Disability in geriatric depression.

The authors examined impairment in self-maintenance skills and in instrumental activities of daily living (IADL) among 211 older patients with unipolar major depression. In regression models, self-maintenance impairment was associated with older age, less reported depressed mood, psychomotor retardation, and severe chronic medical illness. IADL deficit was associated with older age, greater severity of depression, less guilt, more apathy, weight loss, greater cognitive impairment, more severe chronic medical illness, less social interaction, lower subjective social support, and greater instrumental support. The authors conclude that efforts to remediate basic skills deficits in depressed older adults should focus on treating comorbid medical conditions; impaired IADL skills in geriatric depressed patients should improve with treatment of depression and medical illness. Clinicians should be aware that substantial IADL impairment may accompany mild cognitive impairment associated with depression in older patients.