The prevalence and outcome of depression and dementia in Botany's elderly population

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

BACKGROUND

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

FINDINGS

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

CONCLUSIONS

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

Identification of depressive disorder among older people in care homes - a feasibility study

BACKGROUND

Depression is common among older people but more common among those living in care homes. Depression is not easily detected among older adults because of the presentation, and the tendency for older people not to complain of depression, particularly those living in care homes. In general, care home staff have limited training in recognising depression. Depression is undertreated and residents may not receive a therapeutic dose of antidepressant. The true prevalence of depression among care home residents is uncertain.

METHOD

This feasibility study aimed to explore the level of depression among older people in care homes by comparing the outcome of an assessment by care home staff with the outcome of a diagnostic clinical interview, using ICD-10 criteria and the 30-item Geriatric Depression Scale (GDS), conducted by a psychiatrist.

RESULTS

In all, 47 older people from four care homes were interviewed by a psychiatrist. Of them, 39.1% (18/46) of residents were prescribed an antidepressant and were no longer depressed; 8.7% (4/46) were prescribed an antidepressant and remained depressed; and 6.5% (3/46) of residents assessed as being depressed, had not been prescribed an antidepressant. That is, 54% (25/46) of residents had been or were currently depressed. Using ICD-10 criteria, the sensitivity of the GDS at a threshold of 10 and 11 was 100%. In total, 89.4% of residents received a correct diagnosis (presence or absence of depression) using the GDS at the 11 threshold.

SUMMARY

The prevalence of depression in these homes was 54%. Of the residents with depression, 72% (18/25) were managed with an antidepressant and 28% (7/25) were receiving ineffective or no treatment. The 30-item GDS can provide more useful information than a home care staff assessment for identifying depression. More research should explore the value of training home care staff to administer the 30-item GDS to optimise the management of depression in older people in care homes.

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.

Depression among newly admitted Australian nursing home residents

BACKGROUND

This research concerns the prevalence and course of depression in newly admitted nursing home residents. We attempted to recruit consecutive admissions into the study, irrespective of cognitive status, enabling a comparison of the prevalence and course of depression experienced by cognitively intact residents and those exhibiting all levels of cognitive impairment.

METHOD

Depression was assessed at one month, three months and six months post-admission. The assessment of mood in this study entailed the conduct of a semi-structured clinical interview, which encompassed DSM-IV criteria and Cornell Scale for Depression in Dementia (CSDD) items.

RESULTS

Recruitment difficulties resulted in a sample of 51 newly admitted residents, drawn from six nursing homes located in Victoria, Australia. Of particular interest, throughout the duration of the study, only the cognitively impaired were diagnosed with major depression (MD). One month post-admission, 24% of the sample were diagnosed with MD, and a further 20% evidenced a non-major depressive disorder. At the second and third assessments, MD was observed in 14% and 15% of residents, respectively. For residents who completed all three assessments, there was no appreciable change in the proportion diagnosed with a depressive disorder, nor was there a change in the levels of depressive symptomatology.

CONCLUSION

Although subject to limitations, the current study indicated that clinical depression in nursing home facilities most often occurs in residents who also exhibit pronounced cognitive impairment. These depressions are unlikely to remit spontaneously. Accordingly, care staff and general practitioners must be trained in the identification of depression in dementia, and any interventions implemented in these facilities should be tailored to meet the unique needs of this group.

Recognising depression in residential facilities: an Australian challenge

BACKGROUND

Depression in aged care facilities (ACFs) is reportedly under-recognised and under-treated. Observer-rated and self-rated depression rating scales can help identify cases of depression, and could be used to estimate the prevalence of depression in ACFs.

METHOD

Direct care staff in 168 ACFs used a survey form and administered the Cornell Scale for Depression in Dementia (CSDD) and (in those able to be tested) the 15-item Geriatric Depression Scale (GDS-15) to every fourth resident. In seven facilities the same subjects were clinically assessed and (where appropriate) diagnosed by a psychiatrist.

RESULTS

Survey forms and CSDD ratings were completed by staff concerning 91.6% of the one-in-four selected subjects. Their mean age was 82.1 years. CSDD scores of 8 or more, indicating depression, were recorded for 34.7% of the ACF residents, comprising 40.5% of the 1,084 high care (nursing home level) residents, and 25.4% of the 674 low care residents. Of 1,250 residents tested with the GDS-15, 41.1% scored 6 or more, indicating depression. The correlation between GDS-15 and CSDD scores was 0.6. Use of the survey tool allowed staff to identify which factors were most strongly associated with depression, the strongest being grief over loss of abilities and opportunities to participate in valued activities.

CONCLUSIONS

The CSDD (and the GDS-15 in those without severe cognitive impairment) proved useful in identifying residents who were depressed. Survey questions helped draw attention to factors of importance in development or persistence of these depressions, and hence to strategies for intervention.

Prevalence and risk factors for depression in a longitudinal, population-based study including individuals in the community and residential care

OBJECTIVE

The authors report the population prevalence of depression in older adults living in the community and in residential care. Demographic, medical, health behavior, functional and cognitive measures, and transition to residential care are evaluated as risk factors for depression over eight years.

METHODS

Depression prevalence estimates were obtained from the initial electoral role sample of the Australian Longitudinal Study of Ageing that included persons living in residential care. A subsample (N = 1,116) based on follow-up data were included in longitudinal multilevel analyses that evaluated between-person and within-person predictors associated with scores from the Center for Epidemiology-Depression Scale.

RESULTS

At wave 1, 14.4% of community-dwelling and 32.0% of residential care-dwelling participants were depressed (15.2% of total cases). Increase in depression was associated with antidepressant status, sex, education, and marital status, but not history of hypertension, stroke, diabetes, heart disease, or smoking. Time-varying predictors, including residential care, activities of daily living, instrumental activities of daily living, self-rated health, and Mini-Mental State Examination, predicted depressive symptoms both between and within persons.

CONCLUSIONS

Depression is strongly linked with factors indicating increased dependency. Risk assessment and targeting of intervention strategies to prevent depression in late life should incorporate changes in functional capacity, mental status, and need for residential care.

Depression among older people with cognitive impairment: prevalence and detection

BACKGROUND

Past research has demonstrated that there is a high level of depression among older people, particularly for those with cognitive impairment and those in residential care. The current study was designed to determine the prevalence of depression among older people in hostels with cognitive impairment using a structured diagnostic interview. A further aim was to determine an appropriate screening instrument to detect depression within this population. It was also designed to evaluate the extent to which depression among these older people had previously been detected.

METHOD

Five commonly used depression scales were administered and compared to the results of the diagnostic interview.

RESULTS

The results demonstrated that 38.9% of older people were diagnosed with depression, but that only 50% of these people had been previously diagnosed with this disorder. All scales showed some level of validity to detect depression.

CONCLUSIONS

The implications of these findings for our understanding of depression among older people with cognitive impairment are discussed.

Sydney multicenter study of Parkinson's disease: Non‐ L ‐dopa–responsive problems dominate at 15 years

One-third of the 149 people recruited 15 to 18 years ago in the Sydney Multicenter Study of Parkinson's disease have survived. The original study compared low-dose levodopa with low-dose bromocriptine. We now report the problems experienced by people who survive 15 years from diagnosis. The standardized mortality ratio is significantly elevated at 1.86 and is not significantly different between treatment arms. Falls occur in 81% of patients, and 23% sustained fractures. Cognitive decline is present in 84%, and 48% fulfill the criteria for dementia. Hallucinations and depression are experienced by 50%. Choking has occurred in 50%, symptomatic postural hypotension in 35%, and urinary incontinence in 41%. No patient is still employed, and 40% of patients live in aged care facilities. Although approximately 95% have experienced L-dopa-induced dyskinesia/dystonia and end of dose failure of medication, in the majority, these symptoms are not disabling. Dyskinesia and dystonia were delayed by early use of bromocriptine, but end-of-dose failure appeared at a similar time once L-dopa was added. The rate of disease progression is similar in both arms of the study. We conclude that the most disabling long-term problems of Parkinson's disease relate to the emergence of symptoms that are not improved by L-dopa. Neuroprotective interventions in Parkinson's disease should be judged by their ability to improve non-L-dopa-responsive aspects of the disease, rather than just by their capacity to delay the introduction of L-dopa or reduce its associated side effects.

How high is the prevalence of depression in old age?

Depressive symptoms are highly prevalent in late life - in Brazil and around the world. Some experts have argued that depression is less common in old age, quoting studies that show a lower prevalence of major depression in late life. Results from cross-age studies have been remarkably inconsistent, both regarding which age-group has the peak rate and regarding actual rates. A majority of surveys of the prevalence of depressive conditions in old age (not just major depression), warranting clinical interventions, report it to be over 10%. Physical ill-health is the most significant associated factor, but it may distract doctors from recognising depression. Clinical interventions for late life depression are worthwhile. It is recommended that funding be allocated to training in assessment and management, environmental initiatives to counter feelings of helplessness and lowered self-esteem, and research.