Depression, Multimorbidity, and Functional Outcomes in Older Women
Cassandra M. Germain, PhD a Ana Quiñones, PhD, MSb
aUniversity
of North Carolina at Greensboro, School of Nursing, Greensboro, NC
bOHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR
KEY FINDING
 Having high depressive symptoms is independently associated with significantly higher prevalence of functional limitations in women during late-life.
 High depressive symptomology is associated with significantly increased odds of functional limitations in older women independent of chronic disease.
Women have higher prevalence rates of ADL/IADL
impairment and depressive symptoms than men. The presence
of multiple chronic health conditions (multimorbidity) is also
associated with poor ADL/IADL outcomes in older adults. The
current study examines the impact of mulitmorbidity and
depressive symptoms (CESD) on functional limitations in
women aged ≥50.
OBJECTIVES
• To examine the association between morbidity status on
prevalence of ADL/IADL limitations in older women.
• To examine the impact of multimorbidity and depressive
symptoms on ADL/IADL limitations in older women.
RESULTS
RESULTS
INTRODUCTION
Table 2. Unadjusted and Adjusted Odds of Functional Limitations in
Women with High Depressive Symptoms by Chronic Disease Category
Table 1. Sample Characteristics
Overall
Not Depressed
Depressed
9,576
7,823
1,753
Age M(sd)
68.3 (10.48)
68.3 (10.39)
68.2 (10.87)
.59
Education M(sd)
12.37 (3.0)
12.6 (2.86)
11.2 (3.36)
<.001
p
Race (%)
<.001
White
7544 (78.8)
6062 (86.6)
1179 (77.7)
Black
1508 (15.7)
1118 (9.5)
337 (14.2)
524 (5.5)
358 (11.8)
143 (8.1)
61.62 (303.81)
36.19 (72.32)
Mexican American
Total Household Income (per
1000)
56.97 (276.51)
Body Mass Index (kg/m2
27.6 (6.37)
27.4 (6.05)
28.9 (7.50)
<.001
Comorbidities M(sd)
2.0 (1.42)
1.88 (1.35)
2.61 (1.54)
<.001
Current Smoker (%)
1227 12.8
854 (11.8)
308 (20.7)
<.001
ADL Limitation (%)
907 9.5
486 (5.7)
363 (21.1)
<.001
ADLIADL Limitations (%)
1472 15.4
1072 (12.9)
660 (38.5)
<.001
Dataset: 2006 Wave of Health and Retirement Study
Outcomes:
• Basic ADL’s: difficulty with eating, dressing, getting out of bed,
toileting, bathing.
• IADL/ADL Combined Index: eating, dressing, getting out of bed,
toileting, bath out. difficulty with meals, phone, meds, grocery
shopping, managing money.
Predictors:
• Depressive Symptoms: CES-D >=4
• Number of chronic health conditions (hypertension, diabetes, heart
disease, stroke, arthritis, cancer, lung disease, cognitive
impairment).
Covariates: Age, race, years of education, household income, body
mass index (BMI) in kg/m2 and smoking status.
ADL
ADL/IADL
Unadjusted
Adjusted
Unadjusted
Adjusted
0
8.02
[3.35-19.20]
7.67
[3.13-18.83]
4.64
[2.35- 9.14]
4.08
[1.91-8.75]
1
2.86
[1.60- 5.14]
3.14
[1.69-5.84]
4.07
[2.72-6.09]
4.59
[2.98-7.07]
2
3.65
[2.55-5.22]
2.93
[1.99-4.31]
3.29
[2.48- [4.36]
2.99
[2.19-4.08]
3+
3.26
[2.59- 4.11]
2.95
[2.31-3.77]
3.21
[2.65- 3.89]
3.15
[2.56-3.89]
<.001
a. Adjusted for age, sex, race, education, income, number of comorbidities, current smoking status and body mass
index. b. Weighted (observations with zero or negative weights were automatically eliminated from the analyses).
METHODS
Design: Cross-sectional analysis
No. Chronic
Diseases
Figure 1. Prevalence of Limitations by Race/Ethnicity and
Number of Chronic Diseases
CONCLUSION
• Treatment for depression in addition to effective chronic disease
maintenance is important for reducing odds of functional
limitations in older women.
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