THE COURSE OF DEPRESSION AMONG INSTITUTIONAL ELDERLY

这项建议描述了一项关于抑郁症的纵向研究，体检 老年养老院和会众的虚弱程度和认知功能障碍 公寓住户。先前对老年社区和机构的研究 居民发现抑郁症与健康状况不佳有很强的关联， 功能性残疾和死亡率，以及更小和更有争议的 与认知缺陷的关系。然而，现有的纵向 研究倾向于使用过长的随访间隔来确定 这些变量之间的变化的时间顺序，特别是在 身体虚弱的老年人，他们的身体可能会经历显著的变化， 相对较短时间内的认知和情绪状态。建议数 因此，研究延伸和扩展了以前的“核心”活动 费城老年医学中心/医学院的研究 宾夕法尼亚州老年精神病理学临床研究中心 帮助填补当前知识的空白。具体目标是1)勾勒出 身体健康和健康的互惠关系的性质和强度 住院老年人抑郁的功能能力； 2)为了阐明抑郁症导致死亡的机制， 独立地或结合健康状况不佳；3)解释 抑郁和认知之间联系的时间模式 损害，以及4)确定宏观水平的营养相关性 抑郁症可能在抑郁症和疾病之间的观察到的关系中起中介作用 健康，一种死亡。这些目标是在一个为期5年的项目中实现的 呼吁对不同类别的老年疗养院进行三年一次的评估 并在3年内召集公寓居民。该项目 结合CRC验证的抑郁症自我报告测量，认知 实验室的状态、身体健康和功能状态以及 营养标记物上的人体测量数据；提取的详细健康数据 从医学图表和对抑郁症、认知、 和功能能力。特别关注的是可识别的， 将离散的健康和精神“事件”作为变化的经验性标记。

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.