Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

Abstract

Aims Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. Methods We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. Results The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). Conclusions The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

Projecting the 10-year costs of care and mortality burden of depression until 2032: a Markov modelling study developed from real-world data

“…46 Locally, a cross-sectional survey studying community-dwelling older adults estimated that the annual cost of all-cause healthcare and rehabilitation was US$6230 (valued in 2017/2018) among patients with mild depression. 47 Despite non-comparable results due to different study designs and patient categories, our study projected consistent costs of all-cause care per patient-year among older patients without medical history (US$5349 and US$7030 in women and men). Our findings support the reliability of previous local analyses.…”

International depiction of the cost of functional independence limitations among older adults living in the community: a systematic review and cost-of-impairment study

“…Fourteen studies [47,48,51,59,63,66,75,80,81,91,110,114,119,121,123] provided a total value for societal costs which encompassed health care system costs as well as informal care, assistive services costs, and productivity losses. Sixteen studies estimated the costs of assisted services [39,43,48,63,65,71,79,85,95,99,101,106,113,114,119,123], while 21 studies estimated the costs of home health care [39,40,44,48,57,63,65,71,73,77,79,93,94,101,106,111,113,114,…”

Effectiveness of continuity of care in reducing depression symptoms in elderly: A systematic review and meta‐analysis

“…4 It is often closely associated with adverse events such as increased risk of suicide, reduced quality of life, functional decline, and increased medical burden. [5][6][7] According to statistics, LLD has become the cause of 5.7% of the years lived with disability in older adults aged 60 and older. 8 Depression is easily under-diagnosed, misdiagnosed, or under-treated due to low awareness of depression in older adults, stigma, lower treatment adherence, and the complexities of depression often coexisting with chronic physical illness.…”

“…Depression affects approximately 10.0%–20.0% of older adults worldwide 4 . It is often closely associated with adverse events such as increased risk of suicide, reduced quality of life, functional decline, and increased medical burden 5–7 . According to statistics, LLD has become the cause of 5.7% of the years lived with disability in older adults aged 60 and older 8 .…”