Objective
This study aims to evaluate the impact of depressive multimorbidity (ie, including
depressive symptoms) on the long-term development of activities of daily living (ADL)
and instrumental activities of daily living (IADL) limitations according to racial/ethnic
group in a representative sample of US older adults.
Design
Prospective, observational, population-based 16-year follow-up study of nationally
representative sample.
Setting and Participants
Sample of older non-Hispanic Black, Hispanic, and nonHispanic White Americans from
the Health and Retirement Study (2000‒2016, N = 16,364, community-dwelling adults
≥65 years of age).
Methods
Data from 9 biennial assessments were used to evaluate the accumulation of ADL-IADL
limitations (range 0‒11) among participants with depressive (8-item Center for Epidemiologic
Studies Depression score≥4) vs somatic (ie, physical conditions only) multimorbidity
vs those without multimorbidity (no or 1 condition). Generalized estimating equations
included race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White), baseline
age, sex, body mass index, education, partnered, and net worth.
Results
Depressive and somatic multimorbidity were associated with 5.18 and 2.95 times greater
accumulation of functional limitations, respectively, relative to no disease [incidence
rate ratio (IRR) = 5.18, 95% confidence interval, CI (4.38,6.13), IRR = 2.95, 95%
CI (2.51,3.48)]. Hispanic and Black respondents experienced greater accumulation of
ADL-IADL limitations than White respondents [IRR = 1.27, 95% CI (1.14, 1.41), IRR =
1.31, 95% CI (1.20, 1.43), respectively].
Conclusions and Implications
Combinations of somatic diseases and high depressive symptoms are associated with
greatest accumulation of functional limitations over time in adults ages 65 and older.
There is a more rapid growth in functional limitations among individuals from racial/ethnic
minority groups. Given the high prevalence of multimorbidity and depressive symptomatology
among older adults and the availability of treatment options for depression, these
results highlight the importance of screening/treatment for depression, particularly
among older adults with socioeconomic vulnerabilities, to slow the progression of
functional decline in later life
Keywords
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Article info
Publication history
Published online: December 16, 2022
Footnotes
The study was funded by the National Institute on Aging/National Institutes of Health (Grant Number: 5R01AG055681-04 to Dr. Quinones).
Additional funding form the National Institute on Aging/National Institutes of Health (AG024824 from the University of Michigan - Claude D. Pepper Older Americans Independence Center to AB); UL1TR000433 from the Michigan Institute for Clinical and Health Research (to AB).
All authors meet the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. Study concept and design: Botoseneanu, Quinones. Data acquisition: Elman. Analysis and interpretation of data: Botoseneanu, Quinones, Elman, Allore, Nagel, Newsom, Dorr. Drafting of manuscript: Botoseneanu, Quinones, Elman. Critical revision of the manuscript for important intellectual content: Botoseneanu, Elman, Allore, Dorr, Newsom, Nagel, Quinones. All authors have approved this submission.
The authors declare no conflicts of interest.
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