Depressive symptoms after hospitalization in older adults: function and mortality outcomes

Abstract

Objectives: To determine the relationship between depressive symptoms after hospitalization and survival and functional outcomes.

Design: Secondary analysis of a prospective cohort study.

Setting: General medical service of two urban, teaching hospitals in Ohio.

Participants: Hospitalized individuals aged 70 and older.

Measurements: Ten depressive symptoms, instrumental activities of daily living (IADLs), and basic activities of daily living (ADLs) were measured at hospital discharge and 1, 3, 6, and 12 months later. Participant-specific changes in depressive symptoms (slopes) were determined using all data points. Four groups were also defined according to number of depressive symptoms (≤3 symptoms, low; 4-10 symptoms, high) at discharge and follow-up: low-low, low-high, high-low, and high-high. Mortality was measured 3, 6, and 12 months after hospital discharge.

Results: Participant-specific discharge depressive symptoms and change in depressive symptoms over time (slopes) were associated (P < .05) with functional and mortality outcomes. At 1 year, more participants in the low-low depressive symptom group (49%) were alive and independent in IADLs and ADLs than in the low-high group (37%, P = .02), and more participants in the high-low group (39%) were alive and independent in IADLs and ADLs than in the high-high group (19%, P < .001).

Conclusion: Number of depressive symptoms and change in number of depressive symptoms during the year after discharge were associated with functional and mortality outcomes in hospitalized older adults. Fewer participants with persistently high or increasing depressive symptoms after hospitalization were alive and functionally independent 1 year later than participants with decreasing or persistently low symptoms, respectively.

Figure 1. Depressive Symptom Group during study follow-up

The top panel represents patients with 0–3 depression symptoms at discharge (n=719). The bottom panel represents patients with 4–10 depression symptoms at hospital discharge (n=410). Data shown are actual means (dots) and medians (horizontal bars) of Center for Epidemiologic Studies Depression (CESD) Scale symptoms over time. The mean number of depressive symptoms for the Low-Low group are 1.30, 1.14, 1.16, 1.02, and 0.77; for the Low-High group, 1.79, 2.75, 2.86, 2.46, 5.37; for the High-High group, 5.92, 4.84, 4.72, 4.40, and 5.32; and for the High-Low group, 5.32, 2.33, 2.06, 1.55, and 1.36,, at discharge, 1 month, 3 months, 6months, and 1 year, respectively. Boxes represent the interquartile range of the number of depressive symptoms for each group over time. The width of each box is proportional to the number of patients. Vertical dashed lines represent the range of values encompassing 5% to 95% of depressive symptoms for each group over time.