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The Profile of Instrumental Activities of Daily Living in Geriatric Depression
Geriatric depression,late-onset depression,recurrent depression,instrumental activities of daily living,functional assessment,
|Publication Year :||2019|
|Abstract:||背景: 老年憂鬱症是老年人最常見的心智障礙問題之一，患者除了受憂鬱症狀影響外亦伴隨輕微認知損傷以及工具性日常生活活動(instrumental activities of daily living, IADL)失能。IADL表現困難或減少參與，可能加重憂鬱等負面情緒、造成更嚴重的認知損傷以及影響其生活滿意度，因此IADL的評估與介入是老年憂鬱症臨床實務上相當重要的一環。然而目前針對老年憂鬱症IADL功能探討的文獻不足，現有研究評量失能的方式多侷限於針對其實際表現之問卷，而缺乏其自覺困難程度及操作表現之瞭解，並未比較其是否有所不同。另針對晚發型及復發型老年憂鬱症，由於病因、臨床表徵有所不同，其在IADL上的失能樣態或失能機轉等尚不清楚。
結果: 本研究共納入63名老年憂鬱症者(38名晚發型、25名復發型)及42名健康長者，復發型組平均年齡(59±5.9歲)顯著低於晚發型組(68±7.8歲)和健康組(67±9.0歲)，於性別和教育年數則沒有顯著差異(P性別=.541、P教育=.152)。兩類型老年憂鬱症於IADL整體功能之操作能力、實際表現以及自覺困難度皆顯著較健康組差(能力: P晚=.000、P復=.001 表現: P晚=.000、P復=.002 自覺: P晚=.000、P復=.000)；晚發型和復發型間於各面向IADL功能則皆沒有顯著差異(P能力=.653、P表現=.964、P自覺=.777)。兩類型老年憂鬱症於娛樂(P晚=.000、P復=.001)、外出(P晚=.004、P復=.015)、家務處理(P晚=.007、P復=.018)等IADL項目之實際表現顯著較健康組差，晚發型於財務處理較復發型差(P=.015)、復發型則於準備飯餐顯著較健康組差(P=.031)、於通電話顯著較晚發型差(P=.032)；兩類型老年憂鬱症於各IADL項目之自覺困難度則皆顯著較健康組感到困難(P晚=.000~.005、P復=.000~.034)。控制憂鬱影響下，晚發型憂鬱症之整體認知功能與三面向IADL功能呈現低度至中度相關(r=.222~.545)，復發型則皆為低度相關(r=.385~.393)；控制認知影響下，兩類型老年憂鬱症其憂鬱症狀與IADL操作能力幾乎無相關或僅低度相關(r晚=.032 r復=.208)，於IADL實際表現(r晚=.439 r復=.618)和自覺困難度層面(r晚=.456 r復=.569)則皆可達中度相關。
Background: Geriatric Depression (GD) is the most common mental health disorder among older adults. Patients with GD may suffer from depression symptoms, mild cognitive dysfunction and impairment in instrumental activities of daily living (IADL). Poor IADL performance or decreased IADL participation may worsen their depression symptoms, lead to advanced cognitive impairment, and have an impact on quality of life. Hence, how to assess and improve IADL performance of GD patients is important for healthcare providers. However, there was limited number of studies about IADL performance of GD patients. Previous research mainly focused on IADL performance measured by self-report scales instead of the self-perceived difficulties or capacity in performing IADL. Also, there was a lack of comparison between the self-reported IADL performance and the self-perceived difficulty or capacity in performing IADL. Furthermore, growing evidence suggests that late-onset depression (LOD) differs from recurrent depression (RD) in terms of clinical features and etiology. Nonetheless, the IADL profile and mechanisms of IADL disabilities remain to be clarified.
Aims: The purpose of this study is threefold: (1) To examine the differences between IADL capacity, actual performance of IADL and perceived difficulties when performing IADL among patients with GD and healthy controls (HCs), LOD and RD, (2) to investigate the performance of distinct IADL items in GD, and (3) to evaluate the correlation of depression and cognitive deficits to IADL function.
Methods: A cross-sectional descriptive research design was employed. The GD patients with a diagnosis of major depressive disorder were recruited from psychiatric clinics in a medical center while those community-dwelling older adults without obvious cognitive and mood problems were recruited as the HCs. All participants were administered a series of tests on cognitive function (Montreal Cognitive Assessment, Stroop Color and Word Test), depression severity (Geriatric depression scale-Short Form) and triple-dimensional IADL function (The UCSD Performance-Based Skills Assessment, The Disability Assessment for Dementia-IADL scale). The authors compared the IADL performance between GD and HC, LOD and RD through multiple regression analysis. In addition, we used partial correlation and multiple regression analysis to evaluate the relationship of depression severity and cognitive deficits to IADL function.
Results: There were 105 older adults (38 LOD, 25RD, 42 HC) recruited in this study, with matched gender and educational level (Pgender=.541, Pedu=.152) among the three groups. However, the average age of RD group(59±5.9) is younger than the other groups (LOD:68±7.8, HC:69±9.0). Both of the LOD and RD group were significantly worse than HCs in terms of general IADL capacity (PLOD=.000, PRD=.001), performance (PLOD=.000, PRD=.002) and perceived difficulties (PLOD=.000, PRD=.000). Compared with the RD group, the LOD group performed significantly worse on financial management (P=.015) while performing significantly better on telephoning (P=.032) and preparing meals (P=.031). Both groups were significantly interfered with the performance on leisure (PLOD=.000, PRD=.001), going on an outing (PLOD=.004, PRD=.015) and housework (PLOD=.007, PRD=.018), but not on medications. The results of partial correlation analysis revealed a low to moderate correlation between general cognition and varied dimension of IADL assessments (rLOD=.222~.545, rRD=.385~.393). Nevertheless, depression demonstrated moderate correlations with IADL performance (rLOD=.439, rRD=.618), perceived difficulties (rLOD=.456, rRD=.569) but rare to low correlation with IADL capacity (rLOD=.032, rRD=.208).
Conclusions: This study showed that patients with GD had deficits in IADL capacity, performance and perceived difficulties. Although there were no significant differences between the LOD group and RD group on the triple-dimensional IADL function, they showed certain degree of diversity to distinct IADL items. Cognitive impairment had a prominent effect on IADL capacity of GD group, while depression is the key factor that affects actual performance of IADL and perceived difficulties in performing IADL. Besides, neither cognition nor depression serves as a mediator or mediating variable to IADL function. The results indicate the underlying IADL profile and mechanism of IADL dysfunction among GD patients. Moreover, they may help clinicians to develop an integrative evaluation and customized interventions targeting IADL dysfunction caused by GD.
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