Hoell Andreas, Weyerer Siegfried, Maier Wolfgang, Wagner Michael, Scherer Martin, Stark Anne, Kaduszkiewicz Hanna, Wiese Birgitt, König Hans-Helmut, Bock Jens-Oliver, Stein Janine, Riedel-Heller Steffi G
Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
J Affect Disord. 2016 Nov 1;204:247-54. doi: 10.1016/j.jad.2016.08.004. Epub 2016 Aug 9.
Depression is the most common psychiatric disease in older people, often accompanied by co-morbidities and functional limitations. In cross-sectional studies, depression is associated with an increased use of health care resources, including informal care and home care. Longitudinal data are needed to better understand the causal links between depression, functional impairments, and health care utilization.
Data were obtained at baseline and follow-up of the multicenter, prospective cohort study "Late life depression in primary care: needs, health care utilization and costs" (AgeMooDe). A sample of 955 primary care patients aged 75 years and older was interviewed twice. The primary outcomes were the average respective amounts of time spent utilizing home care, professional nursing care, domestic help and informal care. These outcomes were analyzed with Generalized Linear Mixed Models (GLMM).
GLMM analysis revealed that the amount of time utilizing home care over the study period was positively associated with depression, higher age, and functional and cognitive impairments, but negatively associated with living alone. In-depth analyses revealed that these associations were particularly obvious for the utilization of informal care.
The generalizability of our findings may be limited due to use of a dimensional instrument to determine depressive symptoms.
Over the study period, the average amount of time receiving home care and especially informal care increased in the group of patients with depression only. People with depressive symptoms experience a growing number of functional limitations over time, increasing their dependency on others. Functional limitations, depression and dependency appear to form a vicious cycle.
抑郁症是老年人中最常见的精神疾病，常伴有合并症和功能受限。在横断面研究中，抑郁症与包括非正式护理和家庭护理在内的医疗保健资源使用增加有关。需要纵向数据来更好地理解抑郁症、功能障碍和医疗保健利用之间的因果关系。
数据来自多中心前瞻性队列研究“初级保健中的老年抑郁症：需求、医疗保健利用和成本”（AgeMooDe）的基线和随访。对955名75岁及以上的初级保健患者样本进行了两次访谈。主要结局是使用家庭护理、专业护理、家政服务和非正式护理的平均时间。这些结局采用广义线性混合模型（GLMM）进行分析。
GLMM分析显示，在研究期间使用家庭护理的时间与抑郁症、较高年龄、功能和认知障碍呈正相关，但与独居呈负相关。深入分析表明，这些关联在非正式护理的使用方面尤为明显。
由于使用维度工具来确定抑郁症状，我们研究结果的普遍性可能有限。
在研究期间，仅抑郁症患者组接受家庭护理尤其是非正式护理的平均时间增加。随着时间的推移，有抑郁症状的人功能受限的情况越来越多，对他人的依赖也越来越大。功能受限、抑郁症和依赖似乎形成了一个恶性循环。
