Monetary difficulties in Icelandic older adults after hospital discharge and mental health

Background

Iceland has the 8th highest gross domestic product (GDP) per capita in the world, still financial hardship is reported in Iceland and older adults often find hard to meet ends. Little is known about its impact on older adults following hospital discharge. This study examined both cross-sectional and longitudinal associations between financial hardship, health-related quality of life (QoL), and depressive symptoms in older Icelandic adults discharged from hospital.

Methods

This secondary analysis used data from the HOMEFOOD dietary intervention trial, which included 104 community-dwelling older adults (mean age = 83 years) discharged from hospital. Depressive symptoms were measured using the Iowa variant of the Center for Epidemiologic Studies Depression Scale (CES-D), and health-related QoL was assessed using the EQ-5D instrument. Financial hardship and income categories were self-reported. Associations were examined using linear regression analyses adjusted for relevant covariates.

Results

Financial hardship was reported by 23 participants (22%) and was associated with lower income categories (P = 0.05) but not with gender (P = 0.495). At discharge, financial hardship was cross-sectionally associated with higher CES-D scores (B = 2.3, P = 0.029, adjusted for age and gender), but not with EQ-5D scores (B = –0.05, P = 0.195). Longitudinal analyses showed that financial hardship predicted poorer QoL (EQ-5D: B = –0.1, P = 0.016) and higher depressive symptoms (CES-D: B = 2.2, P = 0.014) six months after discharge, after adjustment for age, gender, intervention group, and baseline values.

Conclusions

Financial hardship is common among older Icelandic adults discharged from hospital and is associated with worse psychological health outcomes. Those reporting financial hardship showed lower quality of life and more depressive symptoms six months after discharge, highlighting the need to consider socioeconomic factors in post-discharge care for older adults.

Key messages

• Financial hardship is common among older Icelandic adults discharged from hospital and is associated with worse psychological health outcomes.

• These participants had lower quality of life and more depressive symptoms six months after discharge, highlighting the need to consider socioeconomic factors in post-discharge care of older adults.