Depression and health service utilization from age 70 to 85: the Jerusalem Longitudinal Study

Health service utilization rises with age, and yet, its determinants are poorly understood. Our objective was to examine the association between depression and health service utilization from age 70-85.

A representative sample (born 1920-1921) from the Jerusalem Longitudinal Cohort Study (1990-2010) was assessed at age 70, 78, and 85 for depression (using the Brief Symptoms Inventory); emergency room (ER) visits, and hospitalization in the previous year; social, functional, and medical domains.

We examined 414, 674, and 1118 subjects at ages 70, 78, and 85, among whom prevalence of depression was 16.2%, 21.1%, and 36.7%, respectively. ER visits and hospitalization were higher among depressed subjects. We adjusted for sex as well as financial status (social model); physical activity, going outdoors, functional status (functional model); and diabetes, ischemic heart disease, hypertension, cancer, dementia, chronic pain, and smoking (medical model). Depressed subjects were more likely to report increased ER visits, after adjustment in social, functional or medical models at age 78 (odds ratio [OR], 2.1, 95% confidence interval [CI], 1.3-3.3; OR, 1.8, 95% CI, 1.1-2.9; OR, 2.0, 95% CI, 1.26-3.26), and at age 85 (OR, 1.7, 95% CI, 1.33-2.3; OR, 1.4, 95% CI, 1.04-1.81; and OR, 1.4, 95% CI, 1.1-1.94), respectively. Aside from the social model at age 85 (OR, 1.5, 95% CI, 1.1-2.0), depression was not associated with increased likelihood of hospitalization.

Depression at ages 78 and 85 is consistently associated with increased ER visits and should be considered among older people presenting to the ER.