The effect of depressive symptoms and antidepressant use on subsequent physical decline and number of hospitalizations in nursing home residents: a nine-year longitudinal study

Abstract

OBJECTIVE: To investigate whether depressive symptoms and antidepressant use at baseline predict the subsequent decline in physical functioning and number of hospitalizations in nursing home residents. METHODS: A total of 1,076 residents from six nursing homes in Hong Kong were followed annually between 2005 and 2013. Multilevel mixed-effects models were fitted to examine the effect of depressive symptoms and antidepressant use on physical decline and number of hospitalizations within 90 days before the assessment, controlling for demographics and chronic conditions (e.g., Alzheimer’s disease, other dementia, and stroke). RESULTS: Within the nine year period, 24.8% residents were still alive until 2013, 68.1% deceased, and 7.0% moved out of the facilities. The presence of baseline depressive symptoms did not have significant association with baseline ADL and number of hospitalizations. However, it was associated with a faster deterioration of physical functioning (coefficient, 0.03; 95% CI 0.00-0.07) and increase of the number of hospitalization (coefficient, 0.05; 95% CI 0.03-0.07). No significant difference between elders using antidepressant and elders who were free from depressive symptoms was observed. If depressive symptoms were presented but antidepressant was not used, a much sharper decline was evident (coefficient, 0.06; 95% CI 0.02-0.09). CONCLUSIONS: This study provided evidence that the presence of depressive symptoms is associated with more utilization of health care services. However, the use of antidepressant can play a significant role in altering the trajectory. The presence of depressive symptoms is a worrisome but treatable condition so that effective intervention/treatment should be called upon.