Difficulty with basic tasks such as activities of daily activities (ADL) or walking a short distance are relatively uncommon in middle life but become increasingly common as people age, often leading to disability. While these disabilities may not become apparent until people enter old age, they likely have their antecedents in risk factors that develop in middle life. Understanding midlife determinants of later life disability is of major public health importance because these disabilities severely compromise the quality of life of older persons and are risk factors for other adverse outcomes such as the need for caregiver assistance, nursing home placement, and death. There is a strong rationale for hypothesizing that mid-life depressive symptoms are an important risk factor for later life disability and related outcomes. Middle age people with depressive symptoms are more likely to have work-related disability and depression in late life is associated with concurrent and future ADL impairment. It is largely unknown, however, whether middle age persons with depressive symptoms are at higher risk for the common disabilities of later life and the consequences of disability. Understanding these relationships is important because depression is common and a potentially modifiable risk factor. We propose to make innovative use of the prospective, population-based Health and Retirement Study (MRS) to examine the impact of midlife depressive symptoms on later life disability and related health outcomes. We will follow 9286 subjects who were age 51-61 when enrolled in 1992 and will range in age from 67-77 by 2008. Depressive symptoms were assessed at enrollment (CES-D) and disability outcomes (such as ADL and walking difficulty) and other health outcomes are assessed every 2 years.
Our aims are to (1) examine the relationship between mid-life depressive symptoms and later life disability; (2) examine whether this relationship differs depending upon demographic and clinical factors, (3) examine whether depressive symptoms are associated with common consequences of disability such as need for caregiver assistance, nursing home placement and death; (4) examine whether depressive symptoms are associated with early retirement and whether early retirement identifies subjects at particularly high risk for later life disability. This study will have unique public health importance because it will be one of the longest outcome studies comprehensively assessing the long term impact of depressive symptoms as subjects progress from middle life to later life. This has important implications for life course interventions to prevent older age disability as it will provide insight into whether it is plausible that better recognition and management of depression in mid life might improves outcomes in later life. ? ? ?
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