Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-22T18:14:57.907Z Has data issue: false hasContentIssue false

Changes in depressive symptoms and functional disability among community-dwelling depressive older adults

Published online by Cambridge University Press:  22 May 2012

Ma Shwe Zin Nyunt
Affiliation:
Gerontological Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
May Li Lim
Affiliation:
Gerontological Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Keng Bee Yap
Affiliation:
Department of Geriatric Medicine, Jurong Hospital, Singapore
Tze Pin Ng*
Affiliation:
Gerontological Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
*
Correspondence should be addressed to: Tze Pin Ng, Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore119074. Phone: +65-6772-4514; Fax: +65-6777-2191. Email: [email protected].
Get access

Abstract

Background: Previous studies have shown that the presence of depressive symptoms among older persons was evidently associated with subsequent physical and functional decline. However, few studies have directly examined the impact of changes in depressive symptoms or depressed mood on changes in functional ability. The present prospective study examined whether changes in the levels and remission of depressive symptoms were associated with changes in functional ability among community-living older persons who were treated for depressive symptoms in a primary care setting.

Methods: Older persons aged 60 and above with depressive symptoms (N = 267) were followed up in a primary care treatment program over 12 months. Geriatric Depression Scale (GDS-15), and instrumental and basic activities of daily living (IADL and ADL) were measured at baseline and at 12-month follow-up. The associations of GDS change scores and conversion to non-depressed status with ADL and IADL change scores, controlling for baseline covariates including chronic medical comorbidity and Mini-Mental State Examination (MMSE), were examined in multiple regression analyses.

Results: An improvement in GDS scores (baseline score minus 12-month score) was significantly associated with improvement (12-month score minus baseline score) in ADL (β = 0.355, p < 0.001) and IADL scores (β = 0.165, p = 0.018) after adjusting for baseline functional status, MMSE, chronic medical comorbidities, and other variables. In particular, conversion in GDS status to “non-depressive” state (GDS ≤4) was associated with an improvement in ADL change scores (β = 0.281, p = 0.019).

Conclusion: In depressed older persons, an improvement in depressive symptoms was associated with improved functional ability.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barberger-Gateau, P., Chaslerie, A., Dartigues, J. F., Commenges, D., Gagnon, M. and Salamon, R. (1992). Health measures correlates in a French elderly community population: the PAQUID study. Journal of Gerontology, 47, S88S95.Google Scholar
Broadhead, W. E., Blazer, D. G., George, L. K. and Tee, C. (1990). Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA, 264, 25242528.CrossRefGoogle Scholar
Bruce, M. L., Seeman, T. E., Merrill, S. S. and Blazer, D. G. (1994). The impact of depressive symptomatology on physical disability: MacArthur studies of successful aging. American Journal of Public Health, 84, 17961799.CrossRefGoogle ScholarPubMed
Carbonara, L. D. et al. (2009). Physical disability and depressive symptomatology in an elderly population – a complex relationship: the Italian Longitudinal Study on Aging (ILSA). American Journal of Geriatric Psychiatry, 17, 144154.Google Scholar
Cronin-Stubbs, D., de Leon, C. F., Beckett, L. A., Field, T. S., Glynn, R. J. and Evans, D. A. (2000). Six-year effect of depressive symptoms on the course of physical disability in community-living older adults. Archives of Internal Medicine, 160, 30743080.Google Scholar
Everson-Rose, S. A., Skarupski, K. A., Bienias, J. L., Wilson, R. S., Evans, D. A. and de Leon, C. F. M. (2005). Do depressive symptoms predict declines in physical performance in an elderly, biracial population? Psychosomatic Medicine, 67, 609615.CrossRefGoogle Scholar
Feng, L., Yap, K. B., Kua, E. H. and Ng, T. P. (2009). Depressive symptoms, physician visits and hospitalization among community-dwelling older adults. International Psychogeriatrics, 21, 568575.Google Scholar
Folstein, M. F., Folstein, S. P. and McHugh, P. R. (1975). “Mini-mental state”: a practical methods for grading the cognitive state of patients for the clinicians. Journal of Psychiatric Research, 12, 189198.Google Scholar
Greiner, P. A., Snowdon, D. A. and Schmitt, F. A. (1996). The loss of independence in activities of daily living: the role of low cognitive function in elderly nuns. American Journal of Public Health, 86, 6266.Google Scholar
Hebert, R., Brayne, C. and Spiegelhalter, D. (1999). Factors associated with functional decline and improvement in a very elderly community-dwelling population. American Journal of Epidemiology, 150, 501510.Google Scholar
Hewitt, B. and Turrell, G. (2011). Short-term functional health and well-being after marital separation: does initiator status make a difference? American Journal of Epidemiology, 173, 13081318.CrossRefGoogle Scholar
Hybels, C. F., Pieper, C. F. and Blazer, D. G. (2009). The complex relationship between depressive symptoms and functional limitations in community-dwelling older adults: the impact of subthreshold depression. Psychological Medicine, 39, 16771688.CrossRefGoogle ScholarPubMed
Köhler, S., Thomas, A. J., Barnett, N. A. and O'Brien, J. T. (2010). The pattern and course of cognitive impairment in late-life depression. Psychological Medicine, 40, 591602.CrossRefGoogle ScholarPubMed
Kondo, N., Kazama, M., Suzuki, K. and Yamagata, Z. (2008). Impact of mental health on daily living activities of Japanese elderly. Preventive Medicine, 46, 457462.Google Scholar
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179186.Google Scholar
Lenze, E. J. et al. (2001). The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. American Journal of Geriatric Psychiatry, 9, 113135.CrossRefGoogle ScholarPubMed
Li, L. W. and Conwell, Y. (2009). Effects of changes in depressive symptoms and cognitive functioning on physical disability in home care elders. Journals of Gerontology A: Biological Sciences and Medical Sciences, 64, 230236.Google Scholar
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 6165.Google ScholarPubMed
Mehta, K. M., Yaffe, K. and Covinsky, K. E. (2002). Cognitive impairment, depressive symptoms, and functional decline in older people. Journal of the American Geriatrics Society, 50, 10451050.Google Scholar
Ng, T. P., Niti, M., Chiam, P. C. and Kua, E. H. (2006a). Physical and cognitive domains of the Instrumental Activities of Daily Living: validation in a multiethnic population of Asian older adults. Journals of Gerontology A: Biological Sciences and Medical Sciences, 61, 726735.Google Scholar
Ng, T. P., Niti, M., Chiam, P. C. and Kua, E. H. (2006b). Prevalence and correlates of functional disability in multiethnic elderly Singaporeans. Journal of the American Geriatrics Society, 54, 2129.CrossRefGoogle ScholarPubMed
Ng, T. P., Niti, M., Chiam, P. C. and Kua, E. H. (2007). Ethnic differences in cognitive performance on Mini-Mental State Examination in Asians. American Journal of Geriatric Psychiatry, 15, 130139.Google Scholar
Nyunt, M. S. Z., Fones, C., Niti, M. and Ng, T. P. (2009a). Criterion-based validity and reliability of the Geriatric Depression Screening Scale (GDS-15) in a large validation sample of community-living Asian older adults. Aging & Mental Health, 13, 376382.CrossRefGoogle Scholar
Nyunt, M. S. Z., Ko, S. M., Kumar, R., Fones, C. C. and Ng, T. P. (2009b). Improving treatment access and primary care referrals for depression in a national community-based outreach programme for the elderly. International Journal of Geriatric Psychiatry, 24, 12671276.Google Scholar
Panza, F. et al. (2010). Late-life depression, mild cognitive impairment, and dementia: possible continuum? American Journal of Geriatric Psychiatry, 18, 98116.Google Scholar
Payette, H., Gueye, N. R., Gaudreau, P., Morais, J. A., Shatenstein, B. and Gray-Donald, K. (2011). Trajectories of physical function decline and psychological functioning: the Quebec longitudinal study on nutrition and successful aging (NuAge). Journals of Gerontology B: Psychological Sciences and Social Sciences, 66, i82i90.CrossRefGoogle ScholarPubMed
Penninx, B. W. et al. (1998). Depressive symptoms and physical decline in community-dwelling older persons. JAMA, 279, 17201726.CrossRefGoogle ScholarPubMed
Penninx, B. W. et al. (1999). Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly. American Journal of Public Health, 89, 13461352.Google Scholar
Penninx, B. W. et al. (2000). Changes in depression and physical decline in older adults: a longitudinal perspective. Journal of Affective Disorders, 61, 112.CrossRefGoogle ScholarPubMed
Preisig, M., Merikangas, K. R. and Angst, J. (2001). Clinical significance and comorbidity of subthreshold depression and anxiety in the community. Acta Psychiatrica Scandinavica, 104, 96103.CrossRefGoogle ScholarPubMed
Rappaport, M. H. and Judd, L. L. (1998). Minor depressive disorder and subsyndromal depressive symptoms: functional impairment and response to treatment. Journal of Affective Disorders, 48, 227232.CrossRefGoogle Scholar
Soh, K. C., Kumar, R., Niti, M., Kua, E. H. and Ng, T. P. (2008). Subsyndromal depression in old age: clinical significance and impact. International Psychogeriatrics, 20, 188200.Google Scholar
Thomas, A. J. and O'Brien, J. T. (2008). Depression and cognition in older adults. Current Opinion in Psychiatry, 21, 813.CrossRefGoogle ScholarPubMed
Williams, K. and Umberson, , , D. (2004). Marital status, marital transitions, and health: a gendered life course perspective. Journal of Health and Social Behaviour 45, 8198.Google Scholar
Yesavage, J. A. et al. (1983). Development and validation of a Geriatric Depression Screening scale: a preliminary report. Journal of Psychiatric Research, 17, 3749.Google Scholar