Trajectories and determinants of functional limitations in late-life depression: A 2-year prospective cohort study

Abstract

Background: In mental health research, functional recovery is increasingly valued as an important outcome in addition to symptomatic remission. Methods: Course types of functional limitations among depressed older patients and its relation with symptomatic remission were explored in a naturalistic cohort study (Netherlands Study of Depression in Older persons). 378 depressed older patients (≥60 years) and 132 non-depressed persons were included. Depressive disorders were assessed with Composite International Diagnostic Interview at baseline and two-year follow-up. Functional limitations were assessed every 6 months with the World Health Organization Disability Assessment II. Results: Depressed patients had more functional limitations compared to their non-depressed counterparts. Growth Mixture Modeling among depressed patients identified two trajectories of functional limitations, both starting at a high disability level. The largest subgroup (81.2%) was characterized by a course of high disability levels over time. The smaller subgroup (18.8%) had an improving course (functional recovery). After two years, the main predictor of functional recovery was the remission of depression. Among symptomatic remitted patients, female sex, higher level of education, higher gait speed, and less severe depression were associated with no functional recovery. Non-remitted patients without functional recovery were characterized by the presence of more chronic somatic diseases, a lower sense of mastery, and a higher level of anxiety. Conclusions: 1 in 5 depressed older patients have a course with functional recovery. Combining functional and symptomatic recovery points to a subgroup of older patients that might profit from more rigorous psychiatric treatment targeted at psychiatric comorbidity and a group of frail depressed older patients that might profit from integrated geriatric rehabilitation.

<p>Visual Impairment and Mental Health: Unmet Needs and Treatment Options</p>

“…Indeed, visual disability has been identified as a strong indicator of depression in older adults. 30 In studies of older adults with vision loss a high prevalence of several mental health conditions, but particularly depression, has been observed. [31][32][33][34] Data indicate that up to 8.6% of older adults with vision loss meet criteria for a depressive disorder, 33,35 a notably higher percentage than found in the general aging population 29 , and 10.9-43% report clinically significant levels of depressive symptoms.…”

The Frail Depressed Patient: A Narrative Review on Treatment Challenges

“… 44 This should be changed since depressed older patients are two to four times more likely to be physically frail compared to the general population, 16 , 29 and functional recovering is achieved only in the minority (~20%) of cases. 93 As pointed out in this review, treatment studies on frail depressed patients are lacking. In clinical practice, comorbidity between frailty and depression can be quite complex, and physical frailty can be detected using self-reported questionnaires or simple physical maneuvers.…”

Future Trends in Disability and Its Determinants Among Chinese Community Patients With Anxiety Disorders: Evidence From a 5-Year Follow-Up Study

“…This finding implies that more attention should be paid to improve the functions of AD patients during the treatment process. There are some evidences showing that the disability of ADs patients could still be present even after the remissions of the disease ( 29 ). It may take more time for the recovery from functional limitations than the remission of symptoms do ( 30 ).…”