title: Impact of mental health on daily living activities of Japanese elderly.
abstract: OBJECTIVE
  We investigated the impact of mental health on the decline in higher activities of daily living (ADL) defined in terms of social role performance (SR, the highest ADL), intellectual activity (IA), and instrumental ADL (IADL), as well as the onset of basic ADL disability.
  
  
  METHODS
  Six hundred older adults were randomly selected from Yamanashi prefecture, Japan. An interview survey collected baseline information from 581 people (97%) in 2003. Of those, 93% were followed for 25 months by mail. Cox's proportional hazard model was used.
  
  
  RESULTS
  Among people aged 75+ years, those with severe depressive symptoms had a relative risk (95% confidence intervals) of 3.22 (1.35-7.71), 3.11 (1.38-6.98), and 2.41 (1.07-5.40) for subsequent decline in SR, IA, and IADL, respectively, compared to those without depressive symptoms. The excess risk of IADL decline among people aged 65-74 years was also statistically significant. Social inactivity partly explained the excess risk.
  
  
  CONCLUSIONS
  Severe depressive symptoms in older adults may accelerate the progression of higher ADL decline. The adverse effect of depressive symptoms is more pronounced in senior elderly. By screening depressive symptoms and higher ADL, and promoting social activities of people at high risk, their risk for basic ADL disability could be reduced.
authors.affiliation: Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan. nkondo@yamanashi.ac.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Kondo
authors.forename: Mari
authors.initials: M
authors.lastname: Kazama
authors.forename: Kohta
authors.initials: K
authors.lastname: Suzuki
authors.forename: Zentaro
authors.initials: Z
authors.lastname: Yamagata
mesh_terms: D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged / Q000523:psychology*; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000453:epidemiology*; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008603:Mental Health; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012919:Social Behavior; D012934:Social Isolation