Disability in geriatric depression.
OBJECTIVE
The authors' purpose was to identify the relationship of disability to clinical measures that are part of a comprehensive psychiatric examination of depressed elderly patients.


METHODS
The disability of 75 elderly inpatients and outpatients with major depression whose cognitive function ranged from normality to mild dementia was assessed with the Philadelphia Multilevel Assessment Instrument. Age at onset of depression, chronicity of depression, severity of depression, cognitive impairment, medical burden, social support and living environment were assessed with standardized instruments.


RESULTS
Impairment in instrumental activities of daily living was significantly associated with advanced age, severity of depression, and medical burden. The relationship of depressive symptoms to impairment in instrumental activities of daily living was not influenced by age or medical burden. Anxiety and depressive ideation as well as retardation and weight loss were significantly associated with impairment in instrumental activities of daily living. Interviewer-rated global disability was associated with advanced age at onset of depression, medical burden, and overall cognitive impairment. Specifically, a disturbance in initiation and perseveration was significantly related to global disability.


CONCLUSIONS
Impairment in instrumental activities of daily living appears to be a relatively independent dimension of health status that is related to depressive symptoms, particularly anxiety and depressive ideation as well as retardation and weight loss. Global disability may be associated with impairment in initiation and perseveration and with late onset of depression. These findings provide a basis for studies investigating whether psychotherapy aimed at depressive ideation and rehabilitation efforts focused on instrumental activities of daily living can improve the outcome of geriatric depression.
Alexopoulos
G S
GS
Cornell University Medical College, White Plains, N.Y. USA.
Vrontou
C
C
Kakuma
T
T
Meyers
B S
BS
Young
R C
RC
Klausner
E
E
Clarkin
J
J
D000203:Activities of Daily Living; D017668:Age of Onset; D000368:Aged; D001007:Anxiety / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology; D003863:Depression / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance; D012044:Regression Analysis; D012720:Severity of Illness Index; D012944:Social Support; D015431:Weight Loss