The purpose of this study was to evaluate participant self-efficacy and use of a mobile phone diabetes health intervention for older adults during a 4-week period. Participants included seven adults (mean age, 70.3 years) with type 2 diabetes cared for by community-based primary care physicians. Participants entered blood glucose data into a mobile phone and personalized patient Internet Web portal. Based on blood glucose values, participants received automatic messages and educational information to self-manage their diabetes. Study measures included prior mobile phone/Internet use, the Stanford Self-Efficacy for Diabetes Scale, the Stanford Energy/Fatigue Scale, the Short Form-36, the Patient Health Questionnaire-9 (depression), the Patient Reported Diabetes Symptom Scale, the Diabetes Stages of Change measure, and a summary of mobile system use. Participants had high self-efficacy and high readiness and confidence in their ability to monitor changes to control their diabetes. Participants demonstrated ability to use the mobile intervention and communicate with diabetes educators.

Rationale: Among individuals with chronic obstructive pulmonary disease (COPD), depression is one of the most common yet underrecognized and undertreated comorbidities. Although depression has been associated with reduced adherence to maintenance medications used in other conditions, such as diabetes, little research has assessed the role of depression in COPD medication use and adherence.Objectives: The objective of this study was to assess the impact of depression on COPD maintenance medication adherence among a nationally representative sample of Medicare beneficiaries newly diagnosed with COPD. Methods:We used a 5% random sample of Medicare administrative claims data to identify beneficiaries diagnosed with COPD between 2006 and 2010. We included beneficiaries with 2 years of continuous Medicare Parts A, B, and D coverage and at least two prescription fills for COPD maintenance medications after COPD diagnosis. We searched for prescription fills for inhaled corticosteroids, long-acting b-agonists, and long-acting anticholinergics and calculated adherence starting at the first fill. We modeled adherence to COPD maintenance medications as a function of new episodes of depression, using generalized estimated equations.Measurements and Main Results: Our primary outcome was adherence to COPD maintenance medications, measured as proportion of days covered. The exposure measure was depression. Both COPD and depression were assessed using diagnostic codes in Part A and B data. Covariates included sociodemographics, as well as clinical markers, including comorbidities, COPD severity, and depression severity. Of 31,033 beneficiaries meeting inclusion criteria, 6,227 (20%) were diagnosed with depression after COPD diagnosis. Average monthly adherence to COPD maintenance medications was low, peaking at 57% in the month after first fill and decreasing to 35% within 6 months. In our adjusted regression model, depression was associated with decreased adherence to COPD maintenance medications (odds ratio, 0.93; 95% confidence interval, 0.89-0.98).Conclusions: New episodes of depression decreased adherence to maintenance medications used to manage COPD among older adults. Clinicians who treat older adults with COPD should be aware of the development of depression, especially during the first 6 months after COPD diagnosis, and monitor patients' adherence to prescribed COPD medications to ensure best clinical outcomes.

Objective Sequelae of traumatic brain injury (TBI) include depression, which could exacerbate the poorer cognitive and functional recovery experienced by older adults. The objective of this study was to estimate incidence rates of depression following hospital discharge for TBI among Medicare beneficiaries aged ≥65 years, quantify the increase in risk of depression following TBI, and evaluate risk factors for incident depression post-TBI. Design Retrospective analysis of Medicare claims data Participants Medicare beneficiaries ≥65 years hospitalized for traumatic brain injury (TBI) during 2006–2010 who survived to hospital discharge and had no documented diagnosis of depression prior to the study period(n=67,347). Measurement Diagnosis of depression during the study period. Results The annualized incidence rate of depression per 1,000 beneficiaries was 62.8 (95% confidence interval (CI) 61.6,64.1) pre-TBI and 123.9 (95%CI 121.6,126.2) post-TBI. Annualized incidence rates were highest immediately following hospital discharge and declined over the twelve months post-TBI. TBI increased the risk of incident depression in men (hazard ratio (HR) 1.95;95%CI 1.84,2.06, Wald χ2=511.4,df =1,p < 0.001) and in women (HR 1.69;95%CI 1.62,1.77, Wald χ2=589.3,df =1,p < 0.001). The strongest predictor of depression post-TBI for both men and women was discharge to a skilled nursing facility: men (odds ratio (OR) 1.91;95%CI 1.77,2.06, Wald χ2=277.1,df = 1,p < 0.001), women: (OR 1.72;95%CI 1.63,1.83, Wald χ2=324.2,df = 1,p < 0.001). Conclusions TBI significantly increased the risk of depression among older adults, especially among men and those discharged to a skilled nursing facility. Results from this study will help increase awareness of the risk of depression post-TBI among older adults.

Background and Objective Adherence to chronic obstructive pulmonary disease (COPD) maintenance medications and antidepressants may reduce healthcare utilization among multimorbid individuals with COPD and depression. We quantified the independent effects of adherence to antidepressants and COPD maintenance medications on healthcare utilization among individuals co-diagnosed with COPD and depression. Procedures We conducted a retrospective cohort study using a 2006–2012 5% random sample of Medicare beneficiaries co-diagnosed with COPD and depression who had two or more prescription fills of both COPD maintenance medications and antidepressants. We measured adherence to medications using the proportion of days covered per 30-day period. The primary outcomes were all-cause emergency department (ED) visits and hospitalizations. Beneficiaries were followed over a minimum 12 month follow-up period. Results Of the 16,075 beneficiaries meeting inclusion criteria, 21% achieved adherence ≥80% to COPD maintenance medications and 55% achieved adherence ≥80% to antidepressants. Compared to no use and controlling for antidepressant adherence and potential confounders, higher (≥80%) levels of adherence to COPD maintenance medications were associated with decreased risk of ED visits (hazard ratio (HR) 0.79; 95% CI 0.74, 0.83) and hospitalizations (HR 0.82; 95% CI 0.78, 0.87). Similarly, higher levels (≥80%) of adherence to antidepressants resulted in decreased risk of ED visits (HR 0.74; 95% CI 0.70, 0.78) and hospitalizations (HR 0.77; 95% CI 0.73, 0.81) compared to no use. Conclusions Clinicians can assist in the improved management of their multimorbid patients’ health by treating depression among patients with COPD and monitoring and encouraging adherence to the regimens they prescribe.

Regularly treated depression may increase use of and adherence to necessary maintenance medications for COPD. Antidepressant treatment may be a key determinant to improving medication-taking behaviors among COPD patients comorbid with depression.