Cross-Sectional Associations of Depressive Symptom Severity and Functioning with Health Service Use by Older People in Low-and-Middle Income Countries

Conal Twomey,Alarcos Cieza,Martin Prince,A Prina,David Baldwin

doi:10.3390/ijerph120403774

Abstract

Background: Comprehensive understanding of the determinants of health service use (HSU) by older people with depression is essential for health service planning for an ageing global population. This study aimed to determine the extent to which depressive symptom severity and functioning are associated with HSU by older people with depression in low and middle income countries (LMICs). Methods: A cross-sectional analysis of the 10/66 Dementia Research Group population-based surveys dataset. Participants (n = 4590) were those aged 65 or older, in the clinical range for depressive symptoms (defined as scoring four or more on the EURO-D), living in 13 urban and/or rural catchment areas in nine LMICs. Associations were calculated using Poisson regression and random-effects meta-analysis. Results: After adjustment for confounding variables, (EURO-D) depressive symptom severity was significantly associated with “any community HSU” (Pooled Prevalence Ratios = 1.02; 95% CI = 1.01–1.03) but not hospital admission. Conversely, after adjustment, (WHODAS-II) functioning was significantly associated with hospital admission (Pooled PR = 1.14; 95% CI = 1.02–1.26) but not “any community HSU”. Conclusions: Depressive symptom severity does not explain a large proportion of the variance in HSU by older people with depression in LMICs. The association of functioning with this HSU is worthy of further investigation. In LMICs, variables related to accessibility may be more important correlates of HSU than variables directly related to health problems.

Highlights

Older people- here defined as people aged 65 years or older- consume substantially more health service resources than younger people
Our main aim was to determine the extent to which depressive symptom severity and functioning are associated with health service use (HSU) by older people in low and middle income countries (LMICs)
Data collected pertained to demographics, physical health, mental health, chronic disease risk factors, functioning impairment, HSU, care arrangements and caregiver strain

Summary

Introduction

Older people- here defined as people aged 65 years or older- consume substantially more health service resources than younger people. Health service use (HSU) by older people is 3–5 times higher than in younger people [1]. Better health patterns in old age should be taken into account [4], the ongoing demographic shift towards an older global population will increasingly place greater demands on health services [5]. A comprehensive understanding of the variables associated with HSU by older people is essential for effective health service planning over the long term. Comprehensive understanding of the determinants of health service use (HSU) by older people with depression is essential for health service planning for an ageing global population. This study aimed to determine the extent to which depressive symptom severity and functioning are associated with HSU by older people with depression in low and middle income countries (LMICs). Methods: A cross-sectional analysis of the 10/66 Dementia Research Group population-based surveys dataset

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