Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 50, Issue 4 M196-M202, Copyright © 1995 by The Gerontological Society of America
Hospitalization for major depression among older Americans
CM Callahan and FD Wolinsky
Department of Medicine, Regenstrief Institute for Health Care, Indiana University School of Medicine, USA.
BACKGROUND. The objective of this study was to report the pattern of
hospitalization for major depression among older Americans and to examine
correlates of those hospitalizations. We sought to investigate the
hypothesis that hospitalization for major depression would be more common
among those respondents with declining functional status whose ability to
adapt to this decline was impaired by inadequate social support systems or
economic stressors. METHODS. The data were taken from Version 5 of the
Longitudinal Study on Aging (LSOA), which includes 7,527 subjects who were
aged 70 and older in 1984. We identified all subjects with any
hospitalizations for which major depression was a discharge diagnosis
(ICD9-CM codes 296.2, 296.3, 300.4, and 311), and all subjects for whom
depression was the primary discharge diagnosis. Only patients with a
first-listed discharge diagnosis of depression were considered to have been
hospitalized for major depression. RESULTS. The yearly incidence of
hospitalization for which depression was the primary discharge diagnosis
was 0.1%. The mean length of stay was 14.6 days and the mean hospital
charge was $6,742. Length of stay and charges did not vary by hospital type
(general vs psychiatric), but both charges and length of stay were
significantly longer when major depression was the primary discharge
diagnosis rather than a secondary diagnosis. Patients with a
hospitalization for major depression had more hospitalizations, longer
total lengths of stay, and greater total hospital charges over the
seven-year period as compared to patients with at least one hospitalization
for any other reason. These differences in hospital resource use dissipated
when hospitalizations for depression were excluded. Hospitalization for
major depression was not associated with gender, race, education, or social
support. Hospitalization for major depression was independently associated
with a forced residential move, a history of nursing home stays, decline in
household activities of daily living, younger age, and perceived health
rated as less than excellent. CONCLUSIONS. One older American per thousand
is hospitalized each year with a primary discharge diagnosis of major
depression. These individuals did not have evidence of greater total
hospital resource use if episodes of hospitalization for depression are
eliminated. Hospitalization for major depression was more common among
those with a loss of independent living.
