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

Namkee G. Choi, and C. Nathan Marti are with The University of Texas at Austin, Austin, TX, USA. -- Martha L. Bruce is with the Weill Cornell Medical College, White Plains, NY, USA. -- Mark E. Kunik is with the VA HSRD Houston Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA, and Baylor College of Medicine, Houston, TX, USA, and VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA.Background: Previous research found a high prevalence of depression, along with chronic illnesses and disabilities, among older ED patients. This study examined the relationship between depressive symptom severity and the number of ED visits among low-income homebound older adults who participated in a randomized controlled trial of telehealth problem-solving therapy (PST). Methods: The number of and reasons for ED visits were collected from the study participants (n=121 at baseline) at all assessment points—baseline and 12- and 24-week follow-ups. Depressive symptoms were measured with the 24-item Hamilton Rating Scale for Depression (HAMD). All multivariable analyses examining the relationships between ED visits and depressive symptoms were conducted using zero-inflated Poisson regression models. Results: Of the participants, 67.7% used the ED at least once and 61% of the visitors made at least one return visit during the approximately 12-month period. Body pain (not from fall injury and not including chest pain) was the most common reason. The ED visit frequency at baseline and at follow-up was significantly positively associated with the HAMD scores at the assessment points. The ED visit frequency at follow-up, controlling for the ED visits at baseline, was also significantly associated with the HAMD score change since baseline. Conclusions: The ED visit rate was much higher than those reported in other studies. Better education on self-management of chronic conditions, depression screening by primary care physicians and ED, and depression treatment that includes symptom management and problem-solving skills may be important to reduce ED visits among medically ill, low-income homebound adults. Trial registration ClinicalTrials.gov Identifier: NCT00903019Psycholog