Prevalence and predictors of depression in populations of elderly: a review

The association of relationship quality and social networks with depression, anxiety, and suicidal ideation among older married adults: Findings from a cross-sectional analysis of the Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

Important associations have been found between social relationships and various mental health outcomes. However, limited data exists for these associations among older adults especially in terms of relationship quality in partnerships. This study aimed to examine the associations of positive and negative partner interactions and social networks with depression, anxiety and suicidal ideation.

METHODS

Nationally-representative, cross-sectional data of the Irish Longitudinal Study on Ageing (TILDA) was analyzed. The analytical sample consisted of 4988 community dwelling adults aged >50 years in spouse/partner relationships. Information on sociodemographics and social relationships were assessed using standard questions. Validated scales for depression and anxiety, and a single-item question for suicidal ideation were used to assess mental health outcomes. Multivariable logistic regression was used to assess the association between social relationships and depression, anxiety, and suicidal ideation.

RESULTS

After adjusting for confounders, negative partner interactions were significantly associated with increased likelihood of depression, anxiety, and suicidal ideation, while positive partner interactions were significantly and inversely related to anxiety and suicidal ideation. Higher levels of social integration were significantly associated with lower odds for depression.

LIMITATIONS

Given the cross-sectional nature of the research, no firm conclusions can be made in terms of directions of causality.

CONCLUSION

By assessing the available social network of older adults, as well as the areas in their social relationships that need to be addressed, it may be possible for practitioners and policy makers to maximize the benefits of network integration and minimize the potentially harmful aspects of social relationships, thereby improving overall mental health and emotional well-being.

Self-Rated Health, Cognition, and Dual Sensory Impairment Are Important Predictors of Depression Among Home Care Clients in Ontario

Depression can be a disabling and debilitating condition among older adults (aged 65+). This study examined risk factors for symptoms of depression in a large sample of older home care clients ( n = 218,850) in Ontario, Canada, using existing data collected with the Resident Assessment Instrument for Home Care (RAI-HC). The RAI-HC has been mandated across the province since 2002. The most important predictors of depression were lower self-rated health (odds ratio [OR] = 3.4), cognitive impairment (OR = 2.9), dual sensory impairment (OR = 1.2), and a primary language other than English or French (OR = 1.5). This suggests that not only physical health but also sensory impairments and communication difficulties increase the risk for depression among home care recipients.

Phytopharmaceutical treatment of anxiety, depression, and dementia in the elderly: evidence from randomized, controlled clinical trials

Based on subgroup analyses of randomized, controlled clinical trials, we review the efficacy of three phytopharmaceutical drugs, respectively of the corresponding active substances silexan® (WS® 1265, lavender oil) in anxiety disorders, WS® 5570 (Hypericum extract) in major depression, and EGb 761® (Ginkgo biloba extract) in Alzheimer, vascular, or mixed type dementia, in elderly patients aged ≥ 60 years. Four trials were eligible in each indication. Meta-analyses and analyses based on pooled raw data showed that the three drugs were significantly superior to placebo in the elderly subset, and that their treatment effects reflected in the main outcome measures (Hamilton Anxiety scale, Hamilton Depression scale, Neuropsychiatric Inventory) were comparable with those observed in the original trials without age restrictions. The results confirm the efficacy of the three herbal active substances in elderly patients of ≥ 60 years of age. In anxiety, depression, and dementia, they thus represent efficacious and well-tolerated alternatives to synthetic drugs.

Risk and protective factors for depressive symptoms among American Indian older adults: adverse childhood experiences and social support

OBJECTIVES

Despite efforts to promote health equity, many American Indian and Alaska Native (AI/AN) populations, including older adults, experience elevated levels of depression. Although adverse childhood experiences (ACE) and social support are well-documented risk and protective factors for depression in the general population, little is known about AI/AN populations, especially older adults. The purpose of this study was to examine factors related to depression among a sample of AI older adults in the midwest.

METHOD

Data were collected using a self-administered survey completed by 233 AIs over the age of 50. The survey included standardized measures such as the Geriatric Depression Scale-Short Form, ACE Questionnaire, and the Multidimensional Scale of Perceived Social Support. Hierarchical multivariate regression analyses were conducted to evaluate the main hypotheses of the study.

RESULTS

Two dimensions of ACE (i.e., childhood neglect, household dysfunction) were positively associated with depressive symptoms; social support was negatively associated with depressive symptoms. Perceived health and living alone were also significant predictors.

CONCLUSION

ACE may play a significant role in depression among AI/AN across the life course and into old age. Social support offers a promising mechanism to bolster resilience among AI/AN older adults.

The mobility gap between older men and women: the embodiment of gender

OBJECTIVES

To present the study design and baseline results of the longitudinal International Mobility in Aging Study (IMIAS) on gender differences in physical performance and mobility disability prevalence in five diverse societies.

METHODS

Data are from surveys on random samples of people aged 65-74 years at Canadian (Kingston, Ontario; Saint-Hyacinthe, Quebec), Mediterranean (Tirana, Albania) and Latin American sites (Natal, Brazil; Manizales, Colombia) (N=1995). Mobility disability was defined as reporting difficulty in walking 400m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. The short physical performance battery (SPPB) was used to assess physical performance. Poisson regression models were fitted to estimate prevalence ratios.

RESULTS

Age-adjusted prevalence of low SPPB, mobility disability and ADL disability were higher in women than in men in all sites except for Kingston. After adjustment for education and income, gender differences in SPPB and ADL disability attenuated or disappeared in Saint-Hyacinthe and Manizales but remained large in Tirana and Natal and mobility disability remained more frequent in women than in men at all sites except Kingston. After further adjustment by chronic conditions and depressive symptoms, gender differences in mobility remained large at all sites except Kingston but only in Tirana did women have significantly poorer physical performance than men.

DISCUSSION

Results provide evidence for gender as a risk factor to explain poorer physical function in women and suggest that moving toward gender equality could attenuate the gender gap in physical function in old age.

Depressive symptoms among frail elderly in ordinary living: who is affected and who is treated?

OBJECTIVES

Depression is common but not always recognized and often undertreated among elderly. Cardiovascular diagnoses have been reported to be associated with depression. The study examined if this association could be confirmed in a frail elderly population. It also assessed the association between high depressive scores and certain health complaints and the use of certain drugs, respectively.

METHOD

A total of 153 frail elderly in ordinary living were included. The association between depressive symptoms, assessed by geriatric depression scale (GDS) 20, and an inpatient diagnose of cerebrovascular disease or heart failure was assessed. Depressive symptoms were also compared with health complaints and background data. Furthermore, the use of certain drugs, such as antidepressants and other psychotropics, was compared with depressive symptoms.

RESULTS

Risk of depression was seen in 52% of the patients. Those showing risk of depression more often received municipal care or help with medication distribution and were more often treated with sedatives. They also had significantly more health complaints. No differences were found between those who had or did not have a diagnosis of heart failure or transient ischemic attack (TIA)/stroke during hospital care the previous year regarding risk for depression or treatment with antidepressants, respectively. Sixteen per cent were treated with antidepressants and this group was significantly younger than those who were not treated.

CONCLUSION

Those elderly with a GDS score indicating a risk for depression have poorer health, are more dependent on help and are more often treated with sedatives. The study could not confirm an association between heart failure or TIA/stroke and risk for depression.

Depression, disability and somatic diseases among elderly

OBJECTIVE

Depression among older adults is associated with both disability and somatic disease. We aimed to further understand this complicated relationship and to study the possible modifying effect of increasing age.

DESIGN

Cross sectional survey.

SETTING

Outpatient and inpatient clinics of regional facilities for mental health care and primary care.

PARTICIPANTS

Elderly people, 60 years and older, 378 persons meeting DSM-IV criteria for a depressive disorder and 132 non-depressed comparisons.

MEASUREMENTS

Depression diagnoses were assessed with the CIDI version 2.1. Disability was assessed with the WHO Disability Assessment Schedule (WHODAS). Social-demographic information and somatic diseases were assessed by self-report measurements.

RESULTS

Disability, in general and on all its subscales, was strongly related to depression. Presence of somatic disease did not contribute independently to variance in depression. The relationship was stronger for people of 60-69 years old than for those older than 70 years. Important aspects of disability that contributed to depression were disability in participation, self-care and social activities.

LIMITATIONS

Results are based on cross sectional data. No inferences about causal relationships can be drawn.

CONCLUSION

Disability, especially disability regarding participation, self-care, or social activities is strongly related to late-life depression. Somatic diseases in itself are less of a risk for depression, except that somatic diseases are related to disability.

Association between risk perception, subjective knowledge, and depression in community-dwelling elderly people in Japan

Risk perception is one of the core factors in theories of health behavior promotion. However, the association between knowledge, risk perception, and depressed mood in depression is unknown. The aim of this study was to clarify the relationships between subjective knowledge, risk perception, and objective scores of depression in community-dwelling elderly people in Japan. A total of 747 elderly participants (mean age: 76.1, female: 59.8%) who completed the 15-item Geriatric Depression Scale (GDS-15) along with items assessing subjective knowledge and risk perception were included in the analysis. We assessed the correlation between subjective knowledge and risk perception, and then compare GDS-15 scores by level of subjective knowledge and risk perception. Subjective knowledge was weakly associated with risk perception and related to lower GDS-15 scores in a dose-response pattern, which did not change after adjusting for age, gender, basic activities of daily living (ADL), instrumental ADL, years of education and history of depression. There was no significant association between risk perception and GDS-15 scores. The relationship between knowledge, risk perception, and depressed mood in younger generations is unclear, but warrants examination.

"Noncognitive" symptoms of early Alzheimer disease: a longitudinal analysis

OBJECTIVES

To observe the natural time course of noncognitive symptoms before the onset of symptomatic Alzheimer disease dementia.

METHODS

Using the National Alzheimer's Coordinating Center Uniform Data Set from September 2005 to March 2013, data from cognitively normal individuals who were aged 50 years or older at first visit and had subsequent follow-up were analyzed. Survival analyses were used to examine the development of particular symptoms relative to each other on the Neuropsychiatric Inventory Questionnaire (NPI-Q), Functional Activities Questionnaire, and Geriatric Depression Scale, and to compare the development of individual symptoms for persons who did and did not receive a Clinical Dementia Rating (CDR) .0 (indicating abnormal cognition) during the follow-up period.

RESULTS

The order of symptom occurrence on the NPI-Q was similar for participants who remained at CDR 0 and for those who received a CDR .0 over the follow-up period, although the time to most NPI-Q symptoms was faster for participants who received a CDR.0 (p, 0.001).With the exception of memory, Geriatric Depression Scale symptoms reported by both CDR groups were similar.

CONCLUSIONS

We found a significantly earlier presence of positive symptoms on the NPI-Q in cognitively normal patients who subsequently developed CDR .0. Among participants with no depression symptoms at baseline, results suggest that depressive symptoms may increase with aging regardless of incipient dementia. Such findings begin to delineate the noncognitive course of Alzheimer disease dementia in the preclinical stages. Future research must further elucidate the correlation between noncognitive changes and distinct dementia subtypes.

Cost-effectiveness of integrated care in frail elderly using the ICECAP-O and EQ-5D: does choice of instrument matter?

Economic evaluations likely undervalue the benefits of interventions in populations receiving both health and social services, such as frail elderly, by measuring only health-related quality of life. For this reason, alternative preference-based instruments have been developed for economic evaluations in the elderly, such as the ICECAP-O. The aim of this paper is twofold: (1) to evaluate the cost-effectiveness using a short run time frame for an integrated care model for frail elderly, and (2) to investigate whether using a broader measure of (capability) wellbeing in an economic evaluation leads to a different outcome in terms of cost-effectiveness. We performed univariate and multivariate analyses on costs and outcomes separately. We also performed incremental net monetary benefit regressions using quality adjusted life years (QALYs) based on the ICECAP-O and EQ-5D. In terms of QALYs as measured with the EQ-5D and the ICECAP-O, there were small and insignificant differences between the instruments, due to negligible effect size. Therefore, widespread implementation of the Walcheren integrated care model would be premature based on these results. All results suggest that, using the ICECAP-O, the intervention has a higher probability of cost-effectiveness than with the EQ-5D at the same level of WTP. In case an intervention's health and wellbeing effects are not significant, as in this study, using the ICECAP-O will not lead to a false claim of cost-effectiveness of the intervention. On the other hand, if differences in capability QALYs are meaningful and significant, the ICECAP-O may have the potential to measure broader outcomes and be more sensitive to differences between intervention and comparators.

Mobility Is a Key Predictor of Change in Well-Being Among Older Adults Who Experience Falls: Evidence From the Vancouver Falls Prevention Clinic Cohort

OBJECTIVE

To determine the factors that predict change in well-being over time in older men and women presenting to the falls prevention clinic.

DESIGN

Prospective cohort study.

SETTING

Falls prevention clinic.

PARTICIPANTS

Community-dwelling older adults who were referred to the clinic after sustaining a fall (between N=244 and N=255, depending on the analysis).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The ICEpop CAPability measure for Older people, a measure of well-being or quality of life, was administered at baseline, 6 months, and 12 months. We constructed linear mixed models to determine whether baseline predictor variables were related to baseline well-being and/or changes in well-being over time. In addition, we included interactions with sex to investigate the difference between men and women. Baseline predictors included 2 measures of mobility--Short Performance Physical Battery and timed Up and Go test--and a measure of global cognitive function--Montreal Cognitive Assessment.

RESULTS

All 3 predictors were associated with well-being at baseline (P<.05). Furthermore, both the Short Performance Physical Battery and the timed Up and Go test interacted with sex (P<.05) to predict changes in well-being over time. Follow-up analyses suggested that better mobility was protective against decline in well-being in men but was generally unrelated to changes in well-being in women.

CONCLUSIONS

We found that 2 valid and reliable measures of mobility interacted with sex to predict changes in well-being over time. This is a critical research area to develop in order to appropriately tailor future intervention strategies targeting well-being in older fallers, a population at high risk of functional decline.

Depressive symptoms in younger women and men with acute myocardial infarction: insights from the VIRGO study

Background

Depression was recently recognized as a risk factor for adverse medical outcomes in patients with acute myocardial infarction (AMI). The degree to which depression is present among younger patients with an AMI, the patient profile associated with being a young AMI patient with depressive symptoms, and whether relevant sex differences exist are currently unknown.

Methods and Results

The Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study enrolled 3572 patients with AMI (67.1% women; 2:1 ratio for women to men) between 2008 and 2012 (at 103 hospitals in the United States, 24 in Spain, and 3 in Australia). Information about lifetime history of depression and depressive symptoms experienced over the past 2 weeks (Patient Health Questionnaire; a cutoff score ≥10 was used for depression screening) was collected during index AMI admission. Information on demographics, socioeconomic status, cardiovascular risk, AMI severity, perceived stress (14‐item Perceived Stress Scale), and health status (Seattle Angina Questionnaire, EuroQoL 5D) was obtained through interviews and chart abstraction. Nearly half (48%) of the women reported a lifetime history of depression versus 1 in 4 in men (24%; P<0.0001). At the time of admission for AMI, more women than men experienced depressive symptoms (39% versus 22%, P<0.0001; adjusted odds ratio 1.64; 95% CI 1.36 to 1.98). Patients with more depressive symptoms had higher levels of stress and worse quality of life (P<0.001). Depressive symptoms were more prevalent among patients with lower socioeconomic profiles (eg, lower education, uninsured) and with more cardiovascular risk factors (eg, diabetes, smoking).

Conclusions

A high rate of lifetime history of depression and depressive symptoms at the time of an AMI was observed among younger women compared with men. Depressive symptoms affected those with more vulnerable socioeconomic and clinical profiles.

Leukocyte telomere length and late-life depression

OBJECTIVE

Depressive disorders have been associated with increased risk for aging-related diseases, possibly as a consequence of accelerated cellular aging. Cellular aging, indexed by telomere length (TL) shortening, has been linked to depression in adults younger than 60 years; however, it remains unclear whether this is the case in late-life depression (age >60 years). The objective of this study was to assess differences in TL between persons with current late-life depression and never-depressed comparisons and to examine the association between characteristics of late-life depression and TL.

METHODS

In this cross-sectional study using the Netherlands Study of Depression in Older Persons, 355 persons with current late-life depression and 128 never-depressed comparisons, aged 60-93 years (mean age [SD]: 70.5 [7.4] years, 65% women), were recruited through primary care and mental healthcare. Late-life depression was established using a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-based structured psychiatric interview. Leukocyte TL, expressed in base pairs (bp), was determined in fasting blood samples by performing quantitative polymerase chain reaction.

RESULTS

Mean TL did not differ between depressed persons (bp [SD]: 5,035 [431]) and never-depressed (bp [SD]: 5,057 [729]) comparisons. Further, TL was not associated with severity, duration, and age at onset of depression; comorbid anxiety disorders; anxiety symptoms; apathy severity; antidepressant use; benzodiazepine use; cognitive functioning; and childhood trauma.

CONCLUSION

Late-life depression was not associated with increased cellular aging. This absent association, which contradicts observations in younger adults, may be due to the potential larger heterogenic nature of late-life depression and lifetime cumulative exposure to other TL-damaging factors, possibly overruling effects of late-life depression.

The association between social relationships and depression: a systematic review

BACKGROUND

Depression is one of the most prevalent mental disorders globally and has implications for various aspects of everyday-life. To date, studies assessing the association between social relationships and depression have provided conflicting results. The aim of this paper was to review the evidence on associations between social relationships and depression in the general population.

METHODS

Studies investigating the association of social support, social networks, or social connectedness with depression were retrieved and summarized (searches using Pubmed, ScienceDirect, PsycNet were conducted in May 2014).

RESULTS

Fifty-one studies were included in this review. The strongest and most consistent findings were significant protective effects of perceived emotional support, perceived instrumental support, and large, diverse social networks. Little evidence was found on whether social connectedness is related to depression, as was also the case for negative interactions.

LIMITATIONS

Due to the strict inclusion criteria relating to study quality and the availability of papers in the domain of interest, the review did not capture 'gray literature' and qualitative studies.

CONCLUSION

Future research is warranted to account for potential bias introduced by the use of subjective measures as compared to objective measures of received support and actual networks. Due to the heterogeneity between available studies on the measure of social relationships, the inclusion of comparable measures across studies would allow for more valid comparisons. In addition, well-designed prospective studies will provide more insight into causality. Future research should address how social support and networks interact and together affect risks for depression. Social connectedness and negative interactions appear to be underutilized as measures in population-based studies.

Dietary patterns and incidence of depression in a cohort of community-dwelling older Canadians

OBJECTIVES

To investigate the association of dietary patterns with a 3-year incidence of depression among healthy older adults.

DESIGN

Multiple logistic regression models adjusted for age, sex, marital status, smoking, education, total energy intake, physical activity, body mass index, hypertension, functional autonomy, cognitive functioning, social activities, and stressful life events. Energy and macronutrient intakes were also analyzed as potential predictors of depression.

SETTING

Cities of Montréal, Laval, and Sherbrooke in Quebec, CA.

PARTICIPANTS

Community-dwelling older adults, free of depression at baseline (N=1,358, 67-84 y), followed for 3y in the Québec Longitudinal Study on Nutrition and Aging (NuAge).

MEASUREMENTS

Dietary patterns derived from principal components analysis of three 24 h-recalls at baseline, and depression incidence as measured by the 30-item Geriatric Depression Scale (≥11) and/or use of antidepressants at follow-up years.

RESULTS

170 people (63% women) became depressed over the 3 years. People in the highest tertile of adherence to the "varied diet" had lower risk of depression before adjustment (OR 0.58, 98% C.I. 0.38-0.86) but not significant once age and sex were controlled. No other dietary pattern was associated with the incidence of depression. The highest tertile of energy intake was associated with lower depression incidence after controlling for all confounders (OR 0.55, 95%CI 0.34-0.87).

CONCLUSION

Among healthy older adults, dietary patterns do not appear to be related to depression. Those who eat less, however, possibly reflecting declining health, are at higher risk of becoming depressed.

Childhood adversities, urbanisation and depressive symptoms among middle-aged and older adults: evidence from a national survey in China

The trajectory of modern China, namely from dire poverty and communist fever to economic boom and marketisation under an authoritarian regime, makes the country a unique social laboratory for examining how social environment affects human development of individuals. This study investigated the correlation between childhood adversity and depressive symptoms of Chinese middle-aged and older adults, as well as how urbanisation moderates the correlation. A sub-sample (N = 14,681) of the baseline of the China Health and Retirement Longitudinal Study was analysed. Seven variables were used in the latent class analysis to establish a childhood adversity typology. Three urbanisation statuses were identified according to theHukou(household registration system) status and neighbourhood type: non-urbanised, semi-urbanised and fully urbanised. The correlation between childhood adversity and depressive symptoms and the moderation of urbanization on the correlation were assessed with factorial analysis of covariance. Three latent classes for childhood adversities were identified: ‘normal childhood class', ‘low childhood socio-economic status and health class' and ‘traumatic childhood class'. The class membership was significantly correlated with depressive symptoms (p = 0.015), and the urbanisation status, also significantly affecting depressive symptoms (p = 0.05), had significant moderating effect on the correlation (p = 0.002). It is suggested that more social inclusive policies need to be adopted in order to guarantee the equal distribution of wellbeing led by urbanisation.

Eat now or later: self-control as an overlapping cognitive mechanism of depression and obesity

While overlapping neurobiological mechanisms are known, relatively little is known about how “self-control” and cognitive affective processing of rewards may also influence the bi-directional risk between obesity and depression. The objective of this study was to identify the extent to which “self-control,” measured using a delay discounting task is co-related to BMI and Depression diagnostic thresholds. A within-subjects counterbalanced design was used in which 92 participants (Mean±SD: BMI = 27.9±3.5, HAMD = 14.7±7.7) completed a series of clinical diagnostic, survey, and demographic questionnaires in a behavioral health laboratory setting. For the delay discounting task, participants chose between one large delayed reward and one successively smaller immediate reward for four food types (dessert, fried food, fruit, and vegetable). Results showed that delay discounting scores were predictive of BMI and depression with lower delay discounting scores associated with higher BMI and HAMD for the dessert (HAMD scores (β = -.197, p = .013), BMI (β = -.239, p < .001)) and fried food (HAMD scores (β = -.328, p = .001), BMI (β = -.166, p = .027)). Clinical significance was further evident when HAMD and BMI scores were converted to diagnostic thresholds. Only depression and/or atypical depressive symptoms were related to delay discounting scores with the fruit and vegetable. Thus, reduced cognitive affective self-control for impulsive food choices—particularly for “comfort foods” high in fat and sugar—appears to be a shared cognitive mechanism for both conditions perhaps contributing to the high prevalence of co-morbid mood disorders and weight gain.

Relations between the characteristics and psychological comorbidities of chronic pruritus differ between men and women: women are more anxious than men

BACKGROUND

Although sex and gender are becoming more important in diagnostics and therapy, there is still little knowledge about sex-specific differences in chronic pruritus (CP).

OBJECTIVES

To compare, taking into consideration the characteristics of pruritus, sex-specific differences in psychological symptoms in patients with CP.

METHODS

Sociodemographic data, data on the clinical characteristics of the skin and CP were documented over a 1-year period in all patients attending the Competence Center Chronic Pruritus of the University Hospital Münster for the first time. All patients completed the Hospital Anxiety and Depression Scale. Student's t-tests for independent study groups and linear regression analyses were applied.

RESULTS

A total of 619 patients (278 men, 341 women) were included in the analysis. Women were more anxious than men, but were not more depressed. A linear regression analysis indicated that depression and anxiety scores in women were related to the average intensity of pruritus during the previous 4 weeks and to a more generalized pruritus at the beginning of CP; older age in women also correlated with the scores on the depression subscale. Interestingly, the associations were different in men: scores on the depression scale were associated with the diagnosis of CP pruritus with multiple scratch lesions.

CONCLUSIONS

There are sex-specific differences in the relationship between the psychological symptoms and clinical characteristics of CP; higher anxiety scores were achieved by women. Whether psychological symptoms can be reversed when CP and scratch lesions improve is an issue that needs further exploration.

Residents' perceptions of their own sadness--a qualitative study in Norwegian nursing homes

BACKGROUND

Mood symptoms are highly prevalent among frail old people residing in nursing homes. Systematic diagnostics of depression is scarce, and treatment is not always in accordance with best evidence. The distinction between non-pathological sadness and depression may be challenging, and we know little of the older peoples' perspectives. The aim of this qualitative interview study was to explore residents' perceptions of their own sadness.

METHODS

We performed individual, semi-structured interviews with twelve older people residing in nursing homes with no dementia. The interview guide comprised questions on what made the informants sad and what prevented sadness. We recorded, transcribed verbatim and analysed the interviews using systematic text condensation.

RESULTS

The interviews revealed three main themes. I. Decay and loss of agency. The informants perceived their sadness to be caused by loss of health and functional ability, reliance on long-term care, dysfunctional technical aids and poor care. II. Loneliness in the middle of the crowd. Loss of family and friends, and lack of conversations with staff members and fellow patients were also sources of sadness. III. Relating and identity. The informants kept sadness at bay through: acceptance and re-orientation to their current life situation, maintaining narratives about their identity and belonging, and religiosity.

CONCLUSIONS

Nursing home nurses and doctors should identify and respond to sadness that is a rational response to manageable causes. Further, identifying and supporting residents' resources and coping strategies is a salutogenetic approach that may alleviate sadness.

Nutritional Vulnerability in Older Adults: A Continuum of Concerns

A nutritionally vulnerable older adult has a reduced physical reserve that limits the ability to mount a vigorous recovery in the face of an acute health threat or stressor. Often this vulnerability contributes to more medical complications, longer hospital stays, and increased likelihood of nursing home admission. We have characterized in this review the etiology of nutritional vulnerability across the continuum of the community, hospital, and long term care settings. Frail older adults may become less vulnerable with strong, consistent, and individualized nutritional care. Interventions for the vulnerable older adult must take their nutritional needs into account to optimize resiliency in the face of the acute and/or chronic health challenges they will surely face in their life course.

Eating Alone as Social Disengagement is Strongly Associated With Depressive Symptoms in Japanese Community-Dwelling Older Adults

OBJECTIVES

Depression in later life poses a grave challenge for the aging countries. The reported key risk factors include social disengagement, but the lack of social companionship during mealtimes, namely eating alone, has not been examined extensively, especially in relation to living arrangement. Past studies on changes along geriatric trajectories in the association between social engagement and depression also remain inadequate. This study aims to examine the association between social engagement and depressive symptoms with a particular focus on eating alone and how the association changes along the aging and mental frailty trajectories.

DESIGN

A cross-sectional study.

SETTING

Kashiwa-city, Chiba-prefecture in Japan.

PARTICIPANTS

A total of 1856 community-dwelling older adults.

MEASUREMENTS

The 15-item Geriatric Depression Scale was used to measure depressive symptoms. The indicators used to assess social engagement included eating alone, living arrangement, reciprocity of social support, social participation, social stressors and social ties.

RESULTS

Social engagement was significantly associated with depressive symptoms. Those who live with their families yet eat alone were found to be at particular risk (odds ratio = 5.02, 95% confidence interval 2.5-9.9 for young-old; odds ratio = 2.41, 95% confidence interval 1.2-4.8 for old-old). Younger and less mentally frail populations showed stronger associations.

CONCLUSIONS

Eating alone was a key risk factor for depressive symptoms in community-dwelling older adults. The living arrangement in which they eat alone is important in identifying those with the greatest risk. Mental health management for older adults requires comprehensive assessment of their social relations that takes into account their companionship during mealtimes. Social preventive measures need to involve early interventions in order to augment their effectiveness against mental frailty.

Prevalence of depression in elderly population in the southern part of punjab

Background:

Depressive symptoms are often not detected properly in elderly. The aim of this study was to explore the prevalence of depressive symptoms and possible co relational factors among elderly population.

Materials and Methods:

In a cross-sectional study, 100 elderly persons were screened. Geriatric depression scale (GDS) was used to assess depressive symptoms. A self-rating questionnaire was used to detect some sociodemographics and clinical variables.

Results:

100 respondents interviewed, 40 were 70 years and above and 41% were male. Sixty individuals (25 males and 35 females) were found to be mildly depressed. Seventeen (4 males and 13 females) were suffering from severe depression.

Conclusion:

This study is in line with previous studies showing the high prevalence of depression in elderly. Results suggest a proper screening for depression among elderly.

Possible selves and depressive symptoms in later life

The pursuit of personal goals has been linked to general psychological well-being; however, less is known about the association with depression in later adulthood when individuals are contending with age-related changes in health and social relationships. We explored the connection between both health- and social related goals (as measured by possible selves) and depressive symptoms in a sample of 85 community-dwelling older adults who ranged in age from 60 to 92 (M = 74, standard deviation = 7.5). Participants took part in face-to-face, semistructured interviews in which they responded to measures of possible selves (future images of oneself), health, and depressive symptoms. We found that the presence of health-related, but not social-related, possible selves was significantly associated with fewer reported depressive symptoms. Additionally, the presence of health-related fears was specifically linked to fewer reported depressive symptoms. These findings suggested that the promotion of and investment in health-related personal goals may be useful in off-setting depressive symptoms in older adults, as well as indicated a potential benefit of a disease prevention focus regarding health in later life. Finally, the results may have implications for potential clinical interventions in addressing late-life depression.

Aging and the effects of emotion on cognition: Implications for psychological interventions for depression and anxiety

We review findings from laboratory research on age differences in the effects of emotion on cognition. Particular attention is given to sadness leading to mood congruent memory and to anxiety leading to selective attention bias to threat. While older adults in normal moods show the positivity effect as expected from socio-emotional selectivity theory, older adults whose mood has changed from baseline to sad or anxious show these mood-related cognitive biases. These mood-related biases are a foundational part of the theory underlying cognitive behavior therapy (CBT) and so these laboratory findings suggest ways that CBT may work differently with older adults. Pilot work suggests that the presence or absence of these effects may also predict responsiveness to treatment using CBT.

Depressive Symptoms Among Older Mexicans: The Role of Widowhood, Gender, and Social Integration

Widowhood is often associated with decreased mental health. In developing countries with low institutional support, such as Mexico, social integration can be particularly consequential for widowed older adults' psychological well-being. This study investigates the interplay among depressive symptoms, widowhood, gender, and social integration in a nationally representative sample of older Mexicans. Drawing on Waves 1 (2001) and 2 (2003) of the Mexican Health and Aging Study, we estimated the ordinary least squares regressions to examine the implications of widowhood, gender, social support, social network, and social engagement for changes in depressive symptoms between the waves among Mexicans aged 50 and older (N = 8,708). The findings indicate that social integration can mitigate as well as exacerbate depressive symptomatology among older Mexicans. Certain aspects of social integration can moderate marital status-gender differences in depressive symptoms among older Mexicans.

Association of depression and loneliness with specific cognitive performance in non-demented elderly males

Background

Loneliness and depression are very common in the aged population. Both have negative impacts on cognition in the elderly. The present study aimed to investigate the effect of loneliness and depression on total as well as specific cognitive domains in cognitively normal male subjects.

Material/Methods

A total of 189 cognitively normal male subjects were recruited and underwent Cognitive Abilities Screening Instrument (CASI) and Wechsler Digit Span Task tests. Depression was assessed by the Geriatric Depression Scale-Short Form (GDS-SF) and loneliness by UCLA loneliness scales. Partial correlation test was used to explore the correlation between loneliness/depression and total as well as specific cognition function, with the controlled factors of age and education.

Results

Both depression and loneliness are negatively correlated with global cognitive function as evaluated with CASI (r=−0.227, p=0.002; r=−0.214, p=0.003, respectively). The domains of Attention, Orientation, Abstraction and judgment, and List-generating fluency of cognitive function were specifically associated with loneliness, and the domain of orientation was associated with depression after controlling the factors age and years of education.

Conclusions

Our findings suggest that loneliness and depression may have negative impacts on global and specific domains of cognitive function in non-demented elderly males. Both loneliness and depression should be actively recognized earlier and appropriately treated because they are significant sources of cognitive impairment in the elderly.

Influence of sex and stress exposure across the lifespan on endophenotypes of depression: focus on behavior, glucocorticoids, and hippocampus

Sex differences exist in vulnerability, symptoms, and treatment of many neuropsychiatric disorders. In this review, we discuss both preclinical and clinical research that investigates how sex influences depression endophenotypes at the behavioral, neuroendocrine, and neural levels across the lifespan. Chronic exposure to stress is a risk factor for depression and we discuss how stress during the prenatal, postnatal, and adolescent periods differentially affects males and females depending on the method of stress and metric examined. Given that the integrity of the hippocampus is compromised in depression, we specifically focus on sex differences in how hippocampal plasticity is affected by stress and depression across the lifespan. In addition, we examine how female physiology predisposes depression in adulthood, specifically in postpartum and perimenopausal periods. Finally, we discuss the underrepresentation of women in both preclinical and clinical research and how this limits our understanding of sex differences in vulnerability, presentation, and treatment of depression.

Depressive symptoms in patients with subclinical hypothyroidism--the effect of treatment with levothyroxine: a double-blind randomized clinical trial

Despite the increasing evidence for relationships between thyroid dysfunction and neuropsychiatric alterations, the effect of treatment of thyroid disease on various clinical psychiatric outcomes is controversial. The purpose of this study was to investigate the effect of levothyroxine treatment on depressive symptoms in subjects with subclinical hypothyroidism. A randomized double-blind placebo-controlled clinical trial was performed. Sixty subjects (51 females and 9 males) with subclinical hypothyroidism were enrolled. Beck Depression Inventory was completed for all participants at the beginning of the study and 12 weeks after enrollment. The intervention and control groups received levothyroxine and placebo, respectively, for 12 weeks. There were no statistical differences in the total depression score and its subscales between the two groups at the beginning of the study. The Beck Depression Inventory score decreased from 16.79 ± 13.25 to 12.37 ± 10.01 (p value = 0.04) in the intervention group. The change in score was not significant for the control group (13.77 ± 11.71 to 11.86 ± 10.71; p value= 0.16). The affective subscale of Beck Depression Inventory did not change after 12 weeks of treatment with levothyroxine, while somatic subscale remarkably improved in the intervention group (p value = 0.02). This study showed the efficacy of treatment of subclinical hypothyroidism in people with levothyroxine in relation to depressive symptoms.

Prevalence of depression among recently admitted long-term care patients in Norwegian nursing homes: associations with diagnostic workup and use of antidepressants

AIMS

We aimed to establish the prevalence of depression among recently admitted long-term care patients and to examine associations with diagnostic initiatives and treatment as recorded in patients' medical records.

MATERIALS AND METHODS

Eighty-eight long-term care patients were included. Depression was diagnosed according to the ICD-10 criteria; patients were screened for depression using the Cornell Scale for Depression in Dementia (CSDD) and for dementia with the Clinical Dementia Rating (CDR) scale.

RESULTS

Depression was found in 25% of the patients according to the ICD-10 criteria and in 31% according to a CSDD sum score of ≥ 8. Diagnostic initiatives were documented in the medical records of half of the patients with depression. Forty-four percent of the patients were prescribed antidepressants and 23% actually received them for the treatment of depression.

CONCLUSION

Depression was prevalent among recently admitted long-term care patients, but diagnostic initiatives were too rarely used. Antidepressants were commonly prescribed, but depression was the indication for treatment in only half of the cases. Screening for depression should be mandatory on admission.

Increased depression risk among patients with chronic osteomyelitis

OBJECTIVE

Inflammatory processes, which provoke alternations of neurotransmitter metabolism, neuroendocrine function, and neuroplasticity in the brain, might promote depression. In depression patients who do not exhibit risk factors, including hypertension, diabetes, coronary heart disease, stroke, Parkinson's disease and dementia, particularly in young people, inflammation is a likely risk factor for depression. We explored whether chronic osteomyelitis (COM), a chronic inflammatory disease, increases depression risk.

METHODS

A Taiwanese national insurance claims data set of more than 22 million enrollees was used to select 15,529 COM patients without depression history and 62,116 randomly selected age- and gender-matched controls without depression and COM history to trace depression development for an 12-year follow-up period from January 1, 1999 to December 31, 2010. The depression risk was analyzed using the Cox proportional hazards regression model.

RESULTS

The above-mentioned risk factors for depression were more frequent in the COM cohort, who exhibited significantly higher depression risk than the control group did. Comparing only those without comorbidities, the COM group exhibited higher depression risk than the control group did (hazard ratio [HR]=3.04, 95% confidence interval [CI]: 2.55-3.62). The younger population carried even greater risk (age<45: HR=6.08, 95% CI: 1.71-7.85; age>65: HR=1.75, 95% CI: 1.39-2.19).

CONCLUSIONS

This is the first study connecting COM to increased risk of developing depression. The outcomes suggest that COM is a substantial depression predictor and call for a closer focus on these patients for more rigorous depression prevention, particularly in young people.

The moderating effect of age on the 12-month prevalence of anxiety and depressive disorders in adults with a lifetime history of cancer

OBJECTIVE

To determine how age may modulate the association of a history of cancer with a 12-month history of anxiety and depressive disorders.

METHODS

The authors used population-based, cross-sectional surveys, the Collaborative Psychiatric Epidemiology Surveys. These surveys were conducted in the United States in 2001-2003 and included 16,423 adult participants, of whom 702 reported a cancer history. The Composite International Diagnostic Interview evaluated the presence of a 12-month history of anxiety and depressive disorders.

RESULTS

Among those with a cancer history, older adults (≥60 years old) were less likely than younger adults (18-59 years old) to have a 12-month history of an anxiety or depressive disorder. Compared with their peers without cancer, younger adults with a cancer history had more anxiety (23.8% versus 13.9%) and depressive (16.0% versus 9.5%) disorders, whereas older adults with a cancer history had lower levels of anxiety (3.7% versus 6.3%) and depressive (1.9% versus 3.9%) disorders. In multivariable modeling, there was a statistically significant interaction between age group and cancer history, with the risk for anxiety and depressive disorders elevated in the younger age group with a cancer history (odds ratio: 5.84 and odds ratio: 6.13, respectively) but decreased in the older age group with a cancer history (odds ratio: 0.55 and odds ratio: 0.45, respectively).

CONCLUSION

The authors' findings suggest a considerable age-dependent variation with regard to anxiety and depressive disorders in adults with a cancer history. Investigation of the mechanisms contributing to this apparent age differential in risk could have important mental illness treatment implications in this population.

Depressive symptoms and adverse outcomes from hospitalization in older adults: secondary outcomes of a trial of falls prevention education

Depression is common in older people and symptoms of depression are known to substantially increase during hospitalization. There is little known about predictors of depressive symptoms in older adults or impact of common interventions during hospitalization. This study aimed to describe the magnitude of depressive symptoms, shift of depressive symptoms and the impact of the symptoms of depression among older hospital patients during hospital admission and identify whether exposure to falls prevention education affected symptoms of depression. Participants (n=1206) were older adults admitted within two Australian hospitals, the majority of participants completed the Geriatric Depression Scale - Short Form (GDS) at admission (n=1168). Participants' mean age was 74.7 (±SD 11) years and 47% (n=551) were male. At admission 53% (619 out of 1168) of participants had symptoms of clinical depression and symptoms remained at the same level at discharge for 55% (543 out of 987). Those exposed to the low intensity education program had higher GDS scores at discharge than those in the control group (low intensity vs control n=652, adjusted regression coefficient (95% CI)=0.24 (0.02, 0.45), p=0.03). The only factor other than admission level of depression that affected depressive symptoms change was if the participant was worried about falling. Older patients frequently present with symptoms of clinical depression on admission to hospital. Future research should consider these factors, whether these are modifiable and whether treatment may influence outcomes.

Role of Sociocultural Factors in Depression among Elderly of Twin Cities (Rawalpindi and Islamabad) of Pakistan

This research was conducted to examine the role of sociocultural factors on depression among elderly of twin cities (Rawalpindi and Islamabad) of Pakistan. 310 older adults participated in the present study. Through convenient sampling technique, face to face interview was carried out for data collection. Urdu translated Geriatric Depression Scale Short Form and demographic sheet were used to test hypotheses. Descriptive statistics and t-test were used for data analysis. Results showed significant mean differences among gender, marital status, family system, and status of employment on depression. Financial crisis, feeling of dejection because of isolation, and trend of nuclear family system have been observed as strong predictors of depression in older adults.

Coexistence of urinary incontinence and major depressive disorder with health-related quality of life in older Americans with and without cancer

PURPOSE

This study evaluates the prevalence and factors associated with major depressive disorder (MDD) in a population of cancer survivors and the impact of co-occurring MDD and urinary incontinence (UI) on health-related quality of life (HRQOL).

METHODS

The prevalence of MDD risk among cancer survivors (breast, prostate, bladder, colorectal, lung, and endometrial/uterine cancers) and those without cancer was estimated using the Surveillance, Epidemiology and End Results Program-Medicare Health Outcomes Survey (SEER-MHOS) linked database (n = 9,282 with cancer/n = 289,744 without cancer). Risk for MDD was measured using three items from the Diagnostic Interview Schedule, and HRQOL was measured by the SF-36. UI was defined as self-reported leakage of urine causing a problem in previous 6 months. Factors associated with MDD were investigated using logistic regression, and the impact of co-occurring MDD and UI on HRQOL scores was determined using linear regression.

RESULTS

The prevalence of MDD risk ranged from 19.2 % for prostate to 34.1 % for lung. Lung cancer diagnosis was associated with risk of MDD. Being ≥5 years from diagnosis was associated with decreased risk of MDD (prevalence odds ratio (POR) = 0.82, 95 % confidence interval (95 % CI) 0.71, 0.95). The coexistence of both UI and MDD was associated with a decrease across HRQOL subscales; including 40 points on role-emotional (RE) score.

CONCLUSIONS

Cancer survivors reporting co-occurrence of UI and MDD experienced significant decrements in HRQOL.

IMPLICATIONS OF CANCER SURVIVORS

Understanding the combined effect of UI and MDD may help clinicians to better recognize and alleviate their effects on cancer survivors' HRQOL.

The hospital anxiety and depression scale--dimensionality, reliability and construct validity among cognitively intact nursing home patients

BACKGROUND

Depression and anxiety are particularly common among individuals living in long-term care facilities. Therefore, access to a valid and reliable measure of anxiety and depression among nursing home patients is highly warranted.

AIM

To investigate the dimensionality, reliability and construct validity of the Hospital Anxiety and Depression scale (HADS) in a cognitively intact nursing home population.

METHODS

Cross-sectional data were collected from two samples; 429 cognitively intact nursing home patients participated, representing 74 different Norwegian nursing homes. Confirmative factor analyses and correlations with selected constructs were used.

RESULTS

The two-factor model provided a good fit in Sample1, revealing a poorer fit in Sample2. Good-acceptable measurement reliability was demonstrated, and construct validity was supported.

LIMITATIONS

Using listwise deletion the sample sizes were 227 and 187, for Sample1 and Sample2, respectively. Greater sample sizes would have strengthen the statistical power in the tests. The researchers visited the participants to help fill in the questionnaires; this might have introduced some bias into the respondents׳ reporting. The 14 HADS items were part of greater questionnaires. Thus, frail, older NH patients might have tired during the interview causing a possible bias.

CONCLUSION

Low reliability for depression was disclosed, mainly resulting from three items appearing to be inappropriate indicators for depression in this population. Further research is needed exploring which items might perform as more reliably indicators for depression among nursing home patients.

Housing type and depressive symptoms among older adults: a test of sense of belonging as a mediating and moderating variable

OBJECTIVES

Higher levels of depression have been documented among older adults who reside in an assisted living facility, compared with those who remain in their own homes. The aims of the current study were to test whether the relationship between housing type and depressive symptoms was mediated by a sense of belonging and whether housing type and sense of belonging interact to influence the depressive symptoms among older adults (moderation model).

METHOD

A sample of 257 older adults who lived in their own homes and 166 older adults who lived in an assisted living facility completed the psychological subscale of the Sense of Belonging Instrument and the Center for Epidemiologic Studies Depression Scale.

RESULTS

Results showed that a sense of belonging partially mediated the relationship between housing type and depressive symptoms, such that living in a nursing home was associated with lower levels of belonging, and lower levels of belonging were, in turn, associated with higher levels of depressive symptoms. Residing in an assisted living facility was associated with depressive symptoms at low and average levels of belonging.

CONCLUSION

Results highlight the need for more research on the role of sense of belonging as an influencing factor on depressive symptoms among institutionalised older adults for both theoretical and treatment goals.

Does pain mediate or moderate the relationship between physical activity and depressive symptoms in older people? Findings from The Irish Longitudinal Study on Ageing (TILDA)

Background. Depression is an increasing problem in older adults, which is exacerbated by under diagnosis and ineffective treatment options. Broadly speaking, as people age, their levels of regular physical activity (PA) decrease, while their experience of chronic pain increases. PA has been shown to be an effective, yet under-utilised, treatment for depression in this age-cohort although the influence of pain on the relationship between PA and depressive symptoms has not been considered. Methods. Secondary analysis of national data from The Irish Longitudinal Study on Ageing (TILDA, 2011) (n = 8163 participants aged 50 years and older) examined the mediating or moderating role of pain in the relationship between depressive symptoms and PA, and the impact of PA, pain and depressive symptoms on health-care utilisation. Results. Approximately 8.5% TILDA older adults were depressed. No mediating or moderating effects of pain were found in the association between PA and depressive symptoms. Higher levels of PA were found to be independently associated with lower depressive symptoms, while higher levels of pain significantly increased the likelihood of depressive symptoms supporting previous findings. Depressive symptoms and higher levels of pain were also found to significantly increase health-care utilisation. Conclusions. Consistent with previous findings in this field, both PA and pain were found to be independently associated with depressive symptoms in Irish older adults. Furthermore, pain does not play a mediating or moderating role in the relationship between PA and depressive symptoms. Continued support for ongoing initiatives in this area aimed at increasing PA in older adults as a means to improve both physical and mental well-being is advised. The absence of any synergistic effect between PA and pain suggests that clinicians and health service providers should continue to promote PA as a treatment for depression, irrespective of the pain levels of their patients.

Gender and age differences in suicide mortality in the context of violent death: findings from a multi-state population-based surveillance system

OBJECTIVE

Males are more likely than females to die by all forms of violent death, including suicide. The primary purpose of the present study was to explore whether the gender difference in suicide rates is largely accounted for by males' general greater tendency to experience violent deaths. The current study examined gender and age differences in suicides and other violent deaths, using data from a population-based surveillance system.

METHOD

Pearson's chi-square tests and logistic regression analyses were conducted with data for 32,107 decedents in the 2003-2005 National Violent Death Reporting System (NVDRS). Decedents were categorized by gender, age, and death by suicide versus other violent means.

RESULTS

When suicides were examined in the greater context of violent death, the total proportion of violent deaths due to suicide did not differ across gender. When deaths were examined by age group, after controlling for ethnicity, marital status, and U.S. location in which the death occurred, males in early to mid childhood were significantly more likely than same-aged females to die by suicide relative to all other violent deaths. The portion of deaths due to suicide was for the most part equal across both genders in late childhood, young adulthood, and mid-adulthood. Older males were more likely than older females to die by suicide relative to other violent deaths.

CONCLUSION

Our findings suggest that that the risk of dying by suicide relative to other violent deaths may be more pronounced at certain developmental stages for each gender. This knowledge may be valuable in tailoring prevention strategies.

Ageing and trajectories of depressive symptoms in community-dwelling men and women

OBJECTIVE

The aim of this study was to investigate age-related patterns of depressive symptoms in older men and women and to identify their determinants.

METHODS

The Center for Epidemiological Studies Depression Scale was used to prospectively assess depressive symptoms in 1059 men and 1531 women, enrolled in a French representative population-based cohort (PAQUID study) and followed over a period of 20 years. Using a group-based trajectory method with an accelerated longitudinal design, we modelled the course of depressive symptoms between 65 and 104 years of age and examined associations between trajectory patterns and baseline socio-demographic and health variables.

RESULTS

In men, we identified three rising trajectories: 'never depressed' including 65% of the sample, 'emerging depression' (28%) and 'increasing depression' (7%). Compared with the membership of the never-depressed trajectory, that of the two higher trajectories was significantly associated with a history of depression and dyspnoea. In women, we identified two slightly rising trajectories (never depressed, 56%, and 'rising subclinical', 33%) and one stable high trajectory ('persistent depression', 11%). Membership of the two higher trajectories was significantly associated with the use of benzodiazepine, polymedication and dyspnoea. A history of nondepressive psychiatric disorder was a risk factor for membership of the persistent-depression group, whereas being widowed seemed to be a protective factor for membership of this group.

CONCLUSION

High-risk groups for later-life depression should be targeted differently in older men and women in order to implement appropriate interventions to prevent chronicity and disability.

A pilot study of depression among older people in Rawalpindi, Pakistan

BACKGROUND

Depression is common among elderly in developed countries and it is more pronounced in institutional settings. In Pakistan there is a lack of empirical data on depression among this segment of the population particularly with reference to their living arrangements.The objectives of the present study are to report the magnitude of depression among elderly having two different residential arrangements and to examine the association of depression and its established demographic factors.

FINDINGS

Data were collected from 141 respondents. 108 were community residents (m = 57 and f = 51) and 33 were living in the care homes (m = 29 and f = 4).Prevalence of depression as assessed by Geriatric Depression Scale (GDS) among community and Care Homes (CHs) participants was 31.5 percent and 60.6 percent, respectively.On Centre of Epidemiological Studies Depression Scale (CES-D), 42.6 percent of the community and 69.7 percent of the CH respondents were deemed depressed. Before adjusting for any other potential risk factors the odds of being depressed was significantly increased if the study participants were living in CH, relatively older, female, not currently married, had low educational level, had lower Mini Mental State Examination (MMSE) scores, and reported lower perceived emotional and practical support. In a partially adjusted logistic regression model an increased risk of depression was not confounded by any of the above mentioned risk factors.However, the risk associated was not significant when it was adjusted for social support.

CONCLUSIONS

The findings of the current study are consistent with previous research and throws light on the dire need for interventions to address mental health needs of Pakistani elderly.Implications for improving the mental health status of elderly are also presented.

Late-life depression and quality of life in a geriatric evaluation and management unit: an exploratory study

Background

Late-life depression is common among elderly patients. Ignorance of the health problem, either because of under-diagnosis or under-treatment, causes additional medical cost and comorbidity. For a better health and quality of life (QoL), evaluation, prevention and treatment of late-life depression in elderly patients is essential.

Methods

This study examined (1) the differences of clinical characteristics, degree of improvement on QoL and functionality on discharge between non-depressed and depressed elderly inpatients and (2) factors associated with QoL on discharge. Four hundred and seventy-one elderly inpatients admitted to a geriatric evaluation and management unit (GEMU) from 2009 to 2010 were enrolled in this study. Comprehensive geriatric assessment including the activities of daily living (ADL), geriatric depression scale, and mini-mental state examination were conducted. QoL was assessed using the European Quality of Life-5 Dimensions and the European Quality of Life-5 Dimensions Visual Analog Scale on discharge. Information on hospital stay and Charlson comorbidity index were obtained by chart review. Chi-square tests, independent t-tests, Mann–Whitney U tests and multiple linear regressions were used in statistical analysis.

Results

Worse QoL and ADL on discharge were found among the depressed. Depressive symptoms, female gender, duration of hospital stay, and rehabilitation were significant factors affecting QoL on discharge in linear regression models.

Conclusions

The importance of the diagnosis and treatment of depression among elderly inpatients should not be overlooked during hospital stay and after discharge. Greater efforts should be made to improve intervention with depressed elderly inpatients.