Depressive symptoms forecast disability in older adults with recent diabetes
medwireNews: An increase in depressive symptoms around the time of a new diabetes diagnosis in older adults is associated with increasing difficulty in performing daily activities such as shopping, walking, and dressing, US researchers report.
Of the 419 individuals (mean age 70 years) included in the study, 113 (27%) reported an increase in depressive symptoms on the Center of Epidemiologic Studies Depression Scale in the 2-year period after diabetes diagnosis.
Before diabetes diagnosis, there was no difference in disability level as measured by five activities of daily living (ADL) and five instrumental ADL (IADL), between patients who did and did not report an increase in depressive symptoms postdiagnosis.
However, postdiagnosis, the level of disability increased at a significantly greater rate among the patients with elevated depression than among those without depressive symptoms.
Clinically overt disability (score ≥1) was apparent in the individuals with elevated depressive symptoms as early as 4 years post-diabetes diagnosis (score=1.19) and remained elevated at 6 years (score=1.20). The corresponding scores for individuals without elevated depressive symptoms were 0.51 and 0.58.
The proportions of participants reporting difficulties with each of the 10 ADL and IADL tasks in the 2 years after diabetes diagnosis ranged from 5.3% to 15.0% in those with elevated depressive symptoms compared with 1.6% to 8.5% in those without elevated depressive symptoms.
The researchers note that when they separated ADL (eating, getting in and out of bed, bathing, walking across rooms, and dressing) from IADL (telephone use, money management, medication management, meal preparation, and shopping) there were no significant differences between the patients with and without elevated depressive symptoms.
This suggests that “elevated depressive symptoms may be associated with disability in the spectrum of daily activities from basic (e.g., ambulation, eating) to complex (e.g., shopping) rather than with a specific type of daily activity,” Chao-Yi Wu and colleagues from the University of Pittsburgh in Pennsylvania remark.
Some of the greatest differences observed between the two groups were in dressing, shopping, walking, and meal preparation, with around one in seven older adults with elevated depressive symptoms reporting difficulties in dressing and shopping, and one in 10 reporting difficulties in walking and meal preparation.
“The inability to go shopping, prepare meals, walk, and dress may lead to poor nutrition, an inactive life, and poor skin care, which may potentially deteriorate DM [diabetes mellitus] disease control and create a vicious cycle toward long-term disability,” Wu and co-authors write in Diabetes Care.
They conclude: “Future interventions should take an indicated approach to disability prevention in older adults with newly diagnosed DM, especially for those with a change in depression severity during the window before and after diagnosis of DM.”
By Laura Cowen
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