Diagnostic accuracy of various forms of geriatric depression scale for screening of depression among older adults: Systematic review and meta-analysis

Psychedelic interventions for major depressive disorder in the elderly: Exploring novel therapies, promise and potential

The global population is ageing rapidly, with the number of individuals aged 60 and older reaching 1 billion in 2019 and expected to double by 2050. As people age, neuropsychological health often deteriorates, leading to a higher prevalence of age-related depression. Symptoms may include anxiety, apathy, mood instability, sadness, and, in severe cases, suicidal thoughts. Depression in the elderly is a widespread concern, and conventional treatments such as antidepressants are often limited by side effects, reduced efficacy, and complications arising from polypharmacy. In response, novel therapeutic approaches are being explored, including psychedelic interventions. Recent clinical and preclinical studies suggest that psychedelics could offer a promising treatment for major depressive disorder (MDD) in older adults. These compounds, known for their profound neurobiological effects, have gained attention for their potential to address depression where traditional therapies fall short. This review aims to examine the therapeutic promise of psychedelic substances, focusing on those that show potential for treating MDD in the elderly. We also explore the underlying mechanisms through which psychedelics may exert their effects and highlight the preclinical models that support their use. Finally, we address safety considerations and propose strategies to enhance the effectiveness and safety of psychedelics in future clinical trials, offering new hope for treating age-related depressive disorders.

Gaining Recovery in Addiction for Community Elders (GRACE) Project: The Impact of Age-Specific Care on Clinical Outcomes and Health Care Resource Utilization in Older Adults With Substance Use Disorder in an Interprofessional Addiction Clinic

BACKGROUND

The prevalence of substance use disorders (SUDs) in older adults has been increasing, necessitating tailored and effective addiction care for this aging demographic.

AIMS

The purpose of this study was to assess the impact of age-specific, interprofessional addiction care on clinical outcomes and health care resource utilization in older adults with SUD.

METHODS

This quasi-experimental study directly compares patients enrolled in the Gaining Recovery in Addiction for Community Elders (GRACE) Project, an interprofessional age-specific addictions treatment program, with age-matched older adults who received conventional "treatment as usual" (TAU). Through retrospective comparative analysis, substance use outcomes, mental and physical health improvements, and inappropriate use of emergency services were examined among 78 older adults with SUD.

RESULTS

Clinical outcomes and health care resource utilization were superior for older adults who received age-specific addictions care through the GRACE Project, as compared to mixed-age conventional "TAU." GRACE patients had improved treatment adherence, fewer relapses, and longer treatment engagement. While both groups exhibited significant reductions in depression and anxiety scores, GRACE patients showed greater improvements. This group demonstrated superior control of both hypertension and diabetes. Importantly, they had fewer inappropriate emergency department visits and avoidable hospitalizations than conventional "TAU."

CONCLUSIONS

Addiction treatment delivered by an interprofessional team to meet the unique strengths and needs of older adults has the potential to improve treatment adherence and more favorable long-term outcomes in substance use, mental health, and chronic medical conditions. Nurses are poised to lead interprofessional teams to meet the growing demand for specialized addiction treatment and integrated care for older adults.

Design and validation of the CADIS-G: a screening instrument for anxiety, depression, loneliness and anger in the older population

Introduction

The assessment of psychological variables in older adults is often conducted using instruments that are not specifically designed for this population. Moreover, there are few screening tools that are effective for healthcare professionals in detecting emotional difficulties in older individuals. Therefore, the objective of this study was to design a questionnaire that can be used as a screening instrument to measure emotional distress in older individuals. A 12-item instrument (CADIS-G) with a 4-point Likert-type response scale was developed and tested for validity.

Method

186 older adults from eight residences and/or centers for older individuals in Spain. The participants completed, in addition to the 12-item CADIS-G, different instruments considered gold standards: Yesavage Geriatric Depression Scale (GDS-15), Geriatric Anxiety Inventory (GAI), State-Trait Anger Expression Inventory (STAXI-2) and UCLA Loneliness Scale. Exploratory factor analysis (EFA) was performed to study the dimensionality of the CADIS-G items.

Results

The results showed that 10 of the 12 items of the CADIS-G grouped well with the theoretically proposed gold standard scales.

Discussion

The CADIS-G is a screening instrument that shows adequate psychometric properties to measure anxiety, depression, anger and loneliness in older people.

Psychosocial Correlates of Adherence to Mind-Body Interventions

Mind-body interventions involve practices that intentionally combine mental and physical fitness, showing promise for improving psychological and cognitive health in older adults. Limited research exists on adherence to these interventions and the demographic and psychosocial factors that may predict variability in compliance. In the current study, we identified key correlates-demographic, psychosocial, and cognitive-of adherence to two mind-body interventions. Baseline and intervention data were analyzed together from a randomized controlled trial of older adults who participated in two four-week mind-body interventions and completed practice logs (n = 60). Adherence was defined as the average weekly self-reported minutes of homework practice during the intervention. Baseline correlates included education, sex assigned at birth, working memory score, emotion dysregulation, positive and negative affect, trait mindfulness, and depression. Partial least squares regression was used to identify latent components. A significant one-component solution from the final model explained 23.08% of the variance in practice minutes. Greater adherence was associated with mild depressive symptoms, difficulties with emotion regulation, and lower working memory scores. These findings suggest that participants with mild emotional and cognitive difficulties may be more likely to adhere to mind-body interventions. These results emphasize the target population likely to engage in mind-body interventions and may be valuable for designing tailored interventions and developing strategies to maximize adherence. This study was registered on ClinicalTrials.gov (#NCT03432754) on February 14, 2018.

Better Mental Health and Fewer Depressive Symptoms Are Associated With Greater Psychological Resilience After Hip Fracture

BACKGROUND

High psychological resilience is associated with improved functional outcomes for older adults recovering from hip fractures. The objective of this study was to identify factors associated with increased psychological resilience in older women after hip fracture.

METHODS

In total, 129 women aged ≥65 years with recent surgically repaired hip fractures were enrolled in a trial of exercise and testosterone therapy. The Brief Resilience Scale (BRS) measured baseline resilience and was categorized as low (BRS < 4) or high (BRS ≥ 4). Sociodemographic (eg, education), medical, and neuropsychological factors (eg, cognition by Short Blessed Test, mental health by a Global Mental Health Score (PROMIS-GMH), and depressive symptoms by Geriatric Depression Score (GDS)) were considered as independent variables. Individual factors were evaluated for their association with resilience using bivariate regression, and those having a significance level of p ≤ .10 were entered into age-adjusted multivariate logistic regression models.

RESULTS

A total of 57 women (44%) reported high resilience. Neither education nor cognition was significantly associated with resilience. Lower GDS and better PROMIS-GMH scores were associated with high resilience in adjusted models. For every one-point worsening in GDS, the adjusted odds ratio (AOR) for high versus low resilience was 0.76 (95% CI, 0.61,0.93). In a model with GDS, PROMIS-GMH, and age, positive mental health remained significantly associated with higher resilience (AOR 1.34, 95% CI, 1.14,1.58).

CONCLUSIONS

In older women after hip fracture, fewer depressive symptoms and better mental health were associated with higher psychological resilience. Addressing overall mental health when recovering from a hip fracture could contribute to increasing psychological resilience thereby maximizing recovery potential.

Evaluation of the Distress Thermometer in older patients with cancer

INTRODUCTION

The Geriatric Depression Scale is a useful tool in screening for depression in older adults, a particularly vulnerable population in oncology. The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) has been validated as a fast and effective screening tool for psychological distress in general oncology populations, and it could possibly be used as a surrogate for the longer Geriatric Depression Scale (GDS) test in older adults with cancer.

MATERIALS AND METHODS

In this retrospective cross-sectional study in older adults prior to starting cancer treatment, we evaluated the relationship between the DT and GDS by comparing 242 older adults with cancers' DT scores to their GDS scores, used receiver operating characteristic analysis to determine a DT cutoff score, and used logistic regression to identify variables associated with higher distress.

RESULTS

The Spearman correlation coefficient between GDS and DT was 0.41, p < 0.001. A cutoff score of 4 was found to be most sensitive and specific (0.66,0.68) for predicting a positive GDS (c-index = 0.70).

DISCUSSION

These results indicate the potential utility of the DT as a mildly to moderately effective screening tool for depression in older adults with cancer starting treatment and support the current NCCN cutoff guidelines to indicate the need for additional distress interventions.

Practical Assessment of Neuropsychiatric Symptoms: Updated Reliability, Validity, and Cutoffs for the Neuropsychiatric Inventory Questionnaire

OBJECTIVES

To improve assessment of neuropsychiatric symptoms (NPS) by expanding the measurement properties of the Neuropsychiatric Inventory Questionnaire (NPI-Q).

DESIGN

Multicenter, longitudinal observational study.

SETTING

Several Alzheimer's Disease Research Centers (ADRCs).

PARTICIPANTS

Individuals (n = 45,274) who presented to an ADRC with a collateral and completed the NPI-Q.

MEASUREMENTS

The NPI-Q total severity score, four NPI-Q subscales, dementia stage, expert NPS rating, consensus rating of dementia syndrome, global cognitive screening, collateral rating of daily functioning, and self-rating of depression.

RESULTS

There was strong evidence of criterion validity with both dementia stage and expert NPS rating for the NPI-Q total severity index, which informed cutoffs and interpretive ranges. Furthermore, subscales had adequate classification of dementia syndromes and appropriate convergent relationships with cognition, daily functioning, and mood. There was good-to-excellent evidence of reliability for the NPI-Q total severity index over several years, and subscales had adequate-to-good reliability.

CONCLUSIONS

This is the first study to provide empirically established cutoffs, interpretive ranges, and evidence of reliability over a period longer than a month on the NPI-Q and its subscales. This will improve assessment of NPS in clinical and research contexts.

ARTICLE SUMMARY

Neuropsychiatric symptoms of neurodegeneration are increasingly understood as early disease markers with tremendous functional impact later in disease, but are often missed or misdiagnosed. The most common measure of these symptoms, the Neuropsychiatric Inventory Questionnaire (NPI-Q), does not have clinically actionable guidance, which this article provided. We established cutscores for several conditions and test-retest reliability over longer periods for the total score and subscales using a multicenter database.

Overweight, Obesity, and Depression in Multimorbid Older Adults: Prevalence, Diagnostic Agreement, and Associated Factors in Primary Care-Results from a Multicenter Observational Study

Background/Objectives: Obesity and depression, in conjunction with multimorbidity, are interconnected conditions increasingly managed in general practitioner (GP) settings, yet these associations remain insufficiently studied in older patients. This study investigates the prevalence of depression across different body mass index (BMI) classes and includes age and gender differences in multimorbid older patients, offering a novel perspective on subgroup-specific patterns. Further the agreement between GP depression diagnoses and the Geriatric Depression Scale (GDS) is studied and patient-specific factors that may affect the agreement are explored, aiming to improve future diagnostics for vulnerable subgroups. Methods: Data were provided by the baseline assessment of the MultiCare Study, a prospective multicenter observational cohort of multimorbid patients aged 65+ years recruited from 158 GP practices across eight study centers in Germany. Data from 2568 study participants were analyzed based on GP-coded International Classification of Diseases (ICD) diagnoses, structured GP questionnaires, and patient questionnaires. Assessments included data on the BMI and depression (15 item version of the GDS). Agreement between GP diagnoses of depression and GDS assessment was measured using Cohen's kappa. Four logistic regression models were used to examine the effects of patient-specific factors on the agreement of depression diagnosis (match or mismatch). Results: GPs diagnosed depression in 17.3% of cases, compared to the detection of depressive symptoms in 12.4% of the patients by GDS (cut-off ≥ 6 points). The highest prevalence rates were observed in patients with obesity class III (25.0% by GP; 21.7% by GDS). Women were significantly more likely to receive a depression diagnosis by a GP across most BMI classes (except obesity classes II and III). The detection of depressive symptoms by GDS was significantly more prevalent in older multimorbid obese patients (≥75 years), except for patients with obesity class III. The overall agreement between GP diagnosis and GDS assessment was weak (κ = 0.156, p < 0.001). The highest agreement was found for people with obesity class III (κ = 0.256, p < 0.05). Factors associated with a True Positive depression diagnosis (match by both GDS and GP) were female gender (odds ratio (OR) = 1.83, p < 0.05), widowhood (OR = 2.43, p < 0.01), limited daily living skills (OR = 3.14, p < 0.001), and a higher level of education (OR = 2.48, p < 0.01). A significantly lower likelihood of a False Negative depression diagnosis was found for patients with obesity class III. Conclusions: This study highlights the significant prevalence of depression among multimorbid older adults across different BMI classes, particularly in those with obesity class III. The weak diagnostic agreement between GP diagnosis and GDS assessment suggests a need for improved diagnostic practices in primary care. Implementing standardized screening tools and fostering collaboration with mental health specialists could enhance the identification and management of depression in this vulnerable population.

Co-Existing Vestibular Hypofunction Impairs Postural Control, but Not Frailty and Well-Being, in Older Adults with Benign Paroxysmal Positional Vertigo

Background: Vestibular hypofunction occurs in 29.5% of older adults with benign paroxysmal positional vertigo (BPPV), but its impact on postural control, well-being and frailty was not studied before. This study compared the well-being, frailty and postural control between older adults with BPPV and vestibular hypofunction (oaBPPV+), and older adults with only BPPV (oaBPPV). Methods: Thirty-one older adults (≥65 years old) diagnosed with BPPV were recruited. Unilateral vestibular hypofunction was defined as a >25% caloric asymmetry, and bilateral vestibular hypofunction as a total response <6°/s per ear, using bithermal caloric irrigations. The oaBPPV+ group was compared to the oaBPPV group using the measures of well-being (Dizziness Handicap Inventory, Falls Efficacy Scale and 15-item Geriatric Depression Scale), frailty (Modified Fried Criteria), and postural control (timed chair stand test, mini-Balance Evaluation Systems test and Clinical Test of Sensory Interaction on Balance (CTSIB)). Falls and the number of repositioning maneuvers were documented. Significance level was set at α = 0.05. Results: Unilateral vestibular hypofunction was present in 32% of participants, mainly in females (p = 0.04). Bilateral vestibular hypofunction was not found. The oaBPPV+ group (n = 10, mean age 72.5 (4.5)) experienced more comorbidities (p = 0.02) than the oaBPPV group (n = 21, mean age 72.6 (4.9)). Groups did not differ regarding dizziness symptoms (p = 0.46), fear of falling (p = 0.44), depression (p = 0.48), falls (p = 0.08) or frailty (p = 0.36). However, the oaBPPV+ group showed significantly worse postural control under vestibular-dependent conditions (p < 0.001). Conclusions: Despite equally impaired well-being and frailty, the oaBPPV+ group showed greater sensory orientation deficits. Clinicians and researchers should be alert for co-existing vestibular hypofunction in older adults with BPPV, since this may exacerbate their already impaired postural control more than only BPPV.

The role of functional dependence in depressive symptoms among centenarians: Findings from the SWISS100 study

OBJECTIVE

To analyse the prevalence of depressive symptoms in centenarians, identify their predictors, and explore the role of functional dependence as a contributing factor.

DESIGN SETTING, AND PARTICIPANTS

Cross-sectional baseline data from the Swiss Centenarian Study (n = 102), including community-dwelling and institutionalised participants with complete data on depressive symptoms and functional capacity.

MEASUREMENTS

Functional capacity was assessed using the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire. Depressive symptoms were measured with the Geriatric Depression Scale - Short Form. Group differences were analysed using Chi-squared tests; relationships were examined with correlations. Multiple linear regressions identified predictors. Mediation analysis explored the interplay between functional capacity, living situation, and depressive symptoms.

RESULTS

Functional capacity varied, with basic activities of daily living generally better preserved than instrumental activities. Almost one-fourth of participants screened positive for possible clinical depression, which was significantly more common among institutionalised centenarians (p < .05). Health conditions, anxiety, and lower functional capacity were significant predictors of depressive symptoms and together explained 24.7 % of the variance, with anxiety being the strongest predictor followed by health conditions and functional capacity. Mediation analysis showed that functional capacity mediated the relationship between living situation and depressive symptoms, highlighting its critical role in mental health.

CONCLUSIONS

A significant proportion of centenarians screened positive for depression, underscoring the need for greater attention to depressive symptoms and systematic screening. Targeted interventions promoting functional independence may play an important role to prevent depression, and strategies are needed to encourage institutionalised very old individuals to re-develop and maintain a certain level of independence.

Simplified Screening for Depression in Acutely Hospitalized Geriatric Patients: Comparison of the Two-Item Whooley Questions With the Geriatric Depression Scale-15

OBJECTIVE

The aim of the study is to investigate sensitivity and specificity of the two-item Whooley questions compared to the 15-item Geriatric Depression Scale (GDS-15) for the detection of depressive symptoms in acutely hospitalized geriatric patients.

METHODS

Patients were prospectively recruited. Two-item Whooley questions and GDS-15 were performed within 24 h of admission, the GDS-15 being part of the routine geriatric assessment. Montgomery-Asberg Depression Rating Scale (MADRS) served as gold standard in the form of a structured interview which was performed within 48 h of admission. In addition, all patients were examined for independence (Barthel Index), cognition (mini-mental status examination), vision and hearing (finger rub test) and multimorbidity (Charlson Comorbidity Index).

RESULTS

248 patients were recruited. Median (Q1/3) age was 83 (/3 79/86) years, 157 patients (63%) were female. Whooley questions had a sensitivity of 0.95 (95% CI: 0.81-0.99) and specificity of 0.49 (95% CI: 0.43-0.56) identifying moderate depressive symptoms (MADRS ≥ 20 points) with a negative predictive value (NPV) of 0.99. This is compared to a sensitivity of 0.57 (95% CI: 0.37-0.75) and specificity of 0.62 (95% CI: 0.56-0.68) using GDS-15 to identify moderate depressive symptoms. Both functional impairment and cognitive deficits had an impact on the result of GDS-15, but did not influence the result of Whooley questions.

CONCLUSIONS

Compared to the GDS-15, the two-item Whooley questions are more accurate to screen for symptoms of depression in acutely hospitalized geriatric patients.

Nesting of groups: Links among personal magnetism, community trust, inequality perception and depression

BACKGROUND

In the context of China's rapid transition from a collectivist work-unit system to a more individualized, community-oriented society, this study investigates the relationship between personal magnetism-an individual's social appeal-and its protective role in mitigating depression.

OBJECTIVE

This study aims to examine the moderating role of perceived inequality and the mediating effect of community trust in the relationship between personal magnetism and depression.

METHODS

Utilizing longitudinal data from the China Family Panel Studies (CFPS) from 2018 to 2020, involving 26,711 respondents aged 16 to 96, this study employs multivariate regression models to explore these relationships.

RESULTS

The findings reveal that perceived inequality amplifies the negative relationship between personal magnetism and depression, suggesting that personal magnetism becomes less effective in alleviating depressive symptoms in contexts of higher inequality. Additionally, community trust is identified as a key mediator, explaining how strong social networks can buffer the psychological effects of inequality and enhance mental well-being.

CONCLUSION

The findings underscore the importance of fostering community trust and addressing income inequality in public policy. By leveraging the positive effects of personal magnetism and social solidarity, targeted interventions can reduce depression and enhance collective well-being in societies undergoing socio-economic transformation.

Cognitive function in generally healthy adults age 70 years and older in the 5-country DO-HEALTH study: MMSE and MoCA scores by sex, education and country

BACKGROUND

Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are validated and frequently used screening tools for cognitive function.

AIMS

To present MMSE and MoCA scores by sex, age and education among community-dwelling older adults.

METHODS

This is a post-hoc observational analysis using data from the DO-HEALTH trial, which included generally healthy adults (≥ 70 years) from Switzerland, Germany, Austria, France, and Portugal who scored at least 24 points on the MMSE at baseline. We present MMSE and MoCA scores overall and by country, sex, age (70-74 years, ≥ 75 years), education (≤ and > median education years).

RESULTS

2151 DO-HEALTH participants (mean age 74.9 years, 57% aged 70-74 years, 62% women) were included. The median (IQR) years of education was 12 (10-15), median MMSE score was 29 (28-30) and median MoCA score was 26 (23-28) points. In subgroups by sex, age, and education, the median MMSE score remained 29 for all subgroups, except for participants with shorter education (≤ 12 years) and higher age (≥ 75), who scored 28 points. For MoCA, the median score in subgroups ranged from 24 to 27 points. Participants with shorter education (≤ 12 years) and higher age (≥ 75) had lowest scores (men 24, women 25 points).

CONCLUSIONS

We provide MMSE and MoCA scores for generally healthy, community-dwelling older adults from Switzerland, Germany, Austria, France and Portugal. The median MMSE and MoCA scores differed with age and education, and - less consistently - with sex.

TRIAL REGISTRATION

International Trials Registry (clinicaltrials.gov; registration ID: NCT01745263), registered December 2012.

Depressive symptoms among resettled Bhutanese older adults in Ohio: a cross-sectional study

BACKGROUND

There has been growing attention given to the mental health challenges faced by older adult populations, particularly among resettled refugee communities. Among these groups, the prevalence of depressive symptoms often remains high due to a multitude of factors associated with displacement, trauma, and acculturation stress. Since 2008, Bhutanese refugees have been resettled in the United States, making them one of the largest refugees in the country. However, mental health issues often remain obscured for this demographic, as they are typically subsumed within largely heterogeneous Asian populations. This study aimed to determine depression symptoms in resettled Bhutanese older adults and analyze the associated factors.

METHODS

Snowball sampling was used to collect data from 276 55+-year-old adults in Ohio from January to June 2022. The questionnaire covered demographics, lifestyle, social support, life satisfaction, chronic disease, and depression. Binary logistic regression assessed the associations between associated factors and depressive symptoms.

RESULTS AND CONCLUSIONS

Approximately one-third (31.8%) of the participants had depressive symptoms. Factors associated with lower odds of having depressive symptoms included better self-reported health, strong social support, life satisfaction, and high resilience. Individuals with chronic diseases were more likely to have depressive symptoms. The high percentage of depressive symptoms among resettled Bhutanese older adults emphasizes the need for a supportive environment in the host country, ensuring access to resources, and comprehensive and tailored interventions to address their mental health needs.

Depressive Symptoms and Amyloid Pathology

Importance

Depressive symptoms are associated with cognitive decline in older individuals. Uncertainty about underlying mechanisms hampers diagnostic and therapeutic efforts. This large-scale study aimed to elucidate the association between depressive symptoms and amyloid pathology.

Objective

To examine the association between depressive symptoms and amyloid pathology and its dependency on age, sex, education, and APOE genotype in older individuals without dementia.

Design, Setting, and Participants

Cross-sectional analyses were performed using data from the Amyloid Biomarker Study data pooling initiative. Data from 49 research, population-based, and memory clinic studies were pooled and harmonized. The Amyloid Biomarker Study has been collecting data since 2012 and data collection is ongoing. At the time of analysis, 95 centers were included in the Amyloid Biomarker Study. The study included 9746 individuals with normal cognition (NC) and 3023 participants with mild cognitive impairment (MCI) aged between 34 and 100 years for whom data on amyloid biomarkers, presence of depressive symptoms, and age were available. Data were analyzed from December 2022 to February 2024.

Main Outcomes and Measures

Amyloid-β1-42 levels in cerebrospinal fluid or amyloid positron emission tomography scans were used to determine presence or absence of amyloid pathology. Presence of depressive symptoms was determined on the basis of validated depression rating scale scores, evidence of a current clinical diagnosis of depression, or self-reported depressive symptoms.

Results

In individuals with NC (mean [SD] age, 68.6 [8.9] years; 5664 [58.2%] female; 3002 [34.0%] APOE ε4 carriers; 937 [9.6%] had depressive symptoms; 2648 [27.2%] had amyloid pathology), the presence of depressive symptoms was not associated with amyloid pathology (odds ratio [OR], 1.13; 95% CI, 0.90-1.40; P = .29). In individuals with MCI (mean [SD] age, 70.2 [8.7] years; 1481 [49.0%] female; 1046 [44.8%] APOE ε4 carriers; 824 [27.3%] had depressive symptoms; 1668 [55.8%] had amyloid pathology), the presence of depressive symptoms was associated with a lower likelihood of amyloid pathology (OR, 0.73; 95% CI 0.61-0.89; P = .001). When considering subgroup effects, in individuals with NC, the presence of depressive symptoms was associated with a higher frequency of amyloid pathology in APOE ε4 noncarriers (mean difference, 5.0%; 95% CI 1.0-9.0; P = .02) but not in APOE ε4 carriers. This was not the case in individuals with MCI.

Conclusions and Relevance

Depressive symptoms were not consistently associated with a higher frequency of amyloid pathology in participants with NC and were associated with a lower likelihood of amyloid pathology in participants with MCI. These findings were not influenced by age, sex, or education level. Mechanisms other than amyloid accumulation may commonly underlie depressive symptoms in late life.

Depression's double-edged impact on body mass index. A hidden catalyst for non-communicable diseases in South Africa's aging population in long-term care facilities

INTRODUCTION

The global population of older people, who have a high prevalence of non-communicable diseases, is on an upward trajectory, notably in South Africa. The expansion of this demographic will further strain an already overwhelmed healthcare system, primarily taxed by infectious diseases in younger populations. Physical activity has been shown to effectively reduce risk factors for non-communicable diseases in older people.

OBJECTIVE

To investigate the associations between depression, body mass index (BMI) and physical activity and its complex interplay on non-communicable diseases in older people residing in South African long-term care facilities.

METHOD

We conducted a cross-sectional study on 396 participants residing in South African rural and urban long-term care facilities to analyse BMI, waist-hip ratio, physical activity and depression levels. The Geriatric Depression Scale and the International Physical Activity Questionnaire was used to evaluate depression and physical activity respectively.

RESULTS

The sample had a mean BMI of 27.53 kg/m2 (95% CI [26.99, 28.07], SD = 5.49), with an obesity prevalence of 31.82%. Additionally, 35.10% of participants exhibited some degree of depressive symptoms. In an ordinal regression model BMI was a significant predictor (B = .10, p = .007) for increases in depression. Conversely in a linear regression model, depression (B = -2.01, p = .004) and physical activity (B = -.001, p = .008) were predictors for decreases in BMI.

CONCLUSION

The relationship between depression and BMI in older people is complex, with depression often leading to both weight loss and, conversely, increased BMI contributing to a higher risk of depression. Physical activity serves as a critical intervention, helping to reduce both BMI and depressive symptoms among older people residing in long-term care facilities. This underscores the importance of integrating PA programs into care strategies to improve overall health and well-being in this population.

Depression and Its Effect on Geriatric Rehabilitation Outcomes in Switzerland's Aging Population

Background and Objectives: Depression is a common mental problem in the older population and has a significant impact on recovery and general well-being. A comprehensive understanding of the prevalence of depressive symptoms and their effects on functional outcomes is essential for improving care strategies. The primary aim of this study was to determine the prevalence of depressive symptoms in older patients undergoing geriatric rehabilitation and to assess their specific impact on their functional abilities. Materials and Methods: A retrospective study was conducted at the Lucerne Cantonal Hospital in Wolhusen, Switzerland, spanning from 2015 to 2020 and including 1159 individuals aged 65 years and older. The presence of depressive symptoms was assessed using the Geriatric Depression Scale (GDS) Short Form, while functional abilities were evaluated using the Functional Independence Measure (FIM) and the Tinetti test. Data analysis was performed using TIBCO Statistica 13.3, with statistical significance set at p < 0.05. Results: Of the participants, 22.9% (N = 266) exhibited depressive symptoms, with no notable differences between genders. Although all patients showed functional improvements, the duration of rehabilitation was prolonged by two days (p = 0.012, d = 0.34) in those with depressive symptoms. Alarmingly, 76% of participants were classified as at risk of falling based on the Tinetti score. However, no significant correlation was found between the GDS and Tinetti scores at admission (p = 0.835, r = 0.211) or discharge (p = 0.336, r = 0.184). The results from the non-parametric Wilcoxon matched-pairs test provide compelling evidence of significant changes in FIM scores when comparing admission scores to those at discharge across all FIM categories. Conclusions: Depressive symptoms are particularly common in geriatric rehabilitation patients, leading to prolonged recovery time and increased healthcare costs. While depressive symptoms showed no correlation with mobility impairments, improvements in functional status were directly associated with reduced GDS scores. Considering mental health during admission and planning is critical in optimizing rehabilitation outcomes.

Determinants of Social Activity Among Geriatric Patients in Northern Romania: A Cross-Sectional Study

Background/Objectives: The aging population poses a significant challenge to global public health, impacting the physical, mental, and social health of older adults. Social activity has been widely acknowledged as a protective factor for both mental and physical well-being. Research indicates that consistent engagement in social activities can mitigate the risk of depression, prevent cognitive decline, and support physical functionality. This study aims to explore the correlations and associations between two variables related to social activity (self-reported activity level and time spent with friends) and various other variables among geriatric patients in Northern Romania. Methods: This cross-sectional, single-center observational study utilized data from 588 geriatric patients (402 females and 186 males) admitted to the Geriatrics ward of the Municipal Clinical Hospital. The dataset included variables such as sociodemographic information, Geriatric Depression Scale (GDS), Montreal Cognitive Assessment (MoCA), and SARC-F questionnaire scores, time spent with friends, and activity levels. Descriptive statistics were computed alongside statistical tests to examine group differences, associations, and predictive relationships. Results: The sample was characterized by variability in age, educational attainment, and pension levels. The statistical analyses revealed significant differences based on education, pension, and civil status. Patients with higher GDS and SARC-F scores had lower odds of spending time with friends or belonging to the active or extremely active groups. Notably, women reported higher GDS scores and lower activity levels compared to men. Conclusions: Understanding the factors that influence social activity among older adults is essential for designing targeted interventions aimed at preventing social isolation and fostering healthy aging across diverse demographic and environmental contexts.

Relationship Between Depression and Decreased Activity Level and Cognitive Impairment in Patients with Diabetes Mellitus Type 2 and/or Atrial Fibrillation

Background: The interdependence between type 2 diabetes mellitus (DM-2), atrial fibrillation (AF), and cognitive decline (CD)/dementia is a debated topic. In this study, we highlighted the influence of DM-2 and FA individually and in association on the severity of CD/dementia. Methods: This study comprises 248 patients with very high cardiovascular risk (VHCVR) according to Systematic Coronary Risk Evaluation (SCORE2), of whom 184 had DM-2 and/or AF, and 64 were age-matched controls (without DM-2/AF), admitted to the Municipal Hospital Timisoara. Results: Mini-Mental-State-Examination (MMSE), Montreal Cognitive Assessment (MoCA), Activities of Daily Living Score (ADL), and Instrumental Activities of Daily Living Score (IADL) were significantly decreased, and Geriatric Depression Scale (GDS-15) increased in patients with DM-2 and AF in comparison to controls (p < 0.05), with the subjects with DM-2 and AF having more severe CD compared to those with only one of these two pathologies. The logistic regression model showed that the risk of CD (MMSE < 27) or dementia (MMSE < 24) increased significantly in patients with DM-2 and/or AF depending on the SCORE2 values, ADL, and GDS-15. In DM-2 and/or AF patients, an increase of 1% in SCORE2 was associated with an elevation of 2.40% in the odds of CD and of 4.30% of dementia. In these patients, depression (GDS score) increased the risk of CD by 36.3%, and if ADL improved, the risk of CD decreased by 44.0%. Conclusions: Our findings suggest a direct association between CD, DM-2, and AF with SCORE2, cognitive parameters, ADL, and depression. In patients with DM-2 and/or AF, it is important to identify subclinical CD to prevent the evolution to dementia.

The Impact of the COVID-19 Pandemic in the Interrelationships Among Mental Health, Nutritional Status and Lifestyle Factors of Older Adults: A Cross-Sectional Study in the Pre- and Post-Covid Periods

BACKGROUND/OBJECTIVES

The COVID-19 pandemic has led to detrimental effects on diverse aspects of the mental and physical health of the general population worldwide. The elderly are more susceptible to COVID-19 infection compared to younger age groups. In this aspect, the purpose of the current survey is to evaluate the effect of the COVID-19 pandemic on the interrelationships among the sociodemographic and anthropometric characteristics, depressive behavior, quality of life, cognition status, physical activity and nutritional status of older adults.

METHODS

The present study constitutes a comparative, cross-sectional study of 4162 older adults (mean age ± standard deviation: 72.13 ± 8.1 years and 75.22 ± 8.2 years in the pre- and post-COVID-19 periods, respectively, and a male/female ratio of almost 1:1). We used validated questionnaires to assess depression, cognition function, quality of life, physical activity and nutritional status of the elderly in the pre-Covid and post-Covid periods. Relevant questionnaires were also used for collecting sociodemographic data, while anthropometric data were measured using standard protocols.

RESULTS

The present study finds that the COVID-19 pandemic influenced, in an independent manner, residence location, smoking status, overweight/obesity and abdominal obesity, depressive behavior, quality of life, cognition behavior, physical activity levels and nutritional status of the elderly. The COVID-19 pandemic was also related to employment and living status as well as family economic status. Nevertheless, the above three relationships were insignificant in the multivariate analysis.

CONCLUSIONS

The COVID-19 pandemic exerted deleterious effects on several aspects of the mental and physical health of the elderly, which appeared to strongly persist in the post-Covid period. Future prospective population-based and well-organized surveys should be conducted to establish whether there is a causality long-term effect of the COVID-19 pandemic on diverse aspects of the mental and physical health of the elderly.

Telemedicine in Alzheimer's disease and other dementias: Where we are?

The prevalence and global health burden of dementia including Alzheimer's disease (AD) is rising, while patients living in remote and underserved areas face significant challenges in reaching specialized care. Telemedicine offers a valuable solution in bridging this widening gap, by providing equal and timely access to tertiary-specialized centers. Accumulating evidence highlights that most parts of the remote neuropsychological and neurological evaluation are feasible, with patients, healthcare professionals and caregivers being generally satisfied with this means of care. Herein, we provide an updated overview of the available evidence on the use of telemedicine for patients with cognitive disorders, focusing on the different applications and settings, the remote, video-based neurological and neuropsychological assessment, current recommendations, non-pharmacological interventions, as well as legal and ethical considerations. Based on the literature review and our three-year experience in the "Specialized Outpatient Clinic of Memory, Dementia and Parkinson's disease through the National Telemedicine Network" in the Aiginition University Hospital of Athens, we propose a brief guide for assessing patients with cognitive impairment via telemedicine and suggest future research directions for the more effective and appropriate use of telemedicine in dementia assessment and care.

Subjective health complaints and life satisfaction in older adults: the predictive role of geriatric depression

BACKGROUND

Given the growing number of older adults, it is crucial to understand geriatric depression and to determine the impact of depression on well-being and health. The aim of this study was to examine the predictive effect of geriatric depression on subjective health complaints and life satisfaction in older adults.

METHODS

This cross-sectional study was carried out in two family health centres in a city centre in the northwest of Türkiye. The sample consisted of 257 older adults. Structural equation modelling path analysis was utilised to examine the extent to which geriatric depression predicted subjective health complaints and life satisfaction among older adults.

RESULTS

The study found that geriatric depression was a predictor of both subjective health complaints and life satisfaction. Results showed that as geriatric depression scale score increased, subjective health complaints also increased (Std. β = 0.470, P < 0.001), while life satisfaction decreased (Std. β = -0.573, P < 0.001).

CONCLUSION

Geriatric depression is a complex health issue that biopsychosocially affects older adults. The findings of this study highlight the importance of identifying, diagnosing, and treating depression in older adults.

Differential associations of neighborhood disadvantage, race/ethnicity, and cognitive status with experiences of psychosocial distress in the HABS-HD cohort

INTRODUCTION

Understanding how contextual socioeconomic factors are associated with psychosocial distress among different ethnoracial groups is important for addressing health disparities in individuals at risk for Alzheimer's disease.

METHODS

Using Health and Aging Brain Study-Health Disparities (HABS-HD) data collected between 2017 and 2023, we examined the association of neighborhood disadvantage with psychosocial distress using demographically adjusted linear regression models, stratified by ethnoracial group and cognitive status.

RESULTS

We included 630 non-Hispanic Black, 1109 Hispanic, and 1068 non-Hispanic White older adults deemed cognitively normal (CN) or diagnosed with mild cognitive impairment (MCI). Residing in areas of greater neighborhood disadvantage was associated with increased chronic stress (CS) among CN White participants, but this relationship was attenuated among White participants with MCI. Regardless of cognitive status, severe levels of disadvantage were associated with increased CS and depression among Black participants.

DISCUSSION

Aging in more disadvantaged neighborhoods was associated with greater CS and depression for Black and White participants.

HIGHLIGHTS

Greater neighborhood disadvantage was associated with increased depression and chronic stress for White and Black individuals. Individuals with mild cognitive impairment reported greater levels of psychosocial distress. These findings are relevant for addressing mental health inequity in aging populations.

Cross-cultural translation, validation, and responsiveness of the Pittsburgh Fatigability Scale - Italian version (PFS-I) in a mixed-sample of older adults

INTRODUCTION

Older adults experience fatigue which impacts health-related quality of life. The Pittsburgh Fatigability Scale (PFS) was specifically designed to assess perceived physical and mental fatigability in older adults. The aim of this study was to translate the PFS into Italian (PFS-I) and to investigate its psychometric properties.

METHODS

The PFS-I was translated in accordance with international standards. The following properties were evaluated: structural validity, internal consistency, hypotheses testing for construct validity, test-retest reliability using intraclass correlation coefficients (ICC), and minimal clinically important difference (MCID) for responsiveness.

RESULTS

The study included 87 older adults with cardiovascular/respiratory diseases (CVRD), 46 with Parkinson disease (PD), and 67 healthy controls (HC). The PFS-I Physical and Mental subscales scores were significantly different in these populations, with HC reporting the lowest fatigability. Exploratory and confirmatory factor analysis showed a two-factor structure for both subscales, with good internal consistency (Cronbach's alpha: 0.86 and 0.89, respectively). The PFS-I Physical subscale showed weak goodness-of-fit of the confirmatory factor analysis models, whereas the PFS-I Mental subscale was deemed acceptable. Construct validity of the PFS-I was excellent with 75% (18 out of 24) of hypotheses accepted. Test-retest reliability was analyzed in a subset of 23 patients with CVRD and showed excellent results for both the PFS-I Physical and Mental subscales (ICC = 0.93 and 0.92, respectively). MCID ranged between 6 and 7 points for the Physical and 7-9 points for the Mental subscale.

CONCLUSIONS

The PFS-I is a valid, reliable, and responsive instrument to assess perceived fatigability for healthy older adults as well as those with CRVD and PD.

Physical Activity and Frailty Are Impaired in Older Adults with Benign Paroxysmal Positional Vertigo

Background/Objectives: Benign Paroxysmal Positioning Vertigo (BPPV), diagnosed in 46% of older adults with complaints of dizziness, causes movement-related vertigo. This case-control study compared physical activity, frailty and subjective well-being between older adults with BPPV (oaBPPV) and controls. Methods: Thirty-seven oaBPPV (mean age 73.13 (4.8)) were compared to 22 matched controls (mean age 73.5 (4.5)). Physical activity was measured using the MOX accelerometer and the International Physical Activity Questionnaire. Modified Fried criteria assessed frailty. The Dizziness Handicap Inventory, Falls Efficacy Scale, and 15-item Geriatric Depression Scale assessed subjective well-being. A post-hoc sub-analysis compared all variables compared between frail oaBPPV, robust oaBPPV and robust controls. Significance level was set at α = 0.05. Results: oaBPPV were significantly less physically active and were more (pre-)frail (p < 0.001) compared to controls. They performed significantly less active bouts (p = 0.002) and more sedentary bouts (p = 0.002), and a significantly different pattern of physical activity during the day. OaBPPV reported significantly less time in transportation activities (p = 0.003), leisure (p < 0.001), walking (p < 0.001) and moderate-intensity activities (p = 0.004) compared to controls. Frail oaBPPV were even less active (p = 0.01) and experienced more fear of falling (p < 0.001) and feelings of depression (p < 0.001) than robust oaBPPV and controls. Conclusions: BPPV can induce a vicious cycle of fear of provoking symptoms, decreased physical activity, well-being and consequently frailty. It is also possible that frail and less physically active older adults have an increased prevalence of BPPV. Post-treatment follow-up should assess BPPV, frailty and physical activity to determine if further rehabilitation is needed.

Evaluating the sociodemographic, anthropometric and lifestyle parameters, depression, quality of life, cognitive status, physical activity, and Mediterranean diet adherence of older adults in pre- and post-Covid-19 periods: a comparative cross-sectional study

Ojective: Covid-19 pandemic has exerted deleterious effects on several aspect of mental health worldwide. The detrimental medical complications, the increased prevalence of morbidity and the rapid international spread of Covid-19 have resulted in urgent public health concerns and political measures across the world. This comparative, cross-sectional study aims to assess the changes that were established in sociodemographic, anthropometric and lifestyle parameters and several aspects of mental health of older adults due to Covid-19 pandemic by comparing the pre-Covid period with the post-Covid period. Methods: Qualified questionnaires were applied for assessing the prevalence of depression, quality of life, cognitive status, and Mediterranean Diet (MD) adherence, as well as sociodemographic, anthropometric and lifestyle parameters in 3388 older adults in the pre- and post-Covid period. Results: Covid-19 pandemic independently affected type of residence, smoking habits, BMI and WHR status, risk of depression, quality of life, cognitive status, physical activity levels, and MD adherence. Conclusions: Covid -19 pandemic has exerted persistent detrimental effects on daily quality of life and mental health of older adults in the post-Covid period. Future strategies and public policies should develop healthcare programs to provide psychological and nutritional counseling and support to older adults to minimize the detrimental effects of Covid pandemic.

Prevalence of subthreshold depression in older adults: A systematic review and meta-analysis

BACKGROUND

The prevalence of subthreshold depression (StD) in older adults shows considerable variation across studies. This study aimed to determine the prevalence of subthreshold depression in elderly people.

METHODS

We conducted a thorough literature search across multiple databases, including PubMed, Web of Science, Medline, Cochrane Library, SinoMed, Wan Fang Data, CNKI, and VIP. Statistical analyses were carried out using STATA version 16.0. Our study was prospectively registered with PROSPERO (CRD42023494210).

RESULTS

Seventy-seven studies involving 225,232 individuals were included in this meta-analysis. The overall prevalence of subthreshold depression was 18.6 % (95 % CI: 16.0 %-21.2 %, I2 =99.8 %, p<0.001. Subgroup analyses showed the prevalence of StD in older adults varied depending on the screening tools used and the continent of the study. Funnel plots and Egger's test did not reveal any significant publication bias (Egger's test: p = 0.057).

CONCLUSION

The prevalence of subthreshold depression in older adults is high, suggesting attention needs to be paid to the mental health of the elderly. To prevent a larger public health issue, it is imperative to implement timely and effective preventive measures and interventions, focusing on early detection and intervention.

Decomposing rural-urban differences in depression prevalence: a cross-sectional analysis of two community-based southern Indian cohorts

Introduction

Depression is a growing public health concern in India but its prevalence is uneven across the country, possibly influenced by several sociodemographic factors. We aimed to assess the rural-urban disparity in the prevalence of depression and their associated sociodemographic and lifestyle-related factors.

Methods

Participants were middle-aged and older adults (≥45 years) from two parallel, prospective cohorts from rural (CBR-SANSCOG, n=4493) and urban (CBR-TLSA, n=972) southern India. We used cross-sectional data from the baseline clinical and biochemical assessments of the above two cohorts. The Geriatric Depression Scale (GDS-30) was used to screen for depression (cut-off ≥10). Logistic regression was used to assess the relationship between place of residence (rural vs urban) and prevalence of depression, adjusting for age, sex, education, income, marital status, Body Mass Index (BMI), alcohol use, tobacco use and number of comorbidities. The Fairlie decomposition analysis was used to decompose the rural-urban disparity.

Results

We found that the prevalence of depression was significantly higher in rural than in urban participants (14.49% vs 8.23%, p<0.001). The fully adjusted binary logistic regression model showed that rural-dwelling individuals were 1.57 times more likely to have depression than urban residents (AOR: 1.57, 95% CI: 1.03, 2.39). In the decomposition analysis, the variables included in this model (age, sex, education, income, marital status, BMI, alcohol use, tobacco use and number of comorbidities) explained 35.21% of the rural-urban disparity in the prevalence of depression, with sex and marital status being the significant contributors.

Conclusion

Participants in our rural cohort had significantly higher odds for depression as compared to their urban counterparts, with sociodemographic factors playing a key role in this disparity. This underscores the need for scaling up mental health services in the rural communities of India including training primary healthcare providers to promptly identify and manage depression.

Longitudinal associations between fruit and vegetable intakes and depressive symptoms in middle-aged and older adults from four international twin cohorts

Beneficial associations between higher fruit and vegetable intakes and risk of depression appear to exist but few studies have focused on adults aged 45 + years and the potential that associations are due to residual confounding has not been tested. This longitudinal study of twins (n = 3483, age 45-90 years) from Australia, Denmark, Sweden and USA, assessed the associations between baseline fruit/vegetable intake and depressive symptoms over 5-11 years using linear mixed effects models. Intakes from food frequency questionnaires were trichotomized. Depressive symptoms were assessed using validated measures. The co-twin method was used to examine familial confounding. Compared with low intakes, both high fruit and high vegetable intakes were associated with lower depressive symptoms (fruit: β -.007 [95%CI - .014, < - .001], p = .040; vegetables: β - .006 [95%CI -.011, -.002], p = .002); whereas only moderate vegetable intakes, were associated with lower depressive symptoms (vegetables: β - .005 [95%CI - .009, - .001], p = .014). No familial confounding was found for vegetables, while the results for fruit were inconclusive, likely due to smaller sample size and the marginal significance of the main result. Higher fruit and vegetable intakes may protect against depressive symptoms, presenting another argument for increasing intakes in adults aged 45 + years.

Exploring the interplay of living arrangements, social support, and depression among older adults in rural northwest China

BACKGROUND

With the intensification of aging, depression among the older adults has become a significant global health challenge, especially in developing countries where the problem is particularly severe. This study aims to explore the association between living arrangements and depression, with a specific focus on examining the mediating role of social support in rural northwest China.

METHODS

Data were collected from 501 individuals aged 60 and above in rural Shaanxi Province, northwest China. Living arrangements were assessed based on co-residing family members. Depression was measured using the Geriatric Depression Scale-30, and social support was evaluated with the Social Support Rating Scale. Ordinary Least Squares Regression, Quantile Regression, Generalized Linear Regression, and Ordered Regression analyzed the association between living arrangements and depression. Hierarchical multiple linear regression examined the mediating role of social support. A heterogeneity analysis by gender and socio-economic status was also conducted.

RESULTS

The depression rates were 51.84% for non-empty nests, 67.92% for individuals living alone, and 46.80% for individuals only living with a spouse. The regression analysis did not reveal a significant difference in depressive between empty nests compared to non-empty nests. However, older adults living alone exhibited a higher susceptibility to depression symptoms (β = 2.594, P < 0.05). The mediating analysis showed that empty nesters living alone experience higher rates of depression due to receiving less social support compared to those living with a spouse or in non-empty nest arrangements, particularly concerning subjective social support (β = 0.481, P < 0.05). Heterogeneity analysis identified specific vulnerable groups among older adults, emphasizing the higher susceptibility to depressive symptoms among those living alone, especially among male older adults or those from non-poor families.

CONCLUSIONS

Our findings emphasize a significant prevalence of depression among older adults in rural areas, particularly highlighting the vulnerability of those living alone. This underscores the urgent need for government attention to address the mental health challenges faced by the older adults. Future interventions should focus on improving social support networks to mitigate the impact of living alone on depression symptoms among this population.

Factors Influencing the Development and Severity of Cognitive Decline in Patients with Chronic Heart Failure

Background and Objectives: Considering the increasing prevalence of chronic heart failure (CHF) and cognitive decline (CD) observed in recent decades and the complex interrelation between these two pathologies often encountered in the same patient, in this study, we aimed to highlight the connection between CHF, defined as recommended by the European Society of Cardiology guidelines, and CD, evaluated by employing five neuropsychological scales. Materials and Methods: Our study was conducted on 190 patients with very high cardiovascular risk profiles admitted between 5 September 2021 and 15 November 2023 in the Municipal Emergency Hospital Timisoara. Of these, 103 had CHF (group A) and 87 did not (group B). Results: Although similar concerning age, sex distribution, and risk factors (excepting lipid profile), patients from group A had lower Mini Mental State Evaluation (MMSE) and Montreal Cognitive Assessment (MoCA levels (p = 0.003, respectively, p = 0.017) scores, more reduced daily activity (p = 0.021), and more severe depression (p = 0.015) compared to group B. We documented statistically significant correlations between left-ventricular ejection fraction (LVEF) and the levels of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), as well as with the results of MMSE (r = 0.226, p = 0.002 and r = -0.275, p = 0.005, respectively), daily activity, and depression (p ˂ 0.001). Multi-logistic regression models indicated age, blood pressure values, decreased daily activity, and depression as risk factors for CD in patients with CHF. Conclusions: In patients with CHF, there is an increased propensity of CD, with a direct relationship between MMSE and LVEF levels and an indirect one between MMSE and NT-pro-BNP levels. The concomitance of depression and reduced activity levels are aggravating CD in these patients.

Perceived physical and mental fatigability in older adults with and without multiple sclerosis

BACKGROUND

Fatigue stands out as a prevalent and debilitating symptom in both Multiple Sclerosis (MS) and the aging population. Traditional methods for measuring perceived fatigue may not adequately account for individual activity differences, leading to varied prevalence rates. Perceived fatigability anchors fatigue to specific activities with predetermined intensity and duration, thereby mitigating self-pacing bias. Despite its potential, perceived fatigability is poorly understood in older adults, particularly those with neurological conditions, including MS. This study thus aimed to (1) investigate whether, among older adults, MS was associated with worse perceived physical and mental fatigability; (2) evaluate whether, among older adults with MS (OAMS), greater patient-reported disease-related disability was associated with worse perceived physical and mental fatigability.

METHODS

Participants were 96 older adults with a physician-confirmed diagnosis of MS (mean age: 64.6 ± 4.2) and 110 healthy controls (mean age: 68.2 ± 7.2), all confirmed to be dementia-free through established case conference procedures. Physical and mental fatigability were measured using the Pittsburgh Fatigability Scale, a 10-item questionnaire (score range: 0 to 50) designed to assess fatigue levels that individuals expect to feel after engaging in a range of typical activities for older adults. MS disease-related disability was assessed with the Patient Determined Disease Steps scale, which ranges from 0 (normal) to 8 (bedridden), with scores ≥ 2 indicating worse MS-related disability after a median split. Separate linear regression models were performed to investigate associations between group status (MS vs. Control) as the predictor and perceived physical and mental fatigability scores as the outcome variables. Within the MS group, additional linear regression models were performed to explore the relationship between disease-related disability and fatigability levels. All models adjusted for age, sex, race, education, global health, general cognitive function, and depressive symptoms levels.

RESULTS

The fully adjusted models yielded the following key findings: OAMS reported significantly higher levels of perceived physical fatigability (M = 25.11 ± 9.67) compared to controls (M = 17.95 ± 8.35) (p = 0.003). Similarly, the perceived mental fatigability in OAMS (M = 16.82 ± 11.79) was significantly greater than that in controls (M = 9.15 ± 7.12) (p = 0.003). Within the MS group, individuals with greater disease-related disability reported significantly greater levels of both physical (M = 30.13 ± 7.71 vs. 18.67 ± 8.00, p < 0.001) and mental fatigability (M = 20.31 ± 12.18 vs. 12.33 ± 9.69, p = 0.009) compared to those with lower MS-related disability. Of note, the significance of these findings persisted in models that adjusted for depressive symptoms.

CONCLUSION

Our study provides compelling evidence that OAMS exhibit significantly higher perceived physical and mental fatigability compared to healthy controls. Additionally, worse MS-related disability correlates with worse physical and mental fatigability. These results persist after adjusting for confounders including depressive symptoms. Our findings underscore the necessity of holistic management strategies that cater to both physical and psychological aspects of MS, laying a foundation for future studies to uncover the pathophysiological mechanisms of fatigability in older adults with and without MS.

Frailty and Medication Appropriateness in Rural Adults: Proposing Interventions through Pharmacist-Physician Collaborative Efforts

Background: Frailty and polymedication are closely interrelated. Addressing these concurrent conditions in primary care settings relies on the utilization of potentially inappropriate medication (PIM) lists and medication reviews (MRs), particularly in rural areas, where healthcare professionals serve as the sole point of access to the medical system. The aim of this study was to examine the relationship between medication appropriateness and variables related to frailty in a rural municipality in order to propose potential strategies for therapy optimization. Methods: This cross-sectional study included all adult community dwellers aged 50 and above officially registered in the municipality of Tiriez (Albacete, Spain) in 2023 (n = 241). The primary outcome variable was frailty (assessed using the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale). The independent variables were age, gender, medication regimen, history of falls, comorbidities, PIMs (evaluated using the screening tool of older persons' prescriptions (STOPP) 2023 criteria), fall-risk-increasing drugs (FRID), and anticholinergic burden (ACB). Results: The prevalence of frailty was approximately 20%. FRID and ACB scores were statistically associated (p-value < 0.001) with frailty, 1.1 ± 1.3 vs. 2.5 ± 1.7, and 1.0 ± 1.3 vs. 2.8 ± 2.5, respectively. Regardless of age, frailty was observed to be more prevalent among females (odds ratio (OR) [95% confidence interval (CI)]: 3.5 [1.5, 9.0]). On average, 2.1 ± 1.6 STOPP criteria were fulfilled, with the prolonged use of anxiolytics and anti-peptic-ulcer agents being the most frequent. Priority interventions (PIs) included opioid dose reduction, benzodiazepine withdrawal, and the assessment of antidepressant and antiplatelet treatment plans. Conclusions: The optimization of medication in primary care is of paramount importance for frail patients. Interventional measures should focus on ensuring the correct dosage and combination of drugs for each therapeutic regimen.

Longitudinal Examination of Stress and Depression in Older Adults Over a 2-Year Period: Moderation Effect of Varied Social Support Measures

Depressive symptoms and stress exposure fluctuate over time in community-dwelling older adults, but they are frequently assessed using one-time retrospective self-report measures. Social support viewed as a multifaceted construct can play diverse moderating roles in this association although it is typically gauged through the measure of perceived social support. This study aims to explore the relationships between stress, social support, and depressive symptoms among older adults by utilizing the longitudinal data collected through a smartphone application and supplemented by annual face-to-face interviews conducted over a 2-year period. Using longitudinal multilevel analysis, we analyzed the data on PHQ-9, stress exposure, and four distinct measures of social support collected from 354 community-dwelling older adults in South Korea. The results demonstrated that 59% of the variability in depressive symptoms was attributable to differences between individuals. Stress exposure was a strong predictor (γ = 3.01⁣ ∗∗∗ , 95% CI = 2.34-3.67). As expected, positive functional social support alleviated the effects of stress on depression (γ = -1.12⁣ ∗∗ , 95% CI = -1.92 ~ -0.32) while negative functional social support (γ = 2.36⁣ ∗∗∗ , 95% CI = 1.29-3.44) and negative structural social support (γ = 3.22⁣ ∗ , 95% CI = 0.79-5.64) worsened the effects of stress on depression. A notable finding is that stress-amplifying effects from the negative functional and structural social support, in addition to well-known stress-buffering effects from positive functional social support, should be regarded as indispensable components in safeguarding the mental health of older adults. Considering the decline in social interactions and the lower probability of older adults establishing new social connections, it is essential to consider approaches that prevent a lack of functional and structural social support and foster a high-quality of functional and structural social support, particularly for those facing greater stressors, as a preventative method against depressive symptoms.

The mediating and moderating effect of health-promoting lifestyle on frailty and depressive symptoms for Chinese community-dwelling older adults: A cross-sectional study

BACKGROUND

This study aims to explore the mediating and moderating effect of health-promoting lifestyles on the relationship between frailty and depressive symptoms to provide a practical reference for effectively promoting the mental health of older adults.

METHODS

A cross-sectional survey of community-dwelling older adults (n = 3107) was conducted in three cities of Ningxia Province, China. Depressive symptoms, frailty, and health-promoting lifestyles were assessed through the 30-item Geriatric Depression Scale, frailty scale, and health-promoting Lifestyle profile-II, respectively. The Bootstrap methods PROCESS program is employed to test the mediation and moderation model.

RESULTS

The findings indicated that health-promoting lifestyles are negatively related to depressive symptoms and frailty, while frailty is positively associated with depressive symptoms. Health-promoting lifestyles have mediated the relationship between frailty and depressive symptoms. Besides, the health-promoting lifestyles weakened the positive relationship between frailty and depression symptoms; there existed a moderating effect of health-promoting lifestyles on the relationship between frailty and depression symptoms among older adults.

LIMITATIONS

Given the cross-sectional study, it is impossible to make causal inferences.

CONCLUSIONS

A health-promoting lifestyle might be a protective factor for older adults' health in China. The mediating and moderating effect of a health-promoting lifestyle on the relationship between frailty and depression symptoms among older adults should be integrated to achieve maximum utility. Healthcare practitioners and medical service personnel are recommended to advance health education and publicity, encouraging healthy lifestyles among community-dwelling older adults with frailty to prevent depressive symptoms and promote healthy aging.

A latent profile analysis of rest-activity behavior patterns among community-dwelling older adults and its relationship with intrinsic capacity

Rest-activity behavior clusters within individuals to form patterns are of significant importance to their intrinsic capacity (IC), yet they have rarely been studied. A total of 1253 community-dwelling older adults were recruited between July and December 2021 based on the baseline survey database of the Fujian Prospective Cohort Study on Aging. Latent profile analysis was used to identify profiles of participants based on rest-activity behaviors, whereas logistic regression analysis was carried out to investigate the relationship between profiles and IC. We identified three latent profiles including: (1) Profile 1-labeled "Gorillas": High physical activity (PA), moderate sedentary behaviors (SB), screen time (ST) and sleep (n = 154, 12%), (2) Profile 2-labeled as "Zebras": Moderate PA, low SB, ST and high sleep (n = 779, 62%), and (3) Profile 3-labeled as"Koalas": High SB, ST, low PA and sleep (n = 320, 26%). Logistic regression revealed a negative correlation between low IC and the "Gorillas" profile (β = - 0.945, P < 0.001) as well as the "Zebras" profile (β = - 0.693, P < 0.001) among community-dwelling older adults, with the "Koalas" profile showing the weakest IC compared to the other profiles. The demographic traits i.e., female, older age, living alone, and low educational level also correlated with low IC. Identifying trends of rest-activity behaviors may help in drawing focus on older adults at risk of decreasing IC, and develop personalized improvement plans for IC.

Baseline Depressive Symptoms as a Predictor of Incident Dementia in a Prospectively Followed Cohort of Elders with Essential Tremor

INTRODUCTION

Essential tremor (ET) patients may exhibit a variety of non-motor features, including cognitive decline and depressive symptoms. Studies of several neurodegenerative diseases link depression to cognitive decline, suggesting depression is an early marker of dementia. We examined whether baseline depressive symptoms predict incident dementia in elders with ET.

METHODS

Hundred and forty-one ET cases aged 70 years or older at baseline, enrolled in a prospective study of cognitive performance, took part in evaluations at baseline and at 18, 36, 54, and 72 months. Participants completed the Geriatric Depression Scale (GDS), a 30-item self-report measure of depressive symptoms, and a battery of neuropsychological tests and functional assessments, from which we derived cognitive diagnoses at each evaluation. Cox proportional hazards regression equations determined incident dementia risk based on participants' baseline depression scores.

RESULTS

Mean baseline age was 81.5 ± 6.7 years. Higher baseline GDS scores were associated with increased risk of dementia in an unadjusted model (hazards ratio [HR] = 1.11, 95% confidence interval [CI] = 1.02-1.20, p = 0.01) and after controlling for baseline age, education, number of medications, and tremor onset age (HR = 1.13, 95% CI = 1.02-1.25, p = 0.02).

CONCLUSION

Baseline depression scores predicted incident dementia in elders with ET. With each one-point increase in baseline depression score, there was a 13% increase in incident dementia risk. Given the published data that reported depression may be twice as high in elders with ET compared to controls, this association is particularly worrisome in the ET population.

Detection of anxiety symptoms and disorders in older adults: a diagnostic accuracy systematic review

BACKGROUND

Anxiety symptoms and disorders are common in older adults and often go undetected. A systematic review was completed to identify tools that can be used to detect anxiety symptoms and disorders in community-dwelling older adults.

METHODS

MEDLINE, Embase and PsycINFO were searched using the search concepts anxiety, older adults and diagnostic accuracy in March 2023. Included articles assessed anxiety in community-dwelling older adults using an index anxiety tool and a gold standard form of anxiety assessment and reported resulting diagnostic accuracy outcomes. Estimates of pooled diagnostic accuracy outcomes were completed.

RESULTS

Twenty-three anxiety tools were identified from the 32 included articles. Pooled diagnostic accuracy outcomes were estimated for the Geriatric Anxiety Inventory (GAI)-20 [n = 3, sensitivity = 0.89, 95% confidence interval (CI) = 0.70-0.97, specificity = 0.80, 95% CI = 0.67-0.89] to detect generalized anxiety disorder (GAD) and for the GAI-20 (n = 3, cut off ≥ 9, sensitivity = 0.74, 95% CI = 0.62-0.83, specificity = 0.96, 95% CI = 0.74-1.00), Beck Anxiety Inventory (n = 3, sensitivity = 0.70, 95% CI = 0.58-0.79, specificity = 0.60, 95% CI = 0.51-0.68) and Hospital Anxiety and Depression Scale (HADS-A) (n = 3, sensitivity = 0.78, 95% CI = 0.60-0.89, specificity = 0.76, 95% CI = 0.60-0.87) to detect anxiety disorders in clinical samples.

CONCLUSION

The GAI-20 was the most studied tool and had adequate sensitivity while maintaining acceptable specificity when identifying GAD and anxiety disorders. The GAI-20, GAI-Short Form and HADS-A tools are supported for use in detecting anxiety in community-dwelling older adults. Brief, self-rated and easy-to-use tools may be the best options for anxiety detection in community-dwelling older adults given resource limitations. Clinicians may consider factors including patient comorbidities and anxiety prevalence when selecting a tool and cut off.

Prevalence of depression and anxiety symptoms after stroke in young adults: A systematic review and meta-analysis

BACKGROUND

Young adults with stroke have distinct professional and social roles making them vulnerable to symptoms of post-stroke depression (PSD) and post-stroke anxiety (PSA). Prior reviews have examined the prevalence of anxiety and depression in stroke populations. However, there are a lack of studies that have focused on these conditions in young adults.

OBJECTIVE

We performed a systematic review and meta-analysis of observational studies that reported on symptoms of PSD, PSA and comorbid PSD/PSA in young adults aged 18 to 55 years of age.

METHODS

MEDLINE, EMBASE, SCOPUS and PsycINFO were searched for studies reporting the prevalence of symptoms of PSD and/or PSA in young adults with stroke from inception until June 23, 2023. We included studies that evaluated depression and/or anxiety symptoms with screening tools or interviews following ischemic or hemorrhagic stroke. Validated methods were employed to evaluate risk of bias.

RESULTS

4748 patients from twenty eligible studies were included. Among them, 2420 were also evaluated for symptoms of PSA while 847 participants were evaluated for both PSD and PSA symptoms. Sixteen studies were included in the random effects meta-analysis for PSD symptoms, with a pooled prevalence of 31 % (95 % CI 24-38 %). Pooled PSA symptom prevalence was 39 % (95 % CI 30-48 %) and comorbid PSD with PSA symptom prevalence was 25 % (95 % CI 12-39 %). Varying definitions of 'young adult', combinations of stroke subtypes, and methods to assess PSD and PSA contributed to high heterogeneity amongst studies.

CONCLUSIONS

We identified high heterogeneity in studies investigating the prevalence of symptoms of PSD and PSA in young adults, emphasizing the importance of standardized approaches in future research to gain insight into the outcomes and prognosis of PSD and PSA symptoms following stroke in young adults. Larger longitudinal epidemiological studies as well as studies on tailored interventions are required to address the mental health needs of this important population.

FUNDING

None.

Association of Higher Mediterranean Diet Adherence With Lower Prevalence of Disability and Symptom Severity, Depression, Anxiety, Stress, Sleep Quality, Cognitive Impairment, and Physical Inactivity in Older Adults With Multiple Sclerosis

A good nutritional status and healthy diets may decelerate disease disability and symptom severity and quality of life of peoples with multiple sclerosis (MS). Mediterranean diet (MD) can prevent several chronic diseases, including neurodegenerative disease. This is an observational, cross-sectional study on 279 older adults with MS, aiming to investigate the effects of MD against several aspects of mental health. Qualified questionnaires were used to assess disability and symptom severity, depression, anxiety, stress, sleep quality, cognitive status, physical activity, and MD adherence. Multivariate analysis showed that enhanced MD adherence was independently associated with lower prevalence of disability and symptom severity (P = .0019), depression (P = .0201), anxiety (P = .0287), perceived stress (P = .0021), inadequate sleep quality (P = .0033), cognitive impairment (P = .0018) and physical inactivity (P = .0028). Adopting MD may ameliorate mental health disturbances in older adults with MS. Future public health policies should inform older adults with MS for the favorable impacts of MD in improving the mental health MS comorbidities.

Daily vitality fluctuations in older adults with depressive symptoms: A multilevel location-scale model

BACKGROUND

Examining the daily experiences of older adults with depression facilitates the development and application of personalized effective treatments for them. In previous clinical research on depression, traditional mean-based approaches have mainly been employed. However, the within-person residual variance as a random effect provides greater insight into the heterogeneity of daily experiences among geriatric samples.

OBJECTIVE

This study aimed to examine the relationship between depression and daily vitality in older adults. Specifically, it focused on the mean and residual variance of daily vitality measured by the Ecological Momentary Assessment (EMA).

METHODS

Data from 64 older adults aged 65 years or more, who participated in community welfare centers or retirees' associations, were used. Daily vitality was examined using EMA surveys for seven consecutive days (four random surveys per day). The data were analyzed using a location-scale model.

RESULTS

The intraclass correlation computed from the empty model for the EMA data was 0.488, indicating significant variances in daily vitality across time between individuals. Older adults with higher levels of depressive symptoms showed low mean levels of daily vitality and a large log-residual variance of daily vitality.

CONCLUSIONS

The findings from the current study suggest that individuals experiencing depression not only exhibit low vitality in their daily lives but also struggle to maintain stable levels of vitality in their lives. These insights could contribute to the facilitation and advancement of personalized interventions tailored for older adults.

Depressive Symptoms are Associated with Decline Over Time in Verbal Fluency Performance in Female but Not Male Community-Dwelling Older Adults

OBJECTIVE

The current study was designed to examine associations between depressive symptoms and longitudinal declines in category and letter fluency performance in a gender-stratified sample of older adults.

METHOD

Participants were community-residing older adults (females: n = 289; males: n = 233) followed annually (2011-2018) as part of a cohort study conducted at Albert Einstein College of Medicine in New York. Depressive symptoms were assessed using the Geriatric Depression Scale (GDS). Standard forms assessed category and letter fluency performance. Participants were dementia-free during study enrollment.

RESULTS

The presence of baseline depressive symptoms suggestive of subclinical depression was associated with a worse longitudinal decline in category fluency performance in female but not male participants. These associations remained significant when excluding participants with prevalent and incident mild cognitive impairment and incident dementia. Irrespective of gender, letter fluency performance did not decline over time and was not influenced by the presence of depressive symptoms.

DISCUSSION

The present study's results can aid in identification of older adults who may be at greater risk for cognitive decline, and add to the limited literature examining the influence of gender on longitudinal associations between depressive symptoms and verbal fluency performance.

Association of Depression, Comorbidities, and Sociodemographic Factors among Home Healthcare Recipients

OBJECTIVES

More than 15 million individuals receive home health care (HHC) for chronic conditions, which allows them to maintain a level of independence and self-sufficiency. Although poor mental health can negatively impact health outcomes, little research has been done on the mental health of these individuals.

METHODS

Utilizing National Health Interview Survey years 2019-2022, we ran a cross-sectional analysis to determine rates of depression among individuals who indicated that they utilized HHC services, based on their sociodemographic statuses and diagnosis, as well as their rate of depression by condition whether they utilized HHC services.

RESULTS

HHC recipients were significantly more likely to be depressed if they reported being female, age 55-64, low income, low educational attainment, American Indian/Alaskan Native, Hispanic, or lived in a rural area. HHC recipients were more likely to be depressed than their non-HHC recipient counterparts.

CONCLUSIONS

These results underscore the need for integrated mental health care in home health. Further, the financial burden of HHC, which may have an additional impact on stress, emphasizes the need for expanded accessibility of these services.

CLINICAL IMPLICATIONS

General practitioners and home health professionals should inquire about mental health concerns of these care recipients, and treat or refer accordingly.

Connections between Cognitive Impairment and Atrial Fibrillation in Patients with Diabetes Mellitus Type 2

(1) Background: Cognitive decline (CD), considered a precursory state of dementia, is frequently encountered in patients with diabetes mellitus type 2 (DM-2) and might even have a higher prevalence in those with associated atrial fibrillation (AF). In this study, we aimed to research if the association of DM-2 and AF favors a precocious onset of CD. (2) Methods: This study was conducted on 160 patients, featuring 50 with DM-2, 54 with DM-2 and AF, and 56 subjects without DM-2 and AF, all evaluated clinically and with five neuropsychiatric scales. (3) Results: The Mini-Mental-State-Examination (MMSE), Montreal Cognitive Assessment (MoCA), Activities of Daily Living Score (ADL), Instrumental Activities of Daily Living Score (IADL), and Geriatric Depression Scale (GDS-15) were significantly altered in patients with DM-2 and AF in comparison to patients without these diseases. The logistic regression model indicated that, in patients with DM-2 and AF, an increase of one year in age is associated with a 7.3% augmentation of the risk of a precocious onset of CD (MMSE < 27). (4) Conclusions: CD is more frequent in patients with DM-2, especially when associated with AF, versus those without DM-2 and AF. Our findings suggest that an older age and associated dyslipidemia represent risk factors for CD in patients with DM-2.

Association between residential greenness and depression symptoms in Chinese community-dwelling older adults

BACKGROUND

Studies of residential greenness and depression symptoms among community-dwelling older adults in China are limited. However, understanding the role of greenness in depression symptoms among older adults can inform depression prevention and interventions.

OBJECTIVE

This study explored the relationship between residential greenness and depression symptoms among community-dwelling older adults in China.

METHODS

A cluster random sampling method was used to survey 7512 community-dwelling adults aged 60 and above from three towns in Shanghai. Depression symptoms were assessed using the Geriatric Depression Scale (GDS30). Residential greenness was measured using the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI). Long-term greenspace exposure was defined as the mean NDVI and EVI in the three years prior to the baseline survey. Controlling for the covariates, the relationship between greenness and depression symptoms was assessed using binomial logistic regression and mixed-effects linear regression. Interaction analysis was conducted to explore which covariates potentially alter the association. We also assessed the mediating role of physical activity.

RESULTS

The prevalence of depression symptoms among the participants was 13.72%. Higher residential greenness was associated with lower odds of depression symptoms, after adjusting for covariates. In the logistic regression analysis, the odds of depression symptoms decreased with increasing NDVI and EVI. In linear regression analysis, GDS30 scores decreased with increasing NDVI and EVI. Interaction analyses revealed that higher NDVI and EVI were more protective against depression among male individuals and older adults living with others than among female individuals and older adults living alone. Additionally, physical activity had a masking effect on residential greenness and depression symptoms.

CONCLUSION

Higher residential greenness is associated with lower odds of depression symptoms in community-dwelling Chinese older adults. Increasing urban and neighborhood green spaces may contribute to the prevention and intervention of depression symptoms in community-dwelling older adults.

Distress Symptoms of Old Age and Mild Cognitive Impairment are Two Distinct Dimensions in Older Adults Without Major Depression

Background

Studies in old adults showed bidirectional interconnections between amnestic mild cognitive impairment (aMCI) and affective symptoms and that adverse childhood experiences (ACE) may affect both factors. Nevertheless, these associations may be confined to older adults with clinical depression.

Aim

To delineate the relationship between clinical symptoms of aMCI and affective symptoms in older adults without major depression (MDD) or dysfunctions in activities of daily living (ADL).

Methods

This case-control study recruited 61 participants with aMCI (diagnosed using Petersen's criteria) and 59 older adults without aMCI and excluded subjects with MDD and ADL dysfunctions.

Results

We uncovered 2 distinct dimensions, namely distress symptoms of old age (DSOA), comprising affective symptoms, perceived stress and neuroticism, and mild cognitive dysfunctions, comprising episodic memory test scores, the total Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. A large part of the variance (37.9%) in DSOA scores was explained by ACE, negative life events (health and financial problems), a subjective feeling of cognitive decline, and education (all positively). ACE and NLE have a highly significant impact on the DSOA score and are not associated with aMCI or its severity. Cluster analysis showed that the diagnosis of aMCI is overinclusive because some subjects with DSOA symptoms may be incorrectly classified as aMCI.

Conclusion

The clinical impact is that clinicians should carefully screen older adults for DSOA after excluding MDD. DSOA might be misinterpreted as aMCI.

Association of COVID-19 Infection with Sociodemographic, Anthropometric and Lifestyle Factors: A Cross-Sectional Study in an Older Adults' Population Aged over 65 Years Old

BACKGROUND

The COVID-19 pandemic has led to unfavorable disruptions to daily living routines by exerting deleterious effects on several aspects of human mental and physical health and quality of life worldwide. The purpose of the current survey is to explore the potential association of COVID-19 infection with multiple sociodemographic, anthropometric, and lifestyle factors of community-dwelling older adults.

METHODS

This is a cross-sectional survey including 5197 older adults aged over 65 years old from 10 geographically diverse regions of Greece. Relevant questionnaires were used to record study the population sociodemographic factor, while anthropometric parameters were also measured. Validated questionnaires were also applied to assess several lifestyle factors such as depression, anxiety, stress, cognitive status, sleep quality, health-related quality of life, physical activity levels, and Mediterranean diet (MD) adherence.

RESULTS

In multivariate regression analysis, COVID-19 infection was significantly, independently related with urban residence (p = 0.0107), regular smoking (p = 0.0218), overweight status and obesity (p = 0.0036), as well as abdominal obesity (p = 0.0008), higher risk of depression (p = 0.0027), anxiety (p = 0.0045), stress (p = 0.0038), inadequate sleep quality (p = 0.0108), lower physical activity levels (p = 0.0012), reduced MD compliance (p = 0.0009), and poor health-related quality of life (p = 0.0002). In univariate analysis, older adults' age (p = 0.0001), male gender (p = 0.0015), living alone (p = 0.0023), lower educational and economic level (p = 0.0175 and p = 0.0294, respectively), and cognition decline (p = 0.0032) were also related with the presence of COVID-19 infection; however, these associations were considerably attenuated at a non-significant level by adjustment for several confounders in multivariate analysis.

CONCLUSIONS

This is one of the few available studies supporting evidence that COVID-19 infection may be associated with diverse sociodemographic, anthropometric, and lifestyle factors in an older adults' population in Greece. This study highlights the strong demand to provide psychological and nutritional counselling and support to older adults diagnosed with COVID-19 infection in order to ameliorate disease symptoms and severity, emphasizing the adaptation of healthy dietary and lifestyle habits as preventing and supplementary therapeutic factors against COVID-19.

Factors associated with the effectiveness of immersive virtual therapy in alleviating depressive symptoms during sub-acute post-stroke rehabilitation: a gender comparison

BACKGROUND

The large-scale digitalization of healthcare has induced shifts in patient preferences, prompting the introduction of therapies utilizing novel technologies. In this context, the targeted application of these interventions is deemed as crucial as assessing their overall effectiveness. The aim of this study was to characterize the patient profile who benefited most from immersive virtual reality (VR) therapy.

METHODS

Based on the results from the previous randomized controlled trial study, we employed an exploratory study design to determine the factors associated with the most significant mental health improvement. A secondary analysis was conducted on a sample of 83 participants, with further analysis of participants with elevated depression symptoms, as indicated by a score of > 10 on the 30-item Geriatric Depression Scale (GDS-30). Both groups participated in a similar post-stroke rehabilitation program; however, the experimental group also received additional VR therapy through an immersive VR garden intervention. The GDS-30 was used to assess mood and depressive symptoms, and sociodemographic, cognitive status as well as stroke-related variables were considered as potential factors.

RESULTS

In both the experimental (mean change 5.3) and control groups (mean change 2.8), interventions significantly reduced depressive symptoms, with a more pronounced difference in the experimental group (p < 0.05). When examining gender differences, women exhibited greater improvement in the GDS, with mean between-group differences of 5.0 for the total sample and 6.0 for those with elevated depressive symptoms. Sociodemographic factors, cognitive status, and time from stroke were not found to be factors that alter the effectiveness of VR therapy.

CONCLUSIONS

While VR therapy as an adjunctive treatment for post-stroke rehabilitation seems especially effective for women with elevated depressive symptoms, the results should be interpreted with caution due to the study's small experimental group size. Traditional methods showed reduced effectiveness in women compared to men; thus, developing technologically advanced and gender-specific approaches can lead to more tailored therapy.

TRIAL REGISTRATION

NCT03830372 (February 5, 2019).

Geriatric and Gerontology Research: A Scientometric Investigation of Open Access Journal Articles Indexed in the Scopus Database

BACKGROUND

Scientometric analyses of specific topics in geriatrics and gerontology have grown robustly in scientific literature. However, analyses using holistic and interdisciplinary approaches are scarce in this field of research. This article aimed to demonstrate research trends and provide an overview of bibliometric information on publications related to geriatrics and gerontology.

METHODS

We identified relevant articles on geriatrics and gerontology using the search terms "geriatrics," "gerontology," "older people," and "elderly." VOSviewer was used to perform bibliometric analysis.

RESULTS

A total of 858 analyzed articles were published in 340 journals. Among the 10 most contributory journals, five were in the United States, with the top journal being the Journal of the American Geriatrics Society. The United States was the leading country in research, followed by Japan, Canada, and the United Kingdom. A total of 5,278 keywords were analyzed. In the analysis of research hotspots, the main global research topics in geriatrics and gerontology were older adults (n=663), education and training (n=471), and adults aged 80 years (n=461). These were gradually expanded to include areas related to caring for older adults, such as geriatric assessments (n=395).

CONCLUSION

These results provide direction for fellow researchers to conduct studies in geriatrics and gerontology. In addition, they provide government departments with guidance for formulating and implementing policies that affect older adults, not only in setting academic and professional priorities but also in understanding key topics related to them.

Reliability and Validity of the Geriatric Depression Scale in a Sample of Portuguese Older Adults with Mild-to-Moderate Cognitive Impairment

Although the Geriatric Depression Scale (GDS) is a well-established instrument for the assessment of depressive symptoms in older adults, this has not been validated specifically for Portuguese older adults with cognitive impairment. The objective of this study was to analyze the psychometric properties of two Portuguese versions of the GDS (GDS-27 and GDS-15) in a sample of Portuguese older adults with mild-to-moderate cognitive impairment. Clinicians assessed for major depressive disorder and cognitive functioning in 117 participants with mild-to-moderate cognitive decline (76.9% female, Mage = 83.66 years). The internal consistency of GDS-27 and GDS-15 were 0.874 and 0.812, respectively. There was a significant correlation between GDS-27 and GDS-15 with the Beck Depression Inventory-II (GDS-27: rho = 0.738, p < 0.001; GDS-15: rho = 0.760, p < 0.001), suggesting good validity. A cutoff point of 15/16 in GDS-27 and 8/9 in GDS-15 resulted in the identification of persons with depression (GDS-27: sensitivity 100%, specificity 63%; GDS-15: sensitivity 90%, specificity 62%). Overall, the GDS-27 and GDS-15 are reliable and valid instruments for the assessment of depression in Portuguese-speaking older adults with cognitive impairment.