抑郁情绪和衰弱与死亡率和医疗保健利用的关系：韩国全国队列研究。

Association of Depressive Mood and Frailty With Mortality and Health Care Utilization: Korean National Cohort Study.

机构信息

College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea.

Department of Statistics and Data Science, Yonsei University, Seoul, Republic of Korea.

出版信息

J Am Med Dir Assoc. 2023 Apr;24(4):504-510. doi: 10.1016/j.jamda.2023.01.025. Epub 2023 Mar 3.

DOI:10.1016/j.jamda.2023.01.025

PMID:36878262

Abstract

OBJECTIVES

To investigate the association of depressive mood and frailty with mortality and health care utilization (HCU) and identify the coexisting effect of depressive mood and frailty in older adults.

DESIGN

A retrospective study using nationwide longitudinal cohort data.

SETTING AND PARTICIPANTS

A total of 27,818 older adults age 66 years from the National Screening Program for Transitional Ages between 2007 and 2008, part of the National Health Insurance Service-Senior cohort.

METHODS

Depressive mood and frailty were measured by the Geriatric Depression Scale and Timed Up and Go test, respectively. Outcomes were mortality and HCU, including long-term care services (LTCS), hospital admissions, and total length of stay (LOS) from the index date to December 31, 2015. Cox proportional hazards regression and zero-inflated negative binomial regression were performed to identify differences in outcomes by depressive mood and frailty.

RESULTS

Participants with depressive mood and frailty represented 50.9% and 2.4%, respectively. The prevalence of mortality and LTCS use in the overall participants was 7.1% and 3.0%, respectively. More than 3 hospital admissions (36.7%) and total LOS above 15 days (53.2%) were the most common. Depressive mood was associated with LTCS use [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.05-1.42] and hospital admissions [incidence rate ratio (IRR) 1.05, 95% CI 1.02-1.08]. Frailty had associations with mortality risk (HR 1.96, 95% CI 1.44-2.68), LTCS use (HR 4.86, 95% CI 3.45-6.84), and LOS (IRR 1.30, 95% CI 1.06-1.60). The coexistence of depressive mood and frailty was associated with increased LOS (IRR 1.55, 95% CI 1.16-2.07).

CONCLUSIONS AND IMPLICATIONS

Our findings highlight the need to focus on depressive mood and frailty to reduce mortality and HCU. Identifying combined problems in older adults may contribute to healthy aging by reducing adverse health outcomes and the burden of health care costs.

摘要

目的

探讨抑郁情绪和虚弱与死亡率和医疗保健利用（HCU）的关系，并确定老年人中抑郁情绪和虚弱的共存效应。

设计

一项使用全国纵向队列数据的回顾性研究。

地点和参与者

来自 2007 年至 2008 年国家过渡年龄筛查计划的 27818 名 66 岁以上老年人，为国家健康保险服务-老年人队列的一部分。

方法

使用老年抑郁量表和计时起立行走测试分别测量抑郁情绪和虚弱。结局为死亡率和 HCU，包括从指数日期到 2015 年 12 月 31 日的长期护理服务（LTCS）、住院和总住院时间（LOS）。使用 Cox 比例风险回归和零膨胀负二项回归来确定抑郁情绪和虚弱对结局的差异。

结果

有抑郁情绪和虚弱的参与者分别占 50.9%和 2.4%。所有参与者的死亡率和 LTCS 使用的患病率分别为 7.1%和 3.0%。超过 3 次住院（36.7%）和总 LOS 超过 15 天（53.2%）是最常见的。抑郁情绪与 LTCS 使用相关（风险比 [HR] 1.22，95%置信区间 [CI] 1.05-1.42）和住院治疗（发病率比 [IRR] 1.05，95%CI 1.02-1.08）。虚弱与死亡率风险（HR 1.96，95%CI 1.44-2.68）、LTCS 使用（HR 4.86，95%CI 3.45-6.84）和 LOS（IRR 1.30，95%CI 1.06-1.60）相关。抑郁情绪和虚弱共存与 LOS 增加相关（IRR 1.55，95%CI 1.16-2.07）。