Geriatric heart failure, depression, and nursing home admission: An observational study using propensity score analysis

被引:20
作者
Ahmed, Ali
Ali, Mahmud
Lefante, Christina M.
Mullick, M. Syadul Islam
Kinney, F. Cleveland
机构
[1] Univ Alabama Birmingham, Div Gerontol & Geriatr Med, Dept Med, Sch Med, Birmingham, AL 35294 USA
[2] Univ Alabama Birmingham, Sch Med, Div Geriatr Psychiat, Birmingham, AL 35294 USA
[3] Univ Alabama Birmingham, Sch Med, Dept Psychiat, Birmingham, AL 35294 USA
[4] Univ Alabama Birmingham, Sch Publ Hlth, Dept Epidemiol, Birmingham, AL 35294 USA
[5] Vet Affairs Med Ctr, Sect Geriatr, Birmingham, AL USA
[6] Louisiana State Univ, Hlth Sci Ctr, Dept Epidemiol, Sch Publ Hlth, New Orleans, LA USA
[7] Bangabandhu Sheikh Mujib Med Univ, Dept Psychiat, Dhaka, Bangladesh
关键词
heart failure; older adults; depression; nursing home; propensity score;
D O I
10.1097/01.JGP.0000209639.30899.72
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objective: Heartfailure (HF) and depression are both common in older adults, and the presence of depression is known to worsen BF outcomes. For community-dwelling older adults, admission to a nursing home (NH) is associated with loss of independent living and poor outcomes. The objective of this study was to examine the effect of depression on NH admission for older adults with HE Methods: Using the 2001-2003 National Hospital Discharge Survey datasets, the authors identified all community-dwelling older adults who were discharged alive with a primary discharge diagnosis of HF. The authors then identified those with a secondary diagnosis of depression. Using a multivariable logistic regression model, the authors then determined probability or propensity to have depression for each patient The authors used propensity scores for depression to match all 680 depressed patients with 2,040 nondepressed patients. Finally, the authors estimated the association between depression and NH admission using bivariate and multivariable logistic regression analyses. Results: Patients bad a mean (+/- standard deviation) age of 79 (+/- 8) years, 72% were women, and 9% were blacks. Compared with 17% nondepressed patients, 25% depressed patients were discharged to a NH. Depression was associated with 50% increased risk of NH admission (unadjusted relative risk [RR]1.50, 95% confidence interval [CI]: 1.28-1.74). The association became somewhat stronger after multivarlable adjustment for various demographic and care covariates (adjusted RR: 1.60; 95% CI 7.35-1.68). Conclusion: In ambulatory older adults hospitalized with HF, a secondary diagnosis of depression was associated with a significant increased risk of NH admission.
引用
收藏
页码:867 / 875
页数:9
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