Depressing hospital outcomes in elderly men

By Eleanor McDermid, Senior medwireNews Reporter

Older men with depression have more frequent and longer hospital stays than those without depressive symptoms, a study shows.

Furthermore, the association was dose-dependent, with the risk for hospital admission rising with increasing severity of depression.

This suggests that tackling depressive symptoms could improve hospital outcomes, say lead researcher A Matthew Prina (Cambridge University, UK) and colleagues.

"However, subthreshold symptoms should not be underestimated, because they still have an impact on hospital admission and associated outcomes," they write in the Canadian Medical Association Journal.

The study involved 5411 men from the Health in Men Study who were aged at least 69 years. At baseline, 339 of these men had depression, defined as a score of at least 7 on the 15-item Geriatric Depression Scale (GDS-15).

During the next 2 years, 44.8% of men with depression had an emergency hospital admission, compared with 22.9% of those without, a significant difference. The depressed men spent a total of 21.0 days in hospital, on average, compared with 11.9 days for the nondepressed men, and the median length of each stay was 5.8 versus 4.0 days.

The effect of depression on hospital admission and outcomes persisted after adjustment for confounders, with incidence rate ratios of 1.25 for length of stay, 1.65 for total length of stay, and 1.22 for number of hospital admissions.

"Treatment adherence is known to be poor among patients with mood disorders," say Prina et al. "This could result in patients arriving in hospital at more acute or severe stages of their illness, potentially increasing length of stay and risk of death during admission."

Notably, the influence of depression was independent of comorbidity effects, accounted for in the Charlson Index.

"This suggests that the association between depression and comorbidity, disability and hospital admission is complex and cannot be attributed solely to age, prevalent clinical morbidity, social support, education or smoking," say the researchers.

The men's risk for any hospital admission and for inpatient mortality rose with increasing severity of depression; the risk for admission rose 1.70-, 2.08-, and 3.06-fold with GDS-15 scores of 1-4, 5-9, and 10-15, respectively. For inpatient death, the risk was raised by a corresponding 2.45-, 3.05-, and 4.38-fold, although the increase for GDS-15 scores of 10-15 was nonsignificant.

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