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Am J Psychiatry 1996; 153:877-885
Copyright © 1996 by American Psychiatric Association
Disability in geriatric depression
GS Alexopoulos, C Vrontou, T Kakuma, BS Meyers, RC Young, E Klausner and J Clarkin
Cornell University Medical College, White Plains, N.Y. USA.
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. METHOD: 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.
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