A longitudinal study of depression in old age II: depression and physical disability

OBJECTIVES: As part of an outcome study of depression in older people, the relationship between physical disability and depression was explored at baseline and longitudinally. The aims were to identify whether illness in specific body systems or physical disability was associated with a poorer outcome of depression. METHOD: Subjects over 65 with depression referred to an old age psychiatry service were recruited. Depression was diagnosed according to ICD-10 criteria. An in-depth initial assessment obtained data concerning depression severity and illness in specific body systems as well as disability levels. Objective and subjective ratings of health status were also made. Subjects were followed up at three, six, 12, 18, and 24 months. Ongoing assessments were made of depressive symptomatology and of physical status. RESULTS: Subjects with higher disability levels had more severe depression at baseline. There was no relationship between illness in specific body systems and depression severity. At follow up assessments, those with higher disability scores had poorer outcomes as recorded by depression rating scales and by reviewing the longitudinal course of depression in terms of proportions remaining well, suffering relapses or remaining depressed. CONCLUSIONS: There is an ongoing relationship between depression and disability. Older people with greater physical disability have a poorer outcome of depression. Service providers should be aware of this relationship and respond rapidly and assertively to depression in older people with disability. There should be a lower threshold for initiating treatment in this population.