The longitudinal association between depressive symptoms and functional abilities in older patients

Lucienne A Reichardt; Floor E Nederveen; Rosanne van Seben; Jesse J Aarden; Marike van der Schaaf; Raoul H H Engelbert; Martin van der Esch; Jos W R Twisk; Jos A Bosch; Bianca M Buurman; Hospital-ADL study group

doi:10.1016/j.jpsychores.2020.110195

The longitudinal association between depressive symptoms and functional abilities in older patients

J Psychosom Res. 2020 Jul 23:137:110195. doi: 10.1016/j.jpsychores.2020.110195. Online ahead of print.

Affiliations

¹ Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: l.a.reichardt@amc.uva.nl.
² Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: f.e.nederveen@amc.uva.nl.
³ Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: r.vanseben@amc.uva.nl.
⁴ Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands. Electronic address: j.j.aarden@hva.nl.
⁵ Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: m.vanderschaaf@amc.uva.nl.
⁶ Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands. Electronic address: r.h.h.engelbert@hva.nl.
⁷ ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, the Netherlands. Electronic address: m.vd.esch@reade.nl.
⁸ Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. Electronic address: jwr.twisk@vumc.nl.
⁹ Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychology, Section of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.. Electronic address: j.a.bosch@uva.nl.
¹⁰ Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands. Electronic address: b.m.vanes@amc.uva.nl.

PMID: 32731046
DOI: 10.1016/j.jpsychores.2020.110195

Abstract

Objectives: To investigate the course of depressive symptoms, and basic and instrumental activities of daily living (collectively described as, (I)ADL functioning) from acute admission until one year post-discharge, the longitudinal association between depressive symptoms and (I)ADL functioning, and to disaggregate between- and within-person effects to examine whether changes in depressive symptoms are associated with changes in (I)ADL functioning.

Methods: Prospective multicenter cohort of acutely hospitalized patients aged ≥70. Data gathered over a one-year period were assessed using validated measures of depressive symptoms (GDS-15) and physical functioning (Katz-ADL index). A Poisson mixed model analysis was used to examine the association between the courses and a hybrid model was used to disentangle between- and within-subject effects.

Results: The analytic sample included 398 patients (mean age = 79.6 years, SD = 6.6). Results showed an improvement in depressive symptoms and physical functions over time, whereby changes in depressive symptoms were significantly associated with the course of ADL function (rate ratio (RR) = 0.91, p < .001) and IADL function (RR = 0.94, p < .001), even after adjustment for confounding variables. Finally, both between- and within-person effects of depressive symptoms were significantly associated with the course of ADL function (between-person: RR = 0.85, p < .001; within-person: RR = 0.94, p < .001) and IADL function (between-person: RR = 0.87, p < .001; within-person: RR = 0.97, p < .001).

Conclusion: The course of depressive symptoms and physical functions improved over time, whereby changes in depressive symptoms were significantly associated with changes in physical functions, both at group and individual level. These changes in (I)ADL functioning lie mostly above the estimated minimally important change for both scales, implying clinically relevant changes.

Keywords: Basic and instrumental ADLs; Cognitive-affective depressive symptoms; Hybrid model; Minimally important change.