Depression and mortality in medically ill older adults

OBJECTIVE: To determine if major depressive disorder influences the survival of older, medically ill veterans. DESIGN: Thirty month follow-up of an inception cohort. SETTING: An academically-affiliated Veterans Affairs Medical Center. PARTICIPANTS: One hundred veterans, half of whom have a depressive disorder, recruited from inpatient medical and surgical units in 1990-1991. At initial evaluation all participants were older than age 65, cognitively intact, and medically but not terminally ill. MEASUREMENTS: Severity of medical illness, functional status, social support and presence of depression were measured at initial evaluation, presence of depression was measured 4 to 6 months after initial evaluation, and survival status was determined at 30 months. Retrospective medical record review was used to determine if patients received depression treatment and to explore whether depressed persons received life-sustaining medical treatment less often than nondepressed persons. RESULTS: At 30 months, 36 of the 100 subjects had died. Only two factors predicted mortality: severity of medical illness and depression. The survival of subjects who had recovered from depression at 4 to 6 months was intermediate to never depressed and continuously depressed subjects. Somatic treatment of depression did not alter outcome. There was no significant difference between depressed and nondepressed in how often life-sustaining medical treatments were withheld or withdrawn. CONCLUSION: Presence of major depression in medically-ill older hospitalized veterans continues to be a risk factor for death 30 months after diagnosis.