Depressive Symptoms, Aging, Disability and Health Outcomes

描述（由申请人提供）：日常活动（ADL）或短距离行走等基本任务的困难在中年人中相对不常见，但随着年龄的增长而变得越来越普遍，通常导致残疾。虽然这些残疾可能直到人们进入老年才变得明显，但它们可能在中年时期发展的风险因素中有其前身。了解晚年残疾的中年决定因素具有重大的公共卫生重要性，因为这些残疾严重损害老年人的生活质量，是其他不良后果的风险因素，如需要照顾者的帮助，养老院安置和死亡。假设中年抑郁症状是晚年残疾和相关结局的重要风险因素，这是有充分理由的。有抑郁症状的中年人更有可能患有与工作有关的残疾，晚年抑郁与并发和未来的ADL障碍有关。然而，人们在很大程度上不知道，有抑郁症状的中年人在晚年是否有更高的患上常见残疾的风险，以及残疾的后果。了解这些关系很重要，因为抑郁症很常见，而且是一个潜在的可改变的风险因素。我们建议创新性地利用前瞻性的、基于人群的健康与退休研究（MRS）来研究中年抑郁症状对晚年残疾和相关健康结果的影响。我们将随访9286例受试者，1992年入组时年龄为51-61岁，到2008年年龄范围为67-77岁。在入组时评估抑郁症状（CES-D），每2年评估一次残疾结局（如ADL和行走困难）和其他健康结局。我们的目的是（1）检查中年抑郁症状和晚年残疾之间的关系;（2）检查这种关系是否因人口统计学和临床因素而异;（3）检查抑郁症状是否与残疾的常见后果有关，如需要照顾者帮助，养老院安置和死亡;（4）研究抑郁症状是否与提前退休有关，以及提前退休是否意味着受试者在晚年残疾的风险特别高。这项研究将具有独特的公共卫生重要性，因为它将是全面评估受试者从中年到晚年抑郁症状长期影响的最长结果研究之一。这对预防老年残疾的生命过程干预具有重要意义，因为它将深入了解中年抑郁症的更好识别和管理是否可能改善晚年的结局。

DESCRIPTION (provided by applicant): Difficulty with basic tasks such as activities of daily activities (ADL) or walking a short distance are relatively uncommon in middle life but become increasingly common as people age, often leading to disability. While these disabilities may not become apparent until people enter old age, they likely have their antecedents in risk factors that develop in middle life. Understanding midlife determinants of later life disability is of major public health importance because these disabilities severely compromise the quality of life of older persons and are risk factors for other adverse outcomes such as the need for caregiver assistance, nursing home placement, and death. There is a strong rationale for hypothesizing that mid-life depressive symptoms are an important risk factor for later life disability and related outcomes. Middle age people with depressive symptoms are more likely to have work-related disability and depression in late life is associated with concurrent and future ADL impairment. It is largely unknown, however, whether middle age persons with depressive symptoms are at higher risk for the common disabilities of later life and the consequences of disability. Understanding these relationships is important because depression is common and a potentially modifiable risk factor. We propose to make innovative use of the prospective, population-based Health and Retirement Study (MRS) to examine the impact of midlife depressive symptoms on later life disability and related health outcomes. We will follow 9286 subjects who were age 51-61 when enrolled in 1992 and will range in age from 67-77 by 2008. Depressive symptoms were assessed at enrollment (CES-D) and disability outcomes (such as ADL and walking difficulty) and other health outcomes are assessed every 2 years. Our aims are to (1) examine the relationship between mid-life depressive symptoms and later life disability; (2) examine whether this relationship differs depending upon demographic and clinical factors, (3) examine whether depressive symptoms are associated with common consequences of disability such as need for caregiver assistance, nursing home placement and death; (4) examine whether depressive symptoms are associated with early retirement and whether early retirement identifies subjects at particularly high risk for later life disability. This study will have unique public health importance because it will be one of the longest outcome studies comprehensively assessing the long term impact of depressive symptoms as subjects progress from middle life to later life. This has important implications for life course interventions to prevent older age disability as it will provide insight into whether it is plausible that better recognition and management of depression in mid life might improves outcomes in later life.