Does depression in old age increase only cardiovascular mortality? The Leiden 85‐plus Study

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Abstract
Background: Depression in old age is associated with an increased mortality risk of cardiovascular disease but the mortality risk from non‐cardiovascular causes is disputed.Objective: To investigate the effect of depression on cardiovascular and non‐cardiovascular mortality in old age.Methods: We prospectively followed 500 subjects from age 85 years onwards within the population‐based Leiden 85‐plus Study. Depressive symptoms were assessed annually with the 15‐item Geriatric Depression Scale (GDS‐15). Mortality risks were estimated in a Cox proportional‐hazards model with the annual assessment of depression (GDS‐15≥4 points) as a time‐dependent covariate.Results: During 1654 person‐years of follow‐up (mean per person, 3.2 years), depression was associated with a two‐fold increase of all cause mortality [Relative Risk (RR), 1.83; 95% Confidence Interval (CI), 1.24–2.69] that was not explained by comorbid conditions. Both cardiovascular mortality and non‐cardiovascular mortality contributed equally to the excess mortality (RR 1.95 and 1.75 respectively).Conclusion: Depression in old age contributes to an increase of both cardiovascular and non‐cardiovascular mortality. Motivational depletion may play an important role in the increased mortality in elderly with depression. Copyright © 2004 John Wiley & Sons, Ltd.

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