Examining the Impact of Major Depression On the Discharge Outcomes of Older Adults Following a General Hospital Stay

Background and Purpose: In the US, approximately 1-5% of adults over 65 is diagnosed with major depression (MD). In older adults (OA), MD is associated with decreased social functioning, diminished quality of life, and is often under-treated because of limited access to quality mental health services, difficulties with negotiating fragmented mental health services, or a reluctance to seek help. Furthermore, OA with MD often have co-morbid physical health problems that require treatment in acute care settings. Considering the multiple vulnerabilities of medically-frail OA with MD, the purpose of the current study was to examine the extent to which MD impacts care needs following discharge from a general hospital stay. The study utilized a Nationally-representative sample of hospital inpatients over 65 to examine the extent to which MD predicted discharge to a.) home, b.) to home health care, c.) a skilled rehabilitation facility, d.) a nursing home, or e.) death, while controlling for demographic, clinical, and hospital characteristics. Methods: The study utilized the 2007 Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). The NIS is the largest all-payer database of hospital discharges in the US, and contains over 100 clinical and non-clinical patient-level variables, and 7 million summary records from a sample of 986 hospitals in 33 states. Statistical analyses examined inpatients >65(N=3,180,714). Variables included age, gender, race, payer type, ICD-9 diagnoses, hospital bed size, location/teaching status of hospital, length of stay, illness severity, and discharge outcome. Analyses were performed to describe the sample and chi-square analyses examined differences between patients with MD (defined as a diagnosis of ICD-9 Codes 296.2 and 296.3) and those without MD. Logistic regression models stratified by each predictor variable were constructed to examine the extent to which MD predicted each discharge outcome. Results: In the 2007 NIS sample, .7% (N=22,265) of inpatients over 65 had MD. OA with MD were more likely to be female, have a substance abuse disorder, have more severe physical health problems, and to have longer hospital stays as compared to those without MD. The regression analyses indicated OA with MD were more likely to be discharged a nursing home [OR=.7,p<.000] and less likely to be discharged to home [OR=1.2, p<.000], to home care [OR=1.3, p<.000], to a skilled rehabilitation facility [OR=1.0, p<.000], or to die [OR=2.65, p<.000] than those without MD. Conclusions and Implications: In this Nationally-representative sample, OA with MD were more likely to be institutionalized than their peers without MD. However, those with MD were less likely to be discharged to home care or to skilled rehabilitation following an acute illness. These findings suggest that while those with MD are less able to age in place than those without MD, they are also less likely to be referred for supportive health services aimed at restoring their baseline functioning following hospitalization. Further exploratory research should examine these findings in an effort to expedite access to, and utilization of, services among OA with MD over the course of an illness episode.