Hospital depressive symptoms and ADL disability in older adults: A longitudinal analysis of course and associations



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Depressive symptoms and disability in activities of daily living (ADL) often increase in older adults during hospitalization and for many persist post-discharge. However, little is known about the psychological and functional response of older adults admitted to an Acute Care for Elders (ACE) unit. Questions remain about the association between depressive symptoms and ADL disability and factors that moderate these associations are unknown. Objectives of this study were to investigate: 1) change in depressive symptoms and ADL function from hospital to 3 month follow-up; 2) the association between depressive symptoms in hospital and ADL function 3 months post-discharge; and 3) moderators of the depression-ADL association.\r\n A tri-ethnic (white, black and Hispanic) sample of 403 older adults within an ACE database contributed subjective and objective information related to depressive symptoms, clinical variables and activity/participation measures across two time frames, admission and three months post discharge. A large minority reported high depressive symptoms in hospital and over half reported ADL disability. Across both assessment periods, risk factors for having high depressive symptoms were being unmarried and having any level of ADL disability. Conversely, risk factors for ADL disability were pain and depressive symptoms. At 3 months post discharge, the recovery rate from depression and incident ADL disability was high. Positive change in depression was significantly associated with positive change in ADL status. Increasing severity of hospital depression was associated with increased odds of ADL disability at the 3 month follow-up. Neither gender, marital status, pain nor medical history moderated this relationship. \r\n This study indicates that while older adults experience higher depressive symptoms and ADL disability while hospitalized, resolution of symptoms occur for many. This research contributes to the literature by extending our knowledge of the course and associations between depressive symptoms and ADL disability in hospitalized, older adults. Future research which focuses on interventions to minimize depressive symptoms and ADL disability is warranted. \r\n



older adults, hospitalization, depression, activities of daily livng