@article {7468, title = {Depressive symptoms in middle age and the development of later-life functional limitations: the long-term effect of depressive symptoms.}, journal = {J Am Geriatr Soc}, volume = {58}, year = {2010}, month = {2010 Mar}, pages = {551-6}, publisher = {58}, abstract = {

OBJECTIVES: To determine whether middle-aged persons with depressive symptoms are at higher risk for developing activity of daily living (ADL) and mobility limitations as they advance into older age than those without.

DESIGN: Prospective cohort study.

SETTING: The Health and Retirement Study (HRS), a nationally representative sample of people aged 50 to 61.

PARTICIPANTS: Seven thousand two hundred seven community living participants in the 1992 wave of the HRS.

MEASUREMENTS: Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D 11), with scores of 9 or more (out of 33) classified as significant depressive symptoms. Difficulty with five ADLs and basic mobility tasks (walking several blocks or up one flight of stairs) was measured every 2 years through 2006. The primary outcome was persistent difficulty with ADLs or mobility, defined as difficulty in two consecutive waves.

RESULTS: Eight hundred eighty-seven (12\%) subjects scored 9 or higher on the CES-D 11 and were classified as having significant depressive symptoms. Over 12 years of follow-up, subjects with depressive symptoms were more likely to reach the primary outcome measure of persistent difficulty with mobility or difficulty with ADL function (45\% vs 23\%, Cox hazard ratio (HR)=2.33, 95\% confidence interval (CI)=2.06-2.63). After adjusting for age, sex, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging 1 mile, and difficulty climbing several flights of stairs, the risk was attenuated but still statistically significant (Cox HR=1.44, 95\% CI=1.25-1.66).

CONCLUSION: Depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle-aged persons advance into later life. Middle-aged persons with depressive symptoms may be at greater risk for losing their functional independence as they age.

}, keywords = {Activities of Daily Living, depression, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Mobility Limitation, Proportional Hazards Models, Prospective Studies, Risk Factors, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2010.02723.x}, author = {Kenneth E Covinsky and Kristine Yaffe and Lindquist, Karla and Cherkasova, Elena and Yelin, Edward and Dan G. Blazer} }