Trajectories of concurrent depressive symptoms and cognitive function on health outcomes and mortality among older Mexican Americans

Abstract

Background: We sought to identify distinctive concurrent trajectory classes of depressive symptoms (DS) and cognitive function (CF) in Mexican Americans aged 75+ years, and to examine whether these trajectories were associated with an increased risk of adverse outcomes. Methods: We used 4 waves of Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) data from 2004 to 5 to 2013. Latent growth curve analysis was used to identify distinctive concurrent trajectory classes of DS and CF. Generalized linear mixed models were further used to examine the association between the concurrent trajectories and health outcomes. Cox proportional hazards regression model was used to examine the risk of mortality as a function of the concurrent trajectories. Results: 1,302 older adults followed-up approximately 9-years were successfully classified into 6 distinct concurrent trajectory classes of DS (low-increasing, high) and CF (high, high-declining, medium-declining). Compared to the co-occurrence of low DS and high CF trajectories, those with the high DS and declining CF trajectories were at greater risk of ADL and IADL functional limitations (1.6 − 2.9 times), more medical visits (1.3 − 1.4 times), hospital admissions (1.6 − 1.9 times), and mortality (1.7 − 2.6 times). Conclusions: Differences in adverse health outcomes across concurrent trajectory classes of DS and CF suggest that differences in underlying co-occurrence and progression have important implications for public health interventions as well as development of aging social and health policies.