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

Adapting the UCLA 3-item loneliness scale for community-based depressive symptoms screening interview among older Chinese: a cross-sectional study

OBJECTIVE

Loneliness is a significant and independent risk factor for depression in later life. Particularly in Asian culture, older people may find it less stigmatising to express loneliness than depression. This study aimed to adapt a simple loneliness screen for use in older Chinese, and to ascertain its relevance in detecting depressive symptoms as a community screening tool.

DESIGN, SETTING AND PARTICIPANTS

This cross-sectional study was conducted among 1653 older adults aged 60 years or above living in the community in Hong Kong. This was a convenient sample recruited from four local non-governmental organisations providing community eldercare or mental healthcare services. All data was collected by trained social workers through face-to-face interviews.

MEASURES

Loneliness was measured using an adapted Chinese version of UCLA 3-item Loneliness Scale, depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and social support with emotional and instrumental support proxies (number of people who can offer help). Basic demographics including age, gender, education and living arrangement were also recorded.

RESULTS

The average loneliness score was 3.9±3.0, and it had a moderate correlation with depressive symptoms (r=0.41, p<0.01). A loneliness score of 3 can distinguish those without depression from those with mild or more significant depressive symptoms, defined as a PHQ-9 score of ≥5 (sensitivity 76%, specificity 62%, area under the curve=0.73±0.01). Loneliness explained 18% unique variance of depressive symptoms, adding to age, living arrangement and emotional support as significant predictors.

CONCLUSION

A 3-item loneliness scale can reasonably identify older Chinese who are experiencing depressive symptoms as a quick community screening tool. Its wider use may facilitate early detection of depression, especially in cultures with strong mental health stigma.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT03593889.

An Exploratory Study of the Relative Effects of Various Protective Factors on Depressive Symptoms Among Older People

Objective: The present study investigated the relative importance of various factors found to be negatively associated with depressive symptoms in older adults and assessed the potential moderating effect of sociodemographic characteristics for each factor.

Method: Depressive symptoms were measured with the Center of Epidemiological Studies Depression Scale. Psychological, social, and physical health measures relating to the following factors were also administered: personal growth, purpose in life, self-esteem, self-efficacy, social support, self-rated health, life satisfaction, and physical activity. Multivariate linear regression analysis was used to investigate the most important factors associated with depressive symptoms, and moderation analyses were employed to identify any moderating effects of sociodemographic factors.

Results: Life satisfaction, self-esteem, and purpose in life were found to be negatively associated with depressive symptoms. Only one moderating effect was observed—the negative relationship between life satisfaction and depressive symptoms was significantly stronger among the younger respondents.

Conclusion: These findings suggest that strategies for the prevention or amelioration of depressive symptoms across subgroups of the senior population could be optimized by focusing on enhancing life satisfaction, self-esteem, and purpose in life.

Self-Isolation Due to COVID-19 Is Linked to Small One-Year Changes in Depression, Sleepiness, and Insomnia: Results from a Clinic for Sleep Disorders in Shiga Prefecture, Japan

We aimed to analyze (a) the changes in depression, sleepiness, insomnia, and sleep habits in relation to the degree of self-isolation and (b) the effects of changes in sleep habits and social interactions on depression, insomnia, and sleepiness during the coronavirus disease 2019 (COVID-19) pandemic. We enrolled 164 patients who visited the sleep outpatient clinic in Shiga University of Medical Science Hospital. We compared the sleep habits, depression (Patient Health Questionnaire-9: PHQ-9), insomnia (Athens Insomnia Scale: AIS), and sleepiness (Epworth Sleepiness Scale: ESS) of patients during the period from April to July 2019 vs. May 2020 (a period of self-isolation due to COVID-19). A Wilcoxon signed-rank test indicated no significant differences in PHQ-9, ESS, and AIS scores between 2019 and 2020 within both the strong self-isolation group and no/little self-isolation group. With respect to sleep habits, earlier bedtime (p = 0.006) and increased sleep duration (p = 0.014) were found in the strong self-isolation group. The former (p = 0.009) was also found in the no/little self-isolation group, but we found significant differences in sleep duration between the no/little self-isolation group and the strong self-isolation group (p = 0.047). Therefore, self-isolation due to COVID-19 had relatively small one-year effects on depression, sleepiness, and insomnia in a clinical population.

The impact of socio-demographic features on anxiety and depression amongst navy veterans after retirement: a cross-sectional study

Objective

Retirement from work may trigger various changes in everyday life that affect mental health. The current cross-sectional study, conducted with 231 veterans, examines the relationship between socio-demographic features and both anxiety and depression in navy veterans after retirement. Spielberg’s State-Trait Anxiety Inventory (STAI) was used for anxiety assessment, and the Beck Depression Inventory (BDI) was used for depression assessment. The analysis was performed with the Statistical Package for Social Sciences (SPSS), version 20.0.

Results

It was found that the mean score of state anxiety was 41 and trait anxiety, 38. Severe depression was found in 6.5% of the veterans, moderate in 8.3% and mild in 21.7%. The presence of a serious health problems was an independent predictor of both anxiety and depression’s more serious symptoms. Inversely, the stability in terms of retirement choice was negatively related to depression, while the development of new interests and activities after retirement was negatively related to both anxiety and depression. Further, life satisfaction after retirement was a predictor of lower current anxiety levels among veterans.

Dietary patterns and depression risk in older adults: systematic review and meta-analysis

CONTEXT

Diet may be one of the modifiable environmental factors that could reduce depressive symptoms or abate the development of depression without side effects. However, previous reviews mainly focused on general adult populations.

OBJECTIVE

The aim of this systematic review and meta-analysis was to explore the association between healthy dietary patterns and depression risk in older adults.

DATA SOURCES

Eight databases were searched up to September 2019. The inclusion criteria were older adults aged ≥ 65 years, healthy dietary patterns, depression assessed by a physician or by validated screening tools, and quantitative study design.

DATA EXTRACTION

Data were extracted independently by 2 researchers, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed.

DATA ANALYSIS

Meta-analysis was conducted by calculating the pooled odds ratio (OR) and 95% CIs. A total of 18 eligible studies were meta-analyzed. Results showed that a healthy dietary pattern is associated with a reduced risk of depression in older adults (OR, 0.85; 95%CI, 0.78-0.92; P < 0.001). There was high heterogeneity (I2 = 64.9%; P < 0.001) among the studies. Subgroup analyses indicated that sample size and depression screening tools were the main sources of study heterogeneity.

CONCLUSIONS

An inverse association between healthy dietary patterns and depression risk in older adults was found. However, the high heterogeneity among the studies should be considered.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD 42020169195.

Strain differences in behaviour and immunity in aged mice: Relevance to Autism

The BTBR mouse model has been shown to be associated with deficits in social interaction and a pronounced engagement in repetitive behaviours. Autism spectrum disorder (ASD) is the most prevalent neurodevelopmental condition globally. Despite its ubiquity, most research into the disorder remains focused on childhood, with studies in adulthood and old age relatively rare. To this end, we explored the differences in behaviour and immune function in an aged BTBR T + Itpr3tf/J mouse model of the disease compared to a similarly aged C57bl/6 control. We show that while many of the alterations in behaviour that are observed in young animals are maintained (repetitive behaviours, antidepressant-sensitive behaviours, social deficits & cognition) there are more nuanced effects in terms of anxiety in older animals of the BTBR strain compared to C57bl/6 controls. Furthermore, BTBR animals also exhibit an activated T-cell system. As such, these results represent confirmation that ASD-associated behavioural deficits are maintained in ageing, and that that there may be need for differential interventional approaches to counter these impairments, potentially through targeting the immune system.

The Effects of COVID-19 Among the Elderly Population: A Case for Closing the Digital Divide

The COVID-19 pandemic has had huge effects on the daily lives of most individuals in the first half of 2020. Widespread lockdown and preventative measures have isolated individuals, affected the world economy, and limited access to physical and mental healthcare. While these measures may be necessary to minimize the spread of the virus, the negative physical, psychological, and social effects are evident. In response, technology has been adapted to try and mitigate these effects, offering individuals digital alternatives to many of the day-to-day activities which can no longer be completed normally. However, the elderly population, which has been worst affected by both the virus, and the lockdown measures, has seen the least benefits from these digital solutions. The age based digital divide describes a longstanding inequality in the access to, and skills to make use of, new technology. While this problem is not new, during the COVID-19 pandemic it has created a large portion of the population suffering from the negative effects of the crisis, and unable to make use of many of the digital measures put in place to help. This paper aims to explore the increased negative effects the digital divide is having in the elderly population during the COVID-19 pandemic. It also aims to highlight the need for increased attention and resources to go toward improving digital literacy in the elderly, and the need to put in place measures to offer immediate solutions during the COVID-19 crisis, and solutions to close the digital divide for good in the long-term.

The elderly living in single-person households in South Korea: a latent profile analysis of self-esteem, life satisfaction, and depression

OBJECTIVES

Elderly living alone in South Korea report higher rates of psychological distress compared to the population at large. Using a person-centered approach, the aim of the present study was to identify the latent profiles of South Korean elderly living alone based on self-esteem, life satisfaction, and depression.

METHOD

Latent profile analysis (LPA) was conducted based on data of 1545 older age individuals living alone. In addition, we examined significant factors that differentiate the observed profiles using multinomial logistic regression analysis.

RESULTS

We identified five profiles: "extremely depressed (n = 44, 2.9%)," "severely depressed (n = 169, 10.9%)," "mildly depressed (n = 529, 34.2%)," "low life satisfaction (n = 128, 8.3%)," and "positive adaptation (n = 675, 43.7%)." In addition, results of multinomial logistic regression analysis indicated that males (OR: 1.69; 95% CI: 1.02-2.81), and elderly with lower income (OR: 0.86; 95% CI: 0.81-0.91), lower level of physical health (OR: 0.43; 95% CI: 0.33-0.57), and lower social relationship satisfaction (OR: 0.25; 95% CI: 0.18-0.35) were more likely to fall in the "low life satisfaction" rather than the "positive adaptation" profile. In addition, being female (OR: 0.48; 95% CI: 0.30-0.79), of older age (OR: 1.04; 95% CI: 1.01-.1.07), and higher income (OR: 1.14; 95% CI: 1.08-1.20) were related to classification in the "mildly depressed" rather than the "low life satisfaction" profile. The "severely depressed" group was differentiated by older age (OR: 1.05; 95% CI: 1.01-1.08), lower level of physical health (OR: 0.49; 95% CI: 0.34-0.71), and lower satisfaction with social relationship (OR: 0.54; 95% CI: 0.38-0.76).

CONCLUSION

The results highlight the need for welfare policies that secure income and physical health in elderly living alone to enhance their quality of life. Furthermore, interventions that aim to maintain social networks are tantamount in order to prevent isolation in the elderly living alone.

Prevalence and Correlates of Individuals Screening Positive for Depression and Anxiety on the PHQ-4 in the German General Population: Findings from the Nationally Representative German Socio-Economic Panel (GSOEP)

Our aim was to estimate the prevalence and correlates of probable depression and anxiety in the general adult population in Germany. Repeated cross-sectional data (i.e., cross-sectional data observed at different time points: year 2012 and year 2014) were derived from the innovation sample of the German Socio-Economic Panel, a population-based study of German households. The validated Patient Health Questionnaire (PHQ-4) was used to measure probable depression and anxiety. In the analytical sample, n equaled 2952 individuals. According to the PHQ-4 cut-off values, 10.4% of the individuals had probable depression and 9.8% of the individuals had probable anxiety. Regressions revealed that the likelihood of depression was positively associated with lower age (OR: 0.98 (95% CI: 0.98-0.99)), being unmarried (and living together with spouse) (OR: 0.75 (0.58-0.98)), worse self-rated health (OR: 1.99 (1.73-2.27)), and more chronic diseases (OR: 1.18 (1.07-1.31)). Furthermore, the likelihood of anxiety was positively associated with being female (OR: 1.36 (95% CI: 1.04-1.76)), lower age (OR: 0.98 (95% CI: 0.97-0.99)), low education (medium education, OR: 0.69 (0.50-0.95)), worse self-rated health (OR: 2.00 (1.74-2.30)), and more chronic diseases (OR: 1.15 (1.03-1.27)). The magnitude of depression and anxiety was highlighted. Clinicians should be aware of the factors associated with probable depression and anxiety.

Health and health-care utilisation in old age: the case of older men living alone

A growing number of older men are living alone. They are often referred to as an at-risk group in health-care systems. The purpose of this article is to establish an overview of these men's health and health-care utilisation. We do so by drawing on three sources: an online survey with health-care professionals, data from a national self-report health study and register-based data on health-care utilisation. The results show that older men living alone generally have lower health scores than older men co-habiting and that, among older men living alone, lower educational level is associated with lower health scores but also a greater use of free-of-charge health-care services. Health-care professionals conducting preventive home visits consider older men's social needs the most pronounced problem for the men's wellbeing and call for new services to be custom made for them. In this article, we discuss differences between older men living in rural and urban areas and between those who are single, divorced or widowed. We conclude that health and social care systems must differentiate between sub-groups of older men living alone when developing new services and that free-of-charge services, such as general practitioners and home care, should be considered as vehicles for addressing health inequities.

Association of Late Life Depression, (Non-) Modifiable Risk and Protective Factors with Dementia and Alzheimer's Disease: Literature Review on Current Evidences, Preventive Interventions and Possible Future Trends in Prevention and Treatment of Dementia

The number of people living with dementia and Alzheimer’s disease is growing rapidly, making dementia one of the biggest challenges for this century. Many studies have indicated that depression plays an important role in development of dementia, including Alzheimer’s disease; depression, especially, during the late life may either increase the risk of dementia or even being its prodromal stage. Despite a notably large number of carried observational studies and/or clinical trials, the association between the late life depression and dementia remains, due to the complexity of their relationship, still unclear. Moreover, during past two decades multiple other (non-)modifiable risk and possibly protective factors such as the hypertension, social engagement, obesity, level of education or physical (in)activity have been identified and their relationship with the risk for development of dementia and Alzheimer’s disease has been extensively studied. It has been proposed that to understand mechanisms of dementia and Alzheimer’s disease pathogeneses require their multifactorial nature represented by these multiple factors to be considered. In this review, we first summarize the recent literature findings on roles of the late life depression and the other known (non-)modifiable risk and possibly protective factors in development of dementia and Alzheimer’s disease. Then, we provide evidences supporting hypotheses that (i) depressive syndromes in late life may indicate the prodromal stage of dementia (Alzheimer’s disease) and, (ii) the interplay among the multiple (non-)modifiable risk and protective factors should be considered to gain a better understanding of dementia and Alzheimer’s disease pathogeneses. We also discuss the evidences of recently established interventions considered to prevent or delay the prodromes of dementia and provide the prospective future directions in prevention and treatment of dementia and Alzheimer’s disease using both the single-domain and multidomain interventions.

Psychopathology and HIV diagnosis among older adults in the United States: disparities by age, sex, and race/ethnicity

In 2016, 17% of new HIV infections in the US were among adults aged 50 and older. Differences by age, sex, and race/ethnicity exist among older people living with HIV. Co-morbid mental health and substance use disorders (SUD) are also major challenges for this population. This study examined the association between generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), SUD, depression, and HIV diagnosis among adults aged 50 and older, and the disparities by age, sex, and race/ethnicity. Data were obtained from Cerner Corporation's Health Facts® database. Multivariable logistic regression models were used to determine the associations between GAD, PTSD, SUD, and depression, and HIV diagnosis. Results were also stratified by age group, sex, and race/ethnicity. Overall, there were positive associations between SUD, depression, GAD, PTSD and HIV; and differences by age, sex and race/ethnicity existed in these associations. For example, after adjusting for age, race/ethnicity and marital status, men who were diagnosed with GAD were 10 times more likely (adjusted OR: 10.3; 95% CI: 8.75 - 12.1) to have an HIV diagnosis compared to men who were not diagnosed with GAD. Women who were diagnosed with GAD were five times more likely (adjusted OR: 5.01; 95% CI: 3.81 - 6.58) to have an HIV diagnosis compared to women who were not diagnosed with GAD. HIV prevention and intervention programs for older adults should address GAD, PTSD, SUD and depression and consider the age, sex and racial/ethnic disparities in the association between psychopathology and HIV.

Risk factors, comorbidities, quality of life, and complications after surgery in idiopathic normal pressure hydrocephalus: review of the INPH-CRasH study

OBJECTIVE

Idiopathic normal pressure hydrocephalus (INPH) is a dementia treatable by insertion of a shunt that drains CSF. The cause of the disease is unknown, but a vascular pathway has been suggested. The INPH-CRasH (Comorbidities and Risk Factors Associated with Hydrocephalus) study was a modern epidemiological case-control study designed to prospectively assess parameters regarding comorbidities and vascular risk factors (VRFs) for INPH, quality of life (QOL), and adverse events in patients with shunted INPH. The objective of this review was to summarize the findings of the INPH-CRasH study.

METHODS

VRFs, comorbidities, QOL, and adverse events were analyzed in consecutive patients with INPH who underwent shunt placement between 2008 and 2010 in 5 of 6 neurosurgical centers in Sweden. Patients (n = 176, within the age span of 60–85 years and not having dementia) were compared to population-based age- and gender-matched controls (n = 368, same inclusion criteria as for the patients with INPH). Assessed parameters were as follows: hypertension; diabetes; obesity; hyperlipidemia; psychosocial factors (stress and depression); smoking status; alcohol intake; physical activity; dietary pattern; cerebrovascular, cardiovascular, or peripheral vascular disease; epilepsy; abdominal pain; headache; and clinical parameters before and after surgery. Parameters were assessed through questionnaires, clinical examinations, measurements, ECG studies, and blood samples.

RESULTS

Four VRFs were independently associated with INPH: hyperlipidemia, diabetes, obesity, and psychosocial factors. Physical inactivity and hypertension were also associated with INPH, although not independently from the other risk factors. The population attributable risk percent for a model containing all of the VRFs associated with INPH was 24%. Depression was overrepresented in patients with INPH treated with shunts compared to the controls (46% vs 13%, p < 0.001) and the main predictor for low QOL was a coexisting depression (p < 0.001). Shunting improved QOL on a long-term basis. Epilepsy, headache, and abdominal pain remained common for a mean follow-up time of 21 months in INPH patients who received shunts.

CONCLUSIONS

The results of the INPH-CRasH study are consistent with a vascular pathophysiological component of INPH. In clinical care and research, a complete risk factor analysis as well as screening for depression and a measurement for QOL should probably be included in the workup of patients with INPH. The effect of targeted interventions against modifiable VRFs and antidepressant treatment in INPH patients should be evaluated. Seizures, headache, and abdominal pain should be inquired about at postoperative follow-up examinations.

Insecurity about getting old: age-contingent self-worth, attentional bias, and well-being

Objectives: Older adulthood has often been recognized as a time of increased well-being and positive cognitive biases. However, older adults can also experience many social and identity challenges. We sought to investigate which older adults might be most vulnerable to these difficulties. We propose that to the extent an older adult has age-related contingent self-esteem they will be at risk for lower well-being and negative attentional biases.Methods: Across three studies, we measured older adults' self-reported aging self-worth contingencies, as well as various measures of well-being including subjective stress. We then had participants complete a cued-dot probe task, where each trial either began with an aging threat or not.Results: In an initial pilot study, we found that older adults reporting specific cognitive decline contingencies held an attentional bias toward rejection, primarily when cued with the word senile. In Study 1, we found general aging contingencies to be associated with lower well-being and a rejection bias when cued with old. In Study 2, we found that a stronger rejection bias, particularly when cued with old, was associated with greater stress.Conclusions: These findings demonstrate that older adults who are insecure about aging may have lower well-being and negatively biased social cognitive patterns. Negatively biased attentional patterns may play a key role in maintaining feelings of insecurity. Importantly, our research sheds light on those older adults who may not experience a positivity effect.

Art activities and qigong exercise for the well-being of older adults in nursing homes in Indonesia: a randomized controlled trial

Objective: This study aims to investigate the effect of an integrated intervention of art activities and Qigong exercise on the well-being of older adults in nursing homes in Indonesia.Method: We employed a randomized controlled trial with 4 specific groups, i.e. art, Qigong, integration of art and Qigong, and control group. A total of 267 participants aged 50 years or older were recruited from 9 nursing homes in Jakarta, Indonesia. The participants were randomly allocated to one of the four groups, attending two intervention sessions per week for eight weeks (16 sessions), lasting 90 minutes each. Measurements were administered at baseline (T₀) and post-intervention (T₁). The primary outcome was well-being (WHOQOL-Bref) and secondary outcomes were satisfaction with life (SWLS), depression (BDI-II), and health status (SF-36).Results: The art intervention had a significant positive effect on well-being, in particular in the domain of social relations. It also led to a decrease in depressive symptoms, as did the integration intervention. No significant effects were visible in the Qigong group nor in the integrated intervention compared to either art or Qigong alone.Conclusion: Interventions such as art programs and an integration of art and Qigong may give psychological benefits to older adults. Yet, results of the study need to be interpreted with caution and need to be replicated. A qualitative approach would be welcome to get an in-depth understanding of why art intervention is especially beneficial. (Trial registration: Clinicaltrials.gov NCT02957773, registered 28 September 2016).

The Effectiveness of the Positive Mood and Active Life Program on Reducing Depressive Symptoms in Long-Term Care Facilities

BACKGROUND AND OBJECTIVES

Depression is prevalent among long-term care facility (LTCF) residents. However, interventions are not normally part of the management of these residents due to a shortage of mental health professionals. On the basis of Lewinsohn's behavioral model of depression, we developed a 12-week pleasant activity scheduling intervention, the Positive Mood and Active Life (PMAL) program. This study evaluated the effectiveness of the PMAL program on reducing depressive symptoms and improving quality of life among at-risk LTCF residents.

RESEARCH DESIGN AND METHODS

We adopted a cluster randomized controlled trial design. Four LTCFs were randomly assigned as treatment sites and three provided care as usual. At-risk LTCF residents (N = 68) were identified using the Mood Resident Assessment Protocol from the Minimum Data Set 2.0. The PMAL program was delivered to 34 residents. The primary and secondary outcomes were depressive symptoms and quality of life, as measured by the Geriatric Depression Scale-15 (GDS-15) and the World Health Organization Quality of Life scale-BREF (WHOQoL-BREF), respectively.

RESULTS

After 12 weeks, the GDS-15 score in the intervention group showed a reduction from 7.59 to 5.67, with a significant treatment by time effect (p = .006), based on the mixed model analysis; the WHOQoL-BREF score also substantially increased from 69.83 to 86.61 (p = .000).

DISCUSSION AND IMPLICATIONS

The PMAL program is effective in reducing depressive symptoms of at-risk LTCF residents. It is a feasible intervention that requires minimum resources and can be integrated with standardized assessment systems.

Is "Busy" Always Better? Time-Use Activities and Depressive Symptoms Among Older Mexican Adults

Background and Objectives

Depression among older Mexican adults is underrecognized and of increasing concern due to its association with comorbidities including cognitive and functional impairments. Prior studies have found an association between low involvement levels in social activities and depression. We aimed to examine the association of time-use activities and depressive symptomatology by sex.

Research Design and Methods

We used data from the 2012 and 2015 waves of the Mexican Health and Aging Study. Participants aged 60 and older who had low or no depressive symptoms in 2012 were included in these analyses (N = 4,309). Factor analysis was used to group activities and logistic regression models were used to assess the association of baseline time use with depressive symptomatology in 2015.

Results

Among those with low or no depressive symptomatology in 2012, 21.0% reported elevated symptoms (5+) in 2015. Those with elevated depressive symptoms were more likely to be women, older, lower educated, and with at least one activity of daily living limitation. Four time-use domains emerged from the factor analysis including hobbies and indoor activities, volunteering, caregiving, and working. The hobbies and indoor activities domain was associated with lower odds of elevated symptoms for men and women (odds ratio [OR]: 0.76, 95% confidence interval [CI]: 0.61–0.96; and OR: 0.75, 95% CI: 0.61–0.91, respectively). Additionally, the volunteer and community activities domain was associated with lower odds of depressive symptoms for women (OR: 0.72, 95% CI: 0.58–0.89) and men (OR: 0.77, 95% CI: 0.60–0.99).

Discussion and Implications

Understanding how older Mexicans distribute their time among different activities and its associations with depressive symptoms can help guide policy and sex-specific interventions for psychological well-being. Certain domains had lower odds for elevated depressive symptomatology; future work should examine this association in other countries as well as the context of the built environment.

Exploring Language Learning as a Potential Tool against Cognitive Impairment in Late-Life Depression: Two Meta-Analyses and Suggestions for Future Research

Late-life depression (LLD) affects about an eighth of community-dwelling seniors. LLD impacts well-being, with loneliness and small social networks being typical. It has also been linked to cognitive dysfunction and an increased risk of developing dementia. Safety and efficacy of pharmacological treatments for LLD have been debated, and cognitive dysfunction often persists even after remission. Various cognitive interventions have been proposed for LLD. Among these, one has received special attention: foreign language learning could serve as a social intervention that simultaneously targets brain structures affected in LLD. Lifelong bilingualism may significantly delay the onset of cognitive impairment symptoms by boosting cognitive reserve. Even late-life foreign language learning without lifelong bilingualism can train cognitive flexibility. It is then counterintuitive that the effects of language learning on LLD have never been examined. In order to create a theoretical basis for further interdisciplinary research, this paper presents a status quo of current work through two meta-analyses investigating cognitive functioning in LLD on the one hand and in senior bilinguals or seniors following a language course on the other hand. While LLD was consistently associated with cognitive dysfunction, inconsistent results were found for bilingualism and language learners. Possible reasons for this and suggestions for future research are subsequently discussed.

Der Anteil sexueller Minoritäten in der älteren Wohnbevölkerung in Deutschland und potenzielle Assoziation zwischen der sexuellen Orientierung und depressiven Symptomen

Ziel der Studie Beschreibung des Anteils sexueller Minoritäten in der älteren Wohnbevölkerung in Deutschland und Darstellung einer möglichen Assoziation mit depressiven Symptomen.

Methodik Daten der sechsten Welle (Jahr 2017) des Deutschen Alterssurveys (n = 5133). Das Durchschnittsalter betrug 66,1 Jahre (43–90 Jahre). Die Allgemeine Depressionsskala (Kurzversion, ADS-K) wurde zur Erfassung depressiver Symptome verwendet. Es wurde zwischen Hetero-, Bi- und Homosexuellen unterschieden. In die Analysen haben wir u. a. die folgenden Kovariaten aufgenommen: Alter, Geschlecht, Partnerschaftsstatus, Wohnort, subjektive Gesundheit, körperliche Funktionsfähigkeit (kurze Skala SF-36).

Ergebnisse In der älteren Wohnbevölkerung in Deutschland identifizieren sich 92,8 % der Individuen als Heterosexuelle, 1,7 % als Bisexuelle, 1,1 % als Homosexuelle und 4,3 % als „Andere“. Bivariat zeigte sich, dass kein signifikanter Zusammenhang zwischen sexueller Orientierung und depressiven Symptomen besteht. In multiplen Regressionsanalysen bestätigte sich dieses Ergebnis.

Schlussfolgerung Unsere Ergebnisse deuten darauf hin, dass kein signifikanter Zusammenhang zwischen der sexuellen Orientierung und depressiven Symptomen in der älteren Wohnbevölkerung in Deutschland besteht.

Inequalities in extending working lives beyond age 60 in Canada, Denmark, Sweden and England-By gender, level of education and health

Background

Keeping older workers in employment is critical for societies facing the challenge of an ageing population. This study examined the association between types of health conditions and differentials in the probability of employment by level of education among men and women between 60–69 years of age in Canada, Denmark, Sweden and England.

Methods

Data were drawn from the Canadian Community Health Survey, Survey of Health, Ageing and Retirement in Europe and English Longitudinal Study of Ageing. We combined country data, applied logistic regression, adjusted for educational level, and stratified the analysis by sex to calculate the odds ratio (OR) of employment (>15 hours work per week) for persons with physical health conditions, mental health conditions (depression) and physical-mental health comorbidity.

Results

The odds of employment among men and women with physical-mental health comorbidity were lower compared to those with no/other conditions (men: OR 0.32, 95% CI: 0.25–0.42, women: OR 0.38 95% CI: 0.30–0.48). Women with low education had lower odds of employment compared to their counterparts with high education (OR 0.66, 95% CI: 0.57–0.76). The odds of employment at older ages was lower in Canada, Denmark and England compared with Sweden (e.g. English men: OR 0.48 95% CI 0.40–0.58; English women OR 0.33 95% CI 0.27–0.41).

Conclusions

The odds of employment beyond age 60 is lower for groups with low education, particularly women, and those with physical-mental health co-morbidities. As such, policies to extend working lives should not be ‘one size fits all’ but instead consider subgroups, in particular, these groups that we have shown to be most vulnerable on the labour market.

The Impact of Spouse's Illness on Depressive Symptoms: The Roles of Spousal Caregiving and Marital Satisfaction

OBJECTIVES

To examine (a) the relationship between own depressive symptoms and spouses' health condition changes among mid- and later-life couples and (b) the roles of marital relationship quality and spousal caregiving in this relationship.

METHOD

Fixed-effect analyses were conducted using data from 3,055 couples aged 45 and older from Waves 1 (2006) to 4 (2012) of the Korean Longitudinal Study on Ageing.

RESULTS

Spousal stroke was linked with higher depression symptoms. Spouses' onset of cancer was related to an increase in depressive symptoms for wives, but not for husbands. Spousal caregiving and marital satisfaction were significant moderators: Wives caring for spouses with cancer reported more depressive symptoms than those not providing care; husbands caring for spouses with lung disease reported more depressive symptoms than those not providing care. The associations between wives' heart disease, husbands' cancer diagnosis, and depressive symptoms were weaker for couples with higher marital satisfaction.

DISCUSSION

The findings suggest variations across health condition types and gender. Relationship quality and caregiving are important contexts moderating the negative impact of spousal chronic illness on depression. Health care providers should be aware that spouses' health statuses are connected and that type of illness may affect the care context.

Anxious, Depressed, and Planning for the Future: Advance Care Planning in Diverse Older Adults

OBJECTIVES

To determine whether depression and anxiety are associated with advance care planning (ACP) engagement or values concerning future medical care.

DESIGN

Cross-sectional.

PARTICIPANTS

English- and Spanish-speaking patients, aged 55 years and older, from a San Francisco, CA, county hospital.

MEASURES

Depression was measured by the Patient Health Questionnaire 8-item scale, and anxiety was measured by the Generalized Anxiety Disorder 7-item scale, using standardized cutoffs of 10 or more for moderate-to-severe symptoms. ACP engagement was measured using validated surveys of ACP behavior change (e.g., self-efficacy and readiness; mean five-point Likert score) and ACP actions (e.g., ask, discuss, and document wishes; 0- to 25-point scale), with higher scores representing higher engagement. In addition, we asked a question about valuing life extension ("some health situations would make life not worth living"). We used adjusted linear and logistic regression.

RESULTS

Mean age of 986 participants was 63 years, 81% were non-White, 39% had limited health literacy, 45% were Spanish speaking, 13% had depression, and 10% had anxiety. After adjustment for demographic and health status variables, participants who were depressed versus not depressed had higher ACP behavior change scores (0.2 points; 95% confidence interval (CI) = 0.06-0.38; P = .007), higher ACP action scores (1.5 points; 95% CI = 0.51-2.57; P = .003), and higher odds of not valuing life extension (odds ratio (OR) = 2.5; 95% CI = 1.5-4.3; P < .001). Results were similar in participants with versus without anxiety (ACP behavior change: 0.2 points; 95% CI = 0.05-0.40; P = .01; ACP action scores: 1.2 points; 95% CI = 0.14-2.32; P = .028; odds of not valuing life extension: OR = 2.3; 95% CI = 1.3-3.9; P = .004).

CONCLUSION

Depression and anxiety were associated with greater ACP engagement and not valuing life extension. Although the direction of association between ACP engagement and values with anxiety and depression cannot be determined in this cross-sectional study, these conditions may influence ACP preferences. Future studies should assess whether changes in anxiety or depression affect ACP preferences over time.

Compliance to Recommendations and Mental Health Consequences among Elderly in Sweden during the Initial Phase of the COVID-19 Pandemic-A Cross Sectional Online Survey

Background (1): In the wake of COVID-19, elderly people have been labelled a risk group. As the pandemic is a new crisis in Sweden, we have no knowledge on how this group perceives the information and recommendations being provided. Complying with these recommendations entails physical distancing and, for some, isolation at home. Methods (2): From 16 April to 15 May 2020, we conducted an online survey targeting people aged 70 and older in Sweden (n = 1854). Results (3): A vast majority of the participants find the information and recommendations clear and reliable. Half of the participants report staying at home all the time, and up to half report decreased mental health in terms of, e.g., feeling depressed, having sleeping problems and that isolation makes them feel bad. However, elderly people are not a homogenous group, and there are gender and demographic differences. (4) Conclusion: At this point, we do not know the full extent of the ongoing pandemic, either in terms of duration or in terms of losses. The Swedish model for action on COVID-19 has not included a lock down. However, elderly people seem to comply with recommendations and practice social distancing to a high degree. This might lead to decreased mental health and long-term effects.

Self-perceived general health among community-dwelling Portuguese older adults: do men and women differ?

Evidence on how gender intersects with relevant social constructs in later phases of life is scarce. This investigation examined gender inequalities in perceived health status (self-perceived general health; SPGH) by Portuguese elderly community-dwellers while considering psycho-social and socio-demographic determinants. This study used data from a representative sample of community-dwellers aged ≥65 years (N = 920), who were enrolled in the Portuguese Elderly Nutritional Status Surveillance System (PEN-3S) project. Associations between SPGH and socio-demographic and psycho-social variables, functionality and self-reported morbidity were tested; indirect effects of relevant predictors on SPGH were also tested using a bootstrap method. Gender inequalities in health were found: women significantly rated their health worse than men; overall, participants rated their health as fair. Education, functional status, depression symptoms and self-reported morbidity significantly predicted SPGH among women, whereas only the latter two were associated with SPGH among men. For both genders, depression was the strongest predictor of SPGH. Mediation analyses detected indirect effects of cognitive function and loneliness feelings on SPGH among older adults. Results herein provide insights on the predictive role of psycho-social variables on SPGH and support the need for considering the context when addressing the correlates of SPGH among Portuguese older adults. Altogether, these findings might support cost-effective interventions targeting the most vulnerable groups of the population to inequalities in health and its predictors.

Are Filial Piety and Ethnic Community Engagement Associated With Psychological Wellbeing Among Older Chinese American Immigrants? A Cultural Resource Perspective

This research examined whether perceived receipt of filial piety from adult children and ethnic community engagement—two major ethnocultural resources—were associated with psychological wellbeing of older Chinese American immigrants. Analyses used data from the PINE study, a sample of older Chinese adults in Chicago. Tobit regression revealed that elders who received more filial piety and visited community centers experienced less loneliness and depression than their counterparts did. Tests of interactions showed that community center visits moderated the negative relationship between perceived filial piety and depression. Results suggest the importance of community engagement for diminishing depressive symptoms in older Chinese American immigrants, particularly those with culturally weak intergenerational ties. Discussion centers on how visiting community centers in ethnically dense neighborhoods compensates for unfulfilled filial piety expectations by protecting the mental health of minority elders within a rapidly growing and acculturating immigrant population.

Life negative events and depressive symptoms: the China longitudinal ageing social survey

Background

Although some studies have reported the association between life negative events and depressive disorders, very limited studies have examined the association between life negative events exposure and depressive symptoms risk among Chinese older adults.

Methods

Data were obtained from the China Longitudinal Ageing Social Survey (CLASS), which was a stratified, multi-stage, probabilistic sampling survey, conducted in 2014. General linear regression and logistic regression were used to examine the association between life negative events exposure and depressive symptoms among Chinese older adults.

Results

Life negative events showed statistical dose-response association with depressive symptoms risk after adjustment for the confounding factors (P_trend < 0.001). Under consideration of life negative events exposure, participants who lived in rural areas, without a spouse or live alone were vulnerable to depressive symptoms.

Conclusions

Life negative events played a risk role of depressive symptoms among Chinese older adults, especially among those in rural areas, females or without a spouse. Our current study is valuable for the development of special prevention depressive symptoms programs among elderly individuals, especially those who have experienced negative events.

Laryngeal Pathologies and Their Associations With Mental Health Disorders

OBJECTIVES

Mental health disorders are very common. Understanding their clinical manifestations in terms of voice and laryngeal disorders (VLD) is important because they constitute a significant proportion of all patients seen by otolaryngology-head and neck surgery. In this study, we examine different mental disorders (MDs) and their presenting symptoms and diagnoses of VLD.

METHODS

Case series study, retrospective chart review of patients seen between January 2016 and December 2017 at the Johns Hopkins Voice Center. Diagnoses, demographic data, and comorbidities were collected. VLD were grouped into categories (laryngeal pathology, functional voice disorders, airway, swallowing, other) for statistical analysis.

RESULTS

Of a total 4,249 patients, 836 patients (19.7%) suffered from at least one MD. Those patients presented more frequently with swallowing problems (24.9% of all diagnoses in MD compared to 21.2% in control group; adjusted odds ratio [aOR] 1.280, 95% confidence interval [CI] 1.107-1.480, P = .001) and less frequently with vocal cord pathology (30.9% of all diagnoses in MD compared to 33.9% in control group, aOR 0.793, 95% CI 0.694-0.907, P = .001). Patients suffering from depression had significantly increased odds for dysphagia (aOR 1.570, 95% CI 1.216-2.026, P = .001). VLD clinical presentation profile was created for every MD studied.

CONCLUSION

Patients suffering from mental health disorders present more frequently with swallowing complaints, in particular for dysphagia. Awareness of this can guide appropriate referrals. Objective laryngeal findings are common in patients with substance abuse disorders. They should be screened with careful diagnostic laryngoscopy.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E231-E239, 2021.

Cognitive reserve and depression predict subjective reports of successful aging

BACKGROUND

With graying of western societies, successful aging is a hotly debated topic. Attaining successful aging brings benefits not only at the individual level, but also to society. To better understand successful aging, we conducted a study of older adults in the Republic of Slovenia.

METHODS

We recruited 213 community-dwelling adults, age 65 years and older, who responded to the Successful Aging Inventory (SAI), Purpose of Life Questionnaire (PIL), Satisfaction with Life Scale (SWLS), Beck Depression Inventory (BDI), Cognitive Reserve Index, Functional Activities Questionnaire (FAQ), and Multiple Abilities Self-Report Questionnaire (MASQ).

RESULTS

Responses to all scales were significantly correlated, which was taken into account when identifying covariates of latent successful aging in a structural equation model. Successful aging, as evaluated by the combination questionnaire responses, was most strongly associated with depression and marginally associated with cognitive reserve. Self-rated functional and cognitive capacities did not significantly explain individual differences in successful aging.

DISCUSSION

In our study of community-dwelling, older Slovenes, self-rated depression emerged as a strong correlate of successful aging and, to a lesser degree, cognitive reserve. Future studies of interventions that aim to promote successful aging should consider the role of depression and cognitive reserve in the older adult's experience of aging.

Social support as a protective factor against the effect of grief reactions on depression for bereaved single older adults

This study tested the main effect model and the stress-buffering model of the mechanisms by which social support affects bereaved single older adults' depression. Data from the National Social Life, Health, and Aging Project (Wave 2; N = 621) were used to test a latent moderated structural equation model that explores the interaction between grief reactions and social support on bereaved single older adults' depression in the US. The findings provide evidence for the stress-buffering model (i.e., the relationship between grief reactions and depression, which was strongly positive when social support was low, turned negative when social support was high).

Military-related experiences and late-life depressive symptomatology among Japanese-American world war II veterans

Objectives: To examine military service-related variables and late-life depressive symptomatology among older Japanese-American males.Method: This study is a secondary data analysis of a longitudinal, community-based study. A sample of 2669 participants (771 World War II veterans, 1898 civilians) was drawn from the Honolulu-Asia Aging Study. Depressive symptoms were assessed twice across a 9-year period with the Center for Epidemiologic Studies-Depression scale. Covariates included sociodemographic, physical health, health behavior, and psychosocial variables. Combat exposure and symptomatology were examined among a subset of 426 veterans. Cross-sectional and longitudinal designs were analyzed with linear regression.Results: Veterans and civilians did not differ in depression scores. Baseline depression scores significantly predicted follow-up depression scores. For the full sample, lower ratings of quality of life satisfaction, daily activity control and general health were associated with higher depression scores both cross-sectionally and longitudinally. Among veterans, light combat exposure was marginally associated with lower depression scores and longitudinally, previous depression scores and poorer health ratings were significant predictors of depression scores.Conclusion: Results suggest that military service does not affect late-life depressive symptomatology. However, combat exposure may play a marginal role in increased symptoms. Reasons for results include the possibility that other factors are more relevant to late-life depression, symptomatology naturally decreasing over time, or type of combat exposure measurement. Results expand literature by examination of an ethnoracial group not studied often and longitudinal examination of late-life depressive symptoms within a military-related context. Stakeholders should be knowledgeable of the distinct issues presented when serving aging veterans.

Prevalence of Depression and Its Influence on the Quality of Life of Jordanians Living in Residential Care Facilities

BACKGROUND

As a third-world country experiencing a rise in the elderly population and changes to traditional family structures, improving psychological health is critical to improving quality of life (QoL) in the older adults living in residential care facilities in Jordan.

PURPOSE

This study aimed to (a) estimate the prevalence of depression among nursing home (NH) residents in Jordan; (b) measure perceived QoL in these NH residents in the dimensions of mobility, self-care, usual activity, pain and discomfort, and anxiety/depression; and (c) assess the influence of depression on each of these QoL dimensions.

METHODS

This cross-sectional study recruited a convenience sample of 155 participants living in a residential care facility in Jordan. The instruments used included a sociodemographic and clinical questionnaire, the Mini-Mental State Examination, a Geriatric Depression Scale (GDS), and the EuroQol, which is a five-dimension, five-level questionnaire. The data were presented as means, standard deviations, and percentages as well as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

RESULTS

A high prevalence of depression was found in the study population, with 72.3% having a score between 6 and 9 on the GDS, which is suggestive of depression. Moreover, 18.1% scored ≥ 10 on the GDS, which is indicative of a nearly continual state of depression. With regard to the QoL dimensions, 84.5% of the participants reported experiencing pain, 81.9% reported anxiety/depression, 80.6% reported problems performing usual activities, 75.5% reported problems with self-care, and 63.2% reported mobility difficulties. Pain, anxiety, and depression were found to be significantly associated with level of depression (AOR = 2.78 and 95% CI [1.18, 6.57], AOR = 5.81 and 95% CI [2.14, 15.78], and AOR = 4.75 and 95% CI [1.87, 12.07], respectively).

CONCLUSIONS

Depression is common among NH residents in Jordan and is associated significantly with poor QoL. This study yielded empirical data that may be used to develop strategies to enhance or promote the mental health status and QoL of NH residents in Jordan.

Factors associated with depressive symptoms among elderly Koreans: the role of health status, work ability, financial problems, living alone, and family relationships

OBJECTIVES

The purpose of this study was to explore predictors of depressive symptoms in elderly Koreans.

METHODS

The data from Korean Welfare Panel survey of Korean Institute for Health and Social Affairs in 2015 was used in this study. Six thousand four hundred and seventy-one elderly adults aged 60-99 participated in this study. Mean age of subjects was 74.37 years (SD = 8.27) and participants were 2569 male (39.7%) and 3902 female (60.3%).

RESULTS

Multiple hierarchical regression analysis indicated that perceived health status, family relationships, living alone, financial problems, work ability, gender, age, marital status, and religion are significant predictors of elderly depressive symptoms. In particular, perceived health status, family relationships, and work ability were powerful predictors of depressive symptoms in Korean elderly. The total explanatory amount of the regression model was 28.7%.

CONCLUSIONS

This study suggests that researchers and clinicians should consider together factors associated with health status, interpersonal relationships, economic status, work, and socio-demographic variables in order to prevent elderly depression.

Depression in middle-aged and older first generation migrants in Europe: Results from the Survey of Health, Ageing and Retirement in Europe (SHARE)

Objective

To determine the prevalence of depression in migrants aged 50 years or older in comparison to residents without a history of migration in 11 European countries.

Methods and subjects

The Survey of Health, Ageing and Retirement in Europe (SHARE), a cross-national, multidisciplinary, household-based panel survey using nationally representative probability samples (n = 28,517) of 11 European countries of the non-institutionalized population aged 50 years and older. Depression was measured using the EURO-D scale, and odds ratios (OR) were estimated for migration status. Effects of sociodemographic variables, somatic comorbidities, functional impairment, cognitive function, geographic region, and time lived in current country of residence were assessed in multivariate logistic regression analysis.

Results

Adjusting for confounds, the OR for depression in migrants was 1.42 (95% CI, 1.28–1.59). The influence of migration status on the prevalence of depression was significantly greater in Northern (OR, 1.85; 95% CI, 1.39–2.46) and Western Europe (OR, 1.38; 95% CI, 1.22–1.57), compared to Southern Europe (OR, 1.16; 95% CI, 0.79–1.70) (p < 0.05 for the interaction).

Conclusion

We found a higher prevalence of depression in first-generation migrants aged 50 years or older, together with relevant geographical variation. This difference was not due to other known predictors of depression in older age.

Association between Childhood Suicidal Ideation and Geriatric Depression in Japan: A Population-Based Cross-Sectional Study

Adverse childhood experiences (ACEs) are assumed to increase the risk of depression in late life via development of poor mental health conditions; however, the association between mental distress in childhood and geriatric depression has not been directly examined. This study examined the association between childhood suicidal ideation and geriatric depression, using population-based, cross-sectional survey data from 1140 community-dwelling, functionally independent older adults in Wakuya City, Japan. We assessed childhood suicidal ideation by asking the participants whether they had seriously considered attempting suicide before the age of 18, together with geriatric depression, using the Japanese version of the 15-item Geriatric Depression Scale. Poisson regression was applied to adjust for potential confounders and mediators. In total, 6.1% of the participants reported childhood suicidal ideation. After adjustment for sex, age, personality attributes and ACEs, childhood suicidal ideation was positively associated with geriatric depression prevalence ratio [PR]: 1.40, 95% Confidence Interval (95%CI): 1.04-1.88). The increased PR of geriatric depression remained significant, even after further adjustment for adulthood socio-economic status, recent life stressors and current health status (PR: 1.38, 95%CI: 1.02-1.88). Further prospective studies are warranted, but efforts to deliver mental health services to children with suicidal ideation potentially diminish the highly prevalent geriatric depression.

Stability and transition of depression subtypes in late life

BACKGROUND

The heterogeneity of late-life depression hampers diagnosis and treatment. Data-driven methods have identified several subtypes of depression in older persons, but the longitudinal stability of these subtypes remains unknown.

METHODS

In total 111 older persons with a major depressive disorder both at baseline and 2-year follow-up from the Netherlands Study of Depression in Older persons (NESDO) were included. Latent class analysis was performed to identify subtypes of depression at baseline and at 2-year follow-up, and latent transition analysis was used to examine the stability of these subtypes over time. Transition rates between subtypes and characteristics of groups were examined.

RESULTS

Two subtypes were identified in both baseline (T0) and follow-up data (T1), including a 'melancholic' subtype (prevalence 80.2% (T0) and 62.2% (T1)), and an 'atypical' subtype (prevalence 19.8% (T0) and 37.8% (T1)). The melancholic subtype was characterized by decreased appetite and weight and had a stability of 0.86. The atypical subtype was characterized by increased appetite and weight and had a stability of 0.93, although the discriminating power of different symptoms had decreased at T1. Mean age and education differed significantly between stable and transitioning subgroups, other characteristics did not differ between subgroups.

LIMITATIONS

Limited sample size might have hampered the analyses.

CONCLUSIONS

Subtypes of late-life depression are relatively stable, but symptoms of depression (like weight loss) seem to blur with symptoms of (patho)physiological aging. This underlines the clinical relevance of depression subtyping, but also the importance of further research into subtypes and the influence of aging.

Biography work in in long-term residential aged care with tablet support to improve the quality of life and communication – study protocol for app development and evaluation / Biografiearbeit in Senioreneinrichtungen mit Tablet-Unterstützung zur Verbesserung der Lebensqualität und Kommunikation (BaSeTaLK) – Studienprotokoll zur App-Entwicklung und Evaluation

Background

Older adults in care facilities face a high risk of experiencing depression. The impact that early interventions like biographical work have on the quality of life for older adults in such facilities is unknown.

Aim

To develop and evaluate a tablet-supported intervention for biographical work in long-term residential aged care to increase the quality of life for older adults.

Design

The study will be conducted in a randomized pretest–posttest control group design with follow-up testing in group and single settings. Participants will be randomized to the experimental intervention (tablet-supported biographic work) or the control intervention (planned tablet-supported game playing), each guided by senior volunteers. A total of 80 residents and 16 volunteers will be recruited. The primary outcome for the residents and volunteers will be quality of life as measured with the World Health Organization Quality of Life Assessment-for older adults. Secondary measures will be self-esteem and life satisfaction. In addition, we will examine residents’ ability to communicate and their functional independence.

Method

The first stage of the project involves developing an app. The app is developed in a user-centered, agile development process. It will use multimedia to prepare life history topics and links them to key questions. Next, a workshop is developed for the volunteers who accompany the use of the app in the institutions. During the second phase, biographic work stimulated by the app will be conducted in groups or individually with residents.

Discussion

This is the first known program tailored to older adults in care facilities and senior volunteers that aims to prevent depression by providing digitally supported biographic work.

An Evaluation of the Clinical and Economic Burden Among Older Adult Medicare-Covered Beneficiaries With Treatment-Resistant Depression

OBJECTIVE

To compare the clinical and economic burden of treatment-resistant depression (TRD) among older adult patients with major depressive disorder (MDD) to non-TRD MDD and non-MDD patients.

METHODS

Retrospective cohort study using 5% Medicare data (January 1, 2012-December 31, 2015) for MDD patients aged ≥65 years who were defined as TRD if they received ≥2 antidepressant treatments in the current episode. MDD patients not meeting TRD criteria were deemed non-TRD MDD; those without an MDD diagnosis were categorized as non-MDD. All were required to have continuous health plan enrollment for ≥6 months pre- and ≥12 months postindex date (index: first antidepressant claim/random [non-MDD]). Three cohorts were matched, and generalized linear and Cox proportional hazards models were used to compare medication use, healthcare resource utilization, costs, and risks of initial hospitalization and readmission ≤30 days postdischarge from initial hospitalization.

RESULTS

After matching, 178 patients from each cohort were analyzed. During 12 months of follow-up, TRD patients had higher use of different antidepressants and antipsychotics, higher inpatient and emergency room visits, longer inpatient stays, and higher total healthcare costs ($24,543 versus $16,059, $8,058) than non-TRD MDD and non-MDD cohorts, respectively (all p <0.05). Risk of initial hospitalization was higher in the TRD (hazard ratio [HR] = 3.60, 95% confidence interval [CI] = 2.08-6.23) and non-TRD MDD cohorts (HR = 1.82, 95% CI = 1.02-3.25) than the non-MDD cohort.

CONCLUSIONS

The burden of MDD among older adult Medicare beneficiaries is substantial, and even greater among those with TRD compared to non-TRD MDD, demonstrating the need for more effective treatments than those currently available.

Air pollution is associated with depressive symptoms in elderly women with cognitive impairment

BACKGROUND

Studies on air pollution and depression in the elderly are limited and the results are heterogeneous.

OBJECTIVES

We examined the association of ambient air pollution exposure and diagnosis and symptoms of depression in the elderly; and whether any associations were confounded or modified by cognitive decline.

METHODS

We enrolled 821 elderly women from the German SALIA cohort (follow-up examination, 2007-2010). Self-reported depressive symptoms and level of cognition were evaluated using the CESD-R Scale and the CERAD-Plus test, respectively. We used two depression endpoints for analyses: self-reported doctor diagnosis of depression and frequency of depressive symptoms (CESD-R score). Long-term concentrations of particulate matter (PM) size fractions and nitrogen oxides (NO_x) modeled by land-use regression were assigned to home addresses. Cross-sectional associations were assessed using adjusted logistic and linear regression models.

RESULTS

Concentrations of coarse particles (PM_coarse), fine particles (PM_2.5 and PM_{2.5 abs}) and NO₂ were significantly associated with diagnosis of depression (e.g. for PM_2.5 OR = 1.62, 95%CI: 1.06, 2.46 and for NO₂ OR = 1.54, 95% CI: 1.08, 2.19). Similarly, an increase of one interquartile range in PM₁₀, PM_2.5, NO₂ and NO_x was associated with depressive symptoms assessed with the CESD-R score (e.g. for PM_2.5 16.2% difference in the mean; 95% CI: 5.8%, 26.5% and for NO₂ 14.5%; 95% CI: 4.8%, 24.2%). These associations were stronger in women with cognitive decline (e.g. Pint for PM_2.5:0.022 and NO₂:0.017) compared to women with normal cognition. In addition, living less than 100 m distance to major roads was significantly associated with diagnosis (OR = 1.99, 95% CI: 1.14, 3.47) and symptoms (19.7%; 95% CI: 4.3%, 35.1%) of depression. We did not observe any interaction effect of cognition on prior diagnosis of depression.

CONCLUSIONS

Exposure to air pollution was associated with diagnosis of depression and depressive symptoms in elderly women. Women with impaired cognition may be at greater risk of depressive symptoms when exposed to air pollution.

Adding life to years: Role of gender and social and family engagement in geriatric depression in rural areas of Northern India

Background:

Depression among elderly population is a major public health issue affecting nearly 5% to 7% of the world's elderly. In the coming years, a major share will be contributed by developing countries like India. In the rural areas of Allahabad district of Uttar Pradesh, there is scarce data on the depression.

Methodology:

A community-based cross-sectional study was conducted in rural Allahabad. A total of 411 elderly persons were selected from 2 blocks—Jasra and Bahadurpur—through multistage random sampling method. Short form of geriatric depression scale (GDS) was used to assess depression.

Results:

The prevalence of depression among elderly was 19.7%. On binary logistic regression, depression had significant association with female sex [aOR = 2.4, 95% CI 1.1–5.1], having less-than-good relationship with family members [aOR = 2.7, 95% CI 1.2–6.0], not being cared for during illness by family members [aOR = 3.9, 95% CI 1.2-12.9], not being involved in leisure time activities [aOR = 2.5, 95% CI 1.3–4.9], and not regularly meeting relatives and friends [aOR = 4.7, 95% CI 1.9–11.6].

Conclusions:

The prevalence of depression in elderly was high in rural areas of Allahabad. Female sex and social and family engagement are the important predictors of depression among them.

Association between social health status and depressive symptoms among community-dwelling elderly adults in Zhejiang Province, China

OBJECTIVE

Mental disorders of the elderly population in China deserve attention. Social health is significantly associated with depression. This study aimed to evaluate the rate of depressive symptoms and to test the relationships between social health and depressive symptoms among a large sample of community-dwelling elderly adults.

METHODS

We conducted a cross-sectional study among community-dwelling adults aged 60 years or above in Zhejiang Province, China. Face-to-face interviews were used to complete a structured questionnaire for all participants. We used the Social Health Scale for the Elderly (SHSE) to evaluate social health status and used the short form of the Geriatric Depression Scale to evaluate depressive symptoms. Multivariate logistic regression was used to evaluate the association between social health status and depressive symptoms.

RESULTS

Of the total of 3757 participants included, 1887 (50.23%) were female, and the mean±standard deviation (SD) age was (70.0±8.3) years. The rate of depressive symptoms was 25.92%. The social health score was higher in non-depressed participants than in depressed participants (raw score 50.7 vs. 48.3, P<0.001). Participants with "moderate" or "good" social health had a significantly lower risk of depressive symptoms than those with "poor" social health (odds ratio (OR)=0.55, 95% confidence interval (CI): 0.46-0.66 for moderate social health; OR=0.45, 95% CI: 0.35-0.60 for good social health). The association between social health and depressive symptoms was consistent across several subgroups.

CONCLUSIONS

Social health is significantly inversely associated with depressive symptoms. The SHSE may serve as an efficient screener to identify those elderly adults with social health deficits, but systematic assessment to guide intervention merits further investigation.

[Community pharmacists' and pharmacy technicians' attitudes and beliefs about depression in elderly]

OBJECTIVES

To analyze attitudes and beliefs of community pharmacists and pharmacy technicians about depression and treatment in older patients.

METHODS

A qualitative study was conducted with community pharmacists and pharmacy technicians. The first step of the study was to develop an interview guide to conduct semi-directive interviews. A thematic analysis was conducted based on the transcripts of the recording of audio interviews.

RESULTS

Eight pharmacists and 5 pharmacy technicians were included. The mean duration of semi-directive interviews was 14.8±4.6minutes. The main identified themes were as follows: 1/the depression: beliefs about depression and its risk factors in older patients; how to talk about depression with older patients at the counter; 2/the management of depression: how to talk about antidepressant with older patients at the counter, including treatment duration, dosage, efficacy and adverse effects of treatment, but also alternative therapies and advices; 3/barriers and facilitators of antidepressant adherence in older patients.

CONCLUSIONS

Barriers to conduct pharmaceutical care focusing on depression among older patients in community pharmacy have been identified: disease stigmatization, lack of privacy at the counter and lack of communication with the prescribing physician; but also a lack of knowledge concerning the specific therapeutic strategy for depression in the elderly. Thus, strengthening the pharmacy student teaching and the community pharmacist and pharmacy technician training regarding the posture to adopt and the therapeutic management of older patients with mental illness would be beneficial.

[Interaction of insomnia in old age and associated diseases : Cognitive, behavioral and neurobiological aspects]

The prevalence of insomnia is particularly high in old age. Sleep disturbances and impaired daytime functioning reflected in mood swings and concentration difficulties are often accompanied by other mental disorders such as depression. The objective of this article is to shed light on the role of insomnia in the context of frequent comorbidities in middle and old age. The focus is on the identification of linkage points between insomnia and associated diseases on a neurobiological level; however, possible distinguishing features are also named and deliberations on cognitive behavioral aspects and integrative theories, such as the hyperarousal theory are discussed. In order to provide an outlook for future research opportunities, the UK Biobank is presented as a promising resource of long-term data. Finally, the contents of the preceding deliberations are critically reflected and practical implications for the treatment of older patients with insomnia are derived.

No evidence for any effect of multiple sessions of frontal transcranial direct stimulation on mood in healthy older adults

The dorsolateral prefrontal cortex (DLPFC) is part of a network important for emotional regulation and the possibility of modulating activity in this region with transcranial direct current stimulation (TDCS) to change mood has gained great interest, particularly for application in clinical populations. Whilst results in major depressive disorder have been promising, less is known about the effects of TDCS on mood in non-clinical populations. We hypothesized that multiple sessions of anodal TDCS applied over the left DLPFC would enhance mood, primarily as measured by the Profile of Mood States questionnaire, in healthy older adults. In addition, in an exploratory analysis, we examined the potentially moderating role of working memory training. Working memory, just like emotional regulation, taxes the DLPFC, which suggests that engaging in a working memory task whilst receiving TDCS may have a different effect on activity in this region and consequently mood. A total of 123 participants between 65 and 75 years of age were randomly assigned to receive either 20 sessions of TDCS, with or without working memory training, or 20 sessions sham stimulation, with or without working memory training. We found no support for enhancement of mood due to TDCS in healthy older adults, with or without cognitive training and conclude that the TDCS protocol used is unlikely to improve mood in non-depressed older individuals.

Prevalence of Obsessive-Compulsive Symptoms in Elderly Parkinson Disease Patients: A Case-Control Study

BACKGROUND

The clinical picture of obsessive-compulsive disorder encompasses a broad range of symptoms that are related to multiple psychological domains, including perception, cognition, emotion, and social relatedness. As obsessive-compulsive symptoms (OCS) frequently have an early onset, there are limited data about OCS in older populations (≥65 years) and, in particular, in elderly subjects with Parkinson disease (PD).

OBJECTIVE

This study aimed to estimate the prevalence of OCS using a self-report measure (Obsessive-Compulsive Inventory-Revised) and to identify associated sociodemographic and clinical factors in a sample of elderly PD patients compared to a comparison group of similarly aged healthy volunteers.

RESULTS

The mean age was 74 ± 6 years in the PD patients and 73 ± 7 years in the comparison group. The mean disease duration was 9.6 ± 5.8 years. Among the PD patients, 30.7% reported at least one OCS or a related disorder compared to 21.1% in the comparison group. Hoarding was significantly more common in PD patients than in the comparison group.

CONCLUSIONS

Subclinical OCS were present at a high percentage in both PD patients and comparison group. The OCS phenotype in PD may present differently, as hoarding was more common in PD patients.

Depression but not frailty contributed to a higher risk for all-cause hospitalizations in male older veterans

INTRODUCTION

Frailty is a state of vulnerability to stressors resulting in higher morbidity, mortality, and utilization in older adults. Depression and frailty often coexist, suggesting a bidirectional relationship that may increase the effects of each individual condition on clinical outcomes and health-care utilization in older adults.

OBJECTIVE

To determine the effects of concurrent frailty and depression on all-cause hospitalizations.

METHODS/DESIGN

Prospective cohort study, conducted at a Veterans Affairs (VA) Medical Center. The participants were male, community-dwelling veterans 65 years and older. From 4 January through 30 December 2016, a 46-item frailty index was generated from data obtained from the VA electronic health record. Trained staff conducted in-depth reviews of electronic health records ascertaining depression status. Patients were followed through 31 December 2017 for all-cause hospitalizations following the initial assessment of frailty. After adjusting for covariates, the association of frailty and depression with all-cause hospitalizations was determined with the Andersen-Gill model, accounting for repeated hospitalizations.

RESULTS

Five hundred fifty-three male patients were part of the study, mean age 76.3 (SD = 8.2) years. One hundred eighty-one patients (32.7%) had depression diagnoses. During a median follow-up period of 530 days (interquartile range [IQR] = 245), 123 patients (22.2%) had 240 hospitalizations. Frailty status was not associated with future hospitalizations (adjusted hazard ratio [HR] = 1.61; 95% CI, 95-2.74; P > .05). Depression was associated with higher all-cause hospitalizations (adjusted HR = 1.57; 95% CI, 1.09-2.26); P = .0157).

CONCLUSIONS

Depression but not frailty was significantly associated with higher rates of all-cause hospitalization. Implementing interventions that target older adults with both frailty and depression may reduce the burden of both conditions and reduce hospitalizations.

A New Life Satisfaction Scale Predicts Depressive Symptoms in a National Cohort of Older Japanese Adults

BACKGROUND

Existing satisfaction measures cover general feelings of well-being among older adults, but it is not clear whether life satisfaction is associated with depressive symptoms that decrease psychological well-being. We developed a new life satisfaction scale to assess the associations of health, social factors, and interpersonal relationships with overall life satisfaction. The structural and predictive validity of the scale regarding the onset of depressive symptoms was examined.

METHODS

A 13-item questionnaire was developed based on a literature review. The response options for all of the questions were: 1 = poor, 2 = not very good, 3 = good, and 4 = excellent. For the analysis, a total satisfaction score was calculated by summing the individual scores (range = 13-52), and higher scores indicated higher overall satisfaction. Baseline data were obtained using the Geriatric Depression Scale-Short Form with a 30-month follow-up. Older Japanese adults (n = 1,792, mean age 70.1 ± 6.3 years, 46.4% male) participated in both surveys. An exploratory factor analysis and a logistic regression analysis were used to verify the construct and predictive validity.

RESULTS

In the exploratory factor analysis, a four-factor structure consisting of Personal Satisfaction, Societal Satisfaction, Community Satisfaction, and Health Satisfaction explained 63% of the total variance, with factor weights between 0.42 and 0.90, and internal reliability was acceptable (Cronbach's alpha = 0.86). About 13.8% of the sample was identified as having depressive symptoms during the follow-up period. The Youden index determined the cutpoints regarding the development of depressive symptoms identified by the life satisfaction scale as 39 points. The participants were classified as high life satisfaction (60%, n = 1,068) or low life satisfaction (40%, n = 724). The logistic regression analysis revealed that the scale (cutpoint at 39 points) predicted depressive symptoms while controlling for the effects of other relevant variables (OR = 5.14, 95% Confidence Interval 3.76-7.04, p < 0.001). The relative risk of the low life satisfaction group for developing depressive symptoms compared to the high life satisfaction group was 2.39.

CONCLUSIONS

The 13-item questionnaire is a valid instrument for measuring the risk of depressive symptoms in older adults.