Kondo Naoki, Kazama Mari, Suzuki Kohta, Yamagata Zentaro
Department of Health Sciences, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan.
Prev Med. 2008 May;46(5):457-62. doi: 10.1016/j.ypmed.2007.12.007. Epub 2008 Feb 7.
We investigated the impact of mental health on the decline in higher activities of daily living (ADL) defined in terms of social role performance (SR, the highest ADL), intellectual activity (IA), and instrumental ADL (IADL), as well as the onset of basic ADL disability.
Six hundred older adults were randomly selected from Yamanashi prefecture, Japan. An interview survey collected baseline information from 581 people (97%) in 2003. Of those, 93% were followed for 25 months by mail. Cox's proportional hazard model was used.
Among people aged 75+ years, those with severe depressive symptoms had a relative risk (95% confidence intervals) of 3.22 (1.35-7.71), 3.11 (1.38-6.98), and 2.41 (1.07-5.40) for subsequent decline in SR, IA, and IADL, respectively, compared to those without depressive symptoms. The excess risk of IADL decline among people aged 65-74 years was also statistically significant. Social inactivity partly explained the excess risk.
Severe depressive symptoms in older adults may accelerate the progression of higher ADL decline. The adverse effect of depressive symptoms is more pronounced in senior elderly. By screening depressive symptoms and higher ADL, and promoting social activities of people at high risk, their risk for basic ADL disability could be reduced.
我们研究了心理健康对以社会角色表现（SR，最高级别的日常生活活动）、智力活动（IA）和工具性日常生活活动（IADL）定义的更高水平日常生活活动（ADL）下降以及基本ADL残疾发生的影响。
从日本山梨县随机抽取600名老年人。2003年通过访谈调查收集了581人（97%）的基线信息。其中，93%的人通过邮件随访25个月。使用Cox比例风险模型。
在75岁及以上人群中，与无抑郁症状者相比，有严重抑郁症状者随后SR、IA和IADL下降的相对风险（95%置信区间）分别为3.22（1.35 - 7.71）、3.11（1.38 - 6.98）和2.41（1.07 - 5.40）。65 - 74岁人群中IADL下降的额外风险也具有统计学意义。社交活动不足部分解释了这种额外风险。
老年人的严重抑郁症状可能加速更高水平ADL下降的进程。抑郁症状的不利影响在高龄老年人中更为明显。通过筛查抑郁症状和更高水平的ADL，并促进高危人群的社交活动，可以降低他们发生基本ADL残疾的风险。
