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Int J Geriatr Psychiatry. 2020 Jan;35(1):37-44. doi: 10.1002/gps.5212. Epub 2019 Oct 24.

Depression but not frailty contributed to a higher risk for all-cause hospitalizations in male older veterans.

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Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL.
Miller School of Medicine, University of Miami, Miami, FL.
Mental Health Service, Miami VA Healthcare System, Miami, FL.
Research Service, Miami VA Healthcare System, Miami, FL.
Herbert Wertheim College of Medicine, Florida International University, Miami, FL.



Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality, and utilization in older adults. Depression and frailty often coexist, suggesting a bidirectional relationship that may increase the effects of each individual condition on clinical outcomes and health-care utilization in older adults.


To determine the effects of concurrent frailty and depression on all-cause hospitalizations.


Prospective cohort study, conducted at a Veterans Affairs (VA) Medical Center. The participants were male, community-dwelling veterans 65 years and older. From 4 January through 30 December 2016, a 46-item frailty index was generated from data obtained from the VA electronic health record. Trained staff conducted in-depth reviews of electronic health records ascertaining depression status. Patients were followed through 31 December 2017 for all-cause hospitalizations following the initial assessment of frailty. After adjusting for covariates, the association of frailty and depression with all-cause hospitalizations was determined with the Andersen-Gill model, accounting for repeated hospitalizations.


Five hundred fifty-three male patients were part of the study, mean age 76.3 (SD = 8.2) years. One hundred eighty-one patients (32.7%) had depression diagnoses. During a median follow-up period of 530 days (interquartile range [IQR] = 245), 123 patients (22.2%) had 240 hospitalizations. Frailty status was not associated with future hospitalizations (adjusted hazard ratio [HR] = 1.61; 95% CI, 95-2.74; P > .05). Depression was associated with higher all-cause hospitalizations (adjusted HR = 1.57; 95% CI, 1.09-2.26); P = .0157).


Depression but not frailty was significantly associated with higher rates of all-cause hospitalization. Implementing interventions that target older adults with both frailty and depression may reduce the burden of both conditions and reduce hospitalizations.


depression; frailty; hospitalization; older adults; veterans


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