The impact of depressive symptoms on utilization of home care by the elderly: Longitudinal results from the AgeMooDe study

Abstract

Background: Depression is the most common psychiatric disease in older people, often accompanied by co-morbidities and functional limitations. In cross-sectional studies, depression is associated with an increased use of health care resources, including informal care and home care. Longitudinal data are needed to better understand the causal links between depression, functional impairments, and health care utilization.

Methods: Data were obtained at baseline and follow-up of the multicenter, prospective cohort study "Late life depression in primary care: needs, health care utilization and costs" (AgeMooDe). A sample of 955 primary care patients aged 75 years and older was interviewed twice. The primary outcomes were the average respective amounts of time spent utilizing home care, professional nursing care, domestic help and informal care. These outcomes were analyzed with Generalized Linear Mixed Models (GLMM).

Results: GLMM analysis revealed that the amount of time utilizing home care over the study period was positively associated with depression, higher age, and functional and cognitive impairments, but negatively associated with living alone. In-depth analyses revealed that these associations were particularly obvious for the utilization of informal care.

Limitations: The generalizability of our findings may be limited due to use of a dimensional instrument to determine depressive symptoms.

Conclusions: Over the study period, the average amount of time receiving home care and especially informal care increased in the group of patients with depression only. People with depressive symptoms experience a growing number of functional limitations over time, increasing their dependency on others. Functional limitations, depression and dependency appear to form a vicious cycle.

Keywords: Depression; Elderly population; Health services research; Home care; Informal care.