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6 April 1999 | Volume 130 Issue 7 | Pages 563-569
Background: Depressive symptoms are common in hospitalized older persons. However, their relation to long-term mortality is unclear because few studies have rigorously considered potential confounders of the relation between depression and mortality, such as comorbid illness, functional impairment, and cognitive impairment.
Objective: To measure the association between depressive symptoms and long-term mortality in hospitalized older persons.
Design: Prospective cohort study.
Setting: General medical service of a teaching hospital.
Patients: 573 patients 70 years of age or older.
Measurements: Depressive symptoms (Geriatric Depression Scale score), severity of acute illness (Acute Physiology and Chronic Health Evaluation II score), burden of comorbid illness (Charlson comorbidity index score), physical function (a nurse assessed dependence in six activities of daily living), and cognitive function (modified Mini-Mental State Examination) were measured at hospital admission. Mortality over the 3 years after admission was determined from the National Death Index. Mortality rates among patients with six or more depressive symptoms were compared with those among patients with five or fewer symptoms.
Results: The mean age of the patients was 80 years; 68% of patients were women. Patients with six or more depressive symptoms had greater comorbid illness, functional impairment, and cognitive impairment at admission than patients with fewer depressive symptoms. Three-year mortality was higher in patients with six or more depressive symptoms (56% compared with 40%; hazard ratio, 1.56 [95% CI, 1.22 to 2.00]; P < 0.001). After adjustment for age, acute illness severity, comorbid illness, functional impairment, and cognitive impairment at the time of admission, patients with six or more depressive symptoms continued to have a higher mortality rate during the 3 years after admission (hazard ratio, 1.34 [CI, 1.03 to 1.73]). Although depressive symptoms contributed less to the mortality rate than did the total burden of comorbid medical illnesses, the excess mortality rate associated with depressive symptoms was greater than that conferred by one additional comorbid medical condition.
Conclusions: Depressive symptoms are associated with long-term mortality in older patients hospitalized with medical illnesses. This association is not fully explained by greater levels of comorbid illness, functional impairment, and cognitive impairment in patients with more depressive symptoms.
Author and Article Information
From San Francisco Veterans Affairs Medical Center and University of California, San Francisco School of Medicine, San Francisco, California; Case Western Reserve University and Cleveland Clinic Foundation, Cleveland, Ohio; University of Chicago, Chicago, Illinois; and University of Connecticut Center on Aging, Farmington, Connecticut.
Presented in part at the annual meeting of the Society of General Internal Medicine, 4 April 1998, Chicago, Illinois, and at the annual meeting of the American Geriatrics Society, 9 May 1998, Seattle, Washington.
Grant Support: In part by a grant from the John A. Hartford Foundation (88277-3G) and a grant from the National Institute on Aging to Claude Pepper Older Americans Independence Center at Case Western Reserve University (AG-10418-04). Dr. Covinsky was supported in part by a Clinical Investigator Award from the National Institute on Aging (K08AG00714). Dr. Chin was supported in part by a geriatric academic program award from the National Institute on Aging (5K12-AG00488). Dr. Landefeld was supported in part by a Career Development Award from the Health Services Research and Development Service, Department of Veterans Affairs.
Requests for Reprints: Kenneth Covinsky, MD, MPH, San Francisco Veterans Affairs Medical Center (111G), 4150 Clement Street, Building 1, San Francisco, CA 94121; e-mail, covinsky{at}medicine.ucsf.edu.
Current Author Addresses: Dr. Covinsky: San Francisco Veterans Affairs Medical Center (111G), 4150 Clement Street, Building 1, San Francisco, CA 94121.
Dr. Kahana: Department of Sociology, Case Western Reserve University, Mather Memorial, Room 226, 10900 Euclid Avenue, Cleveland, OH 44106.
Dr. Chin: University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637.
Dr. Palmer: Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A72, Cleveland, OH 44195.
Dr. Fortinsky: University of Connecticut Center on Aging, Administrative Office MC-5215, Farmington, CT 06030-5215.
Dr. Landefeld: San Francisco Veterans Affairs Medical Center (111G), 4150 Clement Street, San Francisco, CA 94121. ARTICLE
Depressive Symptoms and 3-Year Mortality in Older Hospitalized Medical Patients
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