Depression as a risk factor for nursing home admission among older individuals

Abstract

Objectives: Depression is common among those aged 65 and older and has been associated with increased morbidity and mortality. This study investigated whether individuals enrolled in Medicare+Choice with symptoms of depression as measured using the mental health scale from the SF-36 were at increased risk of using nursing home services.

Design: A Cox proportional hazards model was used.

Setting: The study investigated community-based adults aged 65 and older.

Participants: Participants were individuals aged 65 years and older enrolled in Medicare+Choice who responded to the Health Outcomes Survey and were not institutionalized or incapable of responding for themselves at the time of survey administration.

Measurements: The purpose of the study was to predict the risk of admission to a nursing home over time, controlling for variables related to demographics, comorbidity, age, and functional status.

Results: The results indicated that, even after controlling for physical health, functional status, age, demographics, and socioeconomic status, Medicare+Choice enrollees over the age of 65 experiencing symptoms of depression as identified by the SF-36 are at increased risk of using nursing home services.

Conclusions: These results have implications for payers of nursing home services such as Medicare and Medicaid as well as for providers and the families of older individuals. While the results do not prove that prevention is possible, they do suggest that better identification and treatment of depression reduce the risk of nursing home admission. Even if nursing home placement cannot be avoided, it is possible that the individual's quality of life could be significantly enhanced by better diagnosis and treatment of depression. These findings have implications beyond the Medicare+Choice population.