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Hopelessness and Other Depressive Symptoms in Adults 70 Years and Older as Predictors of All-Cause Mortality Within 3 Months After Acute Hospitalization

The Hospital-ADL Study

Reichardt, Lucienne A., MSc; Nederveen, Floor E., MSc; van Seben, Rosanne, MSc; Aarden, Jesse J., MSc; van der Schaaf, Marike, PhD; Engelbert, Raoul H. H., PhD; van der Esch, Martin, PhD; Henstra, Marieke J., MD; Twisk, Jos W.R., PhD; Bosch, Jos A., PhD; Buurman, Bianca M., PhD on Behalf of the Hospital-ADL Study Group

doi: 10.1097/PSY.0000000000000694
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Objective Depression among older adults predicts mortality after acute hospitalization. Depression is highly heterogeneous in its presentation of symptoms, whereas individual symptoms may differ in predictive value. This study aimed to investigate the prevalence of individual cognitive-affective depressive symptoms during acute hospitalization and investigate the predictive value of both overall and individual cognitive-affective depressive symptoms for mortality between admission up to 3-month postdischarge among older patients.

Methods A prospective multicenter cohort study enrolled 401 acutely hospitalized patients 70 years and older (Hospitalization-Associated Disability and impact on daily Life Study). The predictive value of depressive symptoms, assessed using the Geriatric Depression Scale 15, during acute hospitalization on mortality was analyzed with multiple logistic regression.

Results The analytic sample included 398 patients (M (SD) = 79.6 (6.6) years; 51% men). Results showed that 9.3% of participants died within 3 months, with symptoms of apathy being most frequently reported. The depression total score during hospitalization was associated with increased mortality risk (admission: odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.2–1.3; discharge: OR = 1.2, 95% CI = 1.2–1.4). Stepwise multiple logistic regression analyses yielded the finding that feelings of hopelessness during acute hospitalization were a strong unique predictor of mortality (admission: OR = 3.6, 95% CI = 1.8–7.4; discharge: OR = 5.7, 95% CI = 2.5–13.1). These associations were robust to adjustment for demographic factors, somatic symptoms, and medical comorbidities.

Conclusions Symptoms of apathy were most frequently reported in response to acute hospitalization. However, feelings of hopelessness about their situation were the strongest cognitive-affective predictor of mortality. These results imply that this item is important in identifying patients who are in the last phase of their lives and for whom palliative care may be important.

From the Department of Internal Medicine (Reichardt, Nederveen, van Seben, Henstra, Buurman), Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam; Department of Rehabilitation (Aarden, van der Schaaf, Engelbert), Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam; ACHIEVE - Center of Applied Research (Aarden, Engelbert, van der Esch, Buurman), Faculty of Health, Amsterdam University of Applied Sciences; Reade (Esch), Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center; Department of Epidemiology and Biostatistics (Twisk), Amsterdam UMC, Vrije Universiteit Amsterdam; Department of Clinical Psychology (Bosch), University of Amsterdam; and Department of Psychology (Bosch), Section of Psychology, Amsterdam UMC, University of Amsterdam, the Netherlands (Bosch).

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Address correspondence to Lucienne A. Reichardt, MSc, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, F4-105 PO Box 22600, 1100 DD, Amsterdam, the Netherlands. E-mail: l.a.reichardt@amc.uva.nl

Received for publication April 18, 2018; revision received March 27, 2019.

Online date: April 15, 2019

Copyright © 2019 by American Psychosomatic Society
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