Depressive Symptoms, Aging, Disability and Health Outcomes

描述（由申请人提供）：在日常活动活动（ADL）或短距离行走等基本任务方面遇到困难，在中年相对不常见，但随着人们年龄的增长，这种困难变得越来越普遍，往往导致残疾。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先兆。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，并且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果的重要风险因素，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，而晚年的抑郁与并发和未来的ADL损伤有关。然而，有抑郁症状的中年人是否有较高的晚年常见残疾和残疾后果的风险，这在很大程度上是未知的。了解这些关系很重要，因为抑郁症很常见，而且是一种潜在的可改变的风险因素。我们建议创新性地使用前瞻性、基于人群的健康与退休研究（MRS）来检验中年抑郁症状对晚年残疾和相关健康结果的影响。我们将跟踪9286名1992年入组时年龄在51-61岁之间的受试者，到2008年年龄将在67-77岁之间。在入组时评估抑郁症状（CES-D），残疾结局（如ADL和行走困难）和其他健康结局每2年评估一次。我们的目的是：(1)检验中年抑郁症状与晚年生活残疾之间的关系；(2)检查这种关系是否因人口统计学和临床因素而不同；(3)检查抑郁症状是否与残疾的常见后果相关，如需要照顾者的帮助、养老院安置和死亡；(4)研究抑郁症状是否与提前退休有关，以及提前退休是否确定了晚年残疾风险特别高的受试者。这项研究将具有独特的公共卫生重要性，因为它将是最长的结果研究之一，全面评估抑郁症状在受试者从中年到晚年发展过程中的长期影响。这对预防老年残疾的生命过程干预具有重要意义，因为它将提供洞察，更好地识别和管理中年抑郁症是否可能改善晚年生活的结果。

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.