Relationship between depressive symptom severity and emergency department use among low-income, depressed homebound older adults aged 50 years and older 英文参考文献.docVIP

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Relationship between depressive symptom severity and emergency department use among low-income, depressed homebound older adults aged 50 years and older 英文参考文献.doc

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Relationship between depressive symptom severity and emergency department use among low-income, depressed homebound older adults aged 50 years and older 英文参考文献

Choietal.BMCPsychiatry2012,12:233 /1471-244X/12/233 RESEARCH ARTICLE OpenAccess Relationshipbetweendepressivesymptom severityandemergencydepartmentuseamong low-income,depressedhomeboundolderadults aged50yearsandolder NamkeeGChoi1*,CNathanMarti1,MarthaLBruce2andMarkEKunik3,4,5 Abstract Background:Previousresearchfoundahighprevalenceofdepression,alongwithchronicillnessesanddisabilities, amongolderEDpatients.Thisstudyexaminedtherelationshipbetweendepressivesymptomseverityandthe numberofEDvisitsamonglow-incomehomeboundolderadultswhoparticipatedinarandomizedcontrolledtrial oftelehealthproblem-solvingtherapy(PST). Methods:ThenumberofandreasonsforEDvisitswerecollectedfromthestudyparticipants(n=121atbaseline) atallassessmentpoints—baselineand12-and24-weekfollow-ups.Depressivesymptomsweremeasuredwiththe 24-itemHamiltonRatingScaleforDepression(HAMD).Allmultivariableanalysesexaminingtherelationships betweenEDvisitsanddepressivesymptomswereconductedusingzero-inflatedPoissonregressionmodels. Results:Oftheparticipants,67.7%usedtheEDatleastonceand61%ofthevisitorsmadeatleastonereturnvisit duringtheapproximately12-monthperiod.Bodypain(notfromfallinjuryandnotincludingchestpain)wasthe mostcommonreason.TheEDvisitfrequencyatbaselineandatfollow-upwassignificantlypositivelyassociated withtheHAMDscoresattheassessmentpoints.TheEDvisitfrequencyatfollow-up,controllingfortheEDvisitsat baseline,wasalsosignificantlyassociatedwiththeHAMDscorechangesincebaseline. Conclusions:TheEDvisitratewasmuchhigherthanthosereportedinotherstudies.Bettereducationon self-managementofchronicconditions,depressionscreeningbyprimarycarephysiciansandED,anddepression treatmentthatincludessymptommanagementandproblem-solvingskillsmaybeimportanttoreduceEDvisits amongmedicallyill,low-incomehomeboundadults. Trialregistration:ClinicalTIdentifier:NCKeywords:Homeboundolderadults,Depression,Emergencydepartment Background and dehydration [1,3]. Chronic illnesses—especially car- Older adults in North America use emer