Relationship of depression, chronic disease, self-rated health, and gender with health care utilization among community-living elderly

Decomposing the rural-urban differences in depression among multimorbid older patients in India: evidence from a cross-sectional study

BACKGROUND

In India, the prevalence of depression among older adults dealing with multiple health conditions varies between rural and urban areas due to disparities in healthcare access and cultural factors. The distinct patterns observed underscore the necessity for tailored research and interventions to address mental health inequalities among multimorbid older patients in diverse geographic contexts.

METHODS

This study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total of 7,608 adults aged ≥ 60 years who were diagnosed with two or more chronic conditions (such as hypertension, diabetes, cancer, chronic lung disease, chronic heart diseases, stroke, bone/joint disease, any neurological or psychiatric diseases, and high cholesterol) were included in this study. Descriptive statistics, bivariate analysis, logistic regression estimates, and Fairlie decomposition method were used to accomplish the study's objectives.

RESULTS

The prevalence of depression among older adults with multimorbidity was 9.48% higher in rural areas (38.33%) than in urban areas (28.85%).. Older adults with multimorbidity belonging to the scheduled caste group were 40% more likely to experience depression. Moreover, those with multimorbidity and any form of disability in activities of daily living (ADL) were 93% more likely to experience depression than those without disability, whereas those with multimorbidity and perceived good general health were 65% less likely to suffer from depression than those with poor self-perceived health. Additionally, decomposition analysis revealed that education (35.99%), caste status (10.30%), IADL disability (19.30%), and perceived discrimination (24.25%) were the primary factors contributing to the differences in depression prevalence among older adults with multimorbidity between rural and urban areas.

CONCLUSIONS

We found significant rural-urban differences in depression among older Indians with multimorbidity. The findings underscore the need for targeted interventions that address the unique challenges faced by older patients in rural areas, including lack of social capital, discrimination, and limited resources that enable access to healthcare services. Policymakers and healthcare professionals must collaboratively design and implement effective strategies to improve the mental health and overall well-being of rural older adults, particularly those with multiple comorbidities.

PROTOCOL: Non-pharmacological interventions for older people with a diagnosis of depression: An evidence and gap map

This is the protocol for an evidence and gap map. The objectives are as follows: To map available randomized control trials, economic evaluations, and systematic reviews that assess the effectiveness and cost-effectiveness of non-pharmacological interventions for older people with a diagnosis of depression and identify any existing gaps in the evidence that can inform future research.

Urban-rural and gender differential in depressive symptoms among elderly in India

Background

To date, evidence remained inconclusive explaining rural-urban and male-female differential in depression. Unlike other previous research on the association of several risk factors with depressive symptoms among the elderly, this study focussed on the socio-economic status-related inequality in the prevalence of depression among the elderly along with focussing urban-rural and male-female gradients of depression among the elderly.

Methods

This study used data from Longitudinal Ageing Study in India (LASI) Wave-I, 2017-18, survey. The outcome variable for this study was self-reported depression. Bivariate analysis was used to understand the prevalence by sociodemographic clusters. Fairlie decomposition analysis has been done to measures rural-urban inequalities for depression among older men and women.

Results

Results found that around 22 percent of urban elderly and 17 percent of rural elderly reported depression. A higher proportion of female elderly (22.6% vs. 18.4%) reported depression than male elderly. Almost one in every five elderly (20.6%) reported depression in India. The results found that a higher percentage of women in rural and urban areas reported depression than their male counterparts. While examining SES-related inequality in the prevalence of depression, education was a significant factor explaining the SES-related inequality in the prevalence of depression among female elderly and not in male elderly.

Conclusion

Given the large proportion of elderly reporting depression, this study highlights the need for improving health care services among the elderly. The increasing burden of depression in specific sub-populations also highlights the importance of understanding the broader consequences of depression among rural and female elderly.

Association between depression and endometriosis using data from NHANES 2005-2006

Studies on the association between depression and self-reported endometriosis are limited, and further studies are required to investigate this association. Data were collected from the National Health and Nutrition Examination Survey database (2005-2006). Based on the inclusion and exclusion criteria, 100 participants with self-reported endometriosis and 1295 participants without self-reported endometriosis were included, representing a total population of 64,989,430. Depression severity was assessed using the Patient Health Questionnaire 9 (PHQ9). A survey-weighted logistic regression analysis was performed to explore the association between depression and endometriosis. Subgroup analyses were conducted to explore heterogeneity. The prevalence of endometriosis was 7.17%. A significant positive association was found between the PHQ9 score and endometriosis. After adjusting for all covariates, the PHQ9 score positively correlated with endometriosis. Furthermore, compared with the participants without depression, those with moderate depression were more prone to have endometriosis both in unadjusted and fully adjusted model. However, the relationship between severe depression and endometriosis was not significant in all models (P > 0.05). Our findings highlight the influence of depression on the prevalence of self-reported endometriosis. Further studies are required to elucidate the causal relationship between depression and self-reported endometriosis.

Association between chronic diseases and depression in the middle-aged and older adult Chinese population-a seven-year follow-up study based on CHARLS

Background

With the aging of the Chinese population, the prevalence of depression and chronic diseases is continually growing among middle-aged and older adult people. This study aimed to investigate the association between chronic diseases and depression in this population.

Methods

Data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 longitudinal survey, a 7-years follow-up of 7,163 participants over 45 years old, with no depression at baseline (2011). The chronic disease status in our study was based on the self-report of the participants, and depression was defined by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The relationship between baseline chronic disease and depression was assessed by the Kaplan-Meier method and Cox proportional hazards regression models.

Results

After 7-years follow-up, 41.2% (2,951/7163, 95% CI:40.1, 42.3%) of the participants reported depression. The analysis showed that participants with chronic diseases at baseline had a higher risk of depression and that such risk increased significantly with the number of chronic diseases suffered (1 chronic disease: HR = 1.197; 2 chronic diseases: HR = 1.310; 3 and more chronic diseases: HR = 1.397). Diabetes or high blood sugar (HR = 1.185), kidney disease (HR = 1.252), stomach or other digestive diseases (HR = 1.128), and arthritis or rheumatism (HR = 1.221) all significantly increased the risk of depression in middle-aged and older adult Chinese.

Conclusion

The present study found that suffering from different degrees of chronic diseases increased the risk of depression in middle-aged and older adult people, and these findings may benefit preventing depression and improving the quality of mental health in this group.

Influence of social support on subjective well-being of patients with chronic diseases in China: chain-mediating effect of self-efficacy and perceived stress

Introduction

The well-being of patients with chronic diseases is an issue of widespread concern in public health. While social support is thought to have a positive effect on it, the mechanisms of its influence have not been fully addressed. Thus, we explored the possible mediating effects of self-efficacy and perceived stress to determine the relationship between social support and well-being in these patients.

Methods

A cross-sectional study was conducted among 4,657 patients with chronic diseases in China. The PROCESS Macro model 6 of SPSS was employed to explore the intermediary role between variables.

Results

Self-efficacy and perceived stress played a partial intermediary role between social support and subjective well-being, with an effect ratio of 48.25% and 23.61%, respectively. Self-efficacy and perceived stress had a chain intermediary effect (28.14%) between social support and subjective well-being.

Discussion

This study suggested that improving the self-efficacy of patients with chronic diseases to cope with the changes in social support caused by the disease could reduce stress and enhance subjective well-being.

Healthy immigration effect among internal migrants in megacities: a cross-sectional study in Shanghai, China

Objectives

To verify the healthy immigration effect on self-rated health (SRH) among Chinese internal migrants, identify the determinants of SRH, and provide recommendations for the Chinese government to formulate effective intervention strategies to improve population governance and health management in megacities.

Methods

A sample comprising 1,147 white-and blue-collar migrant workers was randomly selected through an online survey conducted in Shanghai from August to December 2021. Multivariate logistic regression models were used to verify the healthy immigration effect as well as determinants of the effect among internal migrants in Shanghai.

Results

Among 1,024 eligible internal migrants, 864 (84.4%) were aged between 18 and 59 years, 545 (53.2%) were men, and 818 (79.9%) were married. When confounders in the logistic regression models were adjusted, the odds ratio of SRH for internal migrants who had lived in Shanghai for 5-10 years was 2.418 (p < 0.001), whereas the odds ratio for those who had lived there for ≥10 years was not statistically significant. Additionally, marital status, a postgraduate or higher degree, income level, number of physical examinations in the past 12 months, and the number of critical diseases they were suffering from, were significant contributing factors for favorable SRH among the internal migrants. Furthermore, a cross-sectional analysis revealed that SRH demonstrated a healthy immigration effect among blue-collar internal migrants from the manufacturing industry but not among white-collar internal migrants.

Conclusion

A healthy immigration effect was observed among internal migrants in Shanghai. The migrant population that had lived in Shanghai for 5-10 years had more health advantages than the locals, whereas those who had lived there for ≥10 years did not. The Chinese government should understand this effect and enact measures accordingly, such as implementing physical examinations, improving acculturation, addressing individual characteristics, and improving socioeconomic conditions to improve the physical and mental health of internal migrants. Enacting such changes could facilitate the integration of migrants into the local culture of megacities.

Trajectories of self-rated health among community-dwelling individuals with depressive symptoms: A latent class growth analysis

BACKGROUND

This study identified differences between individuals with and without depression regarding demographic and socioeconomic variables, health behavior, health status, health care utilization, and self-rated health (SRH) to identify the depressed group's SRH trajectories.

METHODS

Data of individuals with (n = 589) and without (n = 6856) depression aged ≥20 from the 2013-2017 Korean Health Panel were analyzed. A chi-square test and t-tests examined differences in demographic and socioeconomic variables, health behaviors, health status, health care utilization, and the mean of SRH. Latent Growth Curve and Latent Class Growth Modeling identified SRH development trajectories and the most suitable latent classes explaining the trajectories, respectively. Multinomial logistic regression determined the predicting factors that classified latent classes.

RESULTS

The depressed group had a lower mean SRH than the non-depressed group among most variables. Three latent classes were identified, each showing different SRH trajectories. Body-mass index and pain/discomfort were predicting factors for the "poor" classes compared with the "moderate-stable" class; older age, less national health insurance, less physical activity, more pain/discomfort, and more hospitalization were predictors for the "poor-stable" class. The depressed group's mean SRH was "poor."

LIMITATIONS

Latent Class Growth Modeling in individuals with depression was based on experimental data; however, it needed to review other sample data to identify similar types of latent classes to those suggested in the current study.

CONCLUSIONS

Predictors of the "poor-stable" class that were identified in this study can contribute to the formulation of intervention plans for the health and welfare of individuals with depression.

Demand prediction of medical services in home and community-based services for older adults in China using machine learning

Background

Home and community-based services are considered an appropriate and crucial caring method for older adults in China. However, the research examining demand for medical services in HCBS through machine learning techniques and national representative data has not yet been carried out. This study aimed to address the absence of a complete and unified demand assessment system for home and community-based services.

Methods

This was a cross-sectional study conducted on 15,312 older adults based on the Chinese Longitudinal Healthy Longevity Survey 2018. Models predicting demand were constructed using five machine-learning methods: Logistic regression, Logistic regression with LASSO regularization, Support Vector Machine, Random Forest, and Extreme Gradient Boosting (XGboost), and based on Andersen's behavioral model of health services use. Methods utilized 60% of older adults to develop the model, 20% of the samples to examine the performance of models, and the remaining 20% of cases to evaluate the robustness of the models. To investigate demand for medical services in HCBS, individual characteristics such as predisposing, enabling, need, and behavior factors constituted four combinations to determine the best model.

Results

Random Forest and XGboost models produced the best results, in which both models were over 80% at specificity and produced robust results in the validation set. Andersen's behavioral model allowed for combining odds ratio and estimating the contribution of each variable of Random Forest and XGboost models. The three most critical features that affected older adults required medical services in HCBS were self-rated health, exercise, and education.

Conclusion

Andersen's behavioral model combined with machine learning techniques successfully constructed a model with reasonable predictors to predict older adults who may have a higher demand for medical services in HCBS. Furthermore, the model captured their critical characteristics. This method predicting demands could be valuable for the community and managers in arranging limited primary medical resources to promote healthy aging.

"With your age, what do you expect?": Ageism and healthcare of older adults in Spain

INTRODUCTION

Ageism could influence the relationship between older patients' meeting needs and healthcare professionals' answers.

AIMS

To highlight the experience of older adults with healthcare systems, how they perceive ageism from their healthcare providers, and to explore the relationship between perceived ageism and self-perception of aging (SPA).

METHODS

We conducted an exploratory qualitative study. The participants were 14 women over 65 who lived alone in their homes.

RESULTS

Professional responses ignored the expression of preferences of the older patients and excluded them from decision-making processes. These answers influenced older patients' use of health services. Moreover, the negative aspects predominated in a SPA influenced by the internalization of stereotypes and a relationship weighed down by ageist behaviors on the part of health professionals.

CONCLUSION

Explicit situations of ageism influence an imbalance in power relations between older patients and healthcare professionals, a misuse of health services, and a negative SPA.

Ethnic Differences in Socioeconomic and Health Determinants Related to Self-Rated Health Status: A Study on Community-Dwelling Israeli Jews and Arabs in Old Age

Self-rated health (SRH) is widely used as a proxy for general health status. In old age, SRH has been found to be a strong predictor of morbidity, physical functioning, recovery from illness, use of health services, and mortality. This study was designed to examine differences in socioeconomic and health determinants related to self-rated health status among community-dwelling Jews and Arabs aged 65+ years. Cross-sectional data from 2011 on such Jews and Arabs were extracted from reprehensive National Surveys. The association between socioeconomic and health factors with poor SRH was estimated using three hierarchical logistic regression models. The majority of the respondents were Jews (86%), with a mean age of 73.1 (±6.3) years. The study revealed that older Arabs are disadvantaged according to almost every socioeconomic and health indicator compared to Jews. Poor SRH was significantly associated with age (OR = 1.03, p = 0.002), ethnicity (Jews OR = 2.62, p < 0.001), unemployment/retirement (OR = 2.03, p < 0.001), low income (OR = 3.03, p < 0.001), low education (OR = 1.37, p = 0.013), absence of physical activity (OR = 2.17, p < 0.001), dentures (OR = 1.40, p = 0.002), and prevalence of one or more chronic diseases (OR = 4.06, p < 0.001). The findings therefore indicated that these factors need to be detected and focused on by health professionals in order to improve the population's general health status.

Age as a moderator for the association between depression and self-rated health among cancer survivors: a U.S. based population study

BACKGROUND

Self-rated health (SRH) is a salient outcome for cancer survivors. Although depression is a well-studied correlate with SRH, few studies have focused on the role of cancer survivors' age on the association between depression and SRH. This study evaluates demographic and psychosocial factors associated with cancer survivors' SRH. We also assess the moderating role of age to the association between depression and SRH.

MATERIALS AND METHODS

This paper analyzed 2,470 U.S. cancer survivors from the 2019 National Health Interview Survey. Two ordered logistic regression models with complex survey weights were used for analyses. Missing data was addressed using multiple imputations by chained equations.

RESULTS

Being female, higher education and higher income were positively associated with better SRH. While the relationship between higher education and higher income was consistent with previous findings, the positive association between being female and SRH was different from previous studies. Age significantly moderated the association between depression and SRH, evidenced by results of the joint tests of all interaction term coefficients being statistically significant, F(2, 544.6) = 5.13, p < 0.01.

CONCLUSIONS

The findings of the study highlighted the significance of screening for social determinants of health and health disparity when supporting cancer survivors. Additionally, findings of this study emphasized the significance of adopting an age-specific approach when evaluating and addressing depression across different age groups of cancer survivors.

Association between work-family conflict and depressive symptoms in female workers: An exploration of potential moderators

Work-family conflict (WFC), an inter-role conflict between work and family, negatively affects mental health. Using a nationally representative systematic sample, this study aimed to investigate the association between WFC, depressive symptoms, and potential moderators in the association of adult female workers. Data of 4714 female workers (aged ≥19 years) were obtained cross-sectionally from the 2018 nationwide Korean Longitudinal Survey of Women and Families (KLoWF). WFC was assessed using a 7-item questionnaire, based on which scores were classified into high (>75th percentile score) and low (≤75th percentile score) levels of WFC. Significant depressive symptoms were defined as a score of ≥10 on the 10-item version of the Center for Epidemiologic Studies for Depression Scale. Female workers with high WFC levels were more likely to have depressive symptoms than those with low WFC levels (odds ratio = 2.29, 95% confidence interval = 1.91-2.74). In stratified analyses, high WFC levels were associated with the highest odds of depressive symptoms in the following groups: young adults (19-39 years), those with a college degree or above or with high income, never-married individuals, those with a family size of three or a single child, nonstandard workers, and pink-collar workers. This study replicated and extended previous findings on the association between WFC and depressive symptoms. The association was moderated by age, education and income levels, marital status, family size, number of children, and job conditions.

The health status: the ignored risk factor in dementia incidence. NEDICES cohort

BACKGROUND

The causes of the dementia decrease in affluent countries are not well known but health amelioration could probably play a major role. Nevertheless, although many vascular and systemic disorders in adult life are well-known risk factors (RF) for dementia and Alzheimer disease (AD), health status is rarely considered as a single RF.

AIM

To analyse whether the health status and the self-perceived health (SPH) could be RF for dementia and AD and to discuss its biological basis.

METHODS

We analysed different objective health measures and SPH as RF for dementia and AD incidence in 4569 participants of the NEDICES cohort by means of Cox-regression models. The mean follow-up period was 3.2 (range: 0.03-6.6) years.

RESULTS

Ageing, low education, history of stroke, and "poor" SPH were the main RF for dementia and AD incidence, whereas physical activity was protective. "Poor" SPH had a hazard ratio = 1.66 (95% CI 1.17-2.46; p = 0.012) after controlling for different confounders.

DISCUSSION

According to data from NEDICES cohort, SPH is a better predictor of dementia and AD than other more objective health status proxies. SPH should be considered a holistic and biologically rooted indicator of health status, which can predict future development of dementia and AD in older adults.

CONCLUSIONS

Our data indicate that it is worthwhile to include the SPH status as a RF in the studies of dementia and AD incidence and to explore the effect of its improvement in the evolution of this incidence.

Scoping review: Influence of cisgender male and female genders on health literacy of the elderly people

This scoping review mapped out the relevant literature, identified gaps and made suggestions on the influence of cisgender on the health literacy (HL) of the elderly people. This scoping review was guided by the PRISMA-ScR checklist. The databases Wiley Online Library™ and Elsevier™ were searched for academic articles published in the English language between February 2011 and February 2021 that met a pre-set criteria of content. The process of selection of sources of evidence based on screening and eligibility of evidence reduced the initially identified 153 sources of evidence in the searched databases to 14 sources of evidence. The content of these 14 sources of evidence was mapped out on a charting table where data was summarised and synthesised individually and collectively by the authors. Repetitive and irrelevant data were deleted. Identified gaps include the lack of extensive exploration of male and female genders alone as a determinant of HL, how gender may be utilised to encourage elderly men and women to apply HL, how different sociocultural and sociodemographic backgrounds of elderly men and women would require separate academic research, the scarcity of social sciences based research and qualitative research methodologies on the subject as well as the use of mixed-methodologies and longitudinal studies. Future research directions were suggested and limitations of this scoping review are addressed in the discussion.

Three-year prediction of depression and anxiety with a single self-rated health item

BACKGROUND

Self-rated health (SRH) is a single question with which general health status is assessed.

AIMS

To study whether SRH (i) is associated with depression and anxiety symptoms, concurrently and after three years, (ii) predicts the course over time for meeting a cutoff for depression and anxiety, and (iii) predicts development of depression and anxiety after three years.

METHOD

Population-based questionnaire data from northern Sweden were used. In total, 2336 individuals participated at baseline and three-year follow-up. The Hospital Anxiety and Depression Scale was used to quantify symptoms of depression and anxiety. Categorical and continuous data were used for analyses to complement each other.

RESULTS

Regarding prevalence, the analyses showed three- to four-fold increased odds for depression and anxiety at three-year follow-up, and two- to three-fold odds for their development at three-year follow-up. SRH at baseline was also found to be a significant, but weak, predictor of depression and anxiety severity and worsening at follow-up as well as being a predictor over time for meeting a cutoff for depression and anxiety.

CONCLUSIONS

Assessment of SRH may be used in general practice to identify individuals who qualify for further evaluation of depression and anxiety.

Investigation and influencing factors about well-being level of elderly chronic patients during COVID-19 postpandemic period in Beijing

The Corona Virus Disease 2019 (COVID-19) pandemic has huge impacts on the world, including human health and economic decline. The COVID-19 has severe infectivity, especially the elderly with chronic diseases will cause various complications after infection and accelerate the disease process. In addition, COVID-19 will also affect their mental health. Therefore, the mental health of elderly patients with chronic diseases cannot be ignored. The aim of this study was to investigate the well-being level of elderly people with chronic disease during COVID-19 postpandemic period in Beijing and analysis related influencing factors, so as to provide a basis for improving the well-being level of elderly chronic patients during the postpandemic period.Elderly patients with chronic diseases who met the inclusion criteria in 5 different administrative regions in Beijing were selected to carry out a questionnaire survey. The contents of the questionnaire included general data, the Memorial University of Newfoundland Happiness scale and the awareness situation of the COVID-19 pandemic. A total of 500 questionnaires were distributed by WeChat and 486 valid questionnaires were collected. The t test and one-way analysis of variance were used to compare Memorial University of Newfoundland Happiness scores between 2 or more groups, multiple linear regression analysis was used to conduct multiple factor analysis to explore the related factors about well-being level of elderly chronic patients.A total of 109 cases (22.43%) were evaluated high well-being level, 319 cases (65.64%) were evaluated moderate well-being level and 58 cases (11.93%) were evaluated low well-being according to the Memorial University of Newfoundland Happiness (MUNSH) scores rating. The multiple linear regression indicated that the education level, number of chronic diseases, medical expenses, frequency of children's visits, taking care of grandchildren or not, and group activity frequency significantly affected the well-being of patients with chronic diseases during COVID-19 postpandemic period in Beijing (P < .05).Most elderly patients with chronic diseases had moderate or above sense of well-being during postpandemic period, but we should still pay attention to the mental health of those elderly chronic patients with low education level, much comorbidity, more medical expenses, less visits by children, not take care of grandchildren and never participate in group activities.

Exploring the relationship between depression and different multimorbidity patterns among older people covered by long-term care insurance in Shanghai, China

BACKGROUND

Depression is common in patients with multimorbidity, but little is known about the relationship between depression and multimorbidity. The purpose of our research was to investigate multimorbidity patterns and their association with depression in a sample of older people covered by long-term care insurance in Shanghai, China.

METHOD

This was a population-based cross-sectional study, with 1871 participants aged ≥60 years old who are covered by Shanghai long-term care insurance. Multimorbidity was defined as the presence of two or more chronic diseases at the same time. We collected information on chronic conditions using a self-reported medical history, and we used the 30-item Geriatric Depression Scale (GDS-30) to evaluate depressive symptoms. Patterns of multimorbidity were identified with exploratory factor analysis, using oblimin rotation. Logistic regression was used to estimate the relationship between multimorbidity patterns and depressive symptoms.

RESULTS

Among the participants, the prevalence of multimorbidity was 64.7%, and the prevalence of depression was 64.6%. Hypertension, cardiovascular disease, cerebrovascular disease (CVD), and cataracts showed strong associations with depression when co-occurring with other conditions. Three patterns of multimorbidity were identified: a musculoskeletal pattern, cardiometabolic pattern, and degenerative disease pattern. Among these, the cardiometabolic (adjusted odds ratio (AOR) 1.223; 95% confidence interval (CI) 1.102, 1.357) and degenerative disease (AOR 1.185; 95% CI 1.071, 1.311) patterns were associated with a higher risk of depressive symptoms.

CONCLUSION

Two of three multimorbidity patterns were found to be associated with depression. Physical and psychological dimensions require greater attention in the care of older adults who are covered by long-term care insurance.

Multimorbidity and use of health services in the oldest old in Brazil

OBJECTIVE

To estimate the prevalence of multimorbidity in long-lived Brazilian individuals (age ≥80 years) and to associated it with the use of health services.

METHODS

Cross-sectional population-based study with data from the 2019 National Survey of Health (n=6,098). Frequencies of use of services were estimated for older people with multimorbidity and according to sex, health insurance ownership, and self-rated health. The prevalence rates, crude and adjusted prevalence ratios, and the respective 95% confidence intervals were calculated.

RESULTS

The average age of the older adults was 85 years and about 62% were women; the prevalence of multimorbidity was 57.1%, higher in women, in those who have health insurance, and who reside in the southern region of the country (p<0.05). In the oldest old with multimorbidity, the use of services in the last 15 days reached 64.6%, and more than 70% were hospitalized in the last year or did not carry out activities in the previous two weeks for health reasons. Differences were observed for the indicators of service use in relation to sex, health insurance ownership, and self-rated health, according to multimorbidity.

CONCLUSION

Indicators for the use of health services were higher in older individuals who have two or more chronic diseases, regardless of sociodemographic conditions and self-rated health, showing the impact of multimorbidity per se in determining the use of services among the oldest old.

Caregiving Stress and Self-Rated Health during the COVID-19 Pandemic: The Mediating Role of Resourcefulness

Family caregivers faced unprecedented circumstances and experienced increased levels of stress during the COVID-19 pandemic. Resourcefulness can minimize the effect of stress on health outcomes. The purpose of this study was to examine the associations between caregiving stress during the pandemic, resourcefulness, and self-rated health and assess the mediating effect of resourcefulness. A convenience sample of 70 family caregivers of adults with chronic and/or disabling conditions was recruited using social media groups and professional networking platforms. Data were collected using an online survey and analyzed using linear regression. Mediation analysis was conducted using the PROCESS macro. Higher levels of caregiving stress during the pandemic and lower levels of resourcefulness were associated with worse self-rated health, while controlling for age, employment status, and weekly caregiving hours. Resourcefulness mediated the relationship between caregiving stress and self-rated health. Our findings highlight the importance of assessing the psychological impact of the pandemic on family caregivers' outcomes. Resourcefulness skills can be targeted to improve the health and well-being of family caregivers during and beyond the pandemic.

How Inflammation Affects the Brain in Depression: A Review of Functional and Structural MRI Studies

This narrative review discusses how peripheral and central inflammation processes affect brain function and structure in depression, and reports on recent peripheral inflammatory marker-based functional and structural magnetic resonance imaging (MRI) studies from the perspective of neural-circuit dysfunction in depression. Chronic stress stimulates the activity of microglial cells, which increases the production of pro-inflammatory cytokines in the brain. In addition, microglial activation promotes a shift from the synthesis of serotonin to the synthesis of neurotoxic metabolites of the kynurenine pathway, which induces glutamate-mediated excitotoxicity in neurons. Furthermore, the region specificity of microglial activation is hypothesized to contribute to the vulnerability of specific brain regions in the depression-related neural circuits to inflammation-mediated brain injury. MRI studies are increasingly investigating how the blood levels of inflammatory markers such as C-reactive protein, interleukin (IL)-1β, IL-6, and tumor necrosis factor-α are associated with functional and structural neuroimaging markers in depression. Functional MRI studies have found that peripheral inflammatory markers are associated with aberrant activation patterns and altered functional connectivity in neural circuits involved in emotion regulation, reward processing, and cognitive control in depression. Structural MRI studies have suggested that peripheral inflammatory markers are related to reduced cortical gray matter and subcortical volumes, cortical thinning, and decreased integrity of white matter tracts within depression-related neural circuits. These neuroimaging findings may improve our understanding of the relationships between neuroinflammatory processes at the molecular level and macroscale in vivo neuralcircuit dysfunction in depression.

Individual-Level and Couple-Level Discordant Chronic Conditions: Longitudinal Links to Functional Disability

BACKGROUND

Multiple chronic conditions may erode physical functioning, particularly in the context of complex self-management demands and depressive symptoms. Yet, little is known about how discordant conditions (i.e., those with management requirements that are not directly related and increase care complexity) among couples are linked to functional disability.

PURPOSE

We evaluated own and partner individual-level discordant conditions (i.e., discordant conditions within individuals) and couple-level discordant conditions (i.e., discordant conditions between spouses), and their links to levels of and change in functional disability.

METHODS

The U.S. sample included 3,991 couples drawn from nine waves (1998-2014) of the Health and Retirement Study. Dyadic growth curve models determined how individual-level and couple-level discordant conditions were linked to functional disability over time, and whether depressive symptoms moderated these links. Models controlled for age, minority status, education, each partner's baseline depressive symptoms, and each partner's number of chronic conditions across waves.

RESULTS

Wives and husbands had higher initial disability when they had their own discordant conditions and when there were couple-level discordant conditions. Husbands also reported higher initial disability when wives had discordant conditions. Wives had a slower rate of increase in disability when there were couple-level discordant conditions. Depressive symptoms moderated links between disability and discordant conditions at the individual and couple levels.

CONCLUSIONS

Discordant chronic conditions within couples have enduring links to disability that partly vary by gender and depressive symptoms. These findings generate valuable information for interventions to maintain the well-being of couples managing complex health challenges.

The Impact of Sedentary Behavior and Self-Rated Health on Cardiovascular Disease and Cancer among South Korean Elderly Persons Using the Korea National Health and Nutrition Examination Survey (KNHANES) 2014-2018 Data

Cardiovascular disease and cancer have increased the risk of mortality and morbidity in elderly persons worldwide. The aim of this study was to investigate the association of sedentary behavior and self-rated health with cardiovascular disease or cancer in elderly people. The data of 6785 elderly persons aged above 65 years from the Korea National Health and Nutrition Examination Survey 2014-2018 were examined. Binary logistic regression analyses assessed the association of sedentary behavior, self-rated health, and other risk factors with cardiovascular disease or cancer. Prolonged sedentary behavior in elderly people was associated with a high risk for cardiovascular disease (odds ratio (OR): 1.28, 95% confidence interval (CI): 1.08-1.52). There was a high risk for cardiovascular disease (OR: 2.36, 95% CI: 1.85-3.01) or cancer (OR: 1.48, 95% CI: 1.17-1.88) in elderly people who had poor self-rated health. This study identified the association between prolonged sedentary behavior and cardiovascular disease, and between poor self-rated health and cancer. Since prolonged sedentary behavior is related to cardiovascular disease, efforts are needed to reduce sedentary behavior hours and maintain good self-rated health.

[Chronic low back pain-user types of ambulatory care : Cluster analysis of the utilization of ambulatory health care resources with administrative data of the AOK Baden-Württemberg]

Hintergrund

Chronische Kreuzschmerzen (engl. „chronic low back pain“; Abk. CLBP) zählen zu den häufigsten muskuloskeletalen Erkrankungen. Die ambulante Regelversorgung sieht bisher keine strukturierte multimodale Versorgung vor, wobei eine multimodale Therapie empfohlen wird.

Ziel der Arbeit

Es sollte die Inanspruchnahme ambulanter Regelversorgung im ersten Jahr von neu erkrankten Patienten mit CLBP hinsichtlich des multimodalen Behandlungsansatzes exploriert und Nutzertypen bestimmt werden.

Material und Methoden

Eine Two-step-Clusteranalyse wurde mit Routinedaten von 11.182 inzidenten Fällen durchgeführt. Das Alter lag zwischen 18 und 65 Jahren und Daten von vier aufeinander folgenden Quartalen je Patient wurden analysiert. Anhand der Abrechnungsdaten von Orthopäden, Schmerztherapeuten, Psychotherapeuten, Heilmitteln, Schmerzmedikamenten und Opioiden wurden die Cluster ermittelt. Merkmale der Versorgungsstruktur und der Versicherten lieferten die weiteren Ergebnisse.

Ergebnisse

Die Analyse ergab vier Nutzertypen: 39,7 % nahmen keine fachärztliche Versorgung und wenige Heilmittel in Anspruch; 37,3 % wurden orthopädisch versorgt; 15,6 % nahmen orthopädische und schmerztherapeutische Versorgung in Anspruch; 7,4 % wurden orthopädisch, schmerz- und/oder psychotherapeutisch versorgt. Charakteristisch für eine multimodale Inanspruchnahme war: weiblich, hoher Schmerzmittelverbrauch (M = 143,94 DDD), hoher Opioidverbrauch (M = 37,12 DDD), hohe Heilmittelkosten (M = 631,79 €), Akupunktur, Antidepressiva, Hospitalisierung, interdisziplinäre Fallkonferenzen und Konsultationen bei Neurologen. 60,4 % der Studienpopulation nahmen Schmerzmittel ein.

Diskussion

Das Clusterverfahren zeigte unterschiedliche Nutzertypen. Die empfohlene multimodale Therapie erhielten circa 23 % der Studienpopulation.

Association between case volume of ambulance stations and clinical outcomes of out-of-hospital cardiac arrest: A nationwide multilevel analysis

OBJECTIVES

The case volume effects of ambulance stations on the survival of out-of-hospital cardiac arrest (OHCA) patients are uncertain. This study was conducted to evaluate the association between the case volume of ambulance stations and clinical outcomes in OHCAs by the number of emergency medical services (EMS) providers at the scene.

METHODS

Adult cardiac EMS-treated OHCAs between 2015 and 2018 were enrolled. The main exposure was the annual OHCA case volumes of 204 ambulance stations in Korea, which were categorized into three groups; low-volume (<100), moderate-volume (100-159) and high-volume (≥160). The primary and secondary outcomes were good neurological recovery and survival to discharge. Multilevel multivariable logistic regression analysis was conducted to calculate adjusted odds ratios (AORs). Interaction analysis between the number of EMS providers at the scene and the exposure variable was performed.

RESULTS

A total of 92,534 patients were enrolled. OHCAs in the low-volume group tended to be arrest in a public place or a non-metropolitan area, less prehospital administration of an advanced airway and intravenous management. Significant differences were found the main analysis: AORs (95% CIs) compared to the low-volume group were 1.15 (1.03-1.29) and 1.14 (1.03-1.27) in the high-volume and moderate-volume groups for good neurological recovery and 1.19 (1.07-1.33) and 1.14 (1.04-1.25) in the high-volume and moderate-volume groups for survival to discharge. Significant interaction effects between the number of EMS providers at the scene and case volume on clinical outcomes were found.

CONCLUSION

OHCA case volumes of ambulance stations are associated with clinical outcomes after cardiac arrest.

Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China

BACKGROUND

Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability.

METHODS

We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity.

RESULTS

Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16-1.41) and IADL (OR 1.41, 95%CI 1.19-1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40-1.72).

CONCLUSIONS

Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.

Neural substrates for late-life depression: A selective review of structural neuroimaging studies

Recent neuroimaging studies have characterized the pathophysiology of late-life depression (LLD) as a dysfunction of the brain networks involved in the regulation of emotion, motivational behavior, cognitive control, executive function, and self-referential thinking. In this article, we reviewed LLD-associated structural neuroimaging markers such as white matter hyperintensity (WMH), white matter integrity measured by diffusion tensor imaging, cortical and subcortical volumes, and cortical thickness, which may provide a structural basis for brain network dysfunction in LLD. LLD was associated with greater severity or volumes of deep, periventricular, or overall WMH and with decreased white matter integrity in the brain regions belonging to the fronto-striatal-limbic circuits and reduced white matter tract integrity which connects these circuits, such as the cingulum, corpus callosum, or uncinate fasciculus. Decreased volumes or cortical thickness in the prefrontal cortex, orbitofrontal cortex, anterior and posterior cingulate cortex, several temporal and parietal regions, hippocampus, amygdala, striatum, thalamus, and the insula were associated with LLD. These structural neuroimaging findings were also associated with cognitive dysfunction, which is a prominent clinical feature in LLD. Several structural neuroimaging markers including the WMH burden, white matter integrity, and cortical and subcortical volumes predicted antidepressant response in LLD. These structural neuroimaging findings support the hypothesis that disruption of the brain networks involved in emotion regulation and cognitive processing by impaired structural connectivity is strongly associated with the pathophysiology of LLD.

Health Profiles, Health Services Use, and Transition to Dementia in Inpatients With Late-Life Depression and Other Mental Illnesses

OBJECTIVES

Depression has been reported as a risk factor for dementia. We compared health and health service use profiles in older people hospitalized with late-life depression and older people hospitalized with other mental illnesses and examined the transition to dementia.

DESIGN

A retrospective population-based study using linked administrative health data over 11 years.

SETTING AND PARTICIPANTS

The sample includes 55,717 inpatients age 65+ years with depression and 104,068 inpatients age 65+ years with other mental illnesses in New South Wales, Australia.

METHODS

The risk of subsequent dementia under consideration of sociodemographics, comorbidities, and health service use was analyzed with logistic regression.

RESULTS

The most prominent differences were the rates of delirium and self-harm with a 6 times lower rate of delirium and an 8 times higher rate of self-harm in people with late-life depression compared with those with other mental illness. Inpatients with late-life depression had an increased risk of subsequent dementia by 12% and received a dementia diagnosis at a younger age compared with inpatients with other mental illnesses. Besides depression only 3 other conditions, delirium, diabetes, and cerebrovascular accidents, were associated with an increased dementia risk. Other factors associated with an increased dementia risk were longer hospital stays, low socioeconomic status, male sex, and older age.

CONCLUSIONS AND IMPLICATIONS

Results from this study lead to a better understanding of the risk for dementia and of differences in health profiles and health services use in older people with depression compared with those with other mental illnesses. Our findings highlight the importance of the clinical management and prevention of self-harm and delirium in older people.

The Beneficial Effects of Short-Term Exposure to Scuba Diving on Human Mental Health

Exposure to outdoor blue spaces can help improve human health by reducing stress, promoting social relationships, and physical activity. While most studies have focused on the adverse health effects of scuba diving, very few have assessed its health benefits. Moreover, when scuba diving is done in large groups with no diving instructor or pre-dive briefing, negative environmental impacts are generated and negative impacts on human health may also occur due to overcrowding, which may create stress. This is the first study to evaluate the effects of scuba diving on divers' mental health using their diving practices to estimate the impacts on the ecosystem. In the marine-protected area of Cap de Creus and adjacent areas, we assessed the mental health of 176 divers and 70 beach users (control group) by employing a 29-item version of Profile of Mood State (POMS) questionnaires. According to the parameters associated with reduced environmental impacts, two scuba diving experiences were established. Poisson regression models were performed to assess both the contribution of the activity and diving experiences to POMS scores. Both groups (scuba divers and beach goers) reduced their POMS scores after carrying out the activities. Although no significant differences were found between beach and scuba diving activities, nor between the two different scuba diving experiences, our results showed that subjects with regular medication intake due to a chronic or psychiatric illness had a POMS reduction score significantly higher than other subjects. We conclude that both beach and scuba diving activities have positive effects for human mental health, particularly among subjects with regular medication intake.

Potential influence of physical, psychological and lifestyle factors on the association between television viewing and depressive symptoms: A cross-sectional study

OBJECTIVE

To investigate the potential influence of physical, psychological, and lifestyle factors on the association between TV-viewing and depressive symptoms among Brazilian adults.

METHODS

We used cross-sectional data from the Brazilian National Survey, conducted in 2013 with 60,202 adults (≥18 years). Information regarding exposure (TV-viewing), potential influencing factors (multimorbidity, mobility, self-rated health, tobacco use, alcohol consumption, sugar consumption, and physical activity) as well as elevated depressive symptoms (through PHQ-9 - score > 9) (outcome) was collected via interview-administered questionnaires. Data on covariates were self-reported. Body mass index was estimated through the assessment of body mass and stature. Mediation models were estimated through the Karlson-Holm-Breen method.

RESULTS

Individuals who reported >5 h/d of TV viewing showed a higher prevalence of depressive symptoms than those with <5 h/d of TV viewing [8.1%(99%CI:7.6%-8.6%) vs 14.2%(99%CI:12.2%-16.6%)]. The association between TV-viewing and depressive symptoms was influenced by tobacco use (Overall: 7.22%; men: 4.46%, women: 8.59%), physical activity (men: 3.99%, women: 2.28%), mobility (overall: 11.31%, men: 10.85%, women: 11.03%), and multimorbidity (overall: 9.11%, men: 11.6%, women: 6.03%). Poor self-rated health influenced the association between TV-viewing and elevated depressive symptoms only among men (15.55%). Similarly, the association between >4 h/d of TV viewing and depressive symptoms was influenced by tobacco use (men: 6.8%, women: 11.7%), physical activity for women (5.5%), self-rated health for men (14.7%), mobility (men: 8.7%, women: 17.0%), and multimorbidity (men: 9.6%, women: 12.3%).

CONCLUSIONS

Tobacco use, physical activity, mobility, multimorbidity, and self-rated health (men) mediate the relationship between high TV-viewing and elevated depressive symptoms. Longitudinal research is required to confirm/refute our data which may also be useful to contribute to public health interventions.

Relationships between hand-grip strength, socioeconomic status, and depressive symptoms in community-dwelling older adults

BACKGROUND

Depressive symptoms have been found to be associated with decreased hand-grip strength (HGS) and low socioeconomic status (SES) in older adults. We aimed to investigate the potential moderating effect of SES on the association between HGS and depressive symptoms and the potential mediating effect of HGS on the association between SES and depressive symptoms using a nationally representative sample of older adults.

METHOD

Data from 3169 community-dwelling adults aged 60 years or older were acquired from the Korea National Health and Nutrition Examination Survey conducted in 2014 and 2016. HGS was measured using a digital hand-grip dynamometer. Depressive symptoms were evaluated using the 9-item version of the Patient Health Questionnaire-9 (PHQ-9). SES was assessed using equivalent monthly household income and education level.

RESULTS

Older adults in the lowest tertile of HGS measures were more likely to have experienced depressive symptoms compared to those in the highest tertile (odds ratio = 1.95, 95% confidence interval = 1.25-2.74). A significant moderating effect of household income level was observed on the association between HGS and PHQ-9 score (P = 0.014). Older adults with a low income had a stronger inverse correlation between HGS and PHQ-9 score compared to those with a high income (low income: beta =  -0.162, P < 0.001; high income: beta = -0.119, P = 0.036). HGS partially mediated the association between low income and depressive symptoms.

CONCLUSION

Our findings indicate that there may be a stronger relationship between low HGS and depressive symptoms in socioeconomically deprived older people. Further research on muscle strength and income level in older adults is required regarding depression risk assessment.