Cognitive impairment and syndromal depression in estimates of active life expectancy: the 13-year follow-up of the Baltimore Epidemiologic Catchment Area sample.

OBJECTIVE Our hypothesis was that including cognitive status and syndromal depression in specifying functional impairment would result in significant differences in estimates of active life expectancy from specifications that included only standard functional measures (such as activities of daily living). METHOD The subjects were the 3481 continuing participants of the Baltimore Epidemiologic Catchment Area Program. Interviews included criterion-based diagnosis of depression, assessment of cognitive status and standard survey questions on function. RESULTS Estimates of active life expectancy decreased from 9.8 years to 8.9 years at age 65 years for men, and from 10 years to 8.4 years at age 65 years for women, when the definition of active life expectancy included measures of cognitive impairment and syndromal depression. CONCLUSION Measurements of active life expectancy tend to ignore dependencies related to psychological causes, and should move beyond mere enumeration of activities of daily living and instrumental activities of daily living.