Date of Award

Fall 2021

Document Type

Open Access Dissertation


College of Pharmacy

First Advisor

Kevin Lu


Background: Depression and Alzheimer's Disease and Related Dementias (ADRD) are common among older adults. Currently, depression is recognized as one of the risk factors for ADRD. There is conflicting evidence on the association between depression and ADRD. Inadequate detection, diagnosis, and management of depression appear to pose a significant risk to the quality of life and healthcare utilization among older adults. To date, there are few studies on the impact of depression on self-reported healthcare utilization and self-reported health outcomes among Medicare beneficiaries.

Objectives: The aims of this study were to (1) quantify the association between depression and ADRD, quality of life, and healthcare utilization; (2) determine the association between use of antidepressants and ADRD, quality of life, and healthcare utilization among participants with depression; and (3) investigate the association with number of antidepressant prescriptions and quality of life, and health services use among participants with depression.

Methods: We designed this research as a cross-sectional study using Medicare Current Beneficiaries Survey (MCBS), nationally representative from 2015-2017. Univariate and bivariate analyses were used to determine the potential factors associated with patients’ outcomes. Multivariable logistic regressions were further conducted to quantify the relationship between depression, antidepressant use associated with healthcare utilization, patient-reported outcomes, and ADRD among Medicare beneficiaries with depression.

Results: For aim 1 (depression), we identified 18,597 participants. There were 4,070 (21.9%) beneficiaries with depression. We found that depression was associated with ADRD (odds ratio [OR]: 4.70; 95% confidence interval [CI]: 4.04-5.47), ER visits (OR: 1.39; 95% CI: 1.23-1.58), prescriptions use (OR: 1.29; 95% CI: 1.16-1.44), general health status (OR: 0.34; 95% CI: 0.30-0.37), and disability status (OR: 3.36; 95% CI: 3.05-3.70). Aims 2 (antidepressants use) and 3 (number of prescriptions), we identified 3,268 beneficiaries. There were 1,367 (41.8%) users of antidepressants. Atypical antidepressants were associated with ADRD among beneficiaries with depression (OR: 1.49; 95% CI: 1.05-2.12). Tricyclic Antidepressants (TCAs) use was associated with hospitalization (OR: 1.88; 95% CI: 1.02-3.48). For disability status, Serotonin and Norepinephrine Reuptake Inhibitors (SNRI) use was associated with disability status (OR: 2.15; 95% CI: 1.48-3.12), and the number of antidepressant prescriptions (OR: 1.03; 95% CI: 1.01-1.04).

Conclusion: Healthcare providers should consider individual characteristics and patients' potential health outcomes associated with medication use and choose the optimum treatment for each individual to minimize healthcare utilization, reduce the risk of developing ADRD, and improve quality of life. More research is warranted to examine if effective depression management reduces the incidence of ADRD and to explore the association between different classes of antidepressants and quality of life.

Available for download on Friday, May 31, 2024