THE COURSE OF DEPRESSION AMONG INSTITUTIONAL ELDERLY

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This proposal describes a longitudinal study of depression, physical frailty and cognitive impairment among elderly nursing home and congregate apartment residents. Previous research with aged community and institution residents reveals a strong association of depression with ill health, functional disability, and mortality, and a smaller and more controversial relationship with cognitive deficits. However, existing longitudinal research tends to use follow up intervals that are too long to identify the temporal sequencing of changes among these variables, particularly among frail older people, who may experience marked changes in physical, cognitive and emotional status over relative short periods. The proposed research therefore extends and expands previous activities of "Core" research of the Philadelphia Geriatric Center/Medical College of Pennsylvania Clinical Research Center on Psychopathology of the Aged to help fill gaps in current knowledge. Specific aims are 1) to delineate the nature and strength of reciprocal relationships of physical health and functional ability with depression among institutionalized older persons; 2) to clarify the mechanisms by which depression contributes to mortality, both independently and in conjunction with ill health; 3) to explicate temporal patterns of associations between depression and cognitive impairment, and 4) to identify macrolevel nutritional correlates of depression that may mediate observed relationships among depression, ill health, an mortality. These aims are pursued in a 5-year project that calls for tri-yearly assessments of a diverse group of elderly nursing home and congregate apartment residents over a 3-year period. The project combines CRC-validated self-report measures of depression, cognitive status, physical health and functional status with laboratory and anthropometric data on nutritional markers; detailed health data extracted from medical charts, and observational measures of depression, cognition, and functional ability. Particular attention is given identifiable, discrete health and psychiatric "events" as empirical markers of change.