Depression, functional status, treatment for psychiatric problems, and the health-related practices of elderly HMO members.

PURPOSE

To study relationships between depression, functional limitations, psychiatric treatment, and the health-related practices of elderly individuals.

DESIGN

Cross-sectional, observational study based on survey data (response rate = 90%) analyzed using multiple linear and logistic regression models.

SETTING

Kaiser Permanente Northwest, a large nonprofit HMO.

SUBJECTS

Medicare members (4615) aged 65-103 years who responded to a health status survey.

MEASURES

Depression, health and functional status, frequency of alcohol consumption, smoking status, advance medical directive completion, influenza or pneumonia vaccinations, mammograms, recent psychiatric treatment, and attempts to lose weight or increase exercise.

RESULTS

Self-reported depression was related to a greater risk of smoking (odds ratio [OR] = 1.54). Health-related functional limitations were related to fewer attempts to change health behaviors and less preventive service use (significant ORs ranged from 0.84 to 0.94). Minority group membership and Supplemental Security Income were negatively associated with better health practices and with completing advance medical directives (ORs 0.41 and 0.79, respectively). Falls in the prior year, more prescription medications, and psychiatric treatment were positively associated with better health practices (significant ORs ranged from 1.12 to 1.88).

CONCLUSIONS

Depression and smoking are associated among elderly individuals, as are psychiatric treatment and attempts to lose weight. Those with functional limitations, minority status, or Supplemental Security Income use fewer preventive services; the latter two groups are less likely to complete advance medical directives. Older adults with these characteristics might need assistance in improving health-related practices.