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Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms
- Shiyu Lu, Tianyin Liu, Gloria H. Y. Wong, Dara K. Y. Leung, Lesley C. Y. Sze, Wai-Wai Kwok, Martin Knapp, Vivian W. Q. Lou, Samson Tse, Siu-Man Ng, Paul W. C. Wong, Jennifer Y. M. Tang, Terry Y. S. Lum
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 30 / 2021
- Published online by Cambridge University Press:
- 02 February 2021, e10
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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.
MethodsWe 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.
ResultsThe 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).
ConclusionsThe 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.
Rearranging meal times during night shift work promotes weight change: a randomised crossover intervention in shift workers
- Gloria K. W. Leung, Rochelle Davis, Catherine E. Huggins, Erika Rosbotham, Rebekah Warnock, Maxine P. Bonham
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E639
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Up to 20% of the population in industrialised countries are employed as shift workers. Shift work is an independent risk factor for metabolic diseases, such as type-2 diabetes, cardiovascular disease (CVD) and obesity. This may be associated with shift workers’ typical habit of eating during the night, as it forces the body to process nutrients when the body is expecting a period of fast. This study aimed to examine whether redistributing meal times, to create a defined overnight fast period, can improve CVD risk factors in night shift workers.
Eligible participants were permanent or rotating night shift workers who habitually ate on night shift between 1am to 6am and had abdominal obesity as assessed by waist circumference, but were otherwise healthy. This randomised crossover trial comprised a four-week control period and a four-week intervention period separated by a minimum two-week washout period. During the intervention period, participants were advised to rearrange meal and snack times to create a five hour nightly fast between 1am and 6am. Up to four random 24-hour food recalls per participant were performed during both periods of the study, to check compliance and to assess energy intake. All recall periods included a night shift. Participants attended the research facility at the end of each period to be weighed (seca, gmbh & co. kg, Hamburg, Germany). Work schedule and meals were standardised 24 hours prior to attending the research facility. Data were analysed using paired t-test and reported as mean (SD).
Participants (n = 19) were aged 41(10) years. Daily energy intake was not markedly different between the two study periods, intake was 10633 (3591) kJ/ day in the intervention period vs. 10919 (4276) kJ/ day in the control period (n = 60 recalls in each period, p = 0.670). Body weight was significantly lower at the end of the intervention period compared with at the end of the control period (86.2 (17) vs. 87.1 (18) kg, p = 0.001). Similarly, BMI was lower at the end of the intervention period compared with end of control period (30.7 (6) vs. 31.1 (6) kg/m2, p = 0.001).
Increasing evidence indicates that working night shifts potentiates weight gain. We show that advising shift workers to avoid eating during 1am and 6am for a four-week period had a positive impact on body weight. Manipulating meal and snack times for shift workers may be a simple strategy to assist in weight management.