Despite considerable progress in the epidemiology of late life depressive disorders, the determinants and course of late life depressive symptoms remain unclear. The apparent reciprocal relationship between depression and disability, a consistent finding in cross-sectional studies further confounds efforts to estimate the importance of depressive symptoms in the elderly. In a longitudinal study of 1457 aged community residents who completed the Center for Epidemiologic Studies Depression scale at baseline and 24 months later, a significant level of depressive symptoms emerged in 163 respondents (11%), while 1080 (74%) remained symptom free. Unlike other studies, we found that the number of medical conditions, social support, life events, and demographic characteristics contributed little to distinguish those with emerging symptoms from those who remained symptom free. However, increasing disability and declining health preceded the emergence of depressive symptoms and accounted for seventy percent of the variance explained by discriminant analysis. These findings have etiologic implications for both the course and determinants of depression in late life.

OBJECTIVE. Cognitive impairment among the elderly has been linked to mortality in studies of clinical populations. The purpose of this study was to examine the mortality risk associated with cognitive impairment among elderly populations in the community. METHODS. Cognitive impairment and other social and health factors were assessed in 1855 elderly community residents. This sample was reinterviewed periodically to assess changes in health and survival. RESULTS. At baseline 33% of the sample were mildly impaired and 8% were severely impaired. Across a 48-month observation period the survival probability was .85 for the cognitively unimpaired, .69 for the mildly impaired, and .51 for severely impaired respondents. When adjustments were made for the effects of other health and social covariates, severely impaired persons were twice as likely to die as unimpaired persons. Those who were mildly impaired were also at an increased risk. CONCLUSIONS. Other investigators have found that cognitive impairment is a significant predictor of dementia. We found that it is a significant predictor of mortality as well. Early detection of impaired cognition and attention to associated health problems could improve the quality of life of these older adults and perhaps extend their survival.

Studies on the relationship between depression and mortality in elderly community populations have yielded contradictory findings, although an association frequently is found in studies of elderly psychiatric patients. These different results may be due to differences in the measures of depression, the populations under study, the covariates in the analysis, or to sample attrition. In this study of elderly residents of an urban neighborhood, depressive symptoms are measured at two time points. People are classified as consistently nonsymptomatic (N-N), with emergent symptoms (N-D), in remission (D-N), or persistently symptomatic (D-D). Symptoms of depression, sociodemographic characteristics, and measures of changes in health, functional status, number of chronic medical conditions, and social support are examined in relation to mortality in multivariate Cox regression models. Although symptoms of depression are not found to be related to time-to-death, older people, those with declines in health and functional status, and men have greater relative risks of mortality over a three-year follow-up.

Religious devotion is a complex phenomenon but a potentially important source of support and meaning in the lives of older adults. Nonetheless, attendance at religious services and religious preference (affiliation) have received relatively little prominence in epidemiological studies of late life mental illness despite their relative case of measurement. We examined differences in the prevalence and course of depressive symptoms and associated characteristics among 1,855 older community residents who expressed a Jewish, Catholic, or other religious preference. At baseline, Jewish religious preference was associated with a twofold elevation in the prevalence of depressive symptoms compared to Catholics. Lack of attendance at religious services was associated with greater prevalence of depression among all groups, significantly so among Catholics. The relationship of depression with Jewish religious preference and with failure to attend services could not be accounted for by measures of age, gender, health, disability, or social support. Twenty-four months following baseline, Jewish religious preference was associated with the emergence of depressive symptoms and remained significant when the effects of age, gender, health, disability, and social support were controlled. Failure to attend services was associated with both the emergence and persistence of depression but did not remain significant once the effects of other characteristics were controlled. For both religious and health care institutions, these findings have implications for the prevention, recognition, and treatment of late life mental illness.