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Fifteen‐Item Geriatric Depression Scale Predicts 8‐Year Mortality in Older Japanese

To the Editor: The diagnosis of depression and the administration of antidepressant therapy have increased in nursing home residents; more research is needed to assess prognosis. Depressive symptoms in older community-dwelling adults, as defined by a score of 6 or higher on the 15-item Geriatric Depression Scale (GDS), are associated with lower activity of daily living (ADL) and quality of life (QOL) scores in Asian communities, yet the prognostic importance of the GDS remains to be clarified. A meta-analysis of 25 studies concluded that depression increases the risk of mortality, but these studies used various definitions of depression, and the results were not consistent in older adults. Results from the Berlin Aging Study showed that depression predicts mortality in people aged 70 to 84 but not in those aged 85 and older. To evaluate the predictive value of depressive symptoms determined according to the GDS for mortality in elderly Japanese, an 8.4-year mortality analysis was conducted. The study cohort consisted of 254 elderly residents (male:female = 64:190; mean age 79.5 ± 6.5, range: 65–96) of a residential care home in Kyoto, Japan. The interview-based GDS was administered to the residents, with a 91.7% response rate of eligible residents during the baseline examination in 2001; those with scores of at least 6 were classified as having depressive symptoms. Walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, and grooming were evaluated to assess basic ADLs. Residents who were not completely independent in any of these seven ADL items were considered to be dependent in basic ADLs. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) scale (range: 0–13) was used to assess advanced ADLs. Residents with scores of 12 or less were considered to be dependent in advanced ADLs. For QOL assessment, residents rated their subjective sense of health using a 100-mm visual analogue scale (VAS). Lower subjective sense of health was defined as a score of 50% or less on the VAS. Survival curves for residents with GDS scores of 6 or greater were compared with those with scores less than 6 using Kaplan-Meier curves and the Wilcoxon log-rank test. Adjusted Cox regression models were used to examine confounding variables. All data were analyzed using SPSS version 16 (SPSS, Inc., Chicago, IL). Of 254 residents participating in the study, 39.8% (n = 101, male:female = 22:79, mean age 80.6 ± 6.5) had depressive symptoms based on GDS screening at the start of follow-up in 2001, and 40.6% (n = 103, male: female = 28:75, mean age at baseline 82.3 ± 6.3) had died by the end of the 8.4-year follow-up. Figure 1 shows unadjusted Kaplan–Meier survival estimates for the overall study population (Figure 1A) and for each sex (Figure 1B and C) classified according to GDS score. A significant