Effects of Changes in Depressive Symptoms and Cognitive Functioning on Physical Disability in Home Care Elders
Effects of Changes in Depressive Symptoms and Cognitive Functioning on Physical Disability in Home Care Elders
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DOI：
10.1093/gerona/gln023
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发表时间：
2009-02-01
影响因子：
5.1
通讯作者：
Conwell, Yeates
中科院分区：
文献类型：
--
作者：
Li, Lydia W.;Conwell, Yeates
背景。本研究旨在调查抑郁状态的变化对接受家庭护理的老年人身体残疾的影响，检查这种影响是否是由于认知状态的伴随变化引起的，并测试情感状态和认知能力是否相互作用以影响身体残疾。方法。使用大约每 3 个月从密歇根社区长期护理计划老年参与者收集的纵向数据进行多层次分析 (N = 13,129)。该数据集平均提供了九次抑郁症状、认知功能和身体残疾的重复测量。我们估计了抑郁症和认知状态的人体内变化及其相互作用对通过日常生活活动（ADL）和工具性日常生活活动（IADL）衡量的身体残疾的滞后影响，并控制了在此期间发生的健康相关事件。结果。没有和有抑郁症状（包括亚综合征症状）之间的变化对于家庭护理老年人的身体残疾至关重要。这些影响与认知状态的伴随变化无关，认知状态也对身体残疾产生显着的不利影响。有一些证据表明，抑郁症的改善可以缓冲认知能力下降对 IADL 残疾的不利影响。结论。提供者应监测家庭护理老年人的抑郁和认知状态的变化。早期发现和治疗阈下抑郁症，以及努力防止家庭护理老年人认知状态恶化，可能会对他们的家庭生活能力产生有意义的影响。
Background. This study sought to investigate the effect of changes in depression status on physical disability in older persons receiving home care, examine whether the effect is due to concomitant changes in cognitive status, and test whether affective state and cognitive ability interact to influence physical disability.Methods. Multilevel analyses were conducted using longitudinal data collected about every 3 months from older participants in Michigan's community-based long-term care programs ( N = 13,129). The data set provided an average of nine repeated measures of depressive symptoms, cognitive functioning, and physical disability. We estimated the lag effects of within-person changes in depression and cognitive status, and their interaction, on physical disability measured by activities of daily living (ADL) and instrumental activities of daily living (IADL), controlling for health-related events that occurred in the interim.Results. Changes between not having and having depressive symptoms, including subsyndromal symptoms, are critical to physical disability for home care elders. The effects are independent of concomitant changes in cognitive status, which also have significant adverse effects on physical disability. There is some evidence that improvement of depression buffers the adverse effect of cognitive decline on IADL disability.Conclusions. Providers should monitor changes in depression and cognitive status in home care elders. Early detection and treatment of subthreshold depression, as well as efforts to prevent worsening of cognitive status in home care elders, may have a meaningful impact on their ability to live at home.