Depression among older adults with diabetes mellitus

The epidemiology of type 1 diabetes mellitus in older adults

Although type 1 diabetes mellitus (T1DM) is traditionally viewed as a youth-onset disorder, the number of older adults being diagnosed with this disease is growing. Improvements in the average life expectancy of people with T1DM have also contributed to the growing number of older people living with this disease. We summarize the evidence regarding the epidemiology (incidence, prevalence and excess mortality) of T1DM in older adults (ages ≥60 years) as well as the genetics, immunology and diagnostic challenges. Several studies report an incidence peak of T1DM in older adults of a similar size to or exceeding that in children, and population prevalence generally increases with increasing age. Glutamic acid decarboxylase antibody positivity is frequently observed in adult-onset T1DM. Guidelines for differentiating T1DM from type 2 diabetes mellitus in older adults recommend measuring levels of C-peptide and autoantibodies, including glutamic acid decarboxylase antibodies. However, there is no gold standard for differentiating T1DM from type 2 diabetes mellitus in people aged 60 years and over. As such, the global variation observed in T1DM epidemiology might be in part explained by misclassification, which increases with increasing age of diabetes mellitus onset. With a growing global population of older adults with T1DM, improved genetic and immunological evidence is needed to differentiate diabetes mellitus type at older ages so that a clear epidemiological picture can emerge.

Metabolomics in Depression: What We Learn from Preclinical and Clinical Evidences

Depression is one of the predominant common mental illnesses that affects millions of people of all ages worldwide. Random mood changes, loss of interest in routine activities, and prevalent unpleasant senses often characterize this common depreciated mental illness. Subjects with depressive disorders have a likelihood of developing cardiovascular complications, diabesity, and stroke. The exact genesis and pathogenesis of this disease are still questionable. A significant proportion of subjects with clinical depression display inadequate response to antidepressant therapies. Hence, clinicians often face challenges in predicting the treatment response. Emerging reports have indicated the association of depression with metabolic alterations. Metabolomics is one of the promising approaches that can offer fresh perspectives into the diagnosis, treatment, and prognosis of depression at the metabolic level. Despite numerous studies exploring metabolite profiles post-pharmacological interventions, a quantitative understanding of consistently altered metabolites is not yet established. The article gives a brief discussion on different biomarkers in depression and the degree to which biomarkers can improve treatment outcomes. In this review article, we have systemically reviewed the role of metabolomics in depression along with current challenges and future perspectives.

The links between neuroinflammation, brain structure and depressive disorder: A cross-sectional study protocol

INTRODUCTION

It is known that symptoms of major depressive disorder (MDD) are associated with neurodegeneration, that lipopolysaccharide (LPS) can induce symptoms of MDD, and that blood LPS levels are elevated in neurodegeneration. However, it is not known whether blood LPS and cytokine levels correlate with MDD, cognition and brain structure, and this is tested in this study.

METHODS AND ANALYSIS

This cross-sectional study includes individuals with MDD (n = 100) and a control group of individuals with no one-year history of a mental disorder (n = 50). A comprehensive evaluation is performed, including the collection of basic sociodemographic information, data on smoking status, body mass index, course of MDD, past treatment, comorbid diseases, and current use of medications. Diagnosis of MDD is performed according to the WHO's [2019] International Classification of Diseases and related health problems by psychiatrist and severity of MDD is evaluated using the Montgomery-Åsberg Depression Scale. The Cambridge Neuropsychological Test Automated Battery is used to evaluate cognitive functioning. Venous blood samples are taken to measure genetic and inflammatory markers, and multiparametric brain magnetic resonance imaging is performed to evaluate for blood-brain barrier permeability, structural and neurometabolic brain changes. Descriptive and inferential statistics, including linear and logistic regression, will be used to analyse relationships between blood plasma LPS and inflammatory cytokine concentrations in MDD patients and controls. The proposed sample sizes are suitable for identifying significant differences between the groups, according to a power analysis.

ADMINISTRATIVE INFORMATION

Trial registration: Clinicaltrials.gov NCT06203015.

Relationship between eating attitudes, depression, and insight in schizophrenic patients with and without type 2 diabetes mellitus: a comparative study in Guangdong, China

Background

Schizophrenia, a severe mental disorder, is often complicated by Type 2 Diabetes Mellitus (T2DM), which can further impact patients' psychological health. This study investigated the differences in eating attitudes, depression, and insight between schizophrenic patients with and without comorbid T2DM and explored the correlations among these factors to provide empirical support for clinical interventions.

Methods

This case-control study was conducted in Guangdong Province, China. From December 2022 to May 2023, a total of 300 hospitalized patients with schizophrenia (92 with comorbid T2DM and 208 without T2DM) were recruited. Data were collected using the Personal Information Form, Eating Attitudes Test (EAT-26), Hamilton Depression Scale (HAMD), and Insight and Treatment Attitudes Questionnaire (ITAQ). Statistical analyses, including t-tests, ANOVA, and multiple linear regression, were performed to examine differences and predictive factors of eating attitudes among patients. This study was approved by the Ethics Committee of the Affiliated Brain Hospital of Guangzhou Medical University (approval number: 2020028), and written informed consent was obtained from all participants.

Results

Patients with schizophrenia and comorbid T2DM exhibited significantly higher risks of eating disorders (EAT-26: 12.54 ± 9.77 vs. 9.07 ± 7.90, P=0.003), more severe depression (HAMD: 14.71 ± 7.36 vs. 11.80 ± 6.04, P=0.001), and poorer insight (ITAQ: 10.46 ± 6.01 vs. 12.16 ± 6.09, P=0.025) compared to those without T2DM. Regression analysis revealed that gender, weekly exercise frequency, depression, and insight were significant predictors of eating attitudes among patients with T2DM. For patients without T2DM, weekly exercise frequency, smoking status, and insight were significant predictors.

Conclusion

Schizophrenic patients with comorbid T2DM are facing increasing risks related to eating attitudes, depression, and insight which highlight the need for targeted interventions. Regular psychological assessment and tailored support strategies might improve their mental health and quality of life. Future research should focus on longitudinal studies to clarify causal relationships and develop more effective interventions.

Characteristics of and Risk Factors for Depressive Symptoms Preceding Dementia: A Study of 82-Year-Old Men From the Uppsala Longitudinal Study of Adult Men

BACKGROUND

Depression and dementia are known to be associated. The identification of characteristics distinguishing depression prodromal to dementia from other depressive symptoms would be of value for early identification of dementia. The study of risk factors for depressive symptoms prodromal to dementia could improve preventive care and provide clues to the causes of dementia.

METHOD

Dementia-free 82-year-old participants were stratified into groups that did (n = 126) and did not (n = 378) subsequently develop dementia. Examinations took place from 2003 to 2005 and follow-up ended 1 January 2015. Their baseline characteristics and depressive symptoms, measured using the 15-item Geriatric Depression Scale (GDS-15), were compared. Multivariate regression analyses were performed for the two groups separately, with the total GDS-15 score as the dependent variable.

RESULTS

The groups did not differ significantly in answers to any of the GDS-15 questions, or mean ± SD score, which was 2.4 ± 2.5 among those who developed dementia and 2.1 ± 2.3 among those who did not. (p = 0.33). Stroke before the age of 82 years and the inability to use stairs had significant impacts on the GDS-15 scores in both groups. For those who did not develop dementia, age, dependence in activities of daily living, and cancer also had significant impacts. Cancer had opposite associations with depressive symptoms in the two groups.

CONCLUSIONS

No difference was found in depressive symptoms preceding and not preceding dementia using the GDS-15. The results suggest that risk factors for depressive symptoms may differ depending on whether they precede dementia.

Self-management interventions among community-dwelling older adults with type 2 diabetes mellitus: a scoping review protocol

BACKGROUND

Globally, the number of older adults is increasing rapidly; simultaneously, there is an epidemiological shift toward chronic diseases. One such chronic disease is type 2 diabetes mellitus (DM) which is caused either by the inability to produce insulin or due to the ineffective use of insulin. In recent years, self-management programmes for chronic conditions have gained importance, especially among occupational therapists. Though there is an increasing focus on 'self-management interventions' among older adults, there is still a lack of such interventions for older adults with type 2 DM in low- or middle-income countries (LMICs).

OBJECTIVES

Summarise the existing literature on self-management intervention programmes for community-dwelling older adults with type 2 DM; identify the principles, practices and criteria that define a self-management intervention programme for community-dwelling older adults with type 2 DM in LMICs.

METHODS

This present study will be a scoping review, combining quantitative and qualitative literature with a parallel results convergent synthesis design. The synthesis applies to analysing existing principles and practices that influence the selection and application of 'diabetes self-management intervention' among older adults in community settings with type 2 DM in LMICs.

ETHICS AND DISSEMINATION

As a secondary analysis, this scoping review does not require ethics approval. The final review results will be submitted for publication in a peer-reviewed journal in the rehabilitation, diabetes, occupational therapy or health promotion-related fields. Other dissemination strategies may be an oral presentation at international conferences or through various social media networks.

Role perceptions and experiences of adult children in remote glucose management for older parents with type 2 diabetes mellitus: a qualitative study

BACKGROUND

With the advent of the smart phone era, managing blood glucose at home through apps will become more common for older individuals with diabetes. Adult children play important roles in glucose management of older parents. Few studies have explored how adult children really feel about engaging in the glucose management of their older parents with type 2 diabetes mellitus (T2DM) through mobile apps. This study provides insights into the role perceptions and experiences of adult children of older parents with T2DM participating in glucose management through mobile apps.

METHODS

In this qualitative study, 16 adult children of older parents with T2DM, who had used mobile apps to manage blood glucose for 6 months, were recruited through purposive sampling. Semi-structured, in-depth, face-to-face interviews to explore their role perceptions and experiences in remotely managing their older parents' blood glucose were conducted. The Consolidated Criteria for Reporting Qualitative Research (COREQ) were followed to ensure rigor in the study. The data collected were analyzed by applying Colaizzi's seven-step qualitative analysis method.

RESULTS

Six themes and eight sub-themes were identified in this study. Adult children's perceived roles in glucose management of older parents with T2DM through mobile apps could be categorized into four themes: health decision-maker, remote supervisor, health educator and emotional supporter. The experiences of participation could be categorized into two themes: facilitators to participation and barriers to participation.

CONCLUSION

Some barriers existed for adult children of older parents with T2DM participating in glucose management through mobile apps; however, the findings of this study were generally positive. It was beneficial and feasible for adult children to co-manage the blood glucose of older parents. Co-managing blood glucose levels in older parents with T2DM can enhance both adherence rates and confidence in managing blood glucose effectively.

Effects of Comorbid Depressive Symptoms and Diabetes Mellitus on Functional Dyspepsia in Older Patients

Objective

Diabetes mellitus (DM) is a global epidemic; comorbid depressive symptoms are highly prevalent worldwide and commonly manifests as physical symptoms, including functional dyspepsia (FD), a gastrointestinal psychosomatic disorder. This study aimed to explore the effects of comorbid depressive symptoms and DM on FD in older patients.

Methods

In total, 420 older patients with DM completed measures of depression, anxiety, and FD. Relevant demographic characteristics and medical information were self-reported and obtained from the hospital information system.

Results

Among older patients with DM, 30.48% had depressive symptoms. Patients with depressive symptoms were more likely to have FD than those without (42.19% vs. 20.21%, P = .000). Dyspepsia symptoms were more frequent in patients with depression (P = .022). The greater the amount of dyspepsia symptoms, the higher the depression symptoms score (P = .000). Furthermore, dyspepsia symptoms were positively correlated with depressive symptoms (r values were 0.292, 0.311, 0.297, 0.369; all had P < .05). Both FD subtypes, postprandial distress, and epigastric pain syndromes affected depressive symptoms (P < .05). Smoking was significantly associated with FD (P < .05). Diabetes mellitus complications, such as diabetic neuropathy, different therapeutic methods, and anxiety symptoms, influenced FD overlap (x 2 values were 6.298, 16.314, and 30.744; P < .05). Anxiety (odds ratio = 1.832, 95% Confidence Intervals (CI) 1.185-2.834) was a risk factor for FD in comorbid depressive symptoms and diabetes (P < .05).

Conclusion

Comorbid depressive symptoms and DM overlapped with physical symptoms, such as FD, in older patients with DM. Lifestyle, diabetic factors, and anxiety were the associated risk factors.

Multidimensional associations of physical performance, balance, wellness and daily activities with frailty in older adults with coexisting frailty and diabetes

BACKGROUND

The coexistence of frailty and type 2 diabetes mellitus in the older population heightens the risk of adverse events. However, research on functional and wellness factors associated with frailty in this population is limited.

PURPOSE

To investigate the associations of physical performance, functional dependency, physical activity, nutritional status, sleep, self-perceived health and depression with frailty in community-dwelling older adults with coexisting frailty and type 2 diabetes mellitus.

DESIGN

Cross-sectional.

METHODS

The study included 123 community-dwelling older adults (73.7 ± 6.0 years) with pre-frailty/frailty and type 2 diabetes mellitus. Physical performance (Short Physical Performance Battery), functional dependency (Barthel Index and Lawton & Brody), physical activity and inactivity (GeneActiv wrist-worn accelerometer), malnutrition risk (Mini Nutritional Assessment), sleep (Pittsburgh Sleep Quality Index), self-perceived health (EuroQoL 5-Dimension 3-Level) and depression (Yesavage 15-item-Geriatric-Depression-Scale) were evaluated through personal interviews. Principal component analysis (PCA) was performed to categorize the variables into components, and logistic regressions were used to propose the best-fitted model for each component.

RESULTS

The PCA identified four components: (i) physical performance, with gait speed and leg mean velocity as the main variables associated with frailty; (ii) balance, showing significant associations with monopodal balance; (iii) daily activities, with moderate to vigorous physical activity and the Lawton and Brody score as the main variables associated with frailty within this component; and (iv) wellness factors, with nutritional status, self-perceived health and depression score as the primary variables associated with frailty.

CONCLUSIONS

This research underscores the significance of physical function and daily activities as protective factors against frailty in community-dwelling older adults with coexisting frailty and type 2 diabetes mellitus. The health dimension contributes both protective and risk factors, emphasizing the need for comprehensive assessments in managing frailty in this population.

REPORTING METHOD

The study adhered to the STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Social Support as a Correlate of Depression and Quality of Life Among Nigerian Older Adults: a Cross-Sectional Study

Reduced social support has been associated with presence of depression and reduced quality of life among older adults. The relationships may be better understood by exploring the interactions of individual domains among the constructs. This cross-sectional survey involved a consecutive sample of 206 (116 females and 90 males) older adults living in a Southern Nigeria community. The Multidimensional Scale of Perceived Social Support, Geriatric Depression Scale, and World Health Organization Quality of Life-OLD Questionnaire, were used to measure social support, depression, and quality of life respectively. Data was analyzed using frequency counts, percentages, mean, standard deviation, multiple regression and Spearman rank-order correlation coefficient, at 0.05 alpha level. Prevalence rate of depression among participants was 45.5%. Social support was perceived to be low by 37.4% of participants with the lowest mean social support score coming from friends domain. Participants' quality of life was generally fairly good (> 60%) with the lowest scores coming from the intimacy domain. Significant correlations between social support domains and each of quality of life (p < 0.05) and depression were respectively positive and negative; but weakest for the friend and strongest for significant others domains. All quality of life domains were significantly correlated with social support except the death and dying domain. All the domains of social support (family and significant other) were significant predictors of depression except the friend domain. Significant others around individual older adults particularly those with depression ought to be educated on the importance of their roles. Stakeholders including healthcare providers may create and support programmes for improved social networking for the older adults in order to enhance their general wellbeing and quality of life.

Prevalence and patterns of comorbidities in older people with type 2 diabetes in Australian primary care settings

OBJECTIVE

The aim of this study was to identify the prevalence and patterns of comorbidity in community-dwelling older people with type 2 diabetes mellitus (T2DM) attending general practice settings in Australia.

METHODS

This study involved a cross-sectional analysis using the Bettering the Evaluation and Care of Health (BEACH) sub-study data. In a series of sub-studies, a representative sample of general practitioners was asked to record all diagnosed chronic conditions for patients at 40 consecutive encounters using structured paper-based recording forms. The dataset was analysed with descriptive analyses, and exploratory factor analyses were applied to examine comorbidity patterns.

RESULTS

Of the 14,042 patients aged 65 years or older, 2688 had a diagnosis of T2DM (19%). Of the 2688 patients with T2DM, hypertension was present in 67% (95% CI: 64.6-70.0), followed by arthritis 52% (95% CI: 48.8-54.8), hyperlipidaemia 45% (95% CI: 41.8-47.9), ischemic heart disease, 23% (95% CI: 20.7-24.9), depression 16% (95% CI: 48.8-54.8), atrial fibrillation 10% (95% CI: 8.9-11.6), congestive heart failure 7% (95% CI: 6.0-8.1), stroke/cerebrovascular accident 7% (95% CI: 5.4-8.2) and peripheral vascular disease 5% (95% CI: 4.4-6.2). We identified two comorbidity patterns among older people with T2DM. The first were psychological and musculoskeletal conditions and the second were cardiovascular conditions and chronic renal failure.

CONCLUSIONS

The prevalence of cardiovascular and non-cardiovascular comorbidities in community-dwelling older people with T2DM was high. Adequate primary care strategies should be in place to support the long-term care for this population.

Treatment Adherence and Quality of Life Among Elderly Patients With Diabetes Mellitus Registered in the Community

Background This study investigates the association between medication adherence and health-related quality of life among adults with type 2 diabetes mellitus at the Health Center of Tyrnavos community level. Materials and methods This cross-sectional study involved 125 patients with type 2 diabetes mellitus, aged 60 years and older, who were visiting community healthcare facilities. The research was conducted with a structured questionnaire that included 34 questions related to socio-demographic data, self-reported compliance, and stress. The DQOL-BCI (Diabetes Quality of Life - Brief Clinical Inventory) scale was used to measure health-related quality of life. Results A total of 125 patients with a mean (SD) age of 69.2 (8.1) years were included in the study (64 women and 61 men). Based on the results of the descriptive analysis, 88.0% reported high medication adherence. However, 66% of the participants reported having high anxiety levels, with 33.6% having difficulty controlling their anxiety. Quality of life was negatively correlated with lower medication adherence (P < 0.05). Conclusions Older age and low medication adherence are associated with lower quality of life among diabetic patients. Interventions to improve the quality of life in elderly diabetic patients should consider the effect of age and medication adherence.

Prevalence and predictors of diabetes distress and depression in people with type 1 diabetes

Background

People living with diabetes often encounter psychosocial challenges, including diabetes distress and depression. Despite this, little research has focused on the co-occurrence of these conditions. This study aimed to explore the prevalence of depressive symptoms and diabetes distress in people with type 1 diabetes in Kuwait and to identify clinical and demographic factors associated with these conditions.

Methods

A total of 832 people with type 1 diabetes (females: 54.1%, mean age: 29 ± 8.5 years), were invited to participate in Dose Adjustment for Normal Eating (DAFNE) course. Diabetes distress was measured using the Problem Areas in Diabetes (PAID) scale and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Depressive symptoms were defined as PHQ-9 scores ≥10. Data on biomedical outcomes, lifestyle factors, and sociodemographic information were collected.

Results

The prevalence rates of diabetes distress and depressive symptoms were 27.8% and 38.3%, respectively. Notably, 19.6% of people experienced both conditions. In the regression analysis, PAID scale and PHQ-9 scores were significantly associated, patients with higher score on depressive symptoms scale were more likely to suffer diabetes distress (B= 2.65, p < 0.001). Female sex (odds ratio [OR]= 2.2, 95% CI= 1.5, 3.2), higher hemoglobin A1c levels (OR= 1.6, 95% CI= 1.0, 2.5), obesity (OR= 1.7, 95% CI= 1.1, 2.8), inactivity (OR= 2.4, 95% CI= 1.6, 3.6), microvascular complications (OR= 2.8, 95% CI= 1.5, 5.4), and lipohypertrophy (OR= 1.7, 95% CI= 1.1, 2.5) were associated with greater odds for the co-occurrence of diabetes distress and depressive symptoms (p< 0.05 for all).

Conclusion

The majority of people with type 1 diabetes in Kuwait experience both diabetes distress and depressive symptoms. The strong correlation between diabetes distress and depressive symptoms suggests mutual predictability. The co-occurrence of both symptoms is associated with many sociodemographic and clinical factors.

Cohort profile: Beijing Healthy Aging Cohort Study (BHACS)

The Beijing Healthy Aging Cohort Study (BHACS) was established to supplement the limited data of a large representative cohort of older people based on the general population and was designed to evaluate the prevalence, incidence, and natural history of cognitive decline, functional disability, and conventional vascular risk factors. The aim was to determine the evolution of these conditions by estimating the rates and determinants of progression and regression to adverse outcomes, including dementia, cardiovascular events, cancer, and all-cause death. It can therefore provide evidence to help policy makers develop better policies to promote healthy aging in China. BHACS consisted of three cohorts (BLSA, CCHS-Beijing, and BECHCS) in Beijing with a total population of 11 235 (6281 in urban and 4954 in rural areas) and an age range of 55 years or older (55-101 years) with a mean age of 70.35 ± 7.71 years (70.69 ± 7.62 years in urban and 69.92 ± 7.80 years in rural areas). BHACS-BLSA conducted the baseline survey in 2009 with a multistage stratification-random clustering procedure for people aged 55 years or older; BHACS-CCHS-Beijing conducted the baseline survey in 2013-2015 with a stratified multistage cluster random sampling method for people aged 55 years or older; and BHACS-BECHCS conducted the baseline survey in 2010-2014 with two-stage cluster random sampling method for people aged 60 years or older. Data were collected through questionnaires, physical measurements, and laboratory analyses. Topics covered by BHACS include a wide range of physical and mental health indicators, lifestyles and personal, family, and socio-economic determinants of health. There are no immediate plans to make the cohort data freely available to the public, but specific proposals for further collaboration are welcome. For further information and collaboration, please contact the corresponding author Yao He (e-mail: yhe301@x263.net).

Therapeutic choices in elderly diabetic patients

The care of elderly diabetic patients has now become a real public health issue due to the increase in the number of patients. In this population, complications are more serious and are intertwined with more specifically gerontological issues. Treatment goals should be individualized based on the patient's clinical presentation. New therapeutic drug classes are particularly interesting because of their effectiveness in terms of cardiovascular and renal protection, but the risk/benefit ratio needs to be well assessed on an individual basis. Insulin therapy is often necessary, either in case of failure of oral antidiabetics or because of comorbidities, particularly in the event of renal failure. Educating the patient and family early in the course of the disease is one of the keys to effective and safe treatment. The management of elderly diabetic patients must avoid both too much laxity in those who have successfully aged and unreasonable activism in fragile subjects because of the risk of hypoglycemia.

Lower HbA1C of glycemic control is associated with higher risk of depressive symptoms in elderly with type 2 diabetes mellitus-A Nationwide Community-based study

OBJECTIVE

We investigated the correlation between glycemic control status and depressive symptoms in type 2 diabetes elderly.

METHODS

A total of 1527 participants with type 2 diabetes aged 55 years and older from the Healthy Aging Longitudinal Study in Taiwan study were included in this cross-sectional study. The Center for Epidemiologic Studies Depression Scale (CESD) (20 items) score of ≥16 was indicative of depressive symptoms. The participants were divided into HbA1c ≥ 6.5% and < 6.5% representing the glycemic control. Multiple logistic regression (MLR) and Generalized linear model (GLM) were used.

RESULTS

The MLR analysis showed that the low HbA1c group had significant two-fold increased odds of depressive symptoms compared to the high HbA1c group (OR 1.89, 95% CI 1.17-3.05). The risk of depressive symptoms was lower among males (OR 0.49, 95% CI 0.30-0.80) and those with higher BMI (OR 0.93, 95% CI 0.86-1.00); whereas the risk was higher among those who lived alone (OR 2.37, 95% CI 1.31-4.27) and with ADL disability (OR 3.01, 95% CI 1.85-4.89). The GLM showed that the dimension of depressive affect reached statistical significance with lower HbA1c.

CONCLUSION

This nationwide community-based study shows that depressive symptoms are associated with lower HbA1C, reminding us that more attention should be paid to the presence of depressive symptoms in those with lower HbA1C. Further research is needed to clarify the causal relationship.

The assessment of geriatric malnutrition, geriatric depression and associated co-morbidities among forcibly displaced Myanmar nationals in Bangladesh

OBJECTIVE

To assess the nutritional status and depression of the elderly forcibly displaced Myanmar nationals (FDMN) in Bangladesh and determine the associated factors of geriatric depression (GD).

DESIGN

This was a community-based, cross-sectional study among elderly FDMN. The Mini Nutritional Assessment Short-Form (MNA@-SF) and Geriatric Depression Scale Short-Form (GDS-15 SF) were used to determine malnutrition and GD, respectively.

SETTING

The study was conducted between November 2021 and March 2022 in Kutupalong Refugee Camp, Cox's Bazar, Bangladesh.

PARTICIPANTS

The study participants were elderly FDMN aged ≥ 60 years (n 430).

RESULTS

The mean age and BMI were 71·7(±7·8) years and 21·94(±2·6) kg/m2, respectively. There was a high prevalence of self-reported diabetes mellitus (32·1 %), hypertension (26·7 %), hypotension (20 %), skin diseases (28·4 %) and chronic obstructive pulmonary disease (16·5 %). The prevalence of malnutrition was 25·3 %, and another 29·1 % were at risk. The prevalence of GD was 57·9 %, and co-occurrences of GD and malnutrition were seen in 17·5 % of participants. GD was significantly higher among elderly people with malnutrition (adjusted OR, AOR = 1·71, 95 % CI: 1·01, 2·89). FDMN aged ≥ 80 years were at higher risk of GD (AOR = 1·84, 95 % CI: 1·01, 3·37), and having fewer than five members in the household was an independent predictor of GD. Diabetes mellitus (AOR = 1·95, 95 % CI: 1·24, 3·08) and hypotension (AOR = 2·17, 95 % CI: 1·25, 2·78) were also significantly associated with an increased risk of GD.

CONCLUSION

A high prevalence of GD and malnutrition was observed among elderly FDMN in Bangladesh. The agencies working in Cox's Bazar should focus on geriatric malnutrition and GD for the improvement of the health situation of FDMN in Bangladesh.

The relationship between psychological resilience and depression among the diabetes patients under the background of "dynamic zero COVID-19": the mediating role of stigma and the moderating role of medication burden

Objective

Depression in diabetes patients is caused by their own disease or the surrounding social environment. How to cope with changes in mentality and adjust psychological stress responses, especially under China's dynamic zero COVID-19 policy, is worth further discussion. The researchers constructed a moderated mediation model to test the effect of psychological resilience during dynamic zero COVID-19 on depression in diabetes patients and the mediating role of stigma and the moderating effect of medication burden.

Method

From June to September, 2022, data were collected in Jinghu District, Wuhu City, Anhui Province, by multi-stage stratified sampling. Firstly, we selected a tertiary hospital randomly in Jinghu District. Secondly, departments are randomly chosen from the hospital. Finally, we set up survey points in each department and randomly select diabetes patients. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma, medication burden was measured by the Diabetes Treatment Burden Scale (DTBQ), and depression was assessed by the Patient Health Questionnaire-9 (PHQ-9). We used SPSS (version 23.0) and PROCESS (version 4.1) for data analysis.

Results

(1) Psychological resilience was negatively correlated with stigma, medication burden, and depression. Stigma was positively associated with medication burden and depression. Medication burden and depression are positively correlated, (2) The mediation analysis showed that psychological resilience had a direct predictive effect on depression, and stigma partially mediated the relationship, and (3) Medication burden moderates the direct pathway by which psychological resilience predicts depression; Medication burden moderates the first half of "psychological resilience → stigma → depression."

Conclusion

Under the mediating effect of stigma, psychological resilience can improve depression. Medication burden has a moderating effect on the relationship between psychological resilience and depression, and it also has a moderating effect on the relationship between psychological resilience and stigma. These results facilitate the understanding of the relationship mechanisms between psychological resilience and depression.

Treatment-Resistant Late-Life Depression: A Review of Clinical Features, Neuropsychology, Neurobiology, and Treatment

Major depression is common in older adults (≥ 60 years of age), termed late-life depression (LLD). Up to 30% of these patients will have treatment-resistant late-life depression (TRLLD), defined as depression that persists despite two adequate antidepressant trials. TRLLD is challenging for clinicians, given several etiological factors (eg, neurocognitive conditions, medical comorbidities, anxiety, and sleep disruption). Proper assessment and management is critical, as individuals with TRLLD often present in medical settings and suffer from cognitive decline and other marks of accelerated aging. This article serves as an evidence-based guide for medical practitioners who encounter TRLLD in their practice.

Efficacy and safety of Banxia-Houpo-Tang (Banha-Hubak-Tang) for depression: A systematic review and meta-analysis

BACKGROUND

and purpose: Banxia-Houpo-Tang (Banha-Hubak-Tang, BHT) is an East Asian traditional herbal medicine used for treating depression. Hence, this review aimed to provide reliable evidence on the efficacy and safety of BHT for depression.

METHODS

Overall, 15 electronic databases were searched until July 31, 2022, and randomized controlled trials (RCTs) of BHT for depression were reviewed. The cochrane risk of bias tool version 2.0 was used for quality assessment. A meta-analysis was conducted to evaluate the efficacy and safety of BHT for depression.

RESULTS

Fifteen RCTs (1,714 participants) were included. The pooled results suggested that the efficacy of BHT alone (standardized mean difference [SMD], -0.39; 95% confidence interval [CI], -0.79 to 0.00; P = 0.05) was similar to that of antidepressants alone in terms of the Hamilton depression scale (HAMD) scores. Their combination led to a more significant improvement in HAMD scores (SMD, -0.91; 95% CI, -1.21 to 0.60; P < 0.00001). Moreover, compared with antidepressants alone, BHT alone had a lower risk of causing adverse events, but the combination therapy exhibited a similar risk. No severe adverse events were reported. The overall risk of bias was high. The quality of evidence was very low to moderate.

CONCLUSION

The study results indicate that BHT may be beneficial for treating depression. However, due to the clinical heterogeneity and low methodological quality of the included studies, the obtained findings should be interpreted with caution. Hence, further studies on this topic are warranted.

Do Individuals Aged 50 or Older View Cognitive Conditions Differently Than Physical Conditions? Evidence From a Pooled Analysis of Illness Perceptions in Type 2 Diabetes and Mild Cognitive Impairment

Background and Objectives

Type 2 diabetes (T2DM) and mild cognitive impairment (MCI) are common late-life physical and cognitive health conditions. Illness perceptions, an individual's personal beliefs about the conditions, should be explored in the context of disease characteristics (physical or cognitive). This secondary analysis explored illness perceptions with a priori hypotheses about control (perceived controllability) and coherence (perceived understanding) dimensions among persons with T2DM and MCI, treating each as an exemplar of late-life physical and cognitive health conditions. We also explored whether age, education, and comorbid conditions moderate the relationships between T2DM or MCI condition groups and illness perceptions.

Research Design and Methods

This cross-sectional, descriptive study examined baseline data collected from 146 T2DM to 90 MCI participants in 2 independent studies. The 9-item Brief Illness Perception Questionnaire was used to identify the similarities and differences in illness perceptions among persons with T2DM and MCI. We performed hierarchical linear regression controlling for identified covariates.

Results

We found that T2DM and MCI participants had significantly different illness perceptions, including perceptions of personal control (b = -0.943, p = .009), treatment control (b = -1.619, p < .001), and coherence (b = -1.265, p = .001), after controlling for covariates. The results suggest that persons with MCI were likely to believe that their condition is less controllable (through their own strategies or medical treatment) and less understandable compared with their T2DM counterparts. Such associations remained statistically significant when the interactions were added to the models.

Discussion and Implications

As T2DM and MCI are prevalent late-life conditions, health care professionals should consider individuals' subjective perceptions about their conditions in the context of disease characteristics when counseling secondary prevention strategies for disease management. Further research on illness perceptions in other conditions is needed to ensure the replicability of our findings.

The prevalence and predictors of depression and disability in older adults and elderly patients with Diabetes in India: Cross-sectional analysis from the Longitudinal Study on Ageing

AIM

Depression is associated with multiple comorbidities, such as Diabetes Mellitus (DM), especially in the geriatric population. Elderly patients having depression-DM comorbidity are more likely to experience disabilities in daily activities (IADL/ADL). The study objective was to determine the prevalence and predictors of depression in elderly patients with DM in India and also report the prevalence of IADL/ADL (Activities of daily living/Instrumental activities of daily living) disabilities in depressed and non-depressed subgroups of patients with DM.

METHODS

We analyzed the Longitudinal Ageing Study in India (LASI) survey (2017-2018), focusing on individuals aged 45 years and older after excluding those with cognitive impairment. The effective sample size for this study was 66,606.

RESULTS

Findings indicate that 15.48% of participants had depression while 12.96% (95% CI: 11.04, 15.17) were comorbid for depression and DM. Amongst patients with DM, the prevalence of depression comorbidity was 19.89% (95% CI:16.92, 23.24). On adjusted analysis among patients with DM, urban residence compared to rural, and the availability of financial support was protective against the onset of depression while multimorbidity was a risk factor.

CONCLUSIONS

Depressive symptoms in the elderly especially with DM comorbidity are linked to a high burden of poor ADL and IADL. Sensitization of the community towards providing support to the elderly and early screening for IADL/ADL disabilities in depression-DM comorbid patients should be prioritized.

The association between affective temperaments and depressive symptoms in a population of medical university students, Poland

Background

Compared to their peers, medical students are more exposed to stress, and many present symptoms of depression, making them a group prone to experiencing mental illnesses.

Objective

This study investigates a potential link between the occurrence of symptoms of depression and the dominating type of affective temperament in young people studying at a medical university.

Methods

One hundred thirty-four medical students were surveyed using two validated questionnaires; the Polish versions of Beck's Depression Inventory-II (BDI-II) and the Temperament Evaluation of the Memphis, Pisa, and San Diego Autoquestionnaire (TEMPS-A).

Results

The data analysis revealed a significant link between symptoms of depression and affective temperaments, most significantly in subjects with an anxious temperament.

Conclusion

This study confirms the role of various affective temperaments as a risk factor for mood disorders, specifically depression.

Prevalence and risk factors of cognitive frailty in community-dwelling older adults with diabetes: A systematic review and meta-analysis

AIMS

Cognitive frailty can increase the risk of adverse health outcomes in older adults. Estimates of the prevalence of cognitive frailty among older adults with diabetes varied widely in literature. This study aimed to conduct a systematic review and meta-analysis to assess the pooled prevalence of cognitive frailty and risk factors in community-dwelling older adults with diabetes, providing evidence for healthcare professionals to better understand the status of cognitive frailty and help develop effective interventions.

METHODS

Databases of PubMed, Web of Science, Cochrane Library, Embase, Cumulative Index of Nursing and Allied Health, Proquest, China National Knowledge Infrastructure and China Biology Medicine were searched from inception to February 10th, 2022. The reviewers independently selected studies, extracted data and assessed the quality of studies. Pooled prevalence of cognitive frailty and risk factors were estimated. Subgroup analysis, meta-regression analysis, sensitivity analysis and publication bias were also conducted.

RESULTS

A total of 15 studies with 6391 participants were included in this review. The pooled prevalence of cognitive frailty was 11% (95%CI = 7.9-14%) in community-dwelling older adults with diabetes. Pooled estimates showed that increasing age, higher level of HbA1c, shorter night sleep duration and depression were risk factors, and regular exercise was the protective factor of cognitive frailty in community-dwelling older adults with diabetes.

CONCLUSION

Cognitive frailty was common in community-dwelling older adults with diabetes. Routine screening of cognitive frailty and effective interventions should be implemented for this population in community settings.

REGISTRATION

PROSPERO ID CRD42021276973.

Mediating Role of Depression Between Diabetes Management Self-Efficacy and Diabetes Self-Care Behavior Among Elderly Type 2 Diabetes Mellitus Patients in China

Objective

To investigate the current status of diabetes self-care behavior and the association between depression, self-efficacy and self-care in a sample of Chinese elderly type 2 diabetes mellitus (T2DM) patients.

Methods

A cross-sectional study with a convenient sample including 240 elderly T2DM patients collected the data of demographic characteristics, diabetes self-care behavior, self-efficacy and depression status. The difference of self-care behavior in different sample characteristics was compared by independent t-test. The Personal correlation analysis was employed to examine the correlation of study variables. The method of bootstrap was used to analyze mediating role of depression.

Results

Only 22.5% of patients reported better diabetes self-care behavior and depression partly mediated the association between self-efficacy and self-care behavior. The significant coefficient of path a (B = -0.052, p < 0.001) and path b (B = -0.423, p < 0.05) indicated negative associations of self-efficacy on depression, and depression on self-care behavior. The indirect effect (Path a × b) between self-efficacy and self-care behavior through depression was significant (B = 0.022, p < 0.05), the 95% bias-corrected bootstrap confidence interval was 0.004 to 0.006. Meanwhile, the mediating role of depression was not found significant among the participants reported 60-74 years old (B = 0.104, p < 0.001). But depression completely mediated this association among the participants reported 75-89 years old (B = 0.034, p > 0.05).

Conclusion

The level of diabetes self-care behavior among the elderly T2DM patients in Dahu community of Anqing city was hardly optimistic. The self-efficacy focused intervention could be encouraged for community and clinicians to improve diabetes self-care behavior. Moreover, the prevalence of depression and T2DM is increasing in younger population. More work is needed to confirm these findings, especially conducting cohort studies on different populations.

Depression and its associated factors among patients with diabetes: A cross-sectional survey at Mnazi Mmoja Referral Hospital in Zanzibar, Tanzania

BACKGROUND

Depression is one of the mental illnesses that cause disability worldwide, and is a significant contributor to the global burden of diseases. Although depression is reported among patients with diabetes in high-income countries, it remains undetected or undiagnosed in low and middle-income countries. This article describes the prevalence of depression and its associated factors among patients with diabetes in Zanzibar, United Republic of Tanzania.

MATERIALS AND METHODS

A cross-sectional study design was conducted at Mnazi Mmoja Referral Hospital (MMRH). A simple random sampling method was used to select the potential participants. Depressive symptoms were assessed using Patient Health Questionnaire-9(PHQ-9). Data were coded and analyzed using SPSS 23.0. A Chi-square test was performed to obtain the association between depression and socio-demographic, medical and psychological factors. A P-value of <0.05 with a 95% confidence interval was used to determine the significant associations between the variables. Also, multiple logistic regression was performed with the factors with P-value <0.2 to ascertain the confounding factors.

RESULTS

A total of 267 patients with diabetes responded to the questionnaire of which 142 (53.2%) were males. The mean age of participants was 50 years and a standard deviation of ±14. The overall prevalence of depression in this study was 73%. The specific type of depression among diabetic patients varied from severe (8%) to mild depression (30%). Respondents who had difficulties in adhering to the treatment regimen (AOR = 5.7: 95% CI, 2.11-15.18, p = 0.001), feeling angry or stressed (AOR = 4.4: 95% CI, 2.44-8.10, p<0.001), and had diabetic retinopathy (AOR = 2.8: 95% CI, 1.45-5.28, p = 0.002) had symptoms of depression. Furthermore, respondents who had diabetic foot ulcers (AOR = 0.1: 95% CI, 0.04-0.49, p = 0.003) and impotence for male patients (AOR = 0.4: 95% CI, 0.20-0.68, p = 0.002) were 0.1 and 0.4 times less likely to have depression respectively.

CONCLUSION

The majority of patients with diabetes have symptoms of depression. Adherence to the treatment regimen, diabetic retinopathy, feeling angry or stressed, impotence and diabetic foot ulcer were associated with depression. Thus, early screening of depression among patients with diabetes is crucial to enhance self-management and good health outcomes.

Temporal trends in the prevalence and incidence of depression and the interplay of comorbidities in patients with young- and usual-onset type 2 diabetes from the USA and the UK

AIMS/HYPOTHESIS

We aimed to investigate the prevalence and incidence of depression, and the interplay of cardiometabolic comorbidities, in the differentiation of depression risk between young-onset diabetes (diagnosis at age <40 years) and usual-onset diabetes (diagnosis at age ≥40 years).

METHODS

Using electronic medical records from the UK and USA, retrospective cohorts of adults with incident type 2 diabetes diagnosed between 2006 and 2017 were examined. Trends in the prevalence and incidence of depression, and risk of developing depression, in participants with young-onset type 2 diabetes compared with usual-onset type 2 diabetes were assessed separately by sex and comorbidity status.

RESULTS

In total 230,932/1,143,122 people with type 2 diabetes from the UK/USA (mean age 58/60 years, proportion of men 57%/46%) were examined. The prevalence of depression in the UK/USA increased from 29% (95% CI 28, 30)/22% (95% CI 21, 23) in 2006 to 43% (95% CI 42, 44)/29% (95% CI 28, 29) in 2017, with the prevalence being similar across all age groups. A similar increasing trend was observed for incidence rates. In the UK, compared with people aged ≥50 years with or without comorbidity, 18-39-year-old men and women had 23-57% and 20-55% significantly higher risks of depression, respectively. In the USA, compared with those aged ≥60 years with or without comorbidity, 18-39-year-old men and women had 5-17% and 8-37% significantly higher risks of depression, respectively.

CONCLUSIONS/INTERPRETATION

Depression risk has been increasing in people with incident type 2 diabetes in the UK and USA, particularly among those with young-onset type 2 diabetes, irrespective of other comorbidities. This suggests that proactive mental health assessment from the time of type 2 diabetes diagnosis in primary care is essential for effective clinical management of people with type 2 diabetes.

Relationship between Depression with Physical Activity and Obesity in Older Diabetes Patients: Inflammation as a Mediator

Obesity and physical activity (PA) may affect inflammation and are also related to depression. This study aimed to explore the association between depression, obesity, and PA in older diabetes patients mediated by inflammation. We conducted a cross-sectional study with 197 elderly diabetes patients (≥65 y/o). Participants were interviewed to gather demographic and lifestyle data. Assessment of depression was based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. High-sensitivity C-reactive protein was used as a marker of inflammation. Participants with a body mass index (kg/m2) ≥ 27 were considered to be obese. Our data indicated that among all participants with (n = 57) and without (n = 140) depression, older diabetes patients with depression had a lower intake of energy and protein and a lower prevalence of smoking and alcohol consumption than those without depression (p < 0.05). We also found that inflammation may be a partial mediator in the relationship between obesity and depression, and a significant mediator between PA and depression. Additionally, a regression model of obesity and PA showed that PA was a significant predictor of inflammation. However, the association between obesity and inflammation was not significant. When obesity, PA, and inflammation were included in a regression model together, inflammation significantly predicted depression (OR = 4.18, p = 0.004). The association between obesity and depression was also significant (OR = 2.45, p = 0.038). However, the association between PA and depression was not significant, and the mediating effect of inflammation was significant according to the Sobel test (z = −2.01, p = 0.045). In conclusion, the beneficial effects of PA may lower levels of inflammation produced by obesity, thus reducing inflammatory effects that may be related to depression. Overall, inflammation may mediate the relationship between depression and PA in older diabetes patients.

Spotlight on the Challenges of Depression following Retirement and Opportunities for Interventions

As a major life transition characterized by changes in social, behavioral, and psychological domains, retirement is associated with numerous risk factors that can contribute to the development of depression in later life. Understanding how these risk factors intersect with overall health and functioning can inform opportunities for mental health promotion during this transition. The objective of this review is to summarize the literature on risk and protective factors for depression during retirement transitions, discuss challenges related to appropriate management of depression in later life, and describe opportunities for prevention and intervention for depression relating to retirement transitions, both within and beyond the health care system. Key implications from this review are that 1) the relationship between depression and retirement is multifaceted; 2) while depression is a common health condition among older adults, this syndrome should not be considered a normative part of aging or of retirement specifically; 3) the existing mental health specialty workforce is insufficient to meet the depression management needs of the aging population, and 4) therefore, there is a need for interprofessional and multidisciplinary intervention efforts for preventing and managing depression among older adults. In sum, both healthcare providers, public health practitioners, and community organizations have meaningful opportunities for promoting the mental health of older adults during such major life transitions.

Validation of the five-item version of the Geriatric Depression Scale (GDS-5) in a Turkish elderly population

BACKGROUND

Late-life depression is a geriatric syndrome which should be taken seriously. Many clinical scales have been developed for the screening of geriatric depression. Most of these have been validated at different times and in diverse populations. A five-question version of the Geriatric Depression Scale (GDS-5) was developed in 1997. This test has been validated and used in different populations. In the present study, we plan to validate the GDS-5 for the Turkish elderly population.

METHODS

Patients aged 60 years and older who applied to the Geriatrics Clinic of our hospital between November 2018 and November 2019 were included in the study. We compared the effectiveness of Yesavage Geriatric Depression Scale-30 (YGDS-30) and GDS-5 in screening depression, based on Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) depression criteria.

RESULTS

Four hundred participants were included in the study. A significant positive correlation was found between the DSM-5 scale and the GDS-5 scale (rho = 0.726, P <0.001). According to DSM-5, YGDS-30 and GDS-5, 112 participants (28%), 154 patients (%38.5) and 199 patients (%49.8) were diagnosed with depression respectively. When the cut-off value was taken as ≥2, the sensitivity, specificity, positive predictive and negative predictive values for the GDS-5 scale were determined as 96%, 68%, 54%, and 98%, respectively. We obtained these diagnostic measures with 95% confidence intervals.

CONCLUSION

This study demonstrated the validity and reliability of the GDS-5 for Turkish elderly populations. This five-question scale will be significant in daily use to screen for depression in elderly individuals with multiple problems.

Beyond Sarcopenia: older adults with type II diabetes mellitus tend to experience an elevated risk of poor dynamic balance-a case-control study

Background

People with type 2 diabetes mellitus (T2DM) tend to be vulnerable to geriatric syndromes such as sarcopenia and frailty. Reduced physical activity also accompanies sarcopenia and frailty, which is generally typical of patients with T2DM. However, a comprehensive assessment of physical fitness in patients with T2DM has seldom been carried out and verified. This study is thus an attempt to determine the associations among sarcopenia, frailty, and the SFT in diabetic patients and non-diabetic controls to provide a more comprehensive understanding of such associations in future evaluations of T2DM in older individuals.

Methods

Sarcopenia, frailty, and the senior fitness test (SFT) were compared between 78 older men with T2DM (66.5 ± 9.0 years) and 48 age-matched normoglycemic controls (65.8 ± 5.3 years) in this case–control study. The skeletal muscle index (SMI), grip strength, and 4-m walk test were employed to assess for sarcopenia. Frailty was evaluated using the Study of Osteoporotic Fractures index (SOF). The SFT comprises five components, including body composition, muscle strength, flexibility, balance, and aerobic endurance.

Results

The risk level of sarcopenia was significantly higher (p < 0.05) in the T2DM group as compared to the control group. No significant difference between-group differences were found in SMI and grip strength in the T2DM and control groups. However, the T2DM group showed a significant decrease in gait speed (p < 0.01) in comparison with the control group, as well as significant increases in frailty (p < 0.01) and depression (p < 0.05). With respect to the SFT, obvious elevation in BMI, significant declines in extremity muscle strength (elbow extensor, knee flexor, hip abductor, hip flexor, sit to stand), static/dynamic balance (single leg stand: p < 0.05; up-and-go: p < 0.01) and aerobic endurance (2-min step: p < 0.01; 6-min walk: p < 0.01) were found in the T2DM group. Furthermore, the SOF (OR = 2.638, 95% CI = 1.333–5.221), BMI (OR = 1.193, 95% CI = 1.041–1.368) and up-and-go (OR = 2.089, 95% CI = 1.400–3.117) were found to be positively and significantly associated with T2DM.

Conclusions

The findings of this study indicated the importance of countering frailty and maintaining physical fitness, especially dynamic balance, during the early physical deterioration taking place in diabetic patients.

Development of a computerized intervention to improve health literacy in older Hispanics with type 2 diabetes using a pharmacist supervised comprehensive medication management

Objective

The primary objective was to develop a computerized culturally adapted health literacy intervention for older Hispanics with type 2 diabetes (T2D). Secondary objectives were to assess the usability and acceptability of the intervention by older Hispanics with T2D and clinical pharmacists providing comprehensive medication management (CMM).

Materials and methods

The study occurred in three phases. During phase I, an integration approach (i.e., quantitative assessments, qualitative interviews) was used to develop the intervention and ensure cultural suitability. In phase II, the intervention was translated to Spanish and modified based on data obtained in phase I. During phase III, the intervention was tested for usability/acceptability.

Results

Thirty participants (25 older Hispanics with T2D, 5 clinical pharmacists) were included in the study. Five major themes emerged from qualitative interviews and were included in the intervention: 1) financial considerations, 2) polypharmacy, 3) social/family support, 4) access to medication/information, and 5) loneliness/sadness. Participants felt the computerized intervention developed was easy to use, culturally appropriate, and relevant to their needs. Pharmacists agreed the computerized intervention streamlined patient counseling, offered a tailored approach when conducting CMM, and could save them time.

Conclusion

The ability to offer individualized patient counseling based on information gathered from the computerized intervention allows for precision counseling. Future studies are needed to determine the effectiveness of the developed computerized intervention on adherence and health outcomes.

Quality of Life and Self-care Activities in Diabetic Ulcer Patients, Grade 3: Gender Differences

Introduction: Diabetic foot ulcer (DFU) is a common complication of diabetes mellitus associated with increased morbidity and mortality and diminished quality of life (QoL). This study aimed to explore the effect of gender differences on QoL and adherence to self-care activities.

Methods: In this cross-sectional study, we enrolled 135 male and 135 female patients with DFU. Data was collected using the Short Form Health Survey (SF-36) and a questionnaire that measured self-care activities (Diet, Exercise, Blood Examination, and Foot Check). Data analysis was performed using SPSS version 20.

Results: In terms of QoL, male participants had moderate to high levels in the categories of energy/fatigue, emotional well-being, social functioning, and bodily pain, whereas they had low levels in physical functioning, physical role, and emotional role. Female patients had moderate QoL in the categories of energy/fatigue and social functioning, whereas they had low QoL in physical functioning, physical role, emotional role, emotional well-being, and bodily pain. Finally, regarding general health, male participants had moderate QoL and females had moderate to low QoL. Both males and females had low adherence to exercise and high in blood-examinations. For both genders, adherence to exercise had a statistically significant association with all sub-categories of QoL apart from those of role (physical and emotional).

Conclusion: It is essential for health care professionals to provide gender-specific approaches in treatment of ulceration.

The association between diabetes mellitus and HRQoL of older people in Shanghai

BACKGROUND

This study aimed to explore the association between diabetes mellitus and health-related quality of life (HRQoL) of older people in Shanghai, China, especially regarding the differences in each aspect of the EQ-5D and how large the score gaps are between older people with and without diabetes.

METHODS

A total of 11,103 people of either sex older than 60 years were enrolled from 17 districts of Shanghai. The EQ-5D-3L was used to assess the HRQoL of older people. The Wilcoxon rank sum test and t-test were used to compare the difference in HRQoL between people with or without diabetes. After univariate regression, multiple linear regression and ordinal logistic regression were conducted to evaluate the influence of diabetes mellitus and other confounding variables on the EQ VAS scores and on the five dimensions of the EQ-5D.

RESULTS

Twelve percent of all participants had diabetes mellitus, and the proportion was almost the same between men and women. The EQ VAS scores of people with diabetes mellitus were approximately 3.70 points lower than those of people without diabetes (95% CI = -4.40,  -2.99, p < 0.001) after adjusting for confounding variables. People with diabetes mellitus had increased problems with mobility (OR = 1.57, 95% CI = 1.33, 1.85), self-care (OR = 1.65, 95% CI = 1.35, 2.01), usual activities (OR = 1.78, 95% CI = 1.51, 2.11), pain/discomfort (OR = 1.42, 95% CI = 1.24, 1.64), and anxiety/depression (OR = 1.33, 95% CI = 1.07, 1.64).

CONCLUSIONS

This study showed that diabetes mellitus was associated with the HRQoL of older people and that older people with diabetes had poorer performance in every aspect of EQ-5D measurements.

Person-Centered Medication Therapy for Diabetes in Older Adults: A Practical Review

Diabetes is one of the most common disease states in older adults and there are significant risks to the use of antidiabetic medications. The older adult population varies greatly in functional ability, independence, and cognition. These factors, along with increased risk of hypoglycemia, falls, and other comorbidities, add to the complexity of creating medication regimens to treat diabetes in older adults. In the current review, a person-centered approach to diabetes care in older adults is described to aid clinician decision making. By keeping the patient and their individual factors in the center of the decision, risks of over- or under-treating diabetes can be minimized. The review will discuss person-centered goal setting, practical approaches to diabetes medication management, and specific considerations for choosing medication classes based on patient characteristics. [Journal of Gerontological Nursing, 47(10), 7-13.].

Multimorbidity study with different levels of depression status

OBJECTIVE

Depression is one of the leading causes of disability burden and frequently co-occurs with multiple chronic diseases, but limited research has yet evaluated the correlation between multimorbidity and depression status by sex and age.

METHODS

29303 adults from 2005-2016 National Health and Nutrition Examination Survey were involved in the study. The validated Patient Health Questionnaire (PHQ-9) was used to assess depression status. The linear trend of the prevalence of multimorbidity was tested by logistic regressions, which was visualized by the weighted network. Gamma coefficient (γ) was used to evaluate the correlation between multimorbidity and depression status.

RESULTS

The prevalence of multimorbidity in participants with no depression, mild depression, moderate depression and severe depression was 52.1%, 63.0%, 68.4% and 76.1%, respectively (p for trend < 0.001). In network analysis, the absolute network density increased with the levels of depression status (from 4.54 to 15.04). Positive correlation was identified between multimorbidity and depression status (γ=0.21, p<0.001), and the correlation was different by sex and age, where it was stronger in women than men (females: γ=0.23, males: γ=0.16), and stronger in the young and the middle-age (young: γ=0.30, middle-age: γ=0.29, old: γ=0.22).

LIMITATIONS

This is a cross-sectional study and thus we cannot draw firm conclusions on causal correlations.

CONCLUSIONS

Positive correlation between multimorbidity and depression status was identified, where the number of multimorbidity increased with the levels of depression status, especially in females, the young and the middle-age.

Factors Associated with Depressive Symptoms in Korean Adults with Diabetes Mellitus: A Cross-Sectional Study

Depressive symptoms in adults with diabetes are influenced by sociodemographic status, health-related behaviors, and comorbid diseases. This study aimed to examine the factors related to depressive symptoms in Korean adults with diabetes, using data from the Korea National Health and Nutrition Examination Surveys for 2014, 2016, and 2018. A total of 1529 Korean adults with diabetes were selected as subjects for the analysis. The age group of the participants was 19-80 years, with a mean age of 63.34 ± 0.68 years. The depressive symptoms and severity were assessed using the Korean version of the Patient Health Questionnaire-9. Descriptive statistics, chi-squared tests, and univariate and multivariable logistic regression analyses were used by applying a complex sample analysis method. The findings showed that 9.6% of Korean adults with diabetes exhibited moderate to severe depressive symptoms, which gradually decreased during 2014-2018. The most significant independent factors of depressive symptoms were living without a spouse, unemployment, low household income, fair or poor subjective health conditions, high perceived stress, a diabetes duration of over 20 years, and stroke. In females, living without a spouse, low household income, poor subjective health condition, high perceived stress, stroke, and coronary heart disease were significantly associated with depressive symptoms. In males, living without a spouse, unemployment, poor subjective health condition, high perceived stress, and hypertension were significantly associated with depressive symptoms. These findings highlight the importance of regular screening for depressive symptoms in patients with diabetes as the prevalence of depressive symptoms in people with diabetes may be higher than those in the general population. Future studies should also examine the development and effectiveness of psychosocial intervention programs to decrease depressive symptoms in patients with diabetes, considering cost-effective and time-saving approaches.

Assessing prevalence and predictors of depression in Type 2 Diabetes Mellitus (DM) patients - The DEPDIAB study

OBJECTIVES

Depression is common in diabetes and has significant impact on health outcomes. Suicidal ideation also forms a part of the spectrum of diabetes and coexistent depression. To assess the predictors of depression as well as its prevalence in Type 2 Diabetes Mellitus (T2DM) patients, we conducted a cross sectional study entitled "DEPression in DIABetes" (DEPDIAB).

MATERIAL AND METHODS

A cohort of consecutive 1371 T2DM patients from Eastern India suffering from diabetes greater than 1 year was assessed in a cross- sectional survey in 9 different hospitals and medical polyclinics in Kolkata, India for depression by administering the 9-item PHQ - 9 and Beck depression scales. Socioeconomic status was assessed by the "Revised Kuppuswamy and B G Prasad socio-economic scales for 2016", a validated scoring system for assessing the socioeconomic status of Indian patients.

RESULTS

In our study 836 patients (60.9%) were male and 535 (39.02%) were female. 56 patients (4.1%) met the criteria for major depression and 494 patients (36.16%) for minor depression. No sign of depression was found in 816 patients (59.74%). Depression was strongly associated with younger age (18-40 years vs. >60 years) [OR-2.09; 95% CI 1.11-3.96], female sex [OR-1.31; 95% CI 1.11-2.01], low socioeconomic status [OR-2.69; 95% CI 1.34-3.79], poor compliance [OR- 5.05; 95% CI 2.79-8.13], hypoglycemia [OR 1.466; 95% CI 1.076-1.999] and difficulty in managing day-to-day activities [OR- 4.648; 95% CI 3.450-6.262] Suicidal ideation was detected in 201 patients (14.8%). Among patients who had repeated attacks of hypoglycemia (>1 episode per month), 22% experienced suicidal ideation. This was significantly higher than in patients who had not suffered from hypoglycemia (12%) (p < 0.0001). Patients with HbA1C of 7% or lower experienced statistically significantly lesser suicidal ideation than patients with a higher HbA1C (12% vs. 16.8% {p = 0.016}). Suicidal ideation did not correlate withbody mass index (BMI), fasting plasma glucose (FPG) or insulin usage.

CONCLUSIONS

We found a high prevalence of depression in T2DM patients in Eastern India. Younger age, female sex, lower socio-economic status, poor compliance, hypoglycemia, and difficulty in managing day to day activities emerged as significant predictors of depression in this study. Recurrent episodes of hypoglycemia were an independent risk factor for suicidal ideation in patients with depression. Depression was not significantly associated with co morbidities associated with T2D and surprisingly insulin usage was not associated with increased depression.

Questionnaire-based Survey of Demographic and Clinical Characteristics, Health Behaviors, and Mental Health of Young Korean Adults with Early-onset Diabetes

BACKGROUND

The incidence of early-onset diabetes is increasing among young adults. However, there are limited data on the characteristics and management of young Korean adults with diabetes. This study assessed the clinical and demographic characteristics, health behaviors, and mental health among young Korean adults with diabetes mellitus.

METHODS

This cross-sectional study included young Korean adults with diabetes (n = 225) with an onset age of 20-39 years from four university hospitals. Demographic characteristics, management of diabetes, and mental health were assessed using a questionnaire survey.

RESULTS

Type 2 diabetes was the most common type (73.3%), and 13.8% of participants were classified as other types or unknown. Approximately, 64.7% of participants had a strong family history of diabetes, and 76% had treatment within three months of diagnosis. Approximately, 11.1% of participants had diabetic complications; 39.1% of participants received insulin injections, including oral anti-diabetic medications. Additionally, 30.4% were smokers, and only 28% had active physical activity; 26.5% of participants had >3 hours of screen time. One third of participants never had breakfast, and 60.5% went out to eat at least three times a week. Half of the participants showed moderate to severe stress perception, and 21.4% of patients had moderate to severe levels of depression based on the Korean version of Beck Depression Inventory score.

CONCLUSION

Early-onset diabetes was associated with a strong family history and early insulin treatment. Young adults with diabetes had poor health behaviors and frequent mental depression. These findings suggest the necessity of health policies for improving health behaviors and mental distress.

Mood Disorders and Anxiety in Parkinson's Disease: Current Concepts

Mood disorders and anxiety significantly impact the prognosis and disease course of Parkinson's disease. Non-motor symptoms of Parkinson's disease such as apathy, anhedonia, and fatigue overlap with diagnostic criteria for anxiety and depression, thus making accurate diagnosis of mood disorders in Parkinson's disease patients difficult. Furthermore, treatment options for mood disorders can produce motor complications leading to poor adherence and impaired quality of life in Parkinson's disease patients. This review aims to clarify the current state of diagnostic and treatment options pertaining to anxiety and mood disorders in Parkinson's disease. It explores both the pharmacologic and non-pharmacologic treatment modalities for various mood disorders in comorbid Parkinson's disease with a brief discussion of the future outlook of the field given the current state of the literature.

Favorable Effects of 24-Week Whole-Body Vibration on Glycemic Control and Comprehensive Diabetes Therapy in Elderly Patients with Type 2 Diabetes

BACKGROUND

Elderly patients with type 2 diabetes (T2DM) are vulnerable to treatment-inducible hypoglycemia, falls, and depressive symptoms. Although it is challenging for elderly patients to adhere to regular exercise, its positive effect on functional ability, glycemic control, and mental wellness offers comprehensive diabetes treatment. In the present study, we aimed to investigate a novel exercise approach for the elderly, focusing on whole-body vibration (WBV).

METHODS

This retrospective cohort study was conducted in a primary-care setting at a medical fitness center affiliated with the incorporated medical institution of THY (TOTAL HEALTH YARD). Fourteen (WBV group) and 12 (control group) elderly patients with T2DM undergoing and not undergoing our WBV program, respectively, for > 6 months were analyzed. Primary endpoints were the functional ability changes, evaluated by Timed Up and Go (TUG), Sit-to-Stand test (SST), gait length, and grip test. Secondary endpoints were global glycemic control and questionnaires, namely the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and Geriatric Depression Scale (GDS). All records of exercise adherence and any adverse events were followed.

RESULTS

Significant improvements in TUG and SST were found only in the WBV group [TUG: 7.1 ± 0.9, 7.1 ± 0.8 to 7.0 ± 1.0, 6.6 ± 0.9 (s), P = 0.63, 0.01; SST: 10.4 ± 1.9, 11.3 ± 2.4 to 9.7 ± 2.3, 9.5 ± 2.1 (s), P = 0.62, P < 0.01, control vs. WBV group, respectively]. The WBV group demonstrated significant improvement of hemoglobin A1C levels (7.2 ± 0.8 to 6.9 ± 0.5, P < 0.01) and DTSQ and GDS scores, while the control group did not. There were no hypoglycemic events during the study. The WBV program adherence was 93.3 ± 8.0%.

CONCLUSION

We demonstrated the favorable effect of WBV training on balance, diabetes treatment, and mood. Therefore, WBV training can be proposed as comprehensive therapy in a safe manner and potentially has a positive effect on health-related quality of life in elderly patients with T2DM.

High Prevalence of Depressive Symptoms in Patients With Type 1 and Type 2 Diabetes in Developing Countries: Results From the International Diabetes Management Practices Study

OBJECTIVE

Depression is common in people with diabetes, but data from developing countries are scarce. We evaluated the prevalence and risk factors for depressive symptoms in patients with diabetes using data from the International Diabetes Management Practices Study (IDMPS).

RESEARCH DESIGN AND METHODS

IDMPS is an ongoing multinational, cross-sectional study investigating quality of care in patients with diabetes in real-world settings. Data from wave 5 (2011), including 21 countries, were analyzed using the 9-item Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Logistic regression analyses were conducted to identify risk factors of depressive symptoms.

RESULTS

Of 9,865 patients eligible for analysis, 2,280 had type 1 and 7,585 had type 2 diabetes (treatment: oral glucose-lowering drugs [OGLD] only, n = 4,729; OGLDs plus insulin, n = 1,892; insulin only, n = 964). Depressive symptoms (PHQ-9 score ≥5) were reported in 30.7% of those with type 1 diabetes. In patients with type 2 diabetes, the respective figures were 29.0% for OGLDs-only, 36.6% for OGLDs-plus-insulin, and 46.7% for insulin-only subgroups. Moderate depressive symptoms (PHQ-9 score 10-19) were observed in 8-16% of patients with type 1 or type 2 diabetes. Female sex, complications, and low socioeconomic status were independently associated with depressive symptoms. In type 1 diabetes and in the type 2 diabetes OGLDs-only group, depression was associated with poor glycemic control.

CONCLUSIONS

Depressive symptoms are common in patients with diabetes from developing countries, calling for routine screening, especially in high-risk groups, to reduce the double burden of diabetes and depression and their negative interaction.

African American Ethnicity, Hypertension, Diabetes, and Arthritis Independently Predict Co-occurring Depression and Obesity among Community-dwelling Older Adult Alabamians

Although obesity and depression are quite common among older adults, surprisingly published literature has not examined factors associated with co-occurring depression and obesity among older adults. The knowledge that fills this gap would be advantageous for public health social workers and other health professionals who provide health care and public health services to older adults. The objectives of this study were to access the prevalence of and independent predictors of co-occurring depression and obesity among older adults in the state of Alabama. A retrospective analysis was conducted using a statewide survey of Alabamian community-dwelling older adults (n = 1,166). Binomial logistic regression was used to examine predictors of co-occurring depression and obesity. The prevalence of co-occurring depression and obesity among older adults was 16%. In the multivariate analysis, African American ethnicity (OR = 1.505, CI: 1.019-2.223), hypertension (OR = 1.593, CI: 1.050-2.416), diabetes (OR = 1.768, CI: 1.188-2.632), and arthritis (OR = 1.640, CI: 1.096-2.454) were positively associated with co-occurring depression and obesity). Older age (OR = 0.963, CI: 0.942-0.985) and higher levels of physical activity (OR = 1.640, CI: 1.096-2.454) were negatively associated with co-occurring depression and obesity. There is a need for the development and implementation of suitable interventions to prevent and manage co-occurring depression and obesity among older adults, particularly older adults with arthritis, hypertension, diabetes, or of African American ethnicity.

Predictors of frailty among Chinese community-dwelling older adults with type 2 diabetes: a cross-sectional survey

OBJECTIVES

To assess the prevalence of frailty and identify predictors of frailty among Chinese community-dwelling older adults with type 2 diabetes.

DESIGN

A cross-sectional design.

SETTING

Two community health centres in central China.

PARTICIPANTS

291 community-dwelling older adults aged ≥65 years with type 2 diabetes.

MAIN OUTCOME MEASURES

Data were collected via face-to-face interviews, anthropometric measurements, laboratory tests and community health files. The main outcome measure was frailty, as assessed by the frailty phenotype criteria. The multivariate logistic regression model was used to identify the predictors of frailty.

RESULTS

The prevalence of prefrailty and frailty were 51.5% and 19.2%, respectively. The significant predictors of frailty included alcohol drinking (ex-drinker) (OR 4.461, 95% CI 1.079 to 18.438), glycated haemoglobin (OR 1.434, 95% CI 1.045 to 1.968), nutritional status (malnutrition risk/malnutrition) (OR 8.062, 95% CI 2.470 to 26.317), depressive symptoms (OR 1.438, 95% CI 1.166 to 1.773) and exercise behaviour (OR 0.796, 95% CI 0.716 to 0.884).

CONCLUSIONS

A high prevalence of frailty was found among older adults with type 2 diabetes in the Chinese community. Frailty identification and multifaceted interventions should be developed for this population, taking into consideration proper glycaemic control, nutritional instruction, depressive symptoms improvement and enhancement of self-care behaviours.

The efficacy of 5-element therapy for senile diabetes with depression: A protocol for a systematic review and meta-analysis

BACKGROUND

Senile diabetes with depression is a common and frequently-occurring disease, and it is also a difficult and hot point in domestic and international research. However, the efficiency of combination hypoglycemic agents and antidepressants in the treatment of senile diabetes with depression is poor, and new intervention methods are urgently needed. Research shows the 5-element therapy, as a Chinese traditional non-drug intervention, has definite curative effect on the prevention and treatment of various physical and mental diseases. The purpose of this systematic review and meta-analysis is to evaluate the efficacy of 5-element therapy on senile diabetes with depression.

METHODS

The electronic databases including Pubmed, Embase, Cochrane Library, Web of science, Chinese National Knowledge Infrastructure, Wanfang Database, Sino Med,China Biomedical Literature Database will be searched. The time limit for retrieving studies is from establishment to October 2020 for each database. Randomized controlled clinical trials related to 5-element therapy intervention on senile diabetes with depression will be included. Stata V.13.0 and Review manager 5.3 software will be implemented for data synthesis, sensitivity analysis, subgroup analysis, and the assessment of bias risk. We will use the grading of recommendations assessment, development, and evaluation system to assess the quality of evidence.

RESULTS

This study will provide a quantitative and standardized evaluation for the efficacy of 5-element therapy on senile diabetes with depression.

CONCLUSION

This systematic review and meta-analysis will provide the high-quality evidence to assess whether the 5-element therapy has a positive treatment effect for senile diabetes with depression.

REGISTRATION NUMBER

INPLASY2020100081.

Physical Exercise, Social Interaction, Access to Care, and Community Service: Mediators in the Relationship Between Socioeconomic Status and Health Among Older Patients With Diabetes

The differences in socioeconomic status (SES) will cause a disparity in the health of the elderly. Taking diabetes as an example, previous studies have focused on risk factors of diabetes, while the relationship and mechanism between SES, multi-faceted factors, and the health of older patients with diabetes are not well-understood. This study aims to investigate the association between SES and health in older patients with diabetes and the interrelated mediators between them. Based on the data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018, structural equation modeling (SEM) was used to test whether physical exercise, social interaction, access to care, and community service mediated the effect of SES on the health in older patients with diabetes. We found support for the model in which SES predicted the health in older patients with diabetes (comparative fit index = 0.910, incremental fit index = 0.911, goodness-of-fit index = 0.982, adjusted goodness-of-fit index = 0.959, standardized root mean square residual = 0.037, and root mean square error of approximation = 0.061). The total indirect effect of SES on the health accounted for 55.52% of the total effect. Results indicated that physical exercise (β = 0.108, p < 0.01), social interaction (β = 0.253, p < 0.001), and community service (β = 0.111, p < 0.001) had significant positive effects on the health of older patients with diabetes. SES was positively associated with physical exercise (β = 0.417, p < 0.001) and community service (β = 0.126, p < 0.01). Although no direct effect of SES on the health was found, SES mediated the positive effect in their relationship by physical exercise (indirect effect = 0.045, p < 0.01), and community service (indirect effect = 0.014, p < 0.05). This study showed the health disparities of older patients with diabetes were influenced by individual-level (physical exercise, social interaction) and environmental-level (community service). It suggests that a lack of physical exercise and health-related community service may impair the health of older patients with diabetes with low SES, which recommends individuals' positive actions and environmental supports for promoting health of regarding population.

Association between exercise and health-related quality of life and medical resource use in elderly people with diabetes: a cross-sectional population-based study

BACKGROUND

Exercise improves glycemic control and functional capacity in elderly people with diabetes; however, its effect on health-related quality of life (HRQoL) and medical resource use remains unclear. This study aims to clarify the effect of exercise.

METHODS

Using the data from National Health and Nutrition Examination Survey between 2007 and 2016, we identified 1572 elderly people with diabetes for this cross-sectional population-based study. Demographic characteristics, health conditions, comorbidities, HRQoL, and medical resource were compared among four groups (no exercise, low-intensity exercise, moderate-intensity exercise, and high-intensity exercise).

RESULTS

The mean age of all participants was between 71.5 and 73.3 years. Male participants with higher education performed more exercise than their counterparts. The moderate- and high-intensity groups reported better general health condition than the no exercise group. Depression and worse health were more common in the no exercise group. Participants in the moderate-intensity exercise group had lower risk for depression than those in the no exercise group (adjusted odds ratio: 0.13, 95% confidence interval: 0.02-0.92) after adjusting for demographic characteristics, health conditions, and comorbidities, whereas participants in the low- and high-intensity exercise did not have a lower risk. The no exercise group had the highest proportions of emergency, hospitalization, and total healthcare visits.

CONCLUSIONS

Exercise is associated with better HRQoL, and lack of exercise is associated with higher medical resource use in elderly people with diabetes. Encouraging exercise is recommended in this population.