The Profile of Instrumental Activities of Daily Living in Geriatric Depression

• Main Authors: Yu-Wen Huang, 黃鈺雯
• Other Authors: 毛慧芬
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/beqaz9

碩士 === 國立臺灣大學 === 職能治療研究所 === 107 === 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.