Major depression and emergency medical services utilization in community-dwelling elderly persons with disabilities.

摘要

OBJECTIVE: To examine the association between major depression and emergency medical services (EMS) use by community-dwelling older adults with disabilities. METHODS: A prospective observational.study including 1,444 participants age 65+ in 19 counties in three US states that participated in the Medicare Primary and Consumer-Directed Care Demonstration. Eligibility criteria included needing or receiving help with either 2+ activities of daily living (ADLs) or 3+ instrumental ADLs, and having received recent significant healthcare services use. The presence of major depression was measured at baseline by the MINI Major Depressive Episode module. EMS utilization data for the following 2 years were obtained from a daily journal concurrently completed by each subject or a caregiver. RESULTS: More persons with major depression (43%) than without (35%) reported EMS use. When other factors were controlled in a logistic regression model, this effect was no longer statistically significant. However, of those with at least one episode of EMS transport, the depressed reported significantly (25%) more episodes (mean = 2.10) than the non-depressed (mean = 1.68). Major depression was significantly associated with more EMS episodes in both Poisson (Z = 1.99; p = 0.047) and ordinary least squares (t = 2.08; p = 0.038) regression models. CONCLUSIONS: Depressed disabled older adults who utilize EMS have more EMS episodes than those without depression. This higher use may be driven in part by affective illness. Research is needed to determine whether more EMS episodes are necessary to address symptoms of major depression, especially suicidal ideation, or whether they are due to other illnesses that are exacerbated by symptoms of major depression.