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

The Unique Role of Sleep Quality in Older Adults’ Psychological Well-Being

Previous research has established a link between sleep quality and psychological well-being in older adults. However, no research to date has investigated this relationship in the context of other factors known to influence both sleep and psychological well-being. Among a sample of 489 independently living older adults (ages 60 to 98), the current study examined the association between sleep quality and psychological well-being (positive emotions, negative emotions, depression) while controlling for individual differences in factors known to affect sleep: physical health, stress, physical activity, functional ability, and demographics. Multiple linear regression models showed that both better current sleep quality and better comparative sleep quality (from middle to older adulthood) predicted better psychological well-being. Implications include interventions to improve sleep quality in older adults.

Statin use and depressive symptoms in a prospective study of community-living older persons

PURPOSE

The association between statin use and depression is complex, and research findings have been mixed. The present study aimed to investigate the association of statin use with depressive symptoms among community-living older persons, and its effect modifications by gender and medical co-morbidity.

METHOD

Prospective observational study of 1803 participants aged 55 and above in the Singapore Longitudinal Ageing Studies cohort, with data of statin use and other risk factors for depression at baseline, and Geriatric Depression Scale (GDS) symptom scores at follow-up (1.5 years).

RESULTS

Controlling for baseline demographics, cholesterol level and medical co-morbidities, statin use was not associated with depressive symptom scores in the whole sample overall (regression coefficient = -0.12 (SE 0.10), F([1,1782]) = 1.44, p = 0.23). Post hoc analyses suggested that statin use may be associated with fewer depressive symptoms in women (p = 0.02), and more depressive symptoms in men, particularly those with more medical co-morbidities (p = 0.04) and multiple drug use (p = 0.02).

CONCLUSION

This study provided no strong evidence that support an overall association of statin use and depressive symptoms. The post hoc findings in this study are suggestive but may also be spurious and should be replicated in other studies.

Temporal lobe atrophy and white matter lesions are related to major depression over 5 years in the elderly

The influence of organic brain changes on the development of depression in the elderly is uncertain. Cross-sectional studies, most often from clinical samples, report associations with brain atrophy and cerebrovascular disease, while longitudinal population studies have given mixed results. Our aim was to investigate whether cortical atrophy and white matter lesions (WMLs) on computed tomography (CT) predict occurrence of depression in the elderly. This is a prospective population-based study with 5-year follow-up. The baseline sample included 525 elderly subjects, aged 70-86 years, without dementia or major depression, with a score on the Mini-Mental State Examination above 25, and without dementia at follow-up. Cortical atrophy and WMLs were evaluated at baseline using CT. The main outcome measure was development of major or minor depression at follow-up according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition, as evaluated using neuropsychiatric examinations and hospital discharge registers. Logistic regression was used to estimate risk. Over the period of 5 years, 20 individuals developed major and 63 minor depression. Presence of temporal lobe atrophy (odds ratio (OR)=2.81, 95% confidence interval (CI) 1.04-7.62) and moderate-to-severe WMLs (OR=3.21, 95% CI 1.00-10.26) independently predicted major, but not minor, depression after controlling for various confounders. Other brain changes did not predict occurrence of depression. Our findings suggest that temporal lobe atrophy and WMLs represent relatively independent and complementary pathways to major depression in the elderly. This may have implications for prevention, as both neurodegeneration and cerebrovascular disease have been related to preventable factors.

Depressive symptoms in stroke patients: a 13 month follow-up study of patients referred to a rehabilitation unit

BACKGROUND

Although depression is known to be frequently associated with stroke, it is nonetheless underdiagnosed and under-treated in this patient population. Its effect on outcome for stroke patients is thought to be substantial, but prediction is complicated by other pre- and post stroke factors. The aims of this study was to describe changes in depressive symptoms in elderly stroke patients across a timespan of one year, to examine risk factor for such changes and to explore whether depressive symptoms have any independent impact upon one year mortality and nursing home placement.

METHODS

194 patients diagnosed with an ischaemic or hemorrhagic stroke was recruited from the Stroke Rehabilitation Unit, Ullevaal University Hospital, Oslo, Norway during the period between March 2005 and August 2006 and followed up for a period of 13 months. Pre-stroke assessment was accomplished by means of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Frenchay Activities Index (FAI), the Barthel ADL Index and patient's medical history. Post-stroke assessment at inclusion and follow-up examination was performed with the Mini Mental State Examination (MMSE), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Star Cancellation Test, the Barthel ADL Index, the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale (NIHSS). Information was collected from the patients' records.

RESULTS

Institutionalization at 13 months was predicted by more depression (MADRS) and cognitive impairment (RBANS) at baseline, together with lower pre-stroke social activity levels (FAI). Two factors predicted death at 13 months: Cognitive impairment (MMSE) and greater age. The prevalence of depression was relatively unchanged from baseline (56%) to 13 month follow-up (48%). Among the patients who were depressed at baseline 55% still had MADRS score above six (persistent depression) at 13 months, while 35% in the non-depressed group at baseline had developed depression (incident depression). Persistent depression was significantly predicted by lower pre-stroke social activity levels (FAI) together with a more severe stroke (NIHSS) and worse overall function (mRS) at baseline. Incident depression was predicted by receipt of municipal home help before the stroke and a lower score on the delayed memory tasks on RBANS at baseline.

Pharmacological and clinical profile of newer antidepressants: implications for the treatment of elderly patients

The pharmacological treatment of older adults with major depressive disorder presents a variety of challenges, including a relative lack of high quality studies designed to measure the efficacy and safety of antidepressants specific to this patient population. Gaining a clear understanding of how to use antidepressants in elderly patients with depression, especially new and widely used agents, would provide valuable insight to clinicians. The purpose of the current article is to review the pharmacology, efficacy and safety of newer antidepressants (i.e. escitalopram, duloxetine and desvenlafaxine) in the treatment of late-life depression. To accomplish this goal, a MEDLINE and PubMed search (1966 - February 2010) was conducted for relevant articles. Animal and human studies have clearly demonstrated the effects of desvenlafaxine, duloxetine and escitalopram on monoamine reuptake transporters. The serotonergic and noradrenergic actions of desvenlafaxine and duloxetine may provide for a faster onset of antidepressant activity in the elderly, but more definitive data are needed and the clinical effects of the possible faster onset of action need to be elucidated. Duloxetine and escitalopram are extensively metabolized via cytochrome P450 (CYP) enzymes and the decreased hepatic metabolism present in many older adults should be taken into account when prescribing these medications. Duloxetine possesses the greatest likelihood of producing clinically relevant drug-drug interactions because of its inhibition of CYP2D6. All three agents must also be used cautiously in older adults with poor renal function. In terms of clinical efficacy, 14 prospective published trials involving escitalopram (n = 8) and duloxetine (n = 6) in the treatment of older adults with major depressive disorder were identified. No such studies involving desvenlafaxine were found. Of the five randomized, double-blind, controlled trials, 46% and 37% of antidepressant-treated patients were considered responders and remitters, respectively. In contrast to escitalopram, duloxetine-treated patients experienced improvements in depressive symptoms that more consistently differentiated themselves from the symptoms of placebo-treated patients. Escitalopram and duloxetine were generally well tolerated, but 5-20% and 10-27% of patients, respectively, dropped out because of medication-related adverse effects. Adverse effects experienced by older adults were generally similar to those experienced by younger adults, although indirect comparisons suggest that older adults are more likely to experience dry mouth and constipation with duloxetine and escitalopram, while orthostasis may be more common in older adults prescribed desvenlafaxine. Overall, duloxetine and escitalopram represent modestly effective treatments for late-life depression that are generally well tolerated but do produce a variety of adverse effects. Conclusions regarding desvenlafaxine cannot be made at this time because of a lack of geriatric-specific data.

Antidepressant prescribing in older primary care patients in community and care home settings in England and Wales

OBJECTIVE

To compare the prevalence and predictors of antidepressant prescribing in older care home and community residents in England and Wales.

DESIGN

Retrospective analysis of primary care consultation and antidepressant prescribing data.

SETTING

The setting included 326 general (family) practices in England and Wales supplying data to The Health Improvement Network database between 2008 and 2009.

PARTICIPANTS

Participants were 10,387 care home and 403,259 community residents aged 65 to 104.

MAIN OUTCOME MEASURE

Antidepressant prescription in the last 3 months of recorded data for each patient.

RESULTS

Prevalence rates for antidepressant prescribing were 10.3% (95% confidence interval 10%-10.6%) for community and 37.5% (36.2%-38.9%) for care home residents. After excluding low-dose tricyclics (often used for other indications) prevalences were 7.3% (7.1%-7.5%) and 33.6% (32.3%-34.9%) respectively; of these, 21.7% (20.8%-22.6%) of community and 4.8% (3.9%-5.6%) of care home prescriptions were for antidepressants advised as best avoided in this age group. After indirect standardization for age, sex, and chronic disease prevalence, the ratio for prescribing was 2.4 (2.3-2.5) in care homes compared with the community; 28.3% (26.6%-30.1%) of community and 42.5% (39.4%-45.7%) of care home residents prescribed antidepressants had no appropriate recorded indication.

CONCLUSIONS

This national sample confirms the high prevalence of antidepressant prescribing to older people, particularly in care homes, frequently without a documented indication. The strong association found between chronic disease and antidepressant prescribing did not explain the higher care home prescribing rate. Widespread community use of nonrecommended antidepressants is also a concern.

Impairment, disability, social support and depression among older parents in rural Thailand

BACKGROUND

It is not known whether social support modifies the association between depression and impairment or disability in older people from developing countries in Asia.

METHOD

We used a Thai version of the EURO-D scale to measure depression in 1104 Thai rural community-dwelling parents aged 60 years. These were all those providing data on depression who were recruited as part of a study of older adults with at least one living child (biological, stepchild or adopted child). Logistic regression modelling was used to determine: (a) whether impairment, disability and social support deficits were associated with depression; (b) whether social support modified this association.

RESULTS

There were strong graded relationships between impairment, disability, social support deficits and EURO-D caseness. Level of impairment, but not disability, interacted with poor social support in that depression was especially likely in those who had more physical impairments as well as one or more social support deficits (p value for interaction=0.018), even after full adjustment.

CONCLUSIONS

Social support is important in reducing the association between physical impairment and depression in Thai older adults, especially for those with a large number of impairments. Enhancing social support as well as improving healthcare and disability facilities should be emphasized in interventions to prevent depression in older adults.

[Factors influencing depression in elderly people living at home]

PURPOSE

This study was done to identify the factors which influence depression for elderly people who live at home.

METHODS

The participants were 134 elderly people living at home in M city. Data were collected from April 2 to 30, 2009 and analyzed using SPSS/WIN 12.0 and AMOS 5.0 program. I assumed path coefficients by doing path analysis to understand synthetically causal relationship which influences on depression.

RESULTS

Social support, sleep pattern and self esteem had significant direct effects on life satisfaction and accounted for 50% of the total variance in life satisfaction. Physical symptoms, sleep pattern and life satisfaction also had significant direct effects on depression and accounted for 59% of the variance in depression. But social support, self assertiveness and self esteem were not significant for depression.

CONCLUSION

These results provide guidance for designing useful strategies to reduce depression in elderly people living at home.

Prevalence of major depressive disorder and minor depressive disorder in an elderly Korean population: results from the Korean Longitudinal Study on Health and Aging (KLoSHA)

OBJECTIVE

We investigated the prevalence, risk factors and impact of major depressive disorder (MDD) and minor depressive disorder (MnDD) in a randomly selected community-dwelling Korean elderly population.

METHOD

This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA). A study population of 1118 Korean elders was randomly sampled from residents of Seongnam, Korea aged 65 years or older. Standardized face-to-face interviews and neurological and physical examinations were conducted on 714 respondents using the Korean version of Mini International Neuropsychiatric Interview. MDD was diagnosed according to the DSM-IV criteria, and MnDD according to research criteria proposed in Appendix B of the DSM-IV criteria.

RESULTS

Age-, gender- and education-standardized prevalence rates in Korean elders aged 65 years or older were estimated as 5.37% (95% CI=3.72-7.03) for MDD, 5.52% (95% CI=3.84-7.19) for MnDD, and 10.89% (95% CI=8.60-13.17) for overall late-life depression (LLD). A prior MDD episode (OR=3.07, 95% CI=1.38-6.82 in MDD, OR=3.44, 95% CI=1.49-7.94 in MnDD), female gender (OR=3.55, 95% CI=1.53-8.24 in MDD, OR=2.68, 95% CI=1.19-6.04 in MnDD) and history of stroke or TIA (OR=3.45, 95% CI=1.62-7.35 in MDD, OR=2.95, 95% CI=1.34-6.52 in MnDD) were associated with the risks of both MDD and MnDD. Lack of formal education (OR=2.75, 95% CI=1.30-5.85) and low income (OR=2.83, 95% CI=1.02-7.88) were associated with the risk of MDD only. Quality of life (QOL) of the MDD and MnDD patients was worse than that of non-depressed elders (P<0.001, ANOVA).

CONCLUSION

MnDD was as prevalent as MDD in Korean elders and impacted QOL as MDD did. MnDD patients may increase in the future with accelerated population aging and westernization of lifestyle in Korea.

Sex differences in prevalence and risk indicators of geriatric depression: the Shih-Pai community-based survey

BACKGROUND/PURPOSE

Information about sex difference is important for the development of better prevention and intervention strategies for geriatric depression. We investigated sex differences in prevalence and risk indicators associated with geriatric depression among community-dwelling elderly people in Shih-Pai, Taipei, Taiwan.

METHODS

A cross-sectional community-based survey was conducted from June 1999 to November 2002 among non-institutionalized residents aged =65 years in Shih-Pai community. Trained interviewers collected data through home visits. Geriatric depression was defined as a score of = 5 on the Geriatric Depression Scale-Short Form.

RESULTS

The prevalence of geriatric depression was 9.8% in 3970 participants, with a higher rate in women (12.4%) than men (7.8%). Geriatric depression was significantly associated with women [odds ratio (OR) =1.49, 95% confidence interval (CI) =1.07-2.07), separated/divorced marital status (OR =3.29, 95% CI = 1.51-7.18), living alone (OR = 2.56, 95% CI = 1.38-4.77), past history of stroke (OR = 3.63, 95% CI = 2.09-6.31), and cognitive impairment (OR =2.83, 95% CI =1.96-4.09). Living alone (OR = 3.56, 95% CI = 1.48-8.57), living with children (OR = 1.97, 95% CI = 1.02-3.78), and past history of gouty arthritis (OR =2.46, 95% CI = 1.27-4.79) were significantly associated with depression in women, but not in men.

CONCLUSION

Women have a higher prevalence of geriatric depression than men. Our data support the differential exposure hypothesis and the differential vulnerability hypothesis of sex difference in geriatric depression.

End-of-life care in nursing homes: the importance of CNA staff communication

OBJECTIVE

Staff communication has been shown to influence overall nursing home (NH) performance. However, no empirical studies have focused specifically on the impact of CNA communication on end-of-life (EOL) care processes. This study examines the relationship between CNA communication and nursing home performance in EOL care processes.

DESIGN

Secondary data analysis of 2 NH surveys conducted in 2006-2007.

SETTING

One hundred seven nursing homes in New York State.

PARTICIPANTS

Participants were 2636 CNAs and 107 directors of nursing (DON).

MEASUREMENTS

The measures of EOL care processes-EOL assessment and care delivery (5-point Likert scale scores)-were obtained from survey responses provided by 107 DONs. The measure of CNA communication was derived from survey responses obtained from 2636 CNAs. Other independent variables included staff education, hospice use intensity, staffing ratio, staff-resident ethnic overlap index, facility religious affiliation, and ownership.

METHODS

The reliability and validity of the measures of EOL care processes and CNA communication were tested in the current study sample. Multivariate linear regression models with probability weights were used. The analysis was conducted at the facility level.

RESULTS

We found better CNA communication to be significantly associated with better EOL assessment (P = .043) and care delivery (P = .098). Two potentially modifiable factors-staff education and hospice use intensity-were associated with NHs' performance in EOL care processes. Facilities with greater ethnic overlap between staff and residents demonstrated better EOL assessment (P = .051) and care delivery scores (P = .029).

CONCLUSION

Better CNA communication was associated with better performance in EOL care processes. Our findings provide specific insights for NH leaders striving to improve EOL care processes and ultimately the quality of care for dying residents.

Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time

BACKGROUND

B-vitamin deficiencies have been associated with depression; however, there is very little prospective evidence from population-based studies of older adults.

OBJECTIVE

We examined whether dietary intakes of vitamins B-6, folate, or vitamin B-12 were predictive of depressive symptoms over an average of 7.2 y in a community-based population of older adults.

DESIGN

The study sample consisted of 3503 adults from the Chicago Health and Aging project, an ongoing, population-based, biracial (59% African American) study in adults aged > or =65 y. Dietary assessment was made by food-frequency questionnaire. Incident depression was measured by the presence of > or =4 depressive symptoms from the 10-item version of the Center for Epidemiologic Studies Depression scale.

RESULTS

The logistic regression models, which used generalized estimating equations, showed that higher total intakes, which included supplementation, of vitamins B-6 and B-12 were associated with a decreased likelihood of incident depression for up to 12 y of follow-up, after adjustment for age, sex, race, education, income, and antidepressant medication use. For example, each 10 additional milligrams of vitamin B-6 and 10 additional micrograms of vitamin B-12 were associated with 2% lower odds of depressive symptoms per year. There was no association between depressive symptoms and food intakes of these vitamins or folate. These associations remained after adjustment for smoking, alcohol use, widowhood, caregiving status, cognitive function, physical disability, and medical conditions.

CONCLUSION

Our results support the hypotheses that high total intakes of vitamins B-6 and B-12 are protective of depressive symptoms over time in community-residing older adults.

Anxious and depressive symptoms in Parkinson's disease: the French cross-sectionnal DoPaMiP study

Anxiety has been less extensively studied than depression in Parkinson's disease (PD). The DoPaMiP survey allowed assessing simultaneously anxiety and depressive symptoms in PD and comparing correlations of both symptoms with clinical and therapeutic features of the disease. Cross sectional survey conducted prospectively in 450 ambulatory nondemented PD patients and 98 patients with other disorders than PD. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), parkinsonism using the Unified Parkinson's Disease Rating Scale (UPDRS). Other clinical factors were measured using a structured standardized examination/questionnaire. The mean HADS-A (anxiety) subscore was higher in PD patients than in the others (8.2 +/- 3.9 vs. 6.5 +/- 3.2, P < 10(-4)) as was the HADS-D (depressive) subscore (6.6 +/- 3.8 vs. 3.9 +/- 3.2, P < 10(-4)). Patients with possible/probable anxious signs (HADS-A >or= 8) were more prevalent in PD (51% vs. 29%, P < 10(-4)) as were those with depressive symptoms (40% vs. 10%, P < 10(-4)). Conversely, anxiolytic and antidepressant medications consumption was not different between the 2 groups. Patients with anxious symptoms were more frequently female and younger than those without such symptoms, while those with depressive symptoms had more severe indices of parkinsonism, more comorbidities and lower cognitive function (Mini Mental State Exam). The logistic regression model revealed that patients with depressive symptoms received more frequently levodopa and less frequently a dopamine agonist. Anxiety and depressive symptoms were more frequent in PD patients than in medical control group. Both symptoms were commonly associated in the same PD patients, but were correlated with different clinical/therapeutic features, suggesting different underlying pathophysiological mechanisms.

Urban environment, physical inactivity and unhealthy dietary habits correlate to depression among elderly living in eastern Mediterranean islands: the MEDIS (MEDiterranean ISlands Elderly) study

AIMS

To evaluate factors associated with depression in elderly.

METHODS

During 2005-2007, 553 men and 637 women (aged 65 to 100 yrs) living in various Greek islands and in Cyprus participated in the study. The sampling was random and multistage (according to age sex distribution of the referent population). Depressive symptoms were evaluated using the Geriatric Depression Scale (GDS).

RESULTS

Twenty five per cent of men and 35% of women were classified in the highest GDS category (i.e. GDS score > 10), indicating intense depressive symptoms, while 54% of men and 70% of women scored above the depression cut-off (i.e. GDS score > 5) indicating mild-to-severe depressive symptoms. Among the investigated characteristics, living in urban environment, physical inactivity and history of hypertension were correlated with the presence of depressive symptoms (p < 0.05), after adjusting for various confounders. Moreover, the consumption of fish, vegetables and cereals is more prevalent among people with low or moderate depression (p < 0.05).

CONCLUSIONS

The prevalence of depression is quite high between elderly people living in Greek islands and Cyprus. Urban environment that may also interact with sedentarism and unhealthy dietary habits seems to promote depression in the studied population. Efforts to lower the prevalence of depression in the elderly should target on the aforementioned factors that employ functional impairment, social environment and dietary habits.

[The influence of physical exercise on depressive symptoms and functional fitness in elderly residents of south Brazil]

INTRODUCTION

The objective of this study was to investigate the influence of physical exercise on depressive symptoms and functional fitness in a sample of elderly people enrolled in a physical exercise program run by public sector Health Centers in Florianópolis, Brazil.

METHODS

The sample comprised a total of 118 elderly people (101 women and 17 men), who had been receiving treatment for up to 1 year and 4 months and were assessed at predefined intervals, up to a maximum of five times. Evaluations were carried out using the Geriatric Depression Scale (GDS-15); International Physical Activity Questionnaire (IPAQ) and the physical test battery proposed by AAHPERD (American Alliance for Health, Physical Education, Recreation and Dance).

RESULTS

A tendency for depression scores to reduce was observed. However, a statistically significant difference (p=0.008) was only detected among those elderly people who attended 75% or more of the treatment sessions. Analysis demonstrated that the tendency for overall mean functional fitness to increase was statistically significant (p<0.001). Inverse relationships were detected between functional fitness and depression scores at five assessment (r=-0.235, p=0.059; r=-0.206, p=0.099; r=-0.158, p=0.110; r=-0.068, p=0.565), although only one assessment had statistical significance (r=-0.226, p=0.033).

CONCLUSIONS

The results demonstrated a positive effect from physical exercise in reducing depressive symptoms and improving functional fitness, suggesting that there is an inverse relationship between these variables.

Effect of Physical Inactivity on Cognitive Performance after 2.5 Years of Follow-Up

Objective: To examine the association between physical activity and cognitive performance in a longitudinal study. Methods: We analyzed data from 17.333 noninstitutionalized persons aged 50 years or older in 11 European countries who participated in Wave 1 (2004/2005) and Wave 2 (2006/2007) of the Survey of Heath, Ageing, and Retirement in Europe (SHARE). Physical activity at baseline was measured as self-reported frequency of sports or activities requiring vigorous activity, and frequency of activities demanding a moderate level of activity. Cognitive function was measured at baseline and after a mean of 2.5 years of follow-up by delayed word recall and verbal fluency tests. The effects of physical activity at baseline on cognitive performance at follow-up were assessed in hierarchical multilevel random effects models adjusted for sociodemographic variables (age, education), somatic comorbidities, functional impairment (basic and instrumental activities of daily living, maximum grip strength), depressive symptoms, and body mass index. Results: After adjusting for potential confounders, we found physical inactivity (neither moderate nor vigorous) to be associated with a higher rate of cognitive decline over a mean follow-up of 2.5 years (β = –1.79 (SE = 0.17) for verbal fluency; β = –0.35 (SE = 0.04) for delayed word recall). Further analyses showed that vigorous activities more than once a week were especially related to change in cognition over time. Conclusion: Engagement in moderate and vigorous physical activities protects against cognitive decline in older age. Participation in physical activities may be of particular importance when other risk factors for cognitive decline are present.

Prevalence and correlates of clinically significant depressive symptoms among elderly people in Sri Lanka: findings from a national survey

BACKGROUND

Elderly Sri Lankans (11.2% of the nation's population) have witnessed many years of ethnic conflict, a destructive tsunami and increasing emigration of young adults. However, very little is known about the prevalence and correlates of depression among them. The present study utilizes data from a national aging survey to document the prevalence and correlates of clinically significant depressive symptoms among community-dwelling elderly Sri Lankans (aged > or =60 years).

METHODS

The 15-item Geriatric Depression Scale (GDS-15) was administered to 1181 elderly Sri Lankans; the presence of clinically significant depressive symptoms was defined as a GDS-15 score of > or =6. Sociodemographic and health correlates of depressive symptoms were assessed using logistic regression analysis. Interactions between gender and other correlates were also assessed.

RESULTS

The prevalence of depressive symptoms was observed to be 27.8% overall: 24.0% for men, and 30.8% for women. Certain subgroups of the elderly, i.e. those with disabilities, functional limitations, perceived income inadequacy, minorities, and elderly living alone, were significantly more likely to report depressive symptoms. There was a significant interaction between gender and ethnicity.

CONCLUSION

The prevalence of depressive symptoms among Sri Lankan elderly people is higher than that reported for most Asian countries. Clinicians and caregivers need to be aware of the potential presence of depressive symptoms among the elderly, especially among those with lower educational levels, functional limitations, hearing difficulty, physical disability, perceived income inadequacy, and among those who live alone, and ethnic minority males.

Obesity, Physical Activity, and Depressive Symptoms in a Cohort of Adults Aged 51 to 61

Objective: To determine associations between changes in obesity and vigorous physical activity (PA) status and depressive symptoms in a cohort aged 51 to 61 years at baseline. Method: Two waves (1992, 1998) of Health and Retirement Study data were used to divide participants into four obesity and four vigorous PA status categories based on change in or maintenance of their 1992 status in 1998. Depressive symptoms were defined as the upper quintile score (women ≥ 4, men ≥ 3) on the eight-item Center for Epidemiologic Studies—Depression Scale. Logistic regression determined adjusted odds ratios for depressive symptoms associated with obesity and vigorous PA status. Results: Among men, no significant associations were found. Among women, decreasing from high vigorous PA status and maintenance of obese status were independently associated with increased odds for depressive symptoms in 1998. Discussion: The findings illustrate the importance of examining gender differences in studies of risk factors for depression.

Prescribing antidepressants and benzodiazepines in the Netherlands: is chronic physical illness involved?

In this study we assessed differences in new and repeat prescriptions of psycho-tropics between patients receiving prescriptions for drugs to treat a common chronic disease and people without such prescriptions. The study used the databases of two Dutch health insurance companies (3 million people). We selected all Dutch men and women aged 45 and older who were registered for six consecutive years (1999-2004). Our analyses both found a consistent relation between psycho-tropics on the one hand and physical illness on the other. People with multi-morbidity were prescribed these drugs most often, especially men and those younger than 65. Epidemiological studies showed a prevalence of depression among people with multi-morbidity to be twice as high as among people without such conditions. According to recent guidelines non-drug treatment may be the first therapy option for patients with non severe depression. If prescribed for a long time, benzodiazepine prescriptions are especially known to be addictive. Our data raise the question to what extent patients with a chronic physical disease suffering from co-occurring mental problems are prescribed psycho-tropics in accord with the guidelines that also advise mental support in case of non severe mental problems. Further research can answer this important question.

Late-life depression in Peru, Mexico and Venezuela: the 10/66 population-based study

BACKGROUND

The proportion of the global population aged 60 and over is increasing, more so in Latin America than any other region. Depression is common among elderly people and an important cause of disability worldwide.

AIMS

To estimate the prevalence and correlates of late-life depression, associated disability and access to treatment in five locations in Latin America.

METHOD

A one-phase cross-sectional survey of 5886 people aged 65 and over from urban and rural locations in Peru and Mexico and an urban site in Venezuela. Depression was identified according to DSM-IV and ICD-10 criteria, Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm and EURO-D cut-off point. Poisson regression was used to estimate the independent associations of sociodemographic characteristics, economic circumstances and health status with ICD-10 depression.

RESULTS

For DSM-IV major depression overall prevalence varied between 1.3% and 2.8% by site, for ICD-10 depressive episode between 4.5% and 5.1%, for GMS-AGECAT depression between 30.0% and 35.9% and for EURO-D depression between 26.1% and 31.2%; therefore, there was a considerable prevalence of clinically significant depression beyond that identified by ICD-10 and DSM-IV diagnostic criteria. Most older people with depression had never received treatment. Limiting physical impairments and a past history of depression were the two most consistent correlates of the ICD-10 depressive episode.

CONCLUSIONS

The treatment gap poses a significant challenge for Latin American health systems, with their relatively weak primary care services and reliance on private specialists; local treatment trials could establish the cost-effectiveness of mental health investment in the government sector.

Perceptions of self-stigma and its correlates among older adults with depression: a preliminary study

BACKGROUND

Depression is common in old age and is often associated with stigma. However, to date, little is known about self-stigma (internalization of stigmatic beliefs) in depressed older people despite its importance and consequences. The aim of this study was to examine self-stigma and its correlates in depressed older people.

METHODS

Phone interviews were conducted with 54 persons diagnosed with major depression (78% female, average age = 74) from a psychogeriatric clinic in the central area of Israel. Self-stigma was assessed using an adapted version of the Internalized Stigma of Mental Health (ISMI) scale. Symptoms of depression were assessed using the short form of the Geriatric Depression Scale (GDS). Self-esteem was measured using Rosenberg's Self Esteem Scale. Information regarding sociodemographic and psychiatric health characteristics was also collected.

RESULTS

Self-stigma was relatively moderate with 10% to 20% of the participants reporting self-stigma. Those who reported higher levels of self-stigma were younger than those who did not report it. Income and education were lower in persons who reported high levels of stigmatization. Persons who reported stigmatization scored higher on the GDS and reported lower self-esteem than those without stigmatization.

CONCLUSIONS

This study represents an effort to examine the correlates of self-stigma in depressed older people. Since self-stigma exists among older adults, further studies are required to extend this body of knowledge.

Apathy and depressive mood in nursing home patients with early-onset dementia

The study explored whether apathy and depressive mood symptoms (DMS) are related to cognitive and functional features of dementia in 63 nursing home (NH) residents with early-onset dementia (EOD). All EOD residents from one NH (n = 41) and a random sample from another NH were assessed for depressive symptoms (Montgomery Asberg Depression Rating Scale [MADRS]), apathy (Neuropsychiatric Inventory [NPI]), global cognitive functions (Mini-Mental State Examination [MMSE]), activities of daily living (ADL, Minimum Data Set-Resident Assessment Instrument [MDS-RAI]), and overall dementia severity (Global Deterioration Scale [GDS]). DMS were not associated with apathy and dementia severity. Regression analyses adjusted for age, gender, the type of dementia, and DMS revealed that dementia severity measures accounted, respectively, for 14% (ADL), 13% (GDS), and 9% (MMSE) of the variance in apathy. In line with previous research in older patients, the higher apathy scores were associated with more cognitive and functional problems in EOD.

Onset of anxiety and depression in the aging population: comparison of risk factors in a 9-year prospective study

OBJECTIVES

To study the onset and compare risk factors for pure depression (DEP), pure anxiety (ANX), and comorbid anxiety-depression (ANXDEP) in the aging population.

DESIGN

Prospective study with 3-year intervals over a 9-year period.

SETTING

Data of the Longitudinal Aging Study Amsterdam were used, which is a population-based study among older adults (55-85 years at baseline).

PARTICIPANTS

Older adults free of depression and anxiety at baseline (N = 1,712).

MEASUREMENTS

Clinically relevant levels of depression and anxiety were measured with the Center for Epidemiologic Studies Depression scale> or =16 and Hospital Anxiety and Depression Scale > or =7, respectively. A broad range of potential sociodemographic, health, and psychosocial risk factors for anxiety and/or depression were examined by using polytomous logistic regression analyses.

RESULTS

Within 9 years, 184 subjects (10.8%) developed DEP, 93 (5.4%) ANX, and 103 (6.0%) ANXDEP. Concerning sociodemographics, higher age and lower educational level were predictors for DEP. Health indicators were predictive for DEP and ANXDEP but not for ANX. Depressive symptoms at baseline were predictive for DEP, whereas initial anxiety symptoms were predictive for ANX and ANXDEP. Neuroticism increased the risk of DEP and ANXDEP. Mixed effects of psychosocial variables were found: DEP was associated with recent widowhood, whereas ANX and ANXDEP were associated with other life events such as having an ill partner.

CONCLUSION

Although onset of ANXDEP demonstrated communality in risk factors, comparing risk factors associated with DEP and ANX revealed more differences than similarities. This underlines the need to distinguish anxiety from depression in preventive strategies.

Blood homocysteine and risk of depression in the elderly

We studied whether increased blood homocysteine is a predictor for incident depression in a population-based cohort aged >or=65. A total of 240 men and 217 women were identified at baseline and were assessed 4 years later for depression (Geriatric Depression Scale, GDS >or=10 or use of antidepressants). Risk of incident depression was estimated for the highest gender-specific tertile of baseline plasma homocysteine compared to the other tertiles combined in a reference group. As deficiencies of B(12) and folate are the main determinant of increased blood homocysteine in old age, serum concentrations of these vitamins were also measured. In women only, the highest homocysteine tertile was associated with incident depression. However, women with combined serum B(12)/folate deficiency had the highest blood homocysteine but also a lower depression risk than vitamin-replete women. In conclusion, the data only moderately support the hypothesis that blood homocysteine is a predictor of depression.

Rural-urban migration and depression in ageing family members left behind

BACKGROUND

It has been suggested that rural-urban migration will have adverse consequences for older parents left behind.

AIMS

To describe correlates of outmigration and to estimate any association between outmigration of children and depression in rural-dwelling older parents.

METHOD

Population-based survey of 1147 parents aged 60 and over in rural Thailand. We randomly oversampled parents living without children. We defined an outmigrant child as living outside their parent's district, and measured depression as a continuous outcome with a Thai version of the EURO-D.

RESULTS

Outmigration of all children, compared with outmigration of some or no children, was independently associated with less depression in parents. This association remained after taking account of social support, parent characteristics, health and wealth. Parents with all children outmigrated received more economic remittances and they perceived support to be as good as that of those with children close by.

CONCLUSIONS

Outmigration of children was not associated with greater depression in older parents and, after taking account of a range of possible covariables, was actually associated with less parental depression. This could be explained by pre-existing advantages in families sending more migrants and by the economic benefits of migration.

Declínio funcional de idosa institucionalizada: aplicabilidade do modelo da Classificação Internacional de Funcionalidade, Incapacidade e Saúde

O objetivo deste estudo é relatar a evolução clínico-funcional de uma idosa residente em instituição de longa permanência (ILPI), descrevendo a influência das condições contextuais (socioeconômicas e familiares) em sua saúde, bem como discutir a provável relação entre os eventos e seu declínio funcional utilizando o modelo conceitual da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). A CIF foi elaborada pela Organização Mundial de Saúde para atender a diferentes setores e estabelecer uma linguagem comum na descrição da saúde, permitindo uma abrangência multidimensional dos fatores direta e indiretamente relacionados ao quadro clínico-funcional, bem como intervenções de caráter interprofissional na clínica ou no ambiente institucional. A paciente passou por diferentes momentos na ILP e foi a óbito após 12 meses. A discussão do caso permite planejar melhores estratégias para lidar com os eventos adversos à saúde que podem ocorrer nesse contexto.

The community prevalence of depression in older Australians

OBJECTIVE

To estimate the prevalence of depression among older adults in Australia.

METHOD

All general practitioners in Australia's five most populous states who satisfied certain eligibility criteria (e.g., sufficient weekly working hours, sufficient numbers of elderly patients) were invited to participate. Those who consented were asked to identify all of their patients aged 60+ and invite them (either directly or via the study team) to complete a questionnaire. The questionnaire identified those who had experienced 'clinically significant depression' and those who had experienced a 'major depressive episode' in the past two weeks, via the Patient Health Questionnaire (PHQ-9). Consenting patients completed the questionnaire and returned it to the study team in a reply-paid envelope.

RESULTS

In total, 22,251 patients returned questionnaires. Overall, the age-adjusted rate of clinically significant depression was 8.2% (95%CI=7.8%-8.6%), with the age-adjusted rates for males being 8.6% (95%CI=7.9%-9.2%) and for females being 7.9% (95%CI=7.4%-8.4%). The overall, male and female age-adjusted rates for a major depressive episode were 1.8% (95%CI=1.6%-2.0%), 1.9% (95%CI=1.6%-2.2%) and 1.7% (95%CI=1.5%-2.0%), respectively.

DISCUSSION

Our study suggests that depression among older people is a major public health problem. The above estimates provide guidance for efficient planning of services, and establish a baseline against which preventive and treatment interventions can be assessed. Armed with this information, we can progress efforts at reducing this major health problem and its consequences.

Psychological distress and its correlates in older care-dependent persons living at home

OBJECTIVES

This study examined psychological distress in older people receiving home nursing care. The influence of risk factors and personal resources on their perceived psychological distress was also examined.

METHOD

A linear regression analysis was applied in a cross-sectional sample of 214 patients aged 75 years and older. Psychological distress was measured using the General Health Questionnaire (GHQ). The independent variables were sex, education, age, living arrangement, household composition, reported illnesses, Barthel ADL Index, self-rated health, Subjective Health Complaints, Clinical Dementia Rating Scale, Sense of Coherence and Revised Social Provision Scale.

RESULTS

Of the 214 participants, 23 (10.7%) reported experiencing psychological distress using a cutoff point of 4 or more on a GHQ case score. Sense of coherence, education and subjective health complaints were the only factors that were significantly related to psychological distress in the multivariate analysis.

CONCLUSION

The general level of psychological distress was low. Low psychological distress was related to an inner strength conceptualized as sense of coherence. Commonly reported risk factors such as sex, household composition and perceived social support, and objective measures of somatic and mental health and bodily dysfunctions were not related to psychological distress. Suggested reasons for this are greater acceptance of bodily and functional shortcomings and of changes related to goal achievement in old age, according to the model of selective optimization with compensation.

The interrelations of agency, depression, and suicidal ideation among older adults

The high rates of suicide among older men are cause for concern, and have prompted the investigation of factors that might explain these elevated rates. The current research examined whether the gender role construct agency was associated with depression and suicidal ideation among older adults. The results, based on self-report data from a sample of older Australian men (n = 69) and women (n = 90), indicated that depression mediated the relation between agency and suicidal ideation. In addition, for older men only, agency moderated the depression-suicidal ideation relation. The results suggest that older adults, and particularly men, with low levels of agency should be the targets for interventions aimed at increasing levels of agency and improving mental health.

Incidência de depressão e fatores associados em idosos residentes na comunidade: revisão de literatura

Resumo Depressão geriátrica ocorre com frequência, mesmo na população residente na comunidade. Vários fatores de risco associados estão descritos na literatura. O objetivo deste estudo é realizar uma revisão da literatura sobre a incidência de depressão geriátrica e os fatores de risco associados em idosos residentes na comunidade. Para este fim, realizou-se revisão bibliográfica da literatura sobre o tema, sendo efetuada consulta às bases de dados MEDLINE, PUBMED, LILACS e SCIELO, utilizando-se das palavras chaves "idoso", "fator de risco", "depressão" e "incidência". A incidência de depressão na população idosa residente na comunidade é de 13,23%, em média. Os preditores de depressão identificados foram: sexo feminino, idade avançada, condição marital, baixa escolaridade, condição socioeconômica desfavorável, condições de moradia, baixo suporte social, eventos estressores, depressão prévia, co-morbidades psiquiátricas, características de personalidade, distúrbios do sono, déficits cognitivos, condições de saúde adversas, limitação funcional e dor. Depressão ocorre com frequência na população idosa e constitui problema grave. A identificação dos fatores de risco associados com sua incidência pode ajudar os profissionais que atuam na área a diagnosticar e propor intervenções mais precoces e adequadas.

Physical disability and depressive symptomatology in an elderly population: a complex relationship. The Italian Longitudinal Study on Aging (ILSA)

OBJECTIVES

Depressive symptoms (DS) are very frequent in elderly individuals and are associated with negative outcomes. This study was undertaken to evaluate whether DS predict physical disability in this population.

METHODS

A prospective,community-based cohort study, this work included 5,632 individuals aged 65-84 years, who were recruited from the demographic registries of eight Italian municipalities in 1992. The complete data of 3,256 subjects were collected and analyzed. DS were assessed using the Geriatric Depression Scale with a score > or = 10/30 indicating DS. All traditional risk factors for disability established by questionnaires and physical examinations were assessed at baseline. The outcomes were self-reported disability on the activities of daily living (ADL) test and the performance-based physical function assessment (Physical Performance Tests, PPT). The contribution of the predictive variables to the outcomes evaluated after a mean follow-up of 3.5 +/- 0.4 years was assessed using hierarchical logistic nested models.

RESULTS

Baseline DS was associated with higher rates of ADL disability (odds ratio [OR] 1.73, 95%confidence interval [CI] 1.12-2.66) and PPT disability (OR 1.83, 95% CI 1.17-2.85)in men and with ADL disability (OR 1.81, 95% CI 1.28 -2.55) in women. The independent predictors of PPT disability in women were arthritis (OR 2.13, 95% CI 1.28 -3.53) and age (OR 1.09; 95% CI 1.03-1.15).

CONCLUSIONS

This study provides evidence that older persons who report DS are at higher risk of subsequent physical decline. In women, arthritis is a more powerful predictor of preclinical disability, as measured by PPT.

Patterns of hospitalisation for depressive and anxiety disorders across the lifespan in Australia

BACKGROUND

Hospitalisation rates for anxiety and depressive disorders vary with age and sex but there are few detailed analyses.

METHODS

Specialist psychiatric hospital separation data compiled by the Australian Institute of Health and Welfare in the National Hospital Morbidity Database from 1998/99-2004/5 were analysed for the principal psychiatric diagnoses of depressive disorders and neurotic, stress related and somatoform disorders. Separation rates were calculated by age, year and sex using population data linearly extrapolated from Australian censuses.

RESULTS

The average annual rate of specialised psychiatric separations for all depressive disorders was 2.61 per 1000 for men, 4.77 for women. The highest separation rates for depression occurred in men aged 75-79 years. Severe depression without psychosis separations peaked in women in midlife. Psychotic depression separations peaked in late life. The average annual rate of separations for neurotic, stress related and somatoform disorder was 2.08 per 1000 for men, 1.96 for women. In women rates declined with age but in men rates peaked between ages 50 and 60 years due to PTSD. The average length of stay for depressive and anxiety disorders increased with age.

LIMITATIONS

Accuracy of data collection by clinicians and coding by medical records staff is unknown.

CONCLUSIONS

Planning for hospital services should take into account that separation rates for depressive and anxiety disorders vary with age, sex and type of disorder.

The Montgomery-Asberg Depression Rating Scale and the Cornell Scale for Depression in Dementia: a validation study with patients exhibiting early-onset dementia

OBJECTIVE

To investigate some validity measures of Montgomery-Asberg Depression Rating Scale (MADRS) and Cornell Scale for Depression in Dementia (CSDD) in patients with early-onset dementia (EOD).

DESIGN

Cross-sectional design.

SETTING

Nursing home.

PARTICIPANTS

A sample of 63 inpatients with EOD.

MEASUREMENTS

Participants were assessed for the presence of clinical depression using the Provisional Diagnostic Criteria for Depression in Alzheimer Disease. Caregivers were administered the MADRS and CSDD, and two subscales from the Neuropsychiatric Inventory (NPI).

RESULTS

Depressed patients had higher scores on 6 of the 10 MADRS items and on 3 of the 19 CSDD items than nondepressed patients. Receiver operating characteristic curve analysis revealed a larger area under the curve for MADRS (0.87) than for CSDD (0.76), the difference was significant (p = 0.044). A CSDD optimal cutoff score of "5/6" yielded a sensitivity of 0.833 and a specificity of 0.567. A MADRS cutoff score of "19/20" yielded the highest sum of sensitivity (0.750) and specificity (0.843). A MADRS score of "14/15" with almost the same sum of sensitivity and specificity had a higher sum of sensitivity and a negative predictive value than "19/20." Both scales correlated with the NPI subscales depression/dysphoria (MADRS: rs = 0.70; CSDD: rs = 0.62) and apathy/indifference (MADRS: rs = 0.59; CSDD: rs = 0.50).

CONCLUSION

The MADRS and CSDD performed well in distinguishing depressed from nondepressed EOD patients and showed good congruent validity. The scales may be used to assess depressive symptoms in EOD. The MADRS intensity grades may be used for development or refinement of depression scales in (early onset) dementia.

Depression in older adults

Depression is less prevalent among older adults than among younger adults, but it can have serious consequences. More than half of cases represent a first onset in later life. Although suicide rates in the elderly are declining, they are still higher than in younger adults and are more closely associated with depression. Depressed older adults are less likely to endorse affective symptoms and more likely to display cognitive changes, somatic symptoms, and loss of interest than are depressed younger adults. Risk factors leading to the development of late-life depression likely comprise complex interactions among genetic vulnerabilities, cognitive diathesis, age-associated neurobiological changes, and stressful events. Insomnia is an often overlooked risk factor for late-life depression. We suggest that a common pathway to depression in older adults, regardless of which predisposing risks are most prominent, may be curtailment of daily activities. Accompanying self-critical thinking may exacerbate and maintain a depressed state. Offsetting the increasing prevalence of certain risk factors in late life are age-related increases in psychological resilience. Other protective factors include higher education and socioeconomic status, engagement in valued activities, and religious or spiritual involvement. Treatments including behavioral therapy, cognitive-behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy, and life review/reminiscence therapy are effective but are too infrequently used with older adults. Preventive interventions including education for individuals with chronic illness, behavioral activation, cognitive restructuring, problem-solving skills training, group support, and life review have also received support.

Depressive symptoms among older adults in Mexico City

BACKGROUND

Ageing and depression are associated with disability and have significant consequences for health systems in many other developing countries. Depression prevalence figures among the elderly are scarce in developing countries.

OBJECTIVE

To estimate the prevalence of depressive symptoms and their cross-sectional association with selected covariates in a community sample of Mexico City older adults affiliated to the main healthcare provider.

DESIGN

Cross-sectional, multistage community survey.

PARTICIPANTS

A total of 7,449 persons aged 60 years and older.

MEASUREMENTS

Depression was assessed using the 30-item Geriatric Depression Scale (GDS); cognitive impairment, using the Mini-Mental State Examination; and health-related quality of life with the SF-36 questionnaire.

MAIN RESULTS

The prevalence of significant depressive symptoms was estimated to be 21.7%, and 25.3% in those aged 80 and older. After correcting for GDS sensitivity and specificity, major depression prevalence was estimated at 13.2%. Comparisons that follow are adjusted for age, sex, education and stressful life events. The prevalence of cognitive impairment was estimated to be 18.9% in depressed elderly and 13.7% in non-depressed. SF-36 overall scores were 48.0 in depressed participants and 68.2 in non-depressed (adjusted mean difference = -20.2, 95% CI = -21.3, -19.1). Compared to non-depressed elderly, the odds of healthcare utilization were higher among those depressed, both for any health problem (aOR 1.4, 95% CI = 1.1, 1.7) and for emotional problems (aOR 2.7, 95% CI = 2.2, 3.2).

CONCLUSIONS

According to GDS estimates, one of every eight Mexican older adults had major depressive symptoms. Detection and management of older patients with depression should be a high priority in developing countries.

Impacto na qualidade de vida e no estado depressivo de idosas participantes de uma universidade da terceira idade

O objetivo deste estudo foi examinar a associação entre o tempo de participação na Universidade para a Terceira Idade da Universidade Federal do Rio Grande do Sul e as dimensões de personalidade, a qualidade de vida e a depressão em idosas. O método amostral utilizado foi o de conveniência. Cento e três idosas que participavam do grupo da Universidade da Terceira Idade foram avaliadas e responderam a instrumentos sobre condições sociodemográficas, aspectos de personalidade, qualidade de vida e depressão. Os resultados mostraram uma associação entre tempo de participação superior a um ano na Universidade da Terceira Idade e menor intensidade de depressão, bem como melhor percepção de qualidade de vida nos domínios físico, psicológico e social. Os resultados sugerem que o tempo de participação superior a um ano na Universidade da Terceira Idade atua como um possível fator protetor contra a depressão em idosos e auxilia na percepção de uma melhor qualidade de vida nos domínios físico, psicológico e social.

Explaining health differences between men and women in later life: a cross-city comparison in Latin America and the Caribbean

This paper describes differences in health and functional status among older men and women and attempts to anchor the explanations for these differences within a lifecourse perspective. Seven health outcomes for men and women 60 years and older from seven Latin American and Caribbean cities are examined, using data from the 2000 SABE survey (Salud, Bienestar y Envejecimiento-n=10,587). Age-adjusted as well as city- and sex-specific prevalence was estimated for poor self-rated health, comorbidity, mobility limitations, cognitive impairment, depressive symptoms and disability in basic and instrumental activities of daily living. Logistic regressions were fitted to determine if the differences between men and women in each outcome could be explained by differential exposures in childhood (hunger, poverty), adulthood (education, occupation) and old age (income) and/or by differential vulnerability of men and women to these exposures. Sao Paulo, Santiago and Mexico, cities in countries with a high level of income inequalities, presented the highest prevalence of disability, functional limitations and poor physical health for both women and men. Women showed poorer health outcomes as compared with men for all health indicators and in all cities. Controlling for lifecourse exposures in childhood, adulthood and old age did not attenuate these differences. Women's unadjusted and adjusted odds of reporting poor self-rated health, cognitive impairment and basic activities of daily living disability were approximately 50% higher than for men, twice as high for number of comorbidities, depressive symptoms and instrumental activities of daily living disability, and almost three times as high for mobility limitations. Higher vulnerability to lifecourse exposures in women as compared with men was not found, meaning that lifecourse exposures have similar odds of poor health outcomes for men and women. A more integrated understanding of how sex and gender act together to influence health and function in old age needs consideration of additional biological and social factors.

Prevalent depressive symptoms as a risk factor for conversion to mild cognitive impairment in an elderly Italian cohort

OBJECTIVE

To examine the association between depressive symptoms and prevalent and incident mild cognitive impairment (MCI) in elderly individuals; to verify whether it is affected by MCI subtype.

DESIGN

Prospective, population-based, longitudinal cohort study.

SETTING

Adults >or=65 years resident in an Italian municipality.

PARTICIPANTS

Baseline data are for 595 subjects with no cognitive impairment (NCI) and 72 subjects with prevalent MCI. NCI subjects underwent a 4-year follow-up for incident MCI.

MEASUREMENTS

MCI was diagnosed according to international criteria and classified as with (m + MCI) or without memory impairment (m - MCI). Baseline depressive symptoms were measured using the 30-item Geriatric Depression Scale (GDS). Baseline use of antidepressants was also recorded.

RESULTS

Baseline depressive symptoms (GDS >or=10) were more frequent in prevalent MCI cases (44.4%) than in NCI participants (18.3%). The association was independent of MCI subtype, antidepressant use, and sociodemographic and vascular risk factors. In NCI subjects, baseline depressive symptoms were also associated with increased risk of MCI at follow-up, but only for subjects on antidepressant drugs at baseline (incident cases = 72.7%) compared with those without depressive symptoms and not on antidepressant therapy (incident cases = 24.0%). The association was independent of other confounders and stronger for m - MCI (incident cases = 45.4%) with respect to m + MCI (incident cases = 27.3%).

CONCLUSIONS

Depressive symptoms are highly prevalent among elderly MCI subjects and, in cognitively normal elderly individuals, are associated with an increased risk of developing MCI. The association is stronger for the MCI subtype without memory impairment.

Assessment of the prescription of antidepressant drugs in elderly nursing home patients: a clinical and laboratory follow-up investigation

The aim of the study was to investigate the use of antidepressant drugs among elderly people in nursing homes. Elderly residents who where found to have been prescribed at least one antidepressant drug according to the specific medication dispensing system were identified in 8 nursing homes in the county of Ostergötland, Sweden. Data were collected from the medical record forms at the nursing home. Blood samples were drawn for the assessment of drug concentration, blood chemistry parameters and cytochrome P450 expression. At least one antidepressant drug was prescribed to 38% of elderly people in the nursing home studied. A total of 71 patients were evaluated, 80% women and 20% men. The median age was 84 years (range, 71-100 years). Indications for antidepressant drug treatment were found on 96% of medical record forms (depression, 60%); however, information relating to when treatment was initiated could not be found on 34% of medical record forms and a clear time schedule for how long this drug treatment was planned to continue could not be found either. A possible adverse effect of antidepressant drug treatment was retrieved in at least 77% of patients. Polypharmacotherapy was common; median number of drugs per patient was 11. Concentrations of drugs were higher than expected in 73%. Most patients were medicated with citalopram (n = 44). A clear interindividual variability of concentrations at each dose level was found for citalopram and for the metabolites desmethylcitalopram and didesmethylcitalopram. A significant correlation was found between the estimation of creatinine clearance and concentration-dose ratio of citalopram. Poor metabolizers, who had been prescribed an antidepressant drug that are substrate for the cytochrome P450 isoenzyme examined, have higher concentrations of prescribed antidepressant drug than do non-poor metabolizers in relation to dose. An increase in quality contribution to follow-up at antidepressant medications is needed. A more frequent clinical use of therapeutic drug monitoring and pharmacogenetic tests in addition to therapeutic drug monitoring may be one important tool in this process.

A randomised controlled trial of cognitive behaviour therapy vs treatment as usual in the treatment of mild to moderate late life depression

OBJECTIVES

This study provides an empirical evaluation of Cognitive Behaviour Therapy (CBT) alone vs Treatment as usual (TAU) alone (generally pharmacotherapy) for late life depression in a UK primary care setting.

METHOD

General Practitioners in Fife and Glasgow referred 114 Participants to the study with 44 meeting inclusion criteria and 40 participants providing data that permitted analysis. All participants had a diagnosis of mild to moderate Major Depressive Episode. Participants were randomly allocated to receive either TAU alone or CBT alone.

RESULTS

Participants in both treatment conditions benefited from treatment with reduced scores on primary measures of mood at end of treatment and at 6 months follow-up from the end of treatment. When adjusting for differences in baseline scores, gender and living arrangements, CBT may be beneficial in levels of hopelessness at 6 months follow-up. When evaluating outcome in terms of numbers of participants meeting Research Diagnostic Criteria for depression, there were significant differences favouring the CBT condition at the end of treatment and at 3 months follow-up after treatment.

CONCLUSIONS

CBT alone and TAU alone produced significant reductions in depressive symptoms at the end of treatment and at 6 months follow-up. CBT on its own is shown to be an effective treatment procedure for mild to moderate late life depression and has utility as a treatment alternative for older people who cannot or will not tolerate physical treatment approaches for depression.

Cerebrovascular risk factors and incident depression in community-dwelling elderly

OBJECTIVE

The 'vascular depression' hypothesis suggests that late-life depression results from vascular brain damage. We studied the longitudinal association between cerebrovascular risk factors and incident depression in a large population-based study.

METHOD

Two thousand nine hundred and thirty-one persons with the age of > or =61 years were followed up. Data on a comprehensive set of cerebrovascular risk factors were collected at baseline. Participants received a psychiatric assessment 5 years later to establish DSM-IV diagnoses.

RESULTS

Only current smoking and antihypertensive drug use were independently associated with incident depressive symptoms. Diabetes mellitus and the Framingham stroke risk score were related to incident depressive disorder. No relation with depression was observed for cholesterol, diastolic and systolic blood pressure, history of cardiovascular disease, atrial fibrillation, left ventricular hypertrophy or the use of statins and anticoagulants.

CONCLUSION

These results moderately support the 'vascular depression' hypothesis.

Prevalence and predictors of depression among an elderly population of Pakistan

OBJECTIVE

To assess the magnitude and risk factors of the problem of depression in an elderly population of Pakistan.

METHOD

A cross-sectional study was conducted using a sample of 402 people aged 65 and above visiting the Community Health Center of the Aga Khan University, Karachi. Questionnaire based interviews were conducted for data collection and the 15-Item Geriatric Depression Scale was used to screen for depression. Univariate and multivariate logistic regression analyses were performed to identify factors associated with depression.

RESULTS

Of the 402 participants; 69.7% (95% CI=+/-4.5%) were men, 76.4% (95% CI=+/-4.2%) were currently married, 36.8% (95% CI=+/-5%) had received 11 or more years of education and 24.4% (95% CI=+/-4.2%) were employed. The mean age was 70.57 years (SD=+/-5.414 years). The prevalence of depression was found to be 22.9% (95% CI=+/-4.1%) and multiple logistic regression analysis indicated that higher number of daily medications (p-value=0.03), total number of health problems (p-value=0.002), financial problems (p-value<0.001), urinary incontinence (p-value=0.08) and inadequately fulfilled spiritual needs (p-value = 0.067) were significantly associated with depressive symptoms.

CONCLUSION

We have identified several risk factors for depression in the elderly which need to be taken into account by practicing family physicians and health care workers.

Factors associated with depressive symptoms measured by the 12-item General Health Questionnaire in community-dwelling older adults (The Bambuí Health Aging Study)

OBJECTIVE

To investigate factors associated with depressive symptoms in community-dwelling older adults.

METHOD

This study evaluated 1,510 participants of the Bambuí Health Aging Study baseline. The dependent variable was the presence of depressive symptoms assessed by the 12-item General Health Questionnaire and predictive variables were sociodemographic characteristics, social support network, lifestyle and health conditions.

RESULTS

The prevalence of depressive symptoms was 38.5% (12-item General Health Questionnaire > or = 5). Depressive symptoms were positively and independently associated with female gender (PR = 1.15; 95%CI 1.01-1.33), aged 80 years or over (PR = 1.22; 95%CI: 1.02-1.54) compared with 60-69 years, single (PR = 1.25; 95%CI: 1.02-1.46) or separated (PR = 1.30; 95%CI: 1.03-1.65) marital status, less than 4 years of schooling (PR = 1.42; 95%CI: 1.04-2.00), self-reported global health (reasonable: PR = 1.84; 95%CI 1.45-2.34; bad or very bad: PR = 2.44; 95%CI 1.91-3.12), incapacity or great difficulty in performing daily activities (PR = 1.39; 95%CI: 1.22-1.57) and complaint of insomnia in the last month (PR = 1.77; 95%CI: 1.22-1.99).

CONCLUSION

The similarities between factors associated with depressive symptoms in this population and in others do not explain the high prevalence rates previously reported in Bambuí. These findings may guide efforts to investigate others factors to elucidate the etiopathogenesis of depression in this population.

White matter lesions as a predictor of depression in the elderly: the 3C-Dijon study

BACKGROUND

There is increasing evidence for a link between cerebrovascular disease and depression in the elderly but the mechanisms are still unknown. This study examines the longitudinal relationship between depression and white matter lesions (WML) in a sample of elderly aged 65 years and older.

METHODS

Three City (3C)-Dijon is a 4-year follow-up population-based prospective study of 1658 subjects. At baseline, lifetime major depressive episode diagnosis was established using the Mini International Neuropsychiatric Interview. At each study wave, severity of depressive symptoms was assessed using Center for Epidemiological Studies-Depression (CES-D), and antidepressants intake was recorded. At baseline, lifetime major depression (LMD) was defined as lifetime major depressive episode or antidepressant medication intake. At follow-up, subjects were classified "incident depression" if scoring high at CES-D or antidepressant users. At baseline, cerebral magnetic resonance imaging (MRI) was performed to quantify WML volumes using an automated method of detection. At 4-year follow-up, 1214 subjects had a second MRI.

RESULTS

Cross-sectional analysis showed a significantly higher WML volume in subjects with LMD compared with other subjects. Adjusted longitudinal analysis showed that increase in WML load was significantly higher in subjects with baseline LMD (2.1 cm(3) vs. 1.5 cm(3), p = .004). Among subjects free of depression up to baseline (n = 956), the higher the baseline WML volume, the higher the risk of developing depression during follow-up (odds ratio one quartile increase: 1.3; 95% confidence interval: = 1.1-1.7).

CONCLUSIONS

Our data show that depression and WML volumes are strongly related. These results are consistent with the hypothesis of a vascular depression in the elderly.