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J Am Geriatr Soc. 2018 Aug 9. doi: 10.1111/jgs.15496. [Epub ahead of print]

Burden of Depressive Symptoms Over 2 Decades and Risk of Nursing Home Placement in Older Women.

Author information

1
Department of Psychiatry, University of California, San Francisco, San Francisco, California.
2
San Francisco Veterans Affairs Health Care System, San Francisco, California.
3
Research Institute, California Pacific Medical Center, San Francisco, California.
4
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
5
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.
6
Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
7
Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
8
Department of Neurology, University of California, San Francisco, San Francisco, California.

Abstract

OBJECTIVES:

To determine the association between cumulative burden of depressive symptoms and risk of nursing home (NH) placement over 2 decades.

DESIGN:

Prospective cohort study with data linked to Medicare claims files.

SETTING:

Clinic sites in Baltimore, Maryland; Minneapolis, Minnesota; and the Monongahela Valley near Pittsburgh, Pennsylvania.

PARTICIPANTS:

Initially community-dwelling women aged 65 and older (N=3,646).

MEASUREMENTS:

Depressive symptom burden was determined using the Geriatric Depression Scale measured over 18 years to calculate accumulation of burden. NH placement was determined using Medicare claims data.

RESULTS:

In Fine-Gray proportional hazards analyses including demographic characteristics, medical comorbidities, functional impairment, and recent depression exposure and accounting for competing risk of death, women with low depressive symptom burden were twice as likely to experience NH placement as those with minimal burden (hazard ratio (HR) = 1.92, 95% confidence interval (CI) = 1.16-3.20), women with moderate burden were more than twice as likely (HR = 2.62, 95% CI = 1.59-4.31), and women with high burden (HR = 3.08, 95% CI = 1.87-5.08) were three times as likely. The addition of antidepressant use to this model attenuated the risk only slightly.

CONCLUSION:

In older women, cumulative burden of depressive symptoms over nearly 2 decades is associated with greater risk of transitioning from community-living to a NH irrespective of recent depression exposure, medical comorbidities, functional impairment, and the competing risk of death. This work supports the need for improving recognition, monitoring, and treatment of depressive symptoms early, which may reduce or delay NH placement.

KEYWORDS:

aging; care transitions; depression; epidemiology; institutionalization

PMID:
30094824
DOI:
10.1111/jgs.15496

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