Celia F. Hybels

Purpose of the Study: To examine the longitudinal associations between 3 dimensions of religious involvement—religious attendance, use of religious media, and private religious activities—and 3 domains of functional status—limitations in basic activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility in older adults. Design and Methods: Using the data from a survey of 2,924 adults aged 65+, with self-reported religious involvement and functional status collected at baseline, 3, 6, and 10 years postbaseline, we used repeated measures mixed models to predict functional change by religious status at the prior interview. Results: Increased religious attendance was associated with fewer ADL, IADL, and mobility limitations 3–4 years later, controlling for demographic, health, and social variables as well as prior functional status. Neither use of religious media nor private religious activities was associated with functional change in controlled analyses. Use of religious media, however, was associated with developing more IADL and mobility limitations in uncontrolled analysis, suggesting a potential indirect association. Implications: Religious attendance may protect against decline in functional limitations in older adults. Clinicians may wish to consider the importance of attendance at services in preventing disability for those patients for whom religious involvement is important. Gerontologists may wish to include religious participation in their conceptual framework outlining risk factors for functional decline.

Objective: The aim of the study was to compare symptom expression in primarily middle‐aged (N = 664) were screened using the Center for Epidemiologic Studies—Depression scale and sections of the Diagnostic Interview Schedule. Patients were separated into homogeneous clusters based on symptom endorsement using latent class analysis.Results: Older patients were less likely to endorse crying spells, sadness, feeling fearful, being bothered, or feeling life a failure but were more likely to endorse poor appetite and loss of interest in sex. Older patients were also less likely to report enjoying life, feeling as good as others, feeling worthless, wanting to die, and thinking about suicide. In two latent class models with depressive symptoms as indicators, three‐class models best fit the data. Profiles supported heterogeneity in symptom expression. Clusters differed by age when other demographic, clinical, health, and social variables were controlled but did not support age‐specific symptom profiles. Overall, older patients had later age of onset, had fewer lifetime spells, were more likely to have ever received electroconvulsive therapy (ECT), and were less likely to have comorbid anxiety. Older patients also had more cognitive impairment, health conditions, and mobility limitations but had higher levels of subjective social support and had experienced fewer stressful life events.Conclusions: There are age differences in symptom endorsement between younger/middle‐aged and older patients with major depression. The data, however, did not identify a symptom profile unique to late‐life depression. Copyright © 2011 John Wiley & Sons, Ltd.

Objective: Research has shown an association between depression and functional limitations in older adults. Our aim was to explore the latent traits of trajectories of limitations in mobility and instrumental activities of daily living (IADL) tasks in a sample of older adults diagnosed with major depression.Methods: Participants were 248 patients enrolled in a naturalistic depression treatment study. Mobility/IADL tasks included walking one‐fourth mile, going up/down stairs, getting around the neighborhood, shopping, handling money, taking care of children, cleaning house, preparing meals and doing yardwork/gardening. Latent class trajectory analysis was used to identify classes of mobility/IADL function over a 4‐year period. Class membership was then used to predict functional status over time.Results: Using time as the only predictor, three latent class trajectories were identified: (1) Patients with few mobility/IADL limitations (42%), (2) Patients with considerable mobility/IADL limitations (37%) and (3) Patients with basically no limitations (21%). The classes differed primarily in their initial functional status, with some immediate improvement followed by no further change for patients in Classes 1 and 2 and a stable course for patients in Class 3. In a repeated measures mixed model controlling for potential confounders, class was a significant predictor of functional status. The effect of baseline depression score, cognitive status, self‐perceived health and sex on mobility/IADL score differed by class.Conclusions: These findings show systematic variability in functional status over time among older patients with major depression, indicating that a single trajectory may not reflect the pattern for all patients. Copyright © 2009 John Wiley & Sons, Ltd.

Background: Depressive symptoms above screening thresholds have been shown to predict functional decline in older adults. Less is known about the impact of subthreshold depression, and whether more symptoms confer significantly greater risk compared to fewer symptoms. Method: Using data from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) collected over 10 years, we used repeated-measures mixed models to predict functional change by depression status at the prior (index) in-person interview. Depressive symptoms were measured using a modified version of the Center for Epidemiologic Studies Depression Scale (CES-D). Subthreshold depression was operationalized as 6–8 symptoms and CES-D-defined depression as 9–20 symptoms in the previous week. Three domains of functional status were assessed at the subsequent in-person interview: limitations in basic activities of daily living (ADL), instrumental ADL (IADL) and mobility. Results: Controlling for race, sex, age, education, marital status, cognitive status, health status, self-perceived health, perceived social support and functional status at the index interview, having ⩾6 depressive symptoms predicted an increase of 0.12 IADL limitations 3–4 years later (p=0.03). The incremental effect of CES-D-defined depression (⩾9 symptoms compared to 6–8 symptoms) was not significant, suggesting that the effect of more symptomatic depression did not add to that of subthreshold depression. CES-D score modeled as a continuous variable predicted functional change for all domains, but the relationship was not linear, supporting a possible threshold effect. Conclusions: The relationship between depressive symptoms and functional change is complex, not necessarily linear, and may vary by tasks assessed.

Objective The purpose of this study was to identify residual symptoms in a sample of older adults treated for major depression and compare individual symptoms present at baseline with those at three months by remission status. Methods The sample was comprised of 229 patients with DSM-IV major depression who were participants in the NIMH Mental Health Clinical Research Center at Duke University. Symptoms were measured using the Montgomery-Asberg Depression Rating Scale (MADRS). Results At three months, 86 patients (37.6%) had remitted, or had a MADRS score less than or equal to 9. In the remitted group, the most frequently reported symptoms at three months were inner tension and lassitude. Among nonremitters, the most frequently reported symptoms were reported and apparent sadness, as well as lassitude and inner tension. In the sample as a whole, the symptoms most likely to be present at baseline but not three months were pessimistic and suicidal thoughts, while the most frequently reported emergent symptoms were reduced appetite and inner tension. Patients were much more likely to no longer have a particular symptom than to acquire a new symptom. Overall, the symptoms present at three months were not severe in either group. Conclusions In older adults treated for major depression, residual symptoms at three months may include emergent symptoms as well as persistent symptoms, and are likely to include symptoms of anxiety as well as sadness. These findings have clinical implications for the treatment of late-life depression. Copyright © 2005 John Wiley & Sons, Ltd.