Key result
Depression was significantly associated with higher rates of all-cause hospitalization (adjusted HR 1.57; 95% CI 1.09-2.26; P=0.0157), whereas frailty was not.
Why the study?
Depression and frailty frequently coexist, but their effects when occurring concurrently on all-cause hospitalizations in older adults remained unclear.
Does depression or frailty increase the risk of all-cause hospitalizations in older male veterans?
Cohort (n=553)
No
Does depression or frailty increase the risk of all-cause hospitalizations in older male veterans?
Hazard Ratio: 1.57 (95% CI 1.09–2.26)
p-value: p=0.0157
In older male veterans, depression, but not frailty, is significantly associated with a higher risk of all-cause hospitalizations.
Depression may warrant screening to identify higher hospitalization risk in older male veterans; leaves open frailty's independent role pending prospective confirmation.
INTRODUCTION: Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality, and utilization in older adults. Depression and frailty often coexist, suggesting a bidirectional relationship that may increase the effects of each individual condition on clinical outcomes and health-care utilization in older adults. OBJECTIVE: To determine the effects of concurrent frailty and depression on all-cause hospitalizations. METHODS/DESIGN: Prospective cohort study, conducted at a Veterans Affairs (VA) Medical Center. The participants were male, community-dwelling veterans 65 years and older. From 4 January through 30 December 2016, a 46-item frailty index was generated from data obtained from the VA electronic health record. Trained staff conducted in-depth reviews of electronic health records ascertaining depression status. Patients were followed through 31 December 2017 for all-cause hospitalizations following the initial assessment of frailty. After adjusting for covariates, the association of frailty and depression with all-cause hospitalizations was determined with the Andersen-Gill model, accounting for repeated hospitalizations. RESULTS: Five hundred fifty-three male patients were part of the study, mean age 76.3 (SD = 8.2) years. One hundred eighty-one patients (32.7%) had depression diagnoses. During a median follow-up period of 530 days (interquartile range [IQR] = 245), 123 patients (22.2%) had 240 hospitalizations. Frailty status was not associated with future hospitalizations (adjusted hazard ratio [HR] = 1.61; 95% CI, 95-2.74; P > .05). Depression was associated with higher all-cause hospitalizations (adjusted HR = 1.57; 95% CI, 1.09-2.26); P = .0157). CONCLUSIONS: Depression but not frailty was significantly associated with higher rates of all-cause hospitalization. Implementing interventions that target older adults with both frailty and depression may reduce the burden of both conditions and reduce hospitalizations.
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Ruiz et al. (2019) conducted a cohort in Frailty and depression (n=553). Depression vs. No depression was evaluated on all-cause hospitalizations (HR 1.57, 95% CI 1.09-2.26, p=0.0157). Depression was significantly associated with higher rates of all-cause hospitalization (adjusted HR 1.57; 95% CI 1.09-2.26; P=0.0157), whereas frailty was not.
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