Key result
Feelings of hopelessness during acute hospitalization strongly predicted all-cause mortality within 3 months postdischarge (OR 3.6) among adults 70 years and older.
Why the study?
Depression among older adults predicts mortality after acute hospitalization, but depression presentation is highly heterogeneous and individual symptoms may differ in predictive value.
Do depressive symptoms, specifically hopelessness, predict mortality within 3 months after acute hospitalization in adults 70 years and older?
Cohort (n=398)
Yes
Do depressive symptoms, specifically hopelessness, predict mortality within 3 months after acute hospitalization in adults 70 years and older?
Effect estimate: OR 3.6 (95% CI 1.8-7.4)
p-value: p=<0.001
Feelings of hopelessness during acute hospitalization are a strong predictor of 3-month mortality in older adults, serving as a potential marker to identify patients who may benefit from palliative care.
May flag high short-term mortality risk in hospitalized older adults; hypothesis-generating for screening and palliative interventions, pending prospective trials.
OBJECTIVE: Depression among older adults predicts mortality after acute hospitalization. Depression is highly heterogeneous in its presentation of symptoms, whereas individual symptoms may differ in predictive value. This study aimed to investigate the prevalence of individual cognitive-affective depressive symptoms during acute hospitalization and investigate the predictive value of both overall and individual cognitive-affective depressive symptoms for mortality between admission up to 3-month postdischarge among older patients. METHODS: A prospective multicenter cohort study enrolled 401 acutely hospitalized patients 70 years and older (Hospitalization-Associated Disability and impact on daily Life Study). The predictive value of depressive symptoms, assessed using the Geriatric Depression Scale 15, during acute hospitalization on mortality was analyzed with multiple logistic regression. RESULTS: The analytic sample included 398 patients (M (SD) = 79.6 (6.6) years; 51% men). Results showed that 9.3% of participants died within 3 months, with symptoms of apathy being most frequently reported. The depression total score during hospitalization was associated with increased mortality risk (admission: odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.2-1.3; discharge: OR = 1.2, 95% CI = 1.2-1.4). Stepwise multiple logistic regression analyses yielded the finding that feelings of hopelessness during acute hospitalization were a strong unique predictor of mortality (admission: OR = 3.6, 95% CI = 1.8-7.4; discharge: OR = 5.7, 95% CI = 2.5-13.1). These associations were robust to adjustment for demographic factors, somatic symptoms, and medical comorbidities. CONCLUSIONS: Symptoms of apathy were most frequently reported in response to acute hospitalization. However, feelings of hopelessness about their situation were the strongest cognitive-affective predictor of mortality. These results imply that this item is important in identifying patients who are in the last phase of their lives and for whom palliative care may be important.
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Reichardt et al. (2019) conducted a cohort in Acutely hospitalized older adults (n=398). Feelings of hopelessness vs. No feelings of hopelessness was evaluated on All-cause mortality within 3 months postdischarge (OR 3.6, 95% CI 1.8-7.4, p=<0.001). Feelings of hopelessness during acute hospitalization strongly predicted all-cause mortality within 3 months postdischarge (OR 3.6) among adults 70 years and older.
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