurological disorders, and malignant disease. They also discovered that serious physical illness may be a stronger risk factor for suicide in men than in women.
Another study published in 2000 in BJPsych (The British Journal of Psychiatry) investigated the association between depressive syndromes and excess mortality in community-living elderly men and women. Researchers concluded that major depressive syndromes increase the risk of death in both elderly men and women, but mild depression increases the risk of death only in men.
Depression was also linked to the incidence of heart failure in a study published in Psychosomatic Medicine in 2002. However, in this study, researchers concluded that while depression was a risk factor for heart failure among elderly women, it was not an independent risk factor among elderly men.