Special Article
The Association of Late-Life Depression and Anxiety With Physical Disability: A Review of the Literature and Prospectus for Future Research

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Depression and anxiety disorders are associated with excess disability. The authors searched the recent geriatric literature for studies associating late-life depression or anxiety with physical disability. Studies showed depression in old age to be an independent risk factor for disability; similarly, disability was found to be a risk factor for depression. Anxiety in late life was also found to be a risk factor for disability, although not necessarily independently of depression. Increased disability due to depression is only partly explained by differences in socioeconomic measures, medical conditions, and cognition. Physical disability improves with treatment for depression; comparable studies have not been done for anxiety. The authors discuss how these findings inform current concepts of physical disability and discuss the implications for future intervention studies of late-life depression and anxiety disorders.

Section snippets

Disability and Psychiatric Disordersas a Public Health Issue

According to the Global Burden of Disease study, unipolar major depression is the leading worldwide cause of disability in adults.6 Anxiety disorders such as panic disorder and posttraumatic stress disorder were found to be important causes of disability as well. Although the Global Burden of Disease study represents the most comprehensive existing work regarding disability due to depression and anxiety, its results are less applicable to elderly patients because role disability (e.g.,

Objective

Although there is a consensus that late-life depression leads to, amplifies, and is a consequence of physical disability,15., 16., 17., 18. a review of the literature in 1988 concluded that studies at that time could neither elucidate the pathways between late-life depression and disability nor determine the effectiveness of interventions in relieving disability in the context of late-life depression.15 Although the literature in young-adult populations shows that anxiety disorders are also

METHODS

We used MEDLINE and PsycInfo searches to find articles relating late-life depression or anxiety to disability. Search terms were depression, depressive disorders, anxiety, anxiety disorders, panic disorder, social phobia, obsessive–compulsive disorder, and generalized anxiety disorder, in combination with activities of daily living, disabled persons, and disability evaluation, and in combination with aged, for the time frame 1990–2000. Additional articles were identified by the authors'

Depression and Disability

The search yielded 66 studies meeting the above criteria associating depression and disability. Of these, 16 were cross-sectional community studies, 9 were longitudinal community studies, 18 were cross-sectional clinical observational studies, 18 were longitudinal clinical observational studies, and 5 were intervention studies.

Summary of Findings

A significant association between depression and disability was found in community and clinical settings. This association persisted when possible confounds, such as age, gender, education, medical burden, social support, income, and cognitive status, were controlled. The association with increased disability was present whether the disorder was diagnosed as major depression or depressive symptoms assessed by a screening instrument. Some,47., 62., 67. but not all59., 88. studies of minor

CONCLUSIONS

Recent literature has revealed much about the mechanisms by which late-life depression causes or amplifies physical disability. These mechanisms relate the features of the depressed state itself, such as cognitive impairment and motivation depletion, to physical disability. Understanding these disabling effects of depression helps to better inform our concept of “physical” disability and refine it as a construct with physical, cognitive, and emotional components. Similar studies of anxiety

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    The authors acknowledge Ester Saghafi, M.Ed., MLS, for her help with the literature review.

    This work was supported by NIMH grants P30 MH 52247, K05 MH00295, K01 MH01613, R37 MH43832, R01 MH37869, R01 MH59318, and T32 MH19986.

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