OBJECTIVE -To examine the separate and combined effects of depression and diabetes on the incidence of adverse health outcomes among older Mexican Americans. RESULTS -The interaction of diabetes and depression was found to be synergistic, predicting greater mortality, greater incidence of both macro-and microvascular complications, and greater incidence of disability in activities of daily living, even when controlling for sociodemographic characteristics such as sex, age, education, acculturation, and marital status. Importantly, this interaction was found to predict not only greater incidence but also earlier incidence of adverse events in older adults. RESEARCH DESIGN AND METHODSCONCLUSIONS -Whether a marker for underlying disease severity, an indicator of diminished self-care motivation, or the result of physiologic changes, the interaction of depression and diabetes has a synergistic effect on the health of older Mexican Americans, increasing the risk for poor outcomes. This is of particular clinical importance because although depression is often underrecognized in older adults, effective treatment is available and can result in improved medical outcomes.

Our results support the concept that positive affect, or emotional well-being, is different from the absence of depression or negative affect. Positive affect seems to protect individuals against physical declines in old age.

This study offers further evidence that performance-based measures of lower body function are able to predict future disability in older Mexican Americans, as has been found with other elderly populations. These measures were able to detect changes over a relatively short period of time (2 years). In addition, the study found that the short (8-foot) walk was the most sensitive measure in predicting future disability.

Our findings suggest that, rather than simply being correlated markers of increasing frailty, cognitive and functional decline appear to influence the development of one another. Clinicians need to be aware of these associations, which may affect the direction of preventive care and rehabilitation in the oldest old. Appropriate intervention may result in the prevention or delay of functional disability and cognitive decline. Awareness of the specific chronic health conditions that increase the risk for cognitive or functional decline in various ethnic groups, and the effect of comorbid disease, may also help efforts to prevent decline in older adults.

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Using the Center for Epidemiologic Studies of Depression scale, 25.6% of the 2,823 subjects reported high symptom levels. Rates among women (31.9%) and particularly men (17.3%) were higher than has been typically reported for older Mexican Americans and older adults in general. Consistent with previous studies of older adults, gender, lack of insurance, financial strain, chronic health conditions, and disability were found to be associated with depressive symptoms. Several cultural factors were also associated with increased risk, including immigrant status, levels of acculturation and assimilation, health locus of control, and recency of immigration. An interaction between gender and immigrant status was found such that, in relation to subjects born in the United States, female immigrants were at significantly higher risk for depressive symptoms, whereas male immigrants were at lower risk.

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Baseline moderate-severe and mild cognitive status and 2-year decline in cognitive functioning independently predict mortality in older Mexican Americans. Although age and selected medical conditions have been reported as the more salient predictors of mortality, cognitive functioning should be considered part of identifying older persons at high risk for underlying medical conditions and mortality.