Major Depression and Disability in Older Primary Care Patients With Heart Failure

Abstract

The purpose of this study was to examine the association between dependence in activities of daily living (ADL) and instrumental ADL (IADL) and major depression among 415 community-dwelling primary care patients age 65+ with heart failure and significant ADL or IADL dependence. Main findings include (1) a progressive increase in depression prevalence from 0% for no IADL dependence to about 40% for 6 IADL dependencies (P < .001), (2) a steady rise in depression prevalence to 40% for 6 ADL dependencies following a "floor effect" at about 10% for 0 to 2 ADL dependencies (P < .001), and (3) the association in a logistic regression model of major depression with number of IADL dependencies (P = .016) but not with number of ADL dependencies (P = .602). Our principal conclusion is that the progressively greater likelihood of major depression as the number of IADL dependencies increases has important clinical, personal, social, and public health relevance.

Reduced cognitive function predicts functional decline in patients with heart failure over 12 months

“…This is perhaps not surprising given that instrumental ADLs consists of tasks important for self-care maintenance such as medication management. For instance, poor adherence to treatment recommendations (e.g., medication regimens) in HF has been linked with recurrent hospital readmissions, mortality risk, and worsening HF symptoms [7,34,35]. Interestingly, the rate of impairment in simple tasks such as telephone use nearly quadrupled at the 12-month follow-up in this study, suggesting HF patients may be at significant risk for inability to perform critical self-monitoring and life-saving behaviors (e.g., calling 9-1-1 or making doctor appointments).…”

The prevalence of cardiac dysfunction and the correlation with poor functioning among the very elderly

“…Previous research has shown a relationship between cardiac dysfunction and limited physical capacity, depression and cognitive impairment [4][5][6][7][8]. However, little is known about this relationship in the very elderly.…”

Risk Factors for Onset of Disability Among Older Persons Newly Diagnosed With Heart Failure: The Cardiovascular Health Study

“…2 Prior work has demonstrated that among persons with heart failure older persons are more likely than younger persons to be disabled, 3 but relatively little is known about the risk factors for developing disability among older persons with heart failure. 4–6 The burden of disability in an aging society is one of the most pressing problems facing our healthcare system today. Onset of disability can lead to loss of independence, the need for hospital and long-term nursing-home care, and premature death.…”