Saturday, 15 January 2005 - 4:00 PM

This presentation is part of: Services for Older Adults

Rehabilitation Services And Changes In Depression and Disability in Older Adults

Purpose: There is a well-documented, reciprocal relationship between disability and depression in later life, with depression increasing the risk of disability and disability increasing risk of depression among older adults. Rehabilitation programs for age-related disabling conditions typically focus on maximizing functional abilities, but may have direct and/or indirect effects on depression as well. With increased demand for evidence-based health care, research examining the efficacy of rehabilitation services in terms of both physical and emotional functioning is needed. This study examined the effect of rehabilitation on functional ability and depression in adults age 65+ (n=584) with recent vision loss due to age-related eye disease, a condition that tends to worsen over time. Method: All respondents (mean age at baseline =80.1) were first-time applicants for vision rehabilitation services and were interviewed in-person pre-service (baseline) and at 6- and 12-month follow-ups. Depression was measured with the CES-D, Disability with a modified version of the OARS IADL scale, and Rehabilitation Services Use was operationalized as the total number of service hours received from all providers (i.e., vision rehabilitation therapists, low vision specialists, and social workers). Full information maximum likelihood was used to fit a mean and covariance structure model to all available data, which allowed examining change over time in functional disability and depression in relation to rehabilitation service hours. Results: Results showed decreased depression at both 6- and 12-months post-baseline, but functional disability increased over time. Use of more than an average amount of rehabilitation service was associated with a significantly lower rate of increase in functional disability at Time 2 and Time 3. Rehabilitation use was not significantly associated with change in depression over time. However, associations between the functional disability and depression change variables were significant and positive. Significant positive change in depression (greater decline in symptoms) was associated with better than average status (less decline) in functional ability. This provides some evidence for an indirect effect of rehabilitation on change in depression through change in functional disability. Implications: Results show a promising impact of rehabilitative services with regard to enhanced functioning in everyday activities over time. The indirect effect of more service hours on depression suggests that a comprehensive rehabilitation program which encompasses both functional and mental health components has the greatest potential for addressing both the functional and psychosocial consequences of age-related disability. However, future research is needed to understand the pathways and mechanisms by which rehabilitation services, both intensity and type, influence the trajectory of depression among older disabled adults. This research was supported by NEI Grant R01 EY12563.

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