Depression but not frailty contributed to a higher risk for all-cause hospitalizations in male older veterans

Int J Geriatr Psychiatry. 2020 Jan;35(1):37-44. doi: 10.1002/gps.5212. Epub 2019 Oct 24.


Introduction: Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality, and utilization in older adults. Depression and frailty often coexist, suggesting a bidirectional relationship that may increase the effects of each individual condition on clinical outcomes and health-care utilization in older adults.

Objective: To determine the effects of concurrent frailty and depression on all-cause hospitalizations.

Methods/design: Prospective cohort study, conducted at a Veterans Affairs (VA) Medical Center. The participants were male, community-dwelling veterans 65 years and older. From 4 January through 30 December 2016, a 46-item frailty index was generated from data obtained from the VA electronic health record. Trained staff conducted in-depth reviews of electronic health records ascertaining depression status. Patients were followed through 31 December 2017 for all-cause hospitalizations following the initial assessment of frailty. After adjusting for covariates, the association of frailty and depression with all-cause hospitalizations was determined with the Andersen-Gill model, accounting for repeated hospitalizations.

Results: Five hundred fifty-three male patients were part of the study, mean age 76.3 (SD = 8.2) years. One hundred eighty-one patients (32.7%) had depression diagnoses. During a median follow-up period of 530 days (interquartile range [IQR] = 245), 123 patients (22.2%) had 240 hospitalizations. Frailty status was not associated with future hospitalizations (adjusted hazard ratio [HR] = 1.61; 95% CI, 95-2.74; P > .05). Depression was associated with higher all-cause hospitalizations (adjusted HR = 1.57; 95% CI, 1.09-2.26); P = .0157).

Conclusions: Depression but not frailty was significantly associated with higher rates of all-cause hospitalization. Implementing interventions that target older adults with both frailty and depression may reduce the burden of both conditions and reduce hospitalizations.

Keywords: depression; frailty; hospitalization; older adults; veterans.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Depression / epidemiology*
  • Frail Elderly / statistics & numerical data
  • Frailty / epidemiology*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Independent Living
  • Male
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Veterans / psychology*
  • Veterans / statistics & numerical data*