This study explores change trajectories of chronic disease, disability and depression when the effects of contextual and other structural factors are simultaneously considered. This study adopted a prospective, closed cohort study design. The cohort includes 1260 older adults participating in the 1994 Multidimensional Functional Assessment Questionnaire survey in Kaohsiung City, Taiwan. Five follow-up interviews were conducted in 1996, 1998, 2000, 2002 and 2004. The study investtigated changes of status in three health domains at six time points during 1994-2004, controlling for baseline demographic characteristics. Functional status was assessed using 27 items of chronic disease, six Activities of Daily Living and six Instrumental Activities of Daily Living, and 15-items from the Short Psychiatric Evaluation Schedule. Multivariate latent growth modelling was applied to all available data and complete data set. The results show strong change trajectories among the three health domains, with initial poor health status (i.e. existence and level of chronic disease and disability) predictive of further problems across health domains. Continue growth of chronic disease had a significant impact on the development of disability and depression. Furthermore, the initial status of chronic disease and depression had a significant impact on the beginning of depressive symptoms at the early stage. Our results demonstrate that clinicians should carefully evaluate depressive symptoms in person with the new onset of chronic disease and disability.
