Depressive Symptoms and 3-Year Mortality in Older Hospitalized Medical Patients

Covinsky, Kenneth E.; Kahana, Eva; Chin, Marshall H.; Palmer, Robert M.; Fortinsky, Richard H.; Landefeld, C. Seth

doi:10.7326/0003-4819-130-7-199904060-00004

Cited by 244 publications

(157 citation statements)

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“…11 Cognitive impairment and depressive symptoms may lead to an erosion of the physical skills needed to maintain functional independence and may leave a person less resistant to acute stressors, such as hospitalization, that often accelerate functional dependence in older people. [21][22][23] In participants with baseline ADL dependence, cognitive impairment predicted further loss of ADL function, but depressive symptoms did not predict further functional decline, and, in fact, subjects with depressive symptoms, on average, demonstrated a slight improvement in ADL function, similar to subjects with neither condition. This may reflect fundamental differences in the natural history of cognitive impairment and depressive symptoms.…”

Section: Discussionmentioning

confidence: 91%

Cognitive Impairment, Depressive Symptoms, and Functional Decline in Older People

Mehta

Yaffe

Covinsky

2002

J American Geriatrics Society

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210

136

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OBJECTIVES-Although cognitive impairment and depressive symptoms are associated with functional decline, it is not understood how these risk factors act together to affect the risk of functional decline. The purpose of this study is to determine the relative contributions of cognitive impairment and depressive symptoms on decline in activity of daily living (ADL) function over 2 years in an older cohort. DESIGN-Prospective cohort study.SETTING-A U.S. national prospective cohort study of older people, Asset and Health Dynamics in the Oldest Old.PARTICIPANTS-Five thousand six hundred ninety-seven participants (mean age 77, 64% women, 86% white) followed from 1993 to 1995 MEASUREMENTS-Cognitive impairment and depressive symptoms were defined as the poorest scores: 1.5 standard deviations below the mean on a cognitive scale or 1.5 standard deviations above the mean on validated depression scales. Risk of functional decline in participants with depressive symptoms, cognitive impairment, and both, compared with neither risk factor, were calculated and stratified by baseline dependence. Analyses were adjusted for demographics and comorbidity.RESULTS-Eight percent (n = 450) of subjects declined in ADL function. In participants who were independent in all ADLs at baseline, the relative risk (RR) of 2-year functional decline was 2.3 (95% confidence interval (CI) = 1.7-3.1) for participants with cognitive impairment, 1.9 (95% CI = 1.3-2.6) for participants with depressive symptoms, and 2.4 (95% CI = 1.4-3.7) for participants with cognitive impairment and depressive symptoms. In participants who were dependent in one or more ADLs at baseline, RR of 2-year functional decline was 1.9 (95% CI = 1.2-2.8) for participants with cognitive impairment, 0.6 (95% CI = 0.3-1.3) for participants with depressive symptoms, and 1.5 (95% CI = 0.8-2.6) for participants with cognitive impairment and depressive symptoms.CONCLUSIONS-In participants with no ADL dependence at baseline, cognitive impairment and depressive symptoms are risk factors for decline, but that, in participants with dependence in ADL at baseline, cognitive impairment, but not depressive symptoms, is a risk factor for additional decline. The relationship between cognitive status and depressive symptoms and their effect on functional decline is of significant clinical and public health importance because they are common, frequently coexist, and may be treatable. For example, depressive symptoms are thought to exacerbate cognitive problems in older people and may be an independent risk factor for cognitive impairment; conversely, cognitive impairment may lead to depression. [2][3][4] Prior studies on the effect of cognitive impairment or depressive symptoms on functional decline have suggested that depressive symptoms and cognitive impairment are independently associated with functional decline, 4-13 but prior studies are limited because they have not taken into consideration that cognitive impairment and depressive symptoms are interrelated, have not studied ethnical...

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Section: Discussionmentioning

confidence: 91%

Cognitive Impairment, Depressive Symptoms, and Functional Decline in Older People

Mehta

Yaffe

Covinsky

2002

J American Geriatrics Society

Self Cite

210

136

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“…There may even be a direct relationship, with rates of depressive symptoms increasing incrementally with increasing severity of medical comorbidity (Covinsky 1999). The strong association between depression and medical illness has been found in all populations studied: primary care/community samples (Braam 2005), people in residential care (Eisses 2004), hospital in-patients (Moffic 1975) and in different cultures (Ormel 1994).…”

Section: Depression In Medical Illnessmentioning

confidence: 95%

Depression, cardiac mortality and all-cause mortality

Seymour¹,

Benning²

2009

Adv. psychiatr. treat

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SUMMARYDepression is an illness that kills. The links between depression and medical illness are well established and bi-directional, but evidence is mounting that depression increases mortality as well as morbidity in adults, particularly older adults. We examine the evidence that the increase in mortality in depression applies to all-cause mortality as well as cardiac mortality, and describe plausible physiological theories for the association. We conclude that excess mortality arising from depression is a major public health problem that is largely unrecognised and needs to be addressed by a range of clinicians.

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“…Some potential mechanisms for this association have been proposed. Deficits in cognition caused by depression may result in diminished adaptive skills in the face of illness, and affective symptoms associated with depression may discourage friends and family members from providing needed assistance (14). Biological mechanism has been also proposed, for example, psychological stress has been associated with impaired wound healing and increased cardiac ischemia (15,16).…”

Section: Discussionmentioning

confidence: 99%