Depression that developed during the follow-up in previously nondepressed persons was associated with an increased risk for lowering of functional abilities, even when controlling for age, sociodemographic factors, physical diseases, and baseline disabilities. Depressed older people are at high risk for physical disability, and an individually planned program to maintain their functional abilities by training in ADLs and instrumental activities of daily living (IADLs) and physical exercise should be included in their treatment.
The prevalence of depression by sex, age and certain sociodemographic variables was investigated in a sample of elderly Finns (60 years or over) living in the semi-industrialized municipality of Ahtäri (n = 1529). The study was carried out in two phases. In the first phase, depressive symptoms were screened with the Zung Self-rating Depression Scale (ZSDS). In the second phase, persons scoring greater than or equal to 40 points in the ZSDS and a random sample of persons scoring less than 40 ZSDS points were examined by a general practitioner. The prevalence of depression was determined on the basis of DSM-III criteria. The estimated prevalence for men was 22.4%, and for women 29.7%. The estimated prevalence for different categories of depression was as follows: dysthymic disorder, men 17.2% and women 22.9%; major depression, men 2.6% and women 4.5%; atypical depression, men 2.2% and women 2.5%; and cyclothymic disorder, men 0.4% and women 0%. No cases of bipolar disorder were found. A high risk of depression was associated with female sex, widowhood and being in long-term institutional care or receiving home nursing and/or home help. The occurrence of depression was not related to age, education or occupation.
Longstanding and recurrent depressive disorders are quite common in elderly people.1 2 Not much is known, however, of their clinical course and prognosis, including mortality. The need for treatment of longstanding, less severe depressive disorders is a matter of discussion.We studied the relation between longstanding or recurrent depressive disorders and mortality and that between recovery from depressive disorders and mortality in elderly people. Subjects, methods, and resultsThis study is based on the Ähtäri longitudinal epidemiological research project concerning depression in elderly people.1-3 The initial series consisted of people born in 1923 or earlier and living in the municipality of Ähtäri, Finland, on 1 January 1984 (n = 1529). In the first study in 1984-5 the participation rate was 91%. The follow up study was performed in 1989-90 with a participation rate of 94%. Depression was determined after semistructured interviews by the criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III). 1-3We examined mortality in subjects with a longstanding or recurrent course of depression and those who had recovered. Three groups were formed from those people without dementia who were alive in both 1984-5 and 1989-90: people depressed in both assessments (n = 78), people depressed in 1984-5 but not depressed in 1989-90 (n = 101), and people not depressed in both assessments (n = 634). The mean (SD) age of those participating in the follow up study was 74.3 (6.1) years on 1 January 1989. The mortality data from the official statistics were collected for a period from the individual examination days in 1989-90 to 31 December 1995.The causes of death did not differ between the groups, cardiovascular and cerebrovascular diseases and malignant neoplasms being the most common. According to Kaplan-Meier survival analysis, 48% of the people with depression at both time points had died compared with 26% in the group without depression at both times (P < 0.001). In the group with depression in 1984-5 but not in 1989-90, 31% had died, so the survival in this group did not differ from that in the group without depression at either time (P = 0.286). The role of depression as a predictor of mortality was analysed with Cox's proportional hazards model, with age, sex, smoking, physical health, and functional abilities taken into account. Longstanding depression predicted mortality even when these factors were controlled for, while recovery from depression did not (table). CommentLongstanding depression seems to be a predictor for mortality in elderly people. In this study the groups of depressed people were formed on the basis of two measurements at interval of 5 years, and there were no data on the course of depression between the measurements. We assumed, however, that subjects with depression at both time points were suffering from longstanding or recurrent depression, and that this group and the group with depression at the first time point but without depression at the second differed f...
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