Severe Illness in Older Patients: The Association Between Depressive Disorders and Functional Dependency During the Recovery Phase

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Abstract
An association between depression and physical dependency arising from a recent illness has been generally accepted. To clarify this relationship over time, 30 medical rehabilitation patients aged 54 to 94 years were assessed 1 week after admission and at discharge to quantify symptoms of depression, physical dependency, and cognitive functioning using the Hamilton Depression Scale (HAM-D), the Geriatric Depression Scale (GDS), the Barthel Index for physical function, and the Mini-Mental State Examination (MMSE). Significant depressive symptomatology was found by HAM-D in 25 patients on admission and 14 on discharge. No significant association were present between either admission or discharge depression scores and all other variables. The HAM-D change score was significantly correlated with the Barthel change score (r = 0.57, P < 0.001) and with the MMSE change score (r = 0.48, P = 0.01). All patients whose mood improved also improved in physical functioning, whereas 75% of those whose mood did not inprove failed to make headway in physical functioning. This implies that it is not the degree incapacity but rather the failure to regain prior abilities which is strongly associated with persisting depression following a catastrophic illness. Furthermore, charcteristics found commonly in the group whose mood did not improve included physicans'' failure to diagnose and treat depresssion or a setback froma signifcant medical or surgical complication.