Almeida Osvaldo P, Hankey Graeme J, Yeap Bu B, Golledge Jonathan, Hill Keith D, Flicker Leon
School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia; WA Center for Health and Aging of Center for Medical Research, Harry Perkins Institute of Medical Research, Perth, Australia; Department of Psychiatry, Royal Perth Hospital, Perth, Australia.
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia.
J Am Med Dir Assoc. 2017 Jan;18(1):65-69. doi: 10.1016/j.jamda.2016.09.002. Epub 2016 Oct 21.
Older adults with depression have increased risk of frailty and death.
To determine if history of depression hinders future physical and functional capacity.
DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal cohort study of 1148 men aged 70-87 years who were living in the Perth metropolitan community in 2001-2004 and completed a follow-up assessment of physical and functional capacity in 2011-2012.
Outcomes were collected in 2011-2012 and included 4 measures of physical function (timed up-and-go, timed sit-to-stand, functional reach, and step test) and the assessment of basic (activities of daily living) and instrumental activities of daily living. We also collected information on depression and frailty [using the FRAIL (fatigue resistance ambulation illness, and loss of weight) scale] in 2001-2004 and 2011-2012. Frail men at the 2001-2004 were excluded from the analyses.
Men with history of depression at the 2001-2004 assessment showed significantly worse performance than their counterparts in the timed sit-to-stand and step tests 9 years later. They also had approximately twice the risk of attaining the lowest decile of performance in both tests (analyses adjusted for age, education, and prevalent depressive symptoms). In addition, the adjusted risk ratio of impaired instrumental activities of daily living was 58% (95% confidence interval 15%, 116%) greater for men with than without history of past depression. These associations were particularly robust for men with current depression at the 2001-2004 assessment.
Nonfrail older men with history of current or past depression showed greater impairment of physical and functional capacity 9 years later. Older men with history of depression may benefit from regular monitoring of physical and occupational function and should be targeted by preventive trials designed to improve function and decrease frailty.
患有抑郁症的老年人出现身体虚弱和死亡的风险增加。
确定抑郁症病史是否会妨碍未来的身体和功能能力。
设计、地点和参与者：对1148名年龄在70 - 87岁的男性进行前瞻性纵向队列研究，这些男性于2001 - 2004年居住在珀斯大都市社区，并于2011 - 2012年完成了身体和功能能力的随访评估。
结局数据于2011 - 2012年收集，包括4项身体功能测量指标（计时起立行走测试、定时坐立测试、功能性伸展测试和步速测试）以及基本日常生活活动和工具性日常生活活动的评估。我们还收集了2001 - 2004年和2011 - 2012年有关抑郁症和身体虚弱的信息[使用FRAIL（疲劳、抵抗力、行走、疾病和体重减轻）量表]。2001 - 2004年身体虚弱的男性被排除在分析之外。
在2001 - 2004年评估中有抑郁症病史的男性在9年后的定时坐立测试和步速测试中的表现明显比没有抑郁症病史的男性差。在两项测试中，他们达到最低十分位数表现的风险也大约是后者的两倍（分析对年龄、教育程度和普遍存在的抑郁症状进行了调整）。此外，有过抑郁症病史的男性与没有抑郁症病史的男性相比，工具性日常生活活动受损的调整风险比高58%（95%置信区间为15%，116%）。这些关联对于在2001 - 2004年评估时有当前抑郁症的男性尤为显著。
有当前或过去抑郁症病史的非身体虚弱的老年男性在9年后身体和功能能力受损更严重。有抑郁症病史的老年男性可能受益于定期的身体和职业功能监测，并且应该成为旨在改善功能和减少身体虚弱的预防性试验的目标人群。
