Search

Objective: Research has shown an association between depression and functional limitations in older adults. Our aim was to explore the latent traits of trajectories of limitations in mobility and instrumental activities of daily living (IADL) tasks in a sample of older adults diagnosed with major depression.Methods: Participants were 248 patients enrolled in a naturalistic depression treatment study. Mobility/IADL tasks included walking one-fourth mile, going up/down stairs, getting around the neighborhood, shopping, handling money, taking care of children, cleaning house, preparing meals and doing yardwork/gardening. Latent class trajectory analysis was used to identify classes of mobility/IADL function over a 4-year period. Class membership was then used to predict functional status over time.Results: Using time as the only predictor, three latent class trajectories were identified: (1) Patients with few mobility/IADL limitations (42%), (2) Patients with considerable mobility/IADL limitations (37%) and (3) Patients with basically no limitations (21%). The classes differed primarily in their initial functional status, with some immediate improvement followed by no further change for patients in Classes 1 and 2 and a stable course for patients in Class 3. In a repeated measures mixed model controlling for potential confounders, class was a significant predictor of functional status. The effect of baseline depression score, cognitive status, self-perceived health and sex on mobility/IADL score differed by class.Conclusions: These findings show systematic variability in functional status over time among older patients with major depression, indicating that a single trajectory may not reflect the pattern for all patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the course of depressive symptoms in older patients with comorbid major depression and dysthymia. DESIGN: Secondary data analysis using both proportional hazards modeling and a repeated measures mixed model. SETTING: Clinical Research Center for the Study of Depression in Later Life conducted at Duke University. PARTICIPANTS: Two hundred fifty inpatients and outpatients age 60 and older with major depression enrolled in a naturalistic treatment study and followed up for 10 years. MEASUREMENTS: The Diagnostic Interview Schedule was used to confirm a clinical diagnosis of major depression and to identify patients with comorbid dysthymia at the time of study enrollment. Patients were administered the Montgomery-Asberg Depression Rating Scale (MADRS) every 3 months. For the proportional hazards models, partial remission was defined as a MADRS score <16 and full remission as a score <7. RESULTS: A total of 34.8% of the patients had comorbid major depression and dysthymia at baseline enrollment. Compared with those with major depression alone, they had longer time to both partial (median number of days = 175 versus 106) and full remission (median number of days = 433 versus 244) from major depression. In the repeated measures mixed model predicting MADRS score over 3 years of follow-up and controlling for the effects of potential confounders, the effect of having comorbid dysthymia was not consistent over time, with patients with both disorders having higher predicted scores after initial response. CONCLUSIONS: Older patients with comorbid major depression and dysthymia have a less favorable trajectory of recovery compared with those with major depression alone. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite the burden of depression in late life, its origins present a paradox to investigators and clinicians alike. METHOD: We review biological (genetics and heredity factors, neurotransmitter dysfunction, endocrine changes, vascular disorders, and medical co-morbidities), psychological (personality attributes, neuroticism, cognitive distortions, and the lack of emotional control and self-efficacy) and social (stressful life events, bereavement, chronic stress or strain, socio-economic disadvantage and impaired social support) origins of late-life depression based upon an extensive though not exhaustive review of the extant literature. In addition, modifying psychological and social factors are discussed. RESULTS: Older adults appear to be at greater risk for major depression biologically, such as depression resulting from vascular changes, yet the frequency of depression is lower compared to younger adults. Older adults may be protected psychologically due to factors such as socio-emotional selectivity and wisdom, compared to younger adults, and perhaps relatively protected from social risks. CONCLUSIONS: A biopsychosocial approach to evaluating the origins of late-life depression is heuristically valuable, a continual reminder of the many factors that contribute to the onset and persistence of clinically significant symptoms in late life. [ABSTRACT FROM AUTHOR]

Background: The evidence for an association between depression and mortality among community-dwelling elderly persons remains inconclusive, although it is well established for younger individuals. Extant studies suggest that this association weakens when adjusted for potential confounding factors, especially functional impairment. A cohort of elderly subjects followed for 3 years was analyzed to determine the association of depression and 3-year mortality, controlling for the major known risk factors for mortality in the elderly population.Methods: Information on depression (CES-D scores), mortality, demographics, body mass index, chronic disease, smoking history, cognitive impairment, functional impairment, self-rated health, and social support was obtained from a stratified probability-based sample of community-dwelling elderly persons, with equal distribution between African Americans and whites in the Piedmont of North Carolina. Descriptive statistics were calculated, and logistic regression was used for a series of models with progressively more control variables.Results: The unadjusted relative odds of mortality among depressed subjects at baseline was 1.98 over 3 years of follow-up. Inclusion of age, gender, and race into the model did not reduce the relative odds. When chronic disease and health habits, cognitive impairment, functional impairment, and social support were added to the model, the odds ratios for mortality with depression were 1.74, 1.69, 1.29, and 1.21, respectively. This decrease in odds ratios was not observed for other variables in the model when additional variables were added.Conclusions: The estimated odds of dying if depressed moved toward unity as other risk factors for mortality were controlled. Unlike other known risk factors for mortality in the elderly population, depression appears to be associated with mortality through a number of independent mechanisms, perhaps through complex feedback loops. [ABSTRACT FROM AUTHOR]