Burden of Depressive Symptoms Over 2 Decades and Risk of Nursing Home Placement in Older Women

Amy L. Byers, Li Yung Lui, Eric Vittinghoff, Kenneth E. Covinsky, Kristine E. Ensrud, Brent Taylor, Kristine Yaffe

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objectives: To determine the association between cumulative burden of depressive symptoms and risk of nursing home (NH) placement over 2 decades. Design: Prospective cohort study with data linked to Medicare claims files. Setting: Clinic sites in Baltimore, Maryland; Minneapolis, Minnesota; and the Monongahela Valley near Pittsburgh, Pennsylvania. Participants: Initially community-dwelling women aged 65 and older (N=3,646). Measurements: Depressive symptom burden was determined using the Geriatric Depression Scale measured over 18 years to calculate accumulation of burden. NH placement was determined using Medicare claims data. Results: In Fine-Gray proportional hazards analyses including demographic characteristics, medical comorbidities, functional impairment, and recent depression exposure and accounting for competing risk of death, women with low depressive symptom burden were twice as likely to experience NH placement as those with minimal burden (hazard ratio (HR) = 1.92, 95% confidence interval (CI) = 1.16–3.20), women with moderate burden were more than twice as likely (HR = 2.62, 95% CI = 1.59–4.31), and women with high burden (HR = 3.08, 95% CI = 1.87–5.08) were three times as likely. The addition of antidepressant use to this model attenuated the risk only slightly. Conclusion: In older women, cumulative burden of depressive symptoms over nearly 2 decades is associated with greater risk of transitioning from community-living to a NH irrespective of recent depression exposure, medical comorbidities, functional impairment, and the competing risk of death. This work supports the need for improving recognition, monitoring, and treatment of depressive symptoms early, which may reduce or delay NH placement.

Original languageEnglish (US)
Pages (from-to)1895-1901
Number of pages7
JournalJournal of the American Geriatrics Society
Issue number10
StatePublished - Oct 2018

Bibliographical note

Funding Information:
Financial Disclosure: This work was supported by National Institute of Mental Health Grant R01 MH086498 (PI: Dr. Yaffe). Dr. Byers is supported by Award R01 MD007019 from the National Institute on Minority Health and Health Disparities and Clinical Science Research & Development Merit Award I01 CX001119 from the U.S. Department of Veterans Affairs Office of Research and Development. Dr. Yaffe is supported, in part, by Midcareer Investigator Award K24 AG031155 from the National Institute on Aging. SOF was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging (Public Health Service Grants: 2 R01 AG027574–22A1, R01 AG005407, R01 AG027576– 22, 2 R01 AG005394–22A1, AG05407, AG05394, AR35582, AR35583, AR35584, AG026720, R01 AG18037, R01 AG028144–01A1).

Publisher Copyright:
© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society


  • aging
  • care transitions
  • depression
  • epidemiology
  • institutionalization


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