Ho Cyrus Sh, Feng Liang, Fam Johnson, Mahendran Rathi, Kua Ee Heok, Ng Tze Pin
Gerontology Research Programme and Department of Psychological Medicine, Yong Loo Lin School of Medicine,National University of Singapore,Singapore.
Int Psychogeriatr. 2014 Jul;26(7):1221-9. doi: 10.1017/S1041610214000611. Epub 2014 Apr 15.
Depression in the elderly is often associated with coexisting medical illnesses. We investigated the individual and combined impacts of depression and medical illnesses on disability and quality of life among community-living older persons.
Cross-sectional and longitudinal analyses of data from 1,844 participants aged 55 and above of the Singapore Longitudinal Aging Study (SLAS-1). Baseline depressive symptoms (Geriatric Depressive Scale, GDS≥5) and chronic medical comorbidity (≥2) from self-reports were related to baseline and 2-year follow up instrumental and basic activities of daily living (IADL-BADL), and quality of life (Medical Outcomes Study 12-item Short Form (SF-12) physical component summary (PCS) and mental component summary (MCS) scores.
The prevalence of depressive symptoms was 11.4%. In main effect analyses of cross-sectional and longitudinal relationships, depression and medical comorbidity were individually associated with higher risk of IADL-BADL disability and lower PCS and MCS scores of quality of life, and only medical comorbidity was associated with increased risk of hospitalization. Significant interactive effects of depression and medical comorbidity were observed in longitudinal relationships with IADL-BADL disability (p = 0.03), PCS (p < 0.01), and MCS (p < 0.01) scores at follow up. The associations of medical comorbidity with increased odds of IADL-BADL disability and decreased SF-12 PCS and MCS scores were at least threefolds stronger among depressed than nondepressed individuals.
Medical comorbidities and depression exert additive and multiplicative effects on functional disability and quality of life. The adverse impact and potential treatment benefits of coexisting mental and physical conditions should be seriously considered in clinical practice.
老年人抑郁症常与并存的躯体疾病相关。我们调查了抑郁症和躯体疾病对社区居住老年人残疾及生活质量的个体及综合影响。
对新加坡纵向老龄化研究（SLAS-1）中1844名55岁及以上参与者的数据进行横断面和纵向分析。自我报告的基线抑郁症状（老年抑郁量表，GDS≥5）和慢性躯体共病（≥2种）与基线及2年随访时的工具性日常生活活动和基本日常生活活动（IADL-BADL）以及生活质量（医学结局研究12项简短形式（SF-12）身体成分总结（PCS）和精神成分总结（MCS）得分）相关。
抑郁症状的患病率为11.4%。在横断面和纵向关系的主效应分析中，抑郁症和躯体共病分别与IADL-BADL残疾风险增加以及生活质量的PCS和MCS得分降低相关，且只有躯体共病与住院风险增加相关。在随访时与IADL-BADL残疾（p = 0.03）、PCS（p < 0.01）和MCS（p < 0.01）得分的纵向关系中观察到抑郁症和躯体共病的显著交互作用。在抑郁个体中，躯体共病与IADL-BADL残疾几率增加以及SF-12 PCS和MCS得分降低之间的关联比非抑郁个体至少强三倍。
躯体共病和抑郁症对功能残疾和生活质量产生相加和相乘效应。在临床实践中应认真考虑并存的精神和躯体状况的不良影响及潜在治疗益处。
