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Objectives To identify salient characteristics of frailty that increase risk of death in depressed elders. Design Data from the Nordic Research on Ageing Study. Setting Research sites in Denmark, Sweden, and Finland. Participants Sample included 1027 75-year-old adults, 436 men and 591 women. Main Outcome Measure Time of death was obtained, providing a maximum survival time of 11.08 years (initial evaluation took place between 1988-1991). Results Depressed elders showed greater baseline impairments in each frailty characteristic (gait speed, grip strength, physical activity levels, and fatigue). Simultaneous models including all four frailty characteristics showed slow gait speed (HR, 1.84; 95% CI, 1.05-3.21) and fatigue (HR, 1.94; 95% CI, 1.11-3.40) associated with faster progression to death in depressed women; none of the frailty characteristics in the simultaneous model were associated with death in depressed men. In women, the effect of impaired gait speed on mortality rates nearly doubled when depression was present (mortality rates, nondepressed women: no gait impairment =26%; slow gait =40%; depressed women: no gait impairment=32%; slow gait =58%). A similar pattern was observed for fatigue. Conclusions The confluence of specific characteristics of frailty (fatigue and slow gait speed) and depressive illness is associated with an increased risk of death in older adults; this association is particularly strong in older depressed women. Future research should investigate whether multimodal interventions targeting depressive illness, mobility deficits, and fatigue can decrease mortality and improve quality of life in older depressed individuals with characteristics of the syndrome of frailty.

Two cohorts of alumni, leading-edge and trailing-edge baby boomers, first tested in their college years, were followed to ages 43 (N = 136) and 54 (N = 182) on a measure of Erikson's theory of psychosocial development. Hierarchical linear modeling was used to model the trajectory of growth for each psychosocial issue across middle adulthood. As predicted, the early psychosocial issues (trust, autonomy, and initiative) showed patterns of slow and steady increases in favorable resolution, as did the midlife issue of generativity. Industry, found in earlier investigations on the samples to change to differing degrees by cohort, continued to show cohort differences through midlife. The quadratic terms indicated that growth was curvilinear for both cohorts on identity and intimacy, and ego integrity showed variations by cohort, with the older cohort showing steeper patterns of increases. Gender differences were observed on intimacy, with women receiving higher initial scores, but the curves showed deceleration through midlife. Tests of variations in growth curves by the life history variables of educational attainment, occupational prestige, commitment to a long-term relationship, and parenthood status showed variations by cohort, but a general pattern of catching up emerged in which those who entered early adulthood at a relative disadvantage in terms of psychosocial development were able to attain favorable outcomes by midlife.

These findings, replicated across two independent clinical samples, provide the first support for the internal validity of vascular depression as a subtype of late-life depression.

Identity process theory proposes that adjustment to aging can be conceptualized as involving the three processes of identity assimilation (maintaining self-consistency), identity accommodation (making changes in the self), and identity balance (maintaining a sense of self but changing when necessary). Measures of the identity processes and self-consciousness were administered to a community sample of 173 adults (108 women and 65 men) ranging in age from 42 to 85 years (M = 60.80; SD = 12.58). Consistent with theory, identity assimilation was positively associated with age and negatively related to self-reflection. Identity accommodation was negatively related to age and internal state awareness and positively related to self-reflection and public self-consciousness. Identity balance alone was positively related to internal state awareness, indicating that the ability to incorporate age-related changes within identity but at the same time maintain a consistent and positive view of the self is most conducive to successful aging.

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