Increased Depressive and Anxiety Symptoms Predict Increased Severity of Functional Impairment After Five Years: A Nationally Representative Retrospective Cohort Study.

Purpose: Performing self-care and domestic life tasks are key aspects of functional independence for older adults. While both depression and anxiety symptoms are correlated with increased functional limitation, these disorders are often studied separately, despite frequent co-occurrence and plausible interaction, and without the consideration of social health. This study examined the impact of comorbid depressive and anxiety symptoms, controlling for social participation and loneliness, on severity of functional limitation in a nationally representative sample of older adults to improve patient-centered care. Methods: The National Social Life, Health, and Aging Project (NSHAP) Rounds 2 and 3 data were utilized. Primary outcomes were self-reported difficulty with activities of daily living and instrumental activities of daily living. All analyses were weighted for Round 2 to account for NSHAP sampling design. Results: Approximately one-quarter of respondents documented either depressive or anxiety symptoms, with 9.4% documenting both. Those with both depressive and anxiety symptoms reported the greatest number of functional limitations and greatest difficulty with tasks when assessed after 5 years. Using multivariate linear regression, poorer mental health status and increased comorbidity burden significantly predicted severity of functional limitation. While loneliness was associated with slightly worse function, increased social participation appeared to be a protective factor. Conclusions: These results build on existing literature calling for a more holistic assessment of health - physical, mental, and social - and further emphasize the need for mental health interventions as an avenue to increase functional independence in older adults to improve patient experience and patient-centered care.