A longitudinal study on relations of psychiatric symptom clusters to occurrence of physical activities of daily living impairment in community-dwelling older persons

2004 Fiscal Year Final Research Report Summary

• Project/Area Number: 14570337
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Public health/Health science
• Research Institution: Kochi University
• Principal Investigator: YASUDA Nobufumi Kochi University, Kochi Medical School, Associate Professor, 医学部, 助教授 (30240899)
• Co-Investigator(Kenkyū-buntansha): OHARA Hiroshi Kochi University, Kochi Medical School, Professor, 医学部, 教授 (00033209) ; SUGIHARA Yuki Kochi University, Kochi Medical School, Assistant Professor, 医学部, 助手 (90304675) ; OOTA Atsuhiko Kochi University, Kochi Medical School, Assistant Professor, 医学部, 助手 (80346709)
• Project Period (FY): 2002 – 2004
• Keywords: the aged / psychiatric symptoms / depressive symptoms / activities of daily living / longitudinal study

Research Abstract

This longitudinal study examined relations between distinct clusters of psychiatric symptoms and occurrence of impairment in physical activities of daily living (ADLs) among community-dwelling older persons. The subjects included 785 person aged 65 and older who had no ADL impairment at baseline. Psychiatric symptoms at baseline were measured with the General Health Questionnaire 30-item version (GHQ-30) and three distinct symptom clusters (depression, anxiety, and apathy/anergia) were identified by a factor analysis on the responses to the questionnaire. Associations of individual symptom clusters with having ADL impairment at the end of the follow-up period were examined by fitting a polychotomous logistic regression model in which a variable composed of three categories (alive with no ADL impairment, alive with ADL impairment, and dead) was regressed on age, gender and standardized factor scores corresponding to individual clusters of psychiatric symptoms. When three subscales relev ant to psychiatric symptoms were included simultaneously in the model, it was only apathy that was associated with ADL impairment adjusted odds ratios of ADL impairment for one standard deviation or more above the mean on each factor score were 0.8(95 % confidence interval, 0.3-2.0) for depression, 3.2(95 % confidence interval, 1.6-6.2) for apathy, and 1.5 (95 % confidence interval, 0.8-3.1) for anxiety. Among 362 persons who had a physical examination at baseline, the increased risk of ADL impairment associated with apathy was observed when various risk factors of circulatory system disease (ie., blood pressure, serum cholesterol, hemoglobin, and body mass index) were controlled for. In the analysis for 36 persons whose psychiatric symptoms were measured both at baseline and at the follow-up time point, persons whose scores on the apathy subscale deteriorated between the two time point had higher proportions of having experienced ADL impairment than those whose scores on the subscale did not deteriorate. Although depression has attracted attention as a predictor of ADL impairment; the present study indicates that apathy may also be an important attribute to incidence of ADL impairment: The association between depressive symptoms and physical disability should be examined with considering the influence of symptoms relevant to apathy.