DEPRESSION AND MORTALITY IN MEDICALLY ILL OLDER ADULTS

OBJECTIVE: To determine if major depressive disorder influences the su rvival of older, medically ill veterans. DESIGN: Thirty month follow-u p of an inception cohort. SETTING: An academically-affiliated Veterans Affairs Medical Center. PARTICIPANTS: One hundred veterans, half of w hom have a depressive disorder, recruited from inpatient medical and s urgical units in 1990-1991. At initial evaluation all participants wer e older than age 65, cognitively intact, and medically but not termina lly ill. MEASUREMENTS: Severity of medical illness, functional status, social support and presence of depression were measured at initial ev aluation, presence of depression was measured 4 to 6 months after init ial evaluation, and survival status was determined at 30 months. Retro spective medical record review was used to determine if patients recei ved depression treatment and to explore whether depressed persons rece ived life-sustaining medical treatment less often than nondepressed pe rsons. RESULTS: At 30 months, 36 of the 100 subjects had died. Only tw o factors predicted mortality: severity of medical illness and depress ion. The survival of subjects who had recovered from depression at 4 t o 6 months was intermediate to never depressed and continuously depres sed subjects. Somatic treatment of depression did not alter outcome. T here was no significant difference between depressed and nondepressed in how often life-sustaining medical treatments were withheld or withd rawn. CONCLUSION: Presence of major depression in medically-ill older hospitalized veterans continues to be a risk factor for death 30 month s after diagnosis.