DO DEPRESSIVE SYMPTOMS IMPROVE AS OLDER ADULTS TRANSITION FROM HOSPITAL TO POST-ACUTE CARE TO HOME?

AbstractDepression is common among hospitalized older adults. The change in depressive symptoms across transitions in care settings is poorly characterized. We describe the trajectory of depressive symptoms for patients enrolled in a randomized controlled trial to reduce polypharmacy with the hypothesis that symptom prevalence will be higher during hospitalization relative to each subsequent care transition. Patients’ depressive symptoms were assessed during their hospitalization, skilled nursing facility (SNF) discharge, and 7-days after SNF discharge using the Patient Health Questionnaire 9 (PHQ-9), with a score of ≥5 indicating possible depression. During hospitalization and 7-day follow-up periods, the PHQ-9 was administered by trained research personnel. During the SNF stay, the PHQ-9 was administered by SNF staff and recorded on the discharge Minimum Data Set. A total of 59 patients (mean age of 78 (±10), 68% female) enrolled in the larger study had PHQ-9 data at all three time points. The mean PHQ-9 scores at hospital, SNF, and home were 9.4 ± 5.3, 1.9 ± 3.5, 5.7 ± 5.1, respectively. The prevalence of depressive symptoms was lower at 7-day follow-up relative to the hospitalization period: 81.4% to 49.2% of patients with possible depression, respectively. However, the prevalence of depressive symptoms was lowest at SNF, with 10.2% endorsing possible depression. Although the prevalence of depressive symptoms was lower after hospital discharge, the persistence of symptoms at home suggests a need for continued follow-up. Additionally, the lower prevalence and mean score at SNF compared to home implies that depressive symptoms may be under-recognized and therefore go unaddressed during the SNF stay.