PMH6: CHANGE IN INSTRUMENTAL ACTIVITIES OF DAILY LIVING ASSOCIATED WITH ANTIDEPRESSANTS IN OLDER DEPRESSED PATIENTS

Abstract

OBJECTIVES: While most current antidepressant agents, such as SSRIs and dual action agents are reasonably effective in ameliorating depressive symptomatology in older patients, less is known about their impact on concurrent instrumental activities of daily living (IADL's). This study examines change in IADL's, such as the capacity to use the telephone, travel, shop, cook, do housework, handle money, or take medicine, from admission to three-month post-discharge follow-up in geropsychiatric patients (age 55 and older) with major depression (ICD-9-CM codes 296.20-296.36) treated with fluoxetine (n = 77), mirtazapine (n = 36), sertraline (n = 145), or venlaxafine (n = 56). METHODS: Data were obtained from the CQI+SM Outcomes Measurement System, which tracked patients admitted to geropsychiatric inpatient programs in 111 general hospitals across 33 states between 1997?1999. IADL's were measured by selected items from the Duke OARS Multidimensional Functional Assessment Questionnaire (Lawton & Brody, 1969). A Medication Usage Questionnaire was used to track medications prescribed. One-way Analyses of Variance and if significant, Tukey's pairwise comparisons were used to compare medication groups. RESULTS: At admission, patients exhibited moderate to severe inability to independently carry out IADL's (Mean score of 14 to 15 out of 21). Medication groups were indistinguishable on change scores in overall IADL's from time of admission to follow-up. On average, patients showed no change in their ability to carry out IADL's during this time period, despite an improvement in level of depression, as measured by the collateral version of the Geriatric Depression Scale (Nitcher, Burke, Roccaforte, & Wengel, 1993). CONCLUSIONS: Antidepressant agents in this analysis were associated with modest improvement in IADL's as assessed by the Duke OARS Multidemsional Functional Assessment in Older Adults. New treatment modalities that improve IADL's along with depressive symptomatology in older patients would be beneficial. Further controlled studies are needed to better understand these findings.