Depression, functional status, treatment for psychiatric problems, and the health-related practices of elderly HMO members

Abstract

Purpose: To study relationships between depression, functional limitations, psychiatric treatment, and the health-related practices of elderly individuals.

Design: Cross-sectional, observational study based on survey data (response rate = 90%) analyzed using multiple linear and logistic regression models.

Setting: Kaiser Permanente Northwest, a large nonprofit HMO.

Subjects: Medicare members (4615) aged 65-103 years who responded to a health status survey.

Measures: Depression, health and functional status, frequency of alcohol consumption, smoking status, advance medical directive completion, influenza or pneumonia vaccinations, mammograms, recent psychiatric treatment, and attempts to lose weight or increase exercise.

Results: Self-reported depression was related to a greater risk of smoking (odds ratio [OR] = 1.54). Health-related functional limitations were related to fewer attempts to change health behaviors and less preventive service use (significant ORs ranged from 0.84 to 0.94). Minority group membership and Supplemental Security Income were negatively associated with better health practices and with completing advance medical directives (ORs 0.41 and 0.79, respectively). Falls in the prior year, more prescription medications, and psychiatric treatment were positively associated with better health practices (significant ORs ranged from 1.12 to 1.88).

Conclusions: Depression and smoking are associated among elderly individuals, as are psychiatric treatment and attempts to lose weight. Those with functional limitations, minority status, or Supplemental Security Income use fewer preventive services; the latter two groups are less likely to complete advance medical directives. Older adults with these characteristics might need assistance in improving health-related practices.