Depressive symptoms among older adults in Mexico City

Associations of the 'weekend warrior' physical activity pattern with mild dementia: findings from the Mexico City Prospective Study

OBJECTIVES

To investigate associations of the 'weekend warrior' physical activity pattern with mild dementia.

METHODS

Participants in the Mexico City Prospective Study were surveyed from 1998 to 2004 and re-surveyed from 2015 to 2019. Participants were asked about leisure time physical activity at baseline. Those who exercised up to once or twice per week were termed 'weekend warriors' and those who exercised more often were termed 'regularly active'. A Mini Mental State Examination (MMSE) was used to assess mild dementia at re-survey. Cox models were adjusted for age, sex, education, income, blood pressure, smoking, body mass index, civil status, sleep, diet and alcohol at baseline. The attributable fraction was defined as the proportion of cases that would not exist if all adults were to exercise once or twice per week or more often.

RESULTS

The analysis included 10 033 adults of mean (SD) age 51 (10) years followed for 16 (2) years. There were 2400 cases when mild dementia was defined as a score of ≤22 on the MMSE. Compared with the group that reported no sport or exercise, the hazard ratio was 0.75 (95% CI 0.61 to 0.91) in the weekend warrior group, 0.89 (95% CI 0.78 to 1.02) in the regularly active group and 0.84 (95% CI 0.75 to 0.95) in the combined group. The attributable fraction was 13% (95% CI 5% to 21%). Similar results were observed when mild dementia was defined as a score of ≤23 on the MMSE.

CONCLUSIONS

This longitudinal analysis suggests that the weekend warrior physical activity pattern is associated with a reduced risk of mild dementia.

Demographic, socioeconomic and health determinants of depressive symptoms in adults 50 years and older from Mexico: a secondary data longitudinal analysis from the Mexican Health and Aging Study

BACKGROUND

Depression in ageing adults is a public health problem. Worldwide studies have identified social and health risk factors for depressive symptoms. However, little is known about their longitudinal determinants in Mexico.

OBJECTIVES AND SETTING

To find the prevalence of depressive symptoms and their longitudinal individual and contextual risk factors in Mexican adults aged 50 and older.

DESIGN

Secondary data of 6460 persons aged 50 years and older from the Mexican Health and Aging Study were analysed using a 'between-within' panel data analysis approach.

RESULTS

The prevalence of depressive symptoms increased from 35% in 2003 to 38% in 2015. The significantly longitudinal factors associated with these symptoms were getting older (OR 1.02, 95% CI 1.01 to 1.03), being a woman (OR 2.39, 95% CI 2.16 to 2.64), less time spent in formal education (0 years and less than 6 years OR 1.52, 95% CI 1.32 to 1.75 and OR 1.33, 95% CI 1.19 to 1.50, respectively), lower net worth (OR 1.13, 95% CI 1.08 to 1.17), being recently unemployed (OR 1.25, 95% CI 1.10 to 1.25), increased (OR 1.17, 95% CI 1.10 to 1.25) or increasing number (OR 1.23, 95% CI 1.15 to 1.31) of chronic conditions, poor (OR 4.68, 95% CI 4.26 to 5.15) or worsened (OR 1.71, 95% CI 1.61 to 1.81) self-rated health and having impairments on instrumental activities of daily living (IADLs) (OR 2.94 95% CI 2.35 to 3.67) or a new IADL impairment (OR 1.67, 95% CI 1.48 to 1.89), as well as having impairments on ADLs (OR 1.51, 95% CI 1.23 to 1.86) or a new ADL impairment (OR 1.34, 95% CI 1.21 to 1.48).

CONCLUSIONS

The prevalence of depressive symptoms in Mexican adults aged 50 and older is high. Our findings show that they are longitudinally associated with the individual's demographic, socioeconomic, health and disability characteristics. Efforts in public policy should focus on preventing chronic conditions and disability, as well as fighting inequalities to reduce the prevalence of depressive symptoms.

The prevalence and correlates of depression among older adults in greater kumasi of the ashanti region

BACKGROUND

Approximately two million Ghanaians suffer from mental disorders including depression. The WHO defines it as an illness characterized by constant sadness and loss of interest in activities that a person usually enjoys doing and this condition is the leading cause of mental disorders; however, the burden of depression on the aged population is fairly unknown. A better appreciation of depression and its predictors is necessary to design appropriate policy interventions. Therefore, this study aims to assess the prevalence and correlates of depression among older people in the Greater Kumasi of the Ashanti region.

METHODS

A cross-sectional study design with a multi-stage sampling approach was employed to recruit and collect data from 418 older adults aged 60 years and above at the household level in four enumeration areas (EAs) within the Asokore Mampong Municipality. Households within each EAs were mapped and listed by trained resident enumerators to create a sampling frame. Data was collected electronically with Open Data Kit application over 30 days through face-to-face interaction using the Geriatric Depression Scale (GDS). The results were summarized using descriptive and inferential statistics. A multivariable logistics regression using a forward and backward stepwise approach was employed to identify the predictors of depression in the study sample. All analyses were performed using STATA software version 16, and the significance level was maintained at a p-value < 0.05 and presented at a 95% confidence interval.

RESULTS

The study achieved a response rate of 97.7% from the estimated sample size of 428 respondents. The mean age was 69.9 (SD = 8.8), and the distribution was similar for both sexes (p = 0.25). The prevalence of depression in this study was 42.1% and dominated by females, older adults (> 80 years), and lower economic class respondents. The rate was 43.4% for both consumers of alcohol and smokers with a history of stroke (41.2%) and taking medication for chronic conditions (44.2%). The predictors of depression in our study were being single, low class [aOR = 1.97; 95% CI = 1.18-3.27] and having other chronic conditions [aOR = 1.86; 95% CI = 1.59-4.62], and the inability to manage ones' own affairs [aOR = 0.56; 95% CI = 0.32-0.97].

CONCLUSION

The study provides data that can inform policy decisions on the care of the elderly with depression in Ghana and other similar countries, confirming the need to provide support efforts towards high-risk groups such as single people, people with chronic health conditions, and lower-income people. Additionally, the evidence provided in this study could serve as baseline data for larger and longitudinal studies.

Global prevalence of depression in older adults: A systematic review and meta-analysis of epidemiological surveys

BACKGROUND

The reported prevalence of depressive symptoms (depression hereafter) among older adults varied widely across different studies. This was a meta-analysis to systematically examine the global prevalence of depression among older populations and its associated factors.

METHODS

A systematic literature search was performed in PubMed, EMBASE, PsycINFO, and Web of Science. Due to the differences in demographic and clinical characteristics between studies, random-effects model was used to calculate the pooled prevalence of depression and its 95% confidence interval (95% CI).

RESULTS

In total, 55 studies with 59,851 individuals met the study criteria and were included in the analyses. The overall prevalence of depression was 35.1% (95%CI: 30.2-40.4%). Subgroup analyses revealed that different sampling methods (Q=10592.49, p = 0.037), Geriatric Depression Scale versions (Q=13712.55, p < 0.001) and income levels (Q=14.028, P < 0.001) were significantly associated with the pooled prevalence of depression in older adults. In the meta-regression analyses, time of survey (B=0.012, z = 2.30, p = 0.029) was positively associated, and mean age (B=-0.018, z = 2.10, p = 0.044) was negatively associated with the prevalence of depression in older populations. The funnel plot and Egger's test did not reveal any significant publication bias (Egger's test: t = 1.93, p = 0.059).

CONCLUSION

This meta-analysis found that over a third of older populations globally had depression. Effective preventive measures, regular screening and timely interventions are needed to address this highly prevalent public health problem among older adults.

Prevalence and Factors Associated With Elder Abuse in Community-Dwelling Elderly in Korea: Mediation Effects of Social Support

OBJECTIVE

The objectives of this study were to investigate the factors associated with elder abuse and the mediation effects of social support in a community-dwelling elderly population in Korea.

METHODS

This study analyzed a dataset of 10,674 individuals aged 65 years and older in Korea. Data were reviewed from a study conducted by the Korea Institute for Health and Social Affairs in 2011.

RESULTS

In our study, 12.6% of the elderly reported elder abuse, and 29.2% reported having depression (a score ≥8 on the short version geriatric depression scale). Our results revealed that younger age, low economic status, poor social support (odds ratio [OR]=1.448) and depression (OR=2.039) were significantly associated with elder abuse after controlling for all confounding factors. In addition, mediation analysis showed that the OR for depression was reduced from 2.124 to 2.039 after social support was controlled, which indicates that the association between depression and elder abuse is partially mediated by social support.

CONCLUSION

Depression and lack of social support were associated with abuse in community-dwelling Korean elderly. In particular, social support was revealed to buffer the association between depression and elder abuse.

Exploring grip strength as a predictor of depression in middle-aged and older adults

Grip strength (GS) is an indicator of health and vulnerability and inversely associated with depressive symptoms. The aim of this study was to explore GS discrimination capacity for depression; and possible GS cut-off values for depression by sex and age group. Data from 2011 and 2015 on 20,598 (10,416 women) middle-aged and older adults from 14 European countries was analysed. GS was assessed by dynamometer, and depressive symptoms using the EURO-D scale. GS cut-off values for depression were calculated and logistic regression models were used to quantify the odds of having depression in 2011 and in 2015 according to being bellow or above the cut-off value. GS had a weak discriminant capacity for depression, with the area under the curve varying between 0.54 and 0.60 (p < 0.001). Sensitivity varied between 0.57 and 0.74; specificity varied between 0.46 and 0.66. GS cut-off values for discriminating depression were 43.5 kg for men and 29.5 kg for women aged 50–64 years, 39.5 kg for men and 22.5 kg for women aged ≥ 65 years. Having GS above the cut-off represents significant lower odds of depression in 2011 and 4 years later, in 2015. Healthcare practitioners and epidemiologic researchers may consider the low GS cut-off values to screen for potential depression risk. However, due to its weak discriminant values these cut-offs should not be used to identify depression.

Mediterranean diet adherence is associated with better cognitive status and less depressive symptoms in a Greek elderly population

PURPOSE

To evaluate the Mediterranean diet (MD) adherence of an elderly Greek population, and its association with the grade of cognitive decline and psychological status.

METHODS

Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Mediterranean diet score (MedDietScore) questionnaires were used to assess the impact of MD adherence on cognitive abilities and psychological state of a Greek elderly population.

PARTICIPANTS

2092 men and women over 65 years old (mean age 74.97 ± 8.41 years) from seven different Greek cities RESULTS: 34.4% of the study population showed cognitive impairment, while 32.3% of the participants had depressive symptoms. More than half of the participants (52.1%) showed very low or low MD adherence. Higher MD adherence was significantly associated with better MMSE and GDS scores. Moreover, higher MD adherence was significantly associated with younger age, female gender, higher educational level, and better anthropometric parameters. MD adherence was independently associated with cognitive and psychological status, and gender after adjustment for potential confounders.

CONCLUSION

Higher MD adherence is strongly associated with better cognitive status and less depressive symptomatology. Public health policies are recommended to focus on the promotion of the MD, as a crucial strategy to reduce the risk of cognitive impairment and depression.

Longitudinal relationship of diabetes and depressive symptoms in older adults from Mexico: a secondary data analysis

INTRODUCTION

Several studies have argued a causal relationship between diabetes and depression, while others have highlighted that their association is a result of common risk factors. Because Mexico is a country with a high prevalence of diabetes, and diabetes and depression are a frequent comorbidity, we chose this country to investigate the longitudinal relationship of these two conditions, focusing on the influence of demographic, health, and socioeconomic factors which could act as common risk factors for both conditions.

RESEARCH DESIGN AND METHODS

Using the harmonized Mexican Health and Aging Study, a nationally representative sample of adults older than 50 with a response rate of 93%, we analyzed the longitudinal relationship of diabetes and depressive symptoms using 'between-within' random-effects models, focusing on the effect of demographic, socioeconomic and health factors.

RESULTS

While older adults with diabetes reported a higher prevalence of depressive symptoms in the four waves of the study, there was no causal longitudinal association between them once controlling for demographic, socioeconomic and health factors (between-effect OR=0.88, 95% CI 0.77 to 1.01; within-effect OR=0.87, 95% CI 0.69 to 1.11).

CONCLUSIONS

There is no causal longitudinal association between diabetes and depression; the higher prevalence of depression among older adults with diabetes seems a result of socioeconomic and health factors that are not exclusive to respondents with diabetes but are more frequent in this group. Our results highlight the importance of prevention and control of chronic conditions as well as the role of socioeconomic inequalities in mental health.

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.

Multidimensional dependency subgroups in community-dwelling older adults: A latent class analysis

OBJECTIVES

Use latent class analysis (LCA) to identify patterns of multidimensional dependency in a sample of older adults and assess sociodemographic, predictors of class membership.

MATERIAL AND METHODS

Longitudinal data were used from the Mexican Health and Aging Study (MHAS). 7,920 older adults, 55% women, were recruited. LCA were used to identify meaningful subgroups. LCA was conducted using MPlus version. The final class model was chosen based on the comparison of multiple fit statistics and theoretical parsimony, with models of increasing complexity analyzed sequentially until the best fitting model was identified. Covariates were incorporated to explore the association between these variables and class membership.

RESULTS

Three classes groups based on the nine indicators were identified: "Active older adults" was comprised of 64% of the sample participants, "Relatively independent" and "Physically impaired" were comprised of 26% and 10% of the sample. The "Active older adults" profile comprised the majority of respondents who exhibited high endorsement rates across all criteria. The profiles of the "Active older adults" and "Relatively independent" were comparatively more uniform. Finally, respondents belonging to the "Physically impaired" profile, the smallest subgroup, encompassed the individuals most susceptible to a poor dependency profile.

CONCLUSIONS

These findings highlighted the usefulness to adopt a person-centered approach rather than a variable-centered approach, suggesting directions for future research and tailored interventions approaches to older adults with particular characteristics. Based on patterns of multidimensional dependency, this study identified a typology of dependency using data from a large, nationally representative survey.

Late life depressive symptoms and cognitive function among older Mexican adults: the past and the present

Objective: To evaluate associations between depression and individual cognitive domains and how changes in depressive symptoms relate to cognition three years later in the context of Mexico, a developing country experiencing rapid aging.Method: Data comes from the 2012 and 2015 waves of the Mexican Health and Aging Study (n = 12,898, age 50+). Depression is ascertained using a modified Center for Epidemiologic Studies - Depression Scale. Cognition is assessed using verbal learning, verbal memory, visual scanning, verbal fluency, visuospatial ability, visual memory, and orientation tasks. Depressive symptoms and cognitive functioning were both measured in 2012 and 2015. Scores across cognitive domains are modeled using ordinary least squares regression, adjusting for demographic, health, and economic covariates.Results: When depression and cognition were measured concurrently in 2015, depression exhibited associations with all cognitive domains. When considering a respondent's history of depression, individuals who had elevated depressive symptoms in 2012 and recovered by 2015 continued to exhibit poorer cognitive function in 2015 in verbal learning, verbal memory, visual scanning, and verbal fluency tasks compared to individuals who were neither depressed in 2012 nor 2015.Conclusions: Depression was associated with cognition across cognitive domains among older Mexican adults. Despite improvements in depressive symptomatology, formerly depressed respondents continued to perform worse than their counterparts without a history of depression on several cognitive tasks. In addition to current mental health status, researchers should consider an individual's history of depression when assessing the cognitive functioning of older adults.

Effects of protective factors on the depressive status of elderly people in Taiwan

This study was conducted to examine the effect of protective factors on the relationship between crisis episodes and depression in the elderly population in Taiwan.In this study, the Taiwan Longitudinal Study on Aging was used as basis for a cross-sectional secondary data analysis. After eliminating respondents below the age of 65 years and those with missing values, 2426 samples were collected. Predictive variables, such as crisis episodes, personal resources, family ties, social participation, and social support, were investigated, and the dependent variable of "depression status" was measured using the Center for Epidemiologic Studies Depression scale.According to the results of regression analysis, the protective factors of self-assessed health (ß = -0.290, P < .001), instrumental support (ß = -0.153, P < .001), financial satisfaction (ß = -0.126, P < .001), emotional support (ß = -0.101, P < .001), crisis episodes (ß = 0.087, P < .001), support satisfaction (ß = -0.081, P < .001), leisure participation (ß = -0.053, P < .05), family ties (ß = -0.048, P < .05), and community participation (ß = -0.042, P < .05) had a significant effect on depression status. Moreover, leisure participation had a moderating effect on the relationship between crisis episodes and depression (ß = -0.07, P < .01). In addition, according to path analysis results, family ties had a significant negative predictive power on depression (β = -0.225, P < .001), as did social support (β = -0.978, P < .001). The predictive power of crisis episodes on depression through social support was 0.197 (-0.201 × -0.978 = 0.197, P < .001), and it was -0.324 (-0.331 × -0.978 = -0.324, P < .001) through social participation, which indicated that social support plays a mediating role between crisis episodes and depression and between social participation and depression.Strengthening effective protective factors can improve the resilience of elderly people and enable them to cope with dilemmas rapidly and effectively when faced with crisis episodes as well as restore their health status and enjoy a satisfactory life.

Marital Power and Depressive Symptoms among Older Mexican Adults

An extensive body of research documents marital status differences in health among older adults. However, few studies have investigated the heterogeneity in depressive symptomatology among older married adults living in developing countries. Our study investigates the interplay of gender and marital power dynamics for mental health among older Mexican adults. Our sample includes older married couples in the 2015 Wave of the Mexican Health and Aging Study (n=3,621 dyads). We use seemingly unrelated regression to model the association between self-reported distributions of decision-making power within marriages and depressive symptoms for husbands and wives. For approximately 41 per cent of couples, the husband and wife both reported an equal distribution of power in the marriage. Compared to those who reported an equal power distribution, husbands and wives who reported an imbalance of power (having more power or less power than their spouse) reported more depressive symptoms. Levels of depressive symptoms were higher in marriages characterised by an unequal balance of power. The relationship between equality in power and depressive symptoms is not explained by health care needs or living arrangements. Marital quality is an important factor for understanding depressive symptoms among older Mexican adults.

Factors associated with healthy aging in septuagenarian and nonagenarian Mexican adults

OBJECTIVE

To examine the factors associated with healthy aging in a cohort of Mexican adults after a follow-up of 14 years.

STUDY DESIGN

Participants were part of a prospective cohort of the Mexican Healthy Aging Study (MHAS), from which we included 5142 individuals aged 63 years or more.

MAIN OUTCOME

Healthy aging, defined as reaching age 77 or 90 without major chronic conditions or physical limitations.

MEASURES

Information on age, education, marital status, smoking, alcohol consumption, physical activity, self-perceived depression, health conditions and history of age-related diseases was collected at baseline and follow-up.

RESULTS

Among the overall cohort, 57.8% experienced healthy survival to age 77 and 42.2% had died before age 77 or were undergoing normal aging. Participants with long-lived parents and who exercised had a lower risk of being non-healthy agers. Being overweight, obese or a smoker increased the risk of being a non-healthy ager. Physically active participants had increased odds of healthy aging at age 77 (OR: 1.17; 95% CI: 1.01-1.46) and at age 90 (OR: 1.5; 95% CI: 1.01-2.24). Depression had a negative relationship with healthy aging at age 90 (OR: 0.66; 95% CI: 0.45- 0.97). Maternal longevity was associated with healthy aging only at age 77 (OR = 1.34; 95% CI: 1.04-1.72).

CONCLUSIONS

Our findings support the view that a combination of genetic and behavioral factors is associated with healthy aging. In accordance with findings in Caucasian populations, our data suggest for the first time that there might also be a genetic determinant for healthy ageing in Latin Americans.

The impact of poor oral health on the oral health-related quality of life (OHRQoL) in older adults: the oral health status through a latent class analysis

Background

Determine the impact of poor oral health on the oral health-related quality of life (OHRQoL) in community-dwelling older adults.

Methods

Cross-sectional study of community-dwelling older adults in Mexico City. Sociodemographic characteristics were obtained and assessed their OHRQoL according to the Geriatric/General Oral Health Assessment Index (GOHAI). Clinical evaluation of their oral health: painful chewing, use of dentures, dry mouth, xerostomia, plaque, calculus, coronal and root caries, tooth loss and gingival bleeding. Finally, we determined the oral health of participants through Latent Class Analysis (LCA), excluding totally edentulous. The strength of association was determined (Odds Ratio [OR] and 95% confidence interval [95% CI]) through logical regression between the oral health categories (latent classes) and OHRoL in older adults, adjusted with the other variables included in the study: age, sex, marital status, living arrangements (lives alone), educational level, paid work status, comorbidity, cognitive deterioration, depression and use of medical and dental services in the previous 12 months.

Results

The mean (SD) GOHAI score for the 228 older adults to 46.5 (8.7), number of classes to characterize oral health through LCA was three (entropy 0.805). The GOHAI mean for Class 3 (57.0%), acceptable oral health was 50.1 (7.1); totally edentulous (9.6%), 47.9 (8.4); for Class 2 (16.7%), regular oral health, 43.8 (9.3); and for Class 1 (16.7%), poor oral health, 42.2 (9.7). Significant differences were observed among means (p < .001). Using Class 3 an as a reference, the strength of association between the GOHAI scores and low OHRQoL (GOHAI 25th percentile = 24.0) was OR = 0.7, 95% CI = 0.2–3.3 for totally edentulous; OR = 3.0, 95% CI = 1.2–7.6 for Class 2 and OR = 5.0, 95% CI = 2.1–12.1 for Class 1.

Conclusion

Poor oral health was associated with a negative impact on the OHRQoL of community-dwelling older adults.

Clinical relevance

It is essential to design and implement oral health care policies specifically targeted at improving the quality of life in this older adult population.

Migration and Mental Health in Mexico: Domestic Migrants, Return U.S. Migrants, and Non-Migrants

In this paper, we use survey data from the Mexican Retrospective Demographic Survey (Encuesta Demográfica Retrospectiva) and National Survey of Households (Encuesta Nacional de Hogares) collected in 2017 to examine self-reports of depression, anxiety, chronic fatigue, and pain among domestic migrants, returned U.S. migrants, and non-migrants. Although self-reports do not always correspond to clinical diagnoses, they offer some insight into mental health, especially for those without a diagnosis because of limited access to services or stigma. Regression results reveal that domestic migrants, e.g., those who moved within Mexico, reported more anxiety, chronic fatigue, and pain, but risks for U.S. migrants were comparable to non-migrants, controlling for other characteristics. Findings from the decomposition analysis helps explain these findings. While domestic migrant vs. non-migrant differences result both from different migrant demographic attributes, such as age and gender, and differences in the effects of these characteristics between the groups, U.S. migrant vs. non-migrant differences in anxiety and pain emerge only after allowing for the relationship between each observed characteristic and the mental health outcome to vary. Thus, compared to domestic migrants, U.S. migrants are selected on characteristics associated with good mental health-they are positively selected-but those characteristics are not protective for them.

Association Between Depression and Elder Abuse and the Mediation of Social Support: A Cross-Sectional Study of Elder Females in Mexico City

OBJECTIVE

We assessed the association between depression and elder abuse, and the mediation effect of social support among elder women in Mexico City.

METHOD

A total of 526 noninstitutionalized elder women, residing in Mexico City and attending public community centers were selected. Logistic regressions and structural equation models (SEM) were estimated.

RESULTS

One fifth of the elderly women were at risk of depression, one third suffered some type of abuse in the past 12 months, and 82% reported low social support. Logistic models confirmed that depression was statistically associated with elder abuse and vice versa (odds ratio [OR] = 1.97 and 1.96, respectively). In both models, social support significantly reduced the association between these variables leading to study these associations through SEM. This approach highlighted that social support buffers the association between depression and elder abuse.

DISCUSSION

Findings underline the relevance of programs and strategies targeted at increasing social support among urban older adults.

Lifetime Socioeconomic Status and Late-life Health Trajectories: Longitudinal Results From the Mexican Health and Aging Study

Objective

This article examines the association between childhood and adult socioeconomic status (SES) and late-life health trajectories for older adults in Mexico.

Method

Data are from the Mexican Health and Aging Study, a panel survey that began with a nationally representative sample of Mexican adults 50 years and older at baseline (2001), with follow-up in 2003 and 2012. We use a hierarchical repeated measures model to estimate the relationship between SES and depressive symptoms, functional limitations, and self-rated health, respectively. We tested both discrete measures of SES in childhood and adulthood, as well as a combined indicator of lifetime SES.

Results

Childhood SES was significantly associated with later-life health trajectories net of adulthood SES indicators. Adult SES was significantly associated with late-life health trajectories, with some differences by gender and outcome. There were significant SES disparities in health outcomes over the 11-year study period. However, there were no significant multiplicative interactions between SES and age, which would have indicated either diminishing or widening SES health disparities with age.

Discussion

Socioeconomic disparities in health appear to persist into old age in the Mexican context. Efforts to reduce late-life health disparities in Mexico should target socioeconomic and material conditions across the life course.

Frailty in community-dwelling older adults: association with adverse outcomes

BACKGROUND

The study of frailty is important to identify the additional needs of medical long-term care and prevent adverse outcomes in community dwelling older adults. This study aimed to determine the prevalence of frailty and its association with adverse outcomes in community dwelling older adults.

METHODS

A cross-sectional study was carried out from April to September 2014. The population sample was 1,252 older adults (≥60 years) who were beneficiaries of the Mexican Institute of Social Security (IMSS) in Mexico City. Data were derived from the database of the "Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults" (COSFOMA). Operationalization of the phenotype of frailty was performed using the criteria of Fried et al (weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness). Adverse outcomes studied were limitation in basic activities of daily living (ADLs), falls and admission to emergency services in the previous year, and low quality of life (WHOQOL-OLD).

RESULTS

Frailty was identified in 20.6% (n=258), pre-frailty in 57.6% (n=721), and not frail in 21.8% (n=273). The association between frailty and limitations in ADL was odds ratio (OR) =2.3 (95% confidence interval [CI] 1.7-3.2) and adjusted OR =1.7 (95% CI 1.2-2.4); falls OR =1.6 (95% CI 1.2-2.1) and adjusted OR =1.4 (95% CI 1.0-1.9); admission to emergency services OR =1.9 (95% CI 1.1-3.1) and adjusted OR =1.9 (95% CI 1.1-3.4); low quality of life OR =3.4 (95% CI 2.6-4.6) and adjusted OR =2.1 (95% CI 1.5-2.9).

CONCLUSION

Approximately 2 out of 10 older adults demonstrate frailty. This is associated with limitations in ADL, falls, and admission to emergency rooms during the previous year as well as low quality of life.

Analysis of life quality and prevalence of cognitive impairment, anxiety, and depressive symptoms in older adults

Abstract The development of anxiety, depressive symptoms, and a decrease in cognitive performance can affect older adults’ quality of life. The objective of this cross-sectional study was to analyze quality of life and determine the prevalence of cognitive impairment, anxiety, and depression symptoms in senior center participants. A total of 120 older adults living in the city of Passo Fundo, RS, Brazil, participated in this study. The convenience sampling technique was used. All participants answered questions relative to socio-demographic variables, quality of life (World Health Organization Quality of Life-Bref), cognitive performance (Addenbrooke’ Cognitive Examination), and emotional state (Geriatric Depression Scale and Beck Anxiety Inventory). The prevalence of anxiety, depressive symptoms, and cognitive impairment were low indicating satisfactory quality of life of the older adults investigated.

Relation of depression with health behaviors and social conditions of dependent community-dwelling older persons in the Republic of Chile

BACKGROUND

Depressive symptoms are a leading cause of disability and emotional suffering, particularly in old age. However, evidence on depression and old age in developing countries remains largely ignored. The aim of this study was to examine the relation between health behavior and social conditions with depression among dependent community-dwelling older persons in the Republic of Chile.

METHODS

This is a cross-sectional and inferential study, using nationally representative secondary data. Two models used logistic regression on 640 dependent community-dwelling older persons from all over Chile, who personally answered a depression assessment, excluding those taking antidepressants. The geriatric depression scale (GDS-15) was used as outcome. The first model aims at any kind of depression (GDS 5>). The second aims at severe depression (GDS 10>). As exposure, we used the health behavior and social conditions of the older persons. Socio-demographic and physical conditions were used as adjustment.

RESULTS

44.5% of the older persons presented depressive symptoms. Among them, 11% had severe depression. Logistic regression showed that significant detrimental factors for being depressed in both models were visiting the doctor five times or over because of acute diseases, feeling uncomfortable with their living arrangement, and feeling discriminated. On the other hand, every additional day of physical exercise and living alone had a beneficial and detrimental effect only in model one.

CONCLUSION

Analyses on ways to support older persons living alone and the promotion of physical exercise to avoid depression are needed, along with a deeper understanding of the comfort with their living arrangement. Finally, ways to address the discrimination among older persons should be further explored.

Sintomas depressivos em idosos: estudo transversal de base populacional

Resumo Foi realizado um estudo transversal de base populacional na cidade de Pelotas, Rio Grande do Sul, em 2014, com o objetivo de medir a prevalência e identificar os fatores associados aos sintomas depressivos em idosos. A amostragem foi realizada por conglomerados em dois estágios. Todos os idosos (≥ 60 anos) residentes nos domicílios selecionados foram convidados a participar. A ocorrência dos sintomas depressivos foi medida utilizando-se a GDS-10 (Geriatric Depression Scale) com o ponto de corte ≥ 5. Foram obtidas informações de 1.451 idosos. A prevalência dos sintomas depressivos foi de 15,2% (IC95% 13,2-17,2). Após análise multivariável, a ocorrência de sintomas depressivos foi maior entre as mulheres, os idosos de pior situação econômica, aqueles que não trabalhavam, os fisicamente inativos, aqueles com pior autoavaliação de saúde e naqueles com incapacidade funcional. Maior atenção deve ser dada à identificação de sintomas depressivos em idosos e seus fatores associados para fundamentar políticas e planejamentos de intervenções para tratamento e manejo desta doença em nível coletivo.

SF-36 total score as a single measure of health-related quality of life: Scoping review

According to the 36-Item Short Form Health Survey questionnaire developers, a global measure of health-related quality of life such as the "SF-36 Total/Global/Overall Score" cannot be generated from the questionnaire. However, studies keep on reporting such measure. This study aimed to evaluate the frequency and to describe some characteristics of articles reporting the SF-36 Total/Global/Overall Score in the scientific literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses method was adapted to a scoping review. We performed searches in PubMed, Web of Science, SCOPUS, BVS, and Cochrane Library databases for articles using such scores. We found 172 articles published between 1997 and 2015; 110 (64.0%) of them were published from 2010 onwards; 30.0% appeared in journals with Impact Factor 3.00 or greater. Overall, 129 (75.0%) out of the 172 studies did not specify the method for calculating the "SF-36 Total Score"; 13 studies did not specify their methods but referred to the SF-36 developers' studies or others; and 30 articles used different strategies for calculating such score, the most frequent being arithmetic averaging of the eight SF-36 domains scores. We concluded that the "SF-36 Total/Global/Overall Score" has been increasingly reported in the scientific literature. Researchers should be aware of this procedure and of its possible impacts upon human health.

Depression and Quality of Life in Older Persons: A Review

BACKGROUND

Depression is a prevalent and disabling condition in older persons (≥ 60 years) that increases the risk of mortality and negatively influences quality of life (QOL). The relationship between depression, or depressive symptoms, and QOL has been increasingly addressed by research in recent years, but a review that can contribute to a better understanding of this relationship in older persons is lacking. Against this background, we undertook a literature review to assess the relationship between depression and QOL in older persons.

SUMMARY

Extensive electronic database searches revealed 953 studies. Of these, 74 studies fulfilled our criteria for inclusion, of which 52 were cross-sectional studies and 22 were longitudinal studies. Thirty-five studies were conducted in a clinical setting, while 39 were community-based epidemiological studies. A clear definition of the QOL concept was described in 25 studies, and 24 different assessment instruments were employed to assess QOL. Depressed older persons had poorer global and generic health-related QOL than nondepressed individuals. An increase in depression severity was associated with a poorer global and generic health-related QOL. The associations appeared to be stable over time and independent of how QOL was assessed.

KEY MESSAGES

This review found a significant association between severity of depression and poorer QOL in older persons, and the association was found to be stable over time, regardless which assessment instruments for QOL were applied. The lack of a definition of the multidimensional and multilevel concept QOL was common, and the large variety of QOL instruments in various studies make a direct comparison between the studies difficult.

A comparative cross-cultural study of the prevalence of late life depression in low and middle income countries

BACKGROUND

Current estimates of the prevalence of depression in later life mostly arise from studies carried out in Europe, North America and Asia. In this study we aimed to measure the prevalence of depression using a standardised method in a number of low and middle income countries (LMIC).

METHODS

A one-phase cross-sectional survey involving over 17,000 participants aged 65 years and over living in urban and rural catchment areas in 13 sites from 9 countries (Cuba, Dominican Republic, Puerto Rico, Mexico, Venezuela, Peru, China, India and Nigeria). Depression was assessed and compared using ICD-10 and EURO-D criteria.

RESULTS

Depression prevalence varied across sites according to diagnostic criteria. The lowest prevalence was observed for ICD-10 depressive episode (0.3 to 13.8%). When using the EURO-D depression scale, the prevalence was higher and ranged from 1.0% to 38.6%. The crude prevalence was particularly high in the Dominican Republic and in rural India. ICD-10 depression was also associated with increased age and being female.

LIMITATIONS

Generalisability of findings outside of catchment areas is difficult to assess.

CONCLUSIONS

Late life depression is burdensome, and common in LMIC. However its prevalence varies from culture to culture; its diagnosis poses a significant challenge and requires proper recognition of its expression.

The importance of neighborhood ecological assets in community dwelling old people aging outcomes: A study in Northern Portugal

Human development is a bidirectional, person-context relational process, but scarce evidence is available about the relation between the individual variability across the life-span and the neighborhood ecological assets. Therefore, it is important that research focus not only on personal characteristics but on ecological assets as well. This way this study aims to analyze the association between neighborhood ecological assets categorized into four dimensions: human, physical or institutional, social or collective activity, accessibility, and the individual functioning. A 3% sample of residents aged 65 years and older in two downtown and three uptown parishes stratified by age and sex was interviewed at home using a protocol that included the Portuguese version of the Barthel Index in basic activities of daily living (BADL), the Lawton Instrumental Activities of Daily Living Scale (IADL), the Mini Mental State Examination (MMSE), and the Geriatric Depression Scale-15 items (GDS) for evaluating functionality, cognitive performance, and depression. The 162 participants were aged on average 75 years (sd = 7.0), 54% were women and 90% had less than 7 years of education. The majority of participants were independent in BADL (M = 90; sd = 17.7) and moderately dependent in IADL (M = 13, sd = 6.0), 20% showed cognitive impairment and a mean score of 8 (sd = 2.1) in GDS-15. After controlling for the effect of socio-demographic characteristics, functionality, and cognitive performance decreases in persons with worst outdoor mobility. On the other hand depressive symptoms are less common as the number of recreation opportunities, namely associative groups (cultural, educative, professional), increases. These results suggest that aging policies and practices must be ecologically embedded.

Social capital and depression: evidence from urban elderly in China

OBJECTIVES

To study the relationship between social capital and depression among older adults from urban China and the mediating effect of social support on the influence of social capital on depression.

METHODS

Data were collected from face-to-face interviews targeting older adults (N = 928, response rate = 68.1%) aged over 60 years residing in Hangzhou, China, in 2013. Indicators of social capital included both cognitive (trust and reciprocity) and structural (social network and social participation) aspects. The dependent variable depression was measured by the Geriatric Depression Scale, social support was measured by the Multidimensional Scale of Perceived Social Support, and sociodemographic variables (age, education, and household income) and physical function were controlled for analysis. The data were analyzed by factor analysis and a hierarchical regression model.

RESULTS

Trust, reciprocity, and social network were significantly associated with geriatric depression after controlling. Social participation was not correlated with geriatric depression. Social support partially mediated the relationships between social capital and geriatric depression.

CONCLUSION

This study provides new evidence that social capital effectively mediates geriatric depression directly and indirectly. The intervention of social capital on depression should therefore consider the two pathways. Future longitudinal studies should help further understand the mechanisms linking social capital and depression.

Health-promoting lifestyles and depression in urban elderly Chinese

Objective

To explore health-promoting lifestyles, depression and provide further insight into the relationship between health-promoting lifestyles and depression in an urban community sample of elderly Chinese people.

Methods

A cross-sectional descriptive and correlational study of 954 community-dwelling urban elderly Chinese (aged ≥ 60) was conducted from July to December 2010. Lifestyles and depression were assessed using the revised Chinese Version of the Health-Promoting Lifestyle Profile (HPLP-C) and the Geriatric Depression Scale (GDS), respectively.

Results

In this cohort, 15.8% of elderly urban adults met the criteria for depression. Over half of the sample (62.1%) scored greater than 100 on the HPLP-C, with range of score sum from 55 to 160. There were significant correlations between self-actualization (OR = 1.167, 95%CI: 1.111–1.226), nutrition (OR = 1.118, 95%CI: 1.033–1.209), physical activity (OR = 1.111, 95%CI: 1.015–1.216) and depression among community-dwelling elderly Chinese.

Limitations

This was a cross-sectional study. The significant associations found do not represent directional causation. Further longitudinal follow-up is recommended to investigate the specific causal relationship between lifestyles and depression.

Conclusions

Depression was common with medium to high levels of health-promoting lifestyles among urban elderly Chinese people. Lifestyle behaviors such as self-actualization, good nutrition habits and frequent physical activity were correlated to fewer depressive symptoms. Healthy lifestyles should be further developed in this population and measures should be taken for improving their depression.

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

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

Proportion and factors associated with depressive symptoms among elderly in an urban slum in Bangalore

Depression among elderly is emerging as an important public health issue in developing countries like India. Published evidence regarding the magnitude and determinants of depression among elderly hailing from urban slum is currently limited. Hence, the current study was conducted to assess magnitude of the problem and identify factors associated with depression among the elderly in an urban slum. A cross-sectional study was done to cover total of 473 elderly persons from an urban slum in Bangalore, India. They were assessed for depression using Center for Epidemiologic Studies Depression scale. The overall prevalence of depression was found to be 37.8 (95% CI = 33.43-42.16). Multivariate analysis revealed that unemployment (self or children) (odds ratio (OR) 2.6; 95% confidence interval (CI) 1.41-4.72), illness of self (OR 2.2; 95% CI 1.45-3.21), female gender (OR 1.9; 95% CI 1.19-2.89), conflicts in family (OR 1.6; 95% CI 1.03-2.43), and marriage of children or grandchildren (OR 1.6; 95% CI 1.02-2.68) as independent risk factors. Depression among elderly is an important health issue of this area. Psychological intervention need to be provided for all elderly persons especially at the time of being diagnosed with any kind of illness. Strategies should be targeted to the females. The stressful life events need to be identified and remedial actions taken. This facility should be made available to them at the primary level of health care. There is a need to include screening of depression in our national health programs.

Depressive symptoms among adolescents and older adults in Mexico City

PURPOSE

Determine the structure of depressive symptoms among adolescents and older adults through the person-centered approach of latent class analysis (LCA).

METHODS

The study is based on data from two independent samples collected in Mexico City (2,444 adolescents and 2,223 older adults) which included the revised version of the CES-D. The presence or absence of depressed mood (dysphoria), diminished pleasure (anhedonia), drastic change in weight, sleep problems, thinking and concentration difficulties, excessive or inappropriate guilt, fatigue, psychomotor agitation/retardation, and suicide ideation were used in LCA to determine the structure of depressive symptoms for adolescents and older adults.

RESULTS

Adolescents reported higher excessive or inappropriate guilt compared to older adults, while older adults had higher proportions of anhedonia, sleep problems, fatigue, and psychomotor agitation/retardation. Similar proportions were found in other symptoms. The LCA analysis showed the best fit with four latent classes (LC): LC 1, "symptoms suggestive of major depressive episode (MDE)" with prevalence of 5.9 % (n = 144) and 10.3 % (n = 230) among adolescents and older adults, respectively; LC 2, "probable MDE symptoms" 18.2 % (n = 446) and 23.0 % (n = 512); LC 3, "possible MDE" 27.7 % (n = 676) and 21.8 % (n = 485); LC 4, "without significant depressive symptoms" 48.2 % (n = 1,178) and 44.8 % (n = 996). The differences in item thresholds between the two groups (adolescents vs. older adults) were statistically significant (Wald test = 255.684, df = 1, p < 0.001).

CONCLUSIONS

This study documented important similarities and differences in the structure of depressive symptoms between adolescents and older adults that merit acknowledgment, further study, and consideration of their potential clinical and public health implications.

Factors associated with help-seeking behaviors in Mexican older individuals with depressive symptoms: a cross-sectional study

OBJECTIVE

Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling "that something is wrong" and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms.

METHODS

A cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health.

RESULTS

A total of 2322 individuals were studied; from these, 67.14% (n = 1559) were women, and the mean age was 73.18 years (SD = 7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ(2) = 81.66, p < 0.0001), significant variables were female gender (odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.511-0.958, p = 0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p = 0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant.

CONCLUSIONS

Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms.

Prevalence and correlates of depression among HIV-infected and -affected older people in rural South Africa

BACKGROUND

Little is known about depression in older people in sub-Saharan Africa, the associated impact of HIV, and the influence on health perceptions.

OBJECTIVES

Examine the prevalence and correlates of depression; explore the relationship between depression and health perceptions in HIV-infected and -affected older people.

METHODS

In 2010, 422 HIV-infected and -affected participants aged 50+ were recruited into a cross-sectional study. Nurse professionals interviewed participants and a diagnosis of depressive episode was derived from the Composite International Diagnostic Interview (Depression module) using the International Classification of Diseases diagnostic criteria and categorised as major (MDE) or brief (BDE).

RESULTS

Overall, 42.4% (n=179) had a depressive episode (MDE: 22.7%, n=96; BDE: 19.7%, n=83). Prevalence of MDE was significantly higher in HIV-affected (30.1%, 95% CI 24.0-36.2%) than HIV-infected (14.8%, 95% CI 9.9-19.7%) participants; BDE was higher in HIV-infected (24.6%, 95% CI 18.7-30.6%) than in HIV-affected (15.1%, 95% CI 10.3-19.8%) participants. Being female (aOR 3.04, 95% CI 1.73-5.36), receiving a government grant (aOR 0.34, 95% CI 0.15-0.75), urban residency (aOR 1.86, 95% CI 1.16-2.96) and adult care-giving (aOR 2.37, 95% CI 1.37-4.12) were significantly associated with any depressive episode. Participants with a depressive episode were 2-3 times more likely to report poor health perceptions.

LIMITATIONS

Study limitations include the cross-sectional design, limited sample size and possible selection biases.

CONCLUSIONS

Prevalence of depressive episodes was high. Major depressive episodes were higher in HIV-affected than HIV-infected participants. Psycho-social support similar to that of HIV treatment programmes around HIV-affected older people may be useful in reducing their vulnerability to depression.

Late-life depressive symptoms: prediction models of change

BACKGROUND

Depression is a well-recognised problem in the elderly. The aim of this study was to determine the factors associated with predictors of change in depressive symptoms, both in subjects with and without baseline significant depressive symptoms.

METHODS

Longitudinal study of community-dwelling elderly people (>60 years or older), baseline evaluations, and two additional evaluations were reported. Depressive symptoms were measured using a 30-item geriatric depression scale, and a score of 11 was used as cut-off point for significant depressive symptoms in order to stratify the analyses in two groups: with significant depressive symptoms and without significant depressive symptoms. Sociodemographic data, social support, anxiety, cognition, positive affect, control locus, activities of daily living, recent traumatic life events, physical activity, comorbidities, and quality of life were evaluated. Multi-level generalised estimating equation model was used to assess the impact on the trajectory of depressive symptoms.

RESULTS

A number of 7882 subjects were assessed, with 29.42% attrition. At baseline assessment, mean age was 70.96 years, 61.15% were women. Trajectories of depressive symptoms had a decreasing trend. Stronger associations in those with significant depressive symptoms, were social support (OR.971, p<.001), chronic pain (OR 2.277, p<.001) and higher locus of control (OR.581, p<.001). In contrast for those without baseline significant depressive symptoms anxiety and a higher locus of control were the strongest associations.

CONCLUSIONS

New insights into late-life depression are provided, with special emphasis in differentiated factors influencing the trajectory when stratifying regarding basal status of significant depressive symptoms.

LIMITATIONS

The study has not included clinical evaluations and nutritional assessments.

Handgrip strength predicts functional decline at discharge in hospitalized male elderly: a hospital cohort study

Functional decline after hospitalization is a common adverse outcome in elderly. An easy to use, reproducible and accurate tool to identify those at risk would aid focusing interventions in those at higher risk. Handgrip strength has been shown to predict adverse outcomes in other settings. The aim of this study was to determine if handgrip strength measured upon admission to an acute care facility would predict functional decline (either incident or worsening of preexisting) at discharge among older Mexican, stratified by gender. In addition, cutoff points as a function of specificity would be determined. A cohort study was conducted in two hospitals in Mexico City. The primary endpoint was functional decline on discharge, defined as a 30-point reduction in the Barthel Index score from that of the baseline score. Handgrip strength along with other variables was measured at initial assessment, including: instrumental activities of daily living, cognition, depressive symptoms, delirium, hospitalization length and quality of life. All analyses were stratified by gender. Logistic regression to test independent association between handgrip strength and functional decline was performed, along with estimation of handgrip strength test values (specificity, sensitivity, area under the curve, etc.). A total of 223 patients admitted to an acute care facility between 2007 and 2009 were recruited. A total of 55 patients (24.7%) had functional decline, 23.46% in male and 25.6% in women. Multivariate analysis showed that only males with low handgrip strength had an increased risk of functional decline at discharge (OR 0.88, 95% CI 0.79–0.98, p = 0.01), with a specificity of 91.3% and a cutoff point of 20.65 kg for handgrip strength. Females had not a significant association between handgrip strength and functional decline. Measurement of handgrip strength on admission to acute care facilities may identify male elderly patients at risk of having functional decline, and intervene consequently.

Prevalence of mild cognitive impairment and its subtypes in the Mexican population

BACKGROUND/AIM

To estimate the prevalence of mild cognitive impairment (MCI) and its subtypes, taking into account education and health status.

METHODS

This is the first report of our Study on Aging and Dementia in Mexico. This study included 2,944 elderly individuals 60 years old or more with in-home assessment for cognitive impairment. The prevalence of MCI was based on Petersen criteria. MCI was classified as amnestic of single domain (a-MCI-s) or multiple domain (a-MCI-md) or nonamnestic of single domain (na-MCI-s) or multiple domain (na-MCI-md). In addition to a battery of neuropsychological measures, a self-report depression measure and a medical history including history of stroke, heart disease and other health conditions were recorded.

RESULTS

The global estimated prevalence of MCI in the Mexican population was 6.45%. Of these subjects, 2.41% met criteria for a-MCI-s, 2.56% for a-MCI-md, 1.18% for na-MCI-s and 0.30% for na-MCl-md. Women showed a higher prevalence of MCI than men (63.7 vs. 36.3%, respectively). The analysis showed that heart disease [odds ratio (OR) 1.5], stroke (OR 1.2) and depression (OR 2.1) were associated with an increased risk of MCI.

CONCLUSIONS

The prevalence of MCI in Mexico is similar to that in other countries. The results suggest that stroke, heart disease and depression may have an important role in the etiology of MCI.

Depression and associated factors in older adults in South Africa

BACKGROUND AND OBJECTIVE

Late-life depression is an important public health problem because of its devastating consequences. The study aims to investigate the prevalence and associated factors of self-reported symptom-based depression in a national sample of older South Africans who participated in the Study of Global Ageing and Adult Health (SAGE wave 1) in 2008.

METHODS

We conducted a national population-based cross-sectional study with a probability sample of 3,840 individuals aged 50 years or above in South Africa in 2008. The questionnaire included socio-demographic characteristics, health variables, anthropometric and blood pressure measurements as well as questions on depression symptoms in the past 12 months. Multivariable regression analysis was performed to assess the association of socio-demographic factors, health variables, and depression.

RESULTS

The overall prevalence of symptom-based depression in the past 12 months was 4.0%. In multivariable analysis, functional disability, lack of quality of life, and chronic conditions (angina, asthma, arthritis, and nocturnal sleep problems) were associated with self-reported depression symptoms in the past 12 months.

CONCLUSIONS

Self-reported depression in older South Africans seems to be a public health problem calling for appropriate interventions to reduce occurrence. Factors identified to be associated with depression, including functional disability, lack of quality of life, and chronic conditions (angina, asthma, arthritis, and nocturnal sleep problems), can be used to guide interventions. The identified protective and risk factors can help in formulating public health care policies to improve quality of life among older adults.

Effect of social capital and personal autonomy on the incidence of depressive symptoms in the elderly: evidence from a longitudinal study in Mexico

OBJECTIVES

To estimate the effect of social capital (SC) and personal autonomy (PA) on the depressive symptoms (DS) in older people living in poverty.

METHOD

Longitudinal study of elderly participants in the impact evaluation study of a non-contributory pension program in Mexico. For this study we selected the group of older people without significant DS at baseline. PA, SC indicators and covariates were measured at baseline. Using the Geriatric Depression Scale, the incidence of DS was assessed at a follow-up interview after 11 months. The effect of SC and autonomy on the occurrence of DS was estimated by using a multilevel logistic regression model.

RESULTS

Of the various indicators of PA, not being dependent in daily functioning, and being able to read/write were associated with lower risk of DS. A higher level of SC at baseline was associated with lower incidence of DS in women (odds ratio; OR = 0.73, p < 0.01), while for men there was no significant association (OR = 1.04, p = 0.69).

CONCLUSIONS

PA and SC proved to be protective factors against the onset of DS in women. For men, only PA was a protective factor. Future studies need to explore in what ways that PA and SC may reduce risk of DS as well as the role of gender differences.

[Screening for depression in an elderly population living at home. Interest of the Mini-Geriatric Depression Scale]

BACKGROUND

Depression is the most usual mental disorder in the elderly, but underdiagnosed and undertreated. Its prevalence is variable. Symptoms of depression present in the elderly can be masked and difficult to recognize. The purpose of this study was to examine prevalence and risk factors for depression in elderly living in their home.

METHODS

A cross-sectional study of randomly selected homes in randomly selected geographical islets was carried out Monastir City (Tunisia). Questionnaire-based interviews were conducted among the elderly aged more than 65 years living in their home. Depression symptoms were assessed using a Mini-Geriatric Depression Scale. The relationship between the risk of depression and sociodemographic and health-related variables was studied using logistic regression.

RESULTS

Out of 598 (female 66 %, mean (SD) age 72.3 (7.4) years) elderly persons interviewed, 136 (22.7 %) were screened to have a Mini-Geriatric Depression Scale more than or equal to 1. Multiple logistic regression analysis revealed that the following were significant (P<0.01) independent predictors of risk of depression: female sex (OR=2.36 [95 % CI=1.43-3.94]), having a low level of education (OR=4.02 [95 % CI=1.38-11.65]), disability (OR=3.50 [95 % CI=1.94-6.46]), a history of stroke (OR=2.90 [95 % CI=1.20-7.72]) and the use of hypnotic medications (OR=2.47 [95 % CI=1.38-4.42]).

CONCLUSION

This study suggests that the risk of depression is a common psychiatric disorder in elderly living in their home, and underlines the usefulness of the Mini-Geriatric Depression Scale to detect the risk of depression in the elderly. This clinical approach should be encouraged in all medical practices to improve the prognosis of depression in the elderly.

A nationwide survey on the prevalence and risk factors of late life depression in South Korea

OBJECTIVE

This study aimed to estimate prevalence rates and risk factors of LLD among a large nationwide sample of Korean elders in South Korea.

METHOD

Of 8199 randomly sampled Koreans aged 65 years or more, 6018 participated (response rate=73.4%). Using the Korean version of the short form Geriatric Depression Scale (SGDS-K), we classified individual scoring 8 or 9 as having possible depression and those scoring ≥ 10 as having probable depression.

RESULTS

The age-, gender-, education-, and urbanicity-standardized prevalences were 10.1% (95% CI=9.3-10.8) for possible depression, 17.8% (95% CI=16.8-8.7) for probable depression, and 27.8% (95% CI=26.7-29.0) for overall depression. Poverty, living alone, low education, illiteracy, smoking, history of head trauma, and low Mini Mental Status Examination score were associated with greater risk of depression, while mild alcohol use and moderate to heavy exercise were associated with lower risk of depression. However gender difference in the risk of depression was not found.

CONCLUSION

LLD is decidedly common in South Korea. It was associated with various sociodemographic and clinical factors, some of which are amendable through policy actions. This study was limited by use of the SGDS-K rather than a standardized clinical interview.

Pains, joys, and secrets: nurse-led group therapy for older adults with depression

This is the first study of nurse-led group therapy in Mexico. Forty-one depressed older adults with a median age of 71 participated in nurse-led cognitive behavioral group therapy once a week for 12 weeks. Participants' scores on the Patient Health Questionaire-9 showed mild to moderate improvement. Participants experienced positive results in personal growth, changing negative thoughts, and relationships with family. An important therapeutic factor was the support of fellow group members. The nurses experienced positive personal and professional growth. Difficulties included physician resistance and a too-rigid cognitive behavioral group therapy model. A combination of cognitive behavioral therapy and supportive group therapy is recommended.

Depressive symptoms among Mexican medical students: high prevalence and the effect of a group psychoeducation intervention

BACKGROUND

Several studies have demonstrated a higher prevalence of depression among medical students as compared to the general population. On the other hand, psychoeducational interventions have proven its efficacy on diminishing depressive symptoms. The aim of this study is to determine the prevalence of depressive symptoms among medical students in La Salle University and the effect that psychoeducation has on it.

METHODS

Students between the first and the eighth semester voluntarily answered the Beck Depression Inventory test in an anonymous way from 2006 to 2007. After determining the prevalence of depressive symptoms the psychoeducational program was established and prevalence of depressive symptoms was measured for two more years (2008-2009).

RESULTS

A total of 1958 students answered the test during the four years. In the first two years (2006-2007) the 36.29% of the students scored for positive depressive symptoms. The next two years (2008-2009), after the psychoeducation program, the prevalence of depressive symptoms diminishes in a significant manner, only 25.51% of the students have depressive symptoms (p<.0001).

LIMITATIONS

Because the test were answered anonymously, there is no way we can give neither specific attention nor follow-up to the students with depression. Also we can't determine the effect of the mental health group treatment among the medical students.

CONCLUSIONS

Even though the medical students have risks factors for developing depression, we prove that a psychoeducation program can be an effective alternative therapy for decreasing the prevalence of depressive symptoms among medical students.

Prevalence and risk factors for depression in older people in Xi'an China: a community-based study

OBJECTIVE

To estimate the prevalence of depressive symptoms and to determine the impact of socio-demographic variables, chronic diseases and health-related events on depression in a community sample of older adults in Xi'an, Shaanxi Province.

METHODS

Cross sectional, multistage community survey. A semi-structured questionnaire including socio-demographic characteristics, physical health, chronic diseases and health-related events was administered to 1587 older adults from eight communities. Depression was assessed using the 30-item Geriatric Depression Scale (GDS) with a threshold of <11/11+. Analysis was conducted using SPSS16.0 Complex Samples Logistic analysis procedure.

RESULTS

The prevalence of depression was 27.0% (95% CI 24.7-29.2%). In a univariate analysis, the following variables were significantly associated with depression: female gender, low max income, coronary heart disease, suffering 3 or above chronic diseases and functional impairments, 4 adverse life events (financial problems, death of closely related person, unpleasantness experience and horrifying experience) and suffering 1 or above adverse life events. After adjustment for age and gender, odds ratios for depression were significantly higher for coronary heart disease, suffering 3 or above chronic diseases and functional impairments, adverse life event (financial problems, unpleasantness experience) and suffering 3 or above adverse life events.

CONCLUSIONS

According to GDS estimates, 27.0% Chinese urban older adult had depression symptoms. In designing prevention programs, detection and management of older patients with depression should be a high priority in developing countries.

The association between social network relationships and depressive symptoms among older Americans: what matters most?

BACKGROUND

Although social network relationships are linked to mental health in late life, it is still unclear whether it is the structure of social networks or their perceived quality that matters.

METHODS

The current study regressed a dichotomous 8-item version of the Center for Epidemiological Studies Depression Scale (CESD-8) score on measures of social network relationships among Americans, aged 65-85 years, from the first wave of the National Social Life, Health and Aging Project. The network indicators included a structural variable - social network type - and a series of relationship quality indicators: perceived positive and negative ties with family, friends and spouse/ partner. Multivariate logistic regression analyses controlled for age, gender, education, income, race/ethnicity, religious affiliation, functional health and physical health.

RESULTS

The perceived social network quality variables were unrelated to the presence of a high level of depressive symptoms, but social network type maintained an association with this mental health outcome even after controlling for confounders. Respondents embedded in resourceful social network types in terms of social capital--"diverse," "friend" and "congregant" networks--reported less presence of depressive symptoms, to varying degrees.

CONCLUSIONS

The results show that the structure of the network seems to matter more than the perceived quality of the ties as an indicator of depressive symptoms. Moreover, the composite network type variable stands out in capturing the differences in mental state. The construct of network type should be incorporated in mental health screening among older people who reside in the community. One's social network type can be an important initial indicator that one is at risk.

Depressive symptoms and APOE polymorphisms in an elderly population-based sample

AIM

Apolipoprotein E (APOE) has been regarded as the principal susceptibility gene linked with Alzheimer's disease, also suggesting a relationship with depression in the elderly population. Thus, the purpose was to investigate the association of APOE polymorphisms with depression in elderly adults.

METHODS

APOE polymorphisms were determined in a Mexican population-based sample older than 60 years (n=1566) using 5' exonuclease TaqMan genotyping assays.

RESULTS

The distribution of the APOE allele and genotype frequencies was similar in patients with and without depression. There was no significant association between the presence of alleles or genotypes and depression and anxiety (Short Anxiety Screening Test) considering several combinations of other features. However, patients with the APOE*4 allele presented more thinking and concentration impairment than those patients with the APOE*3 allele.

CONCLUSION

Genetic variation at the APOE gene may contribute to some depressive symptoms in late-onset depression, rather than being a specific risk factor.

Cost-effective analysis of genotyping using oral cells in the geriatric population

We evaluated the cost-effectiveness of using buccal swab brushes in comparison with blood samples for obtaining DNA for large epidemiological studies of the elderly population. The data reported here are from the third phase of the Integral Study of Depression among the Elderly in Mexico City's Mexican Institute of Social Security, conducted in 2007. The total cost of the two procedures was determined. The measurement of effectiveness was the quality and quantity of DNA measured in ng/μL and the use of this DNA for the determination of apolipoprotein E (APO E) polymorphism by PCR. Similar rates of amplification were obtained with the two techniques. The cost of the buccal swab brushes, including sample collection and DNA extraction, was US$16.63, compared to the cost per blood sample of US$23.35. Using the buccal swab, the savings was US$6.72 per patient (P < 0.05). The effectiveness was similar. Quantity and quality of DNA obtained were similar for the oral and blood procedures, demonstrating that the swab brush technique offers a feasible alternative for large-scale epidemiological studies.