Risk factors for depression in the elderly: An umbrella review of published meta-analyses and systematic reviews

Associations and attributable burdens in late-life exposure to PM2.5 and its major components and depressive symptoms in middle-aged and older adults: A nationwide cohort study

BACKGROUND

Depression in late life has been associated with reduced quality of life and increased mortality. Whether the chronic fine particular matter (PM2.5) and its components exposure are contributed to the older depression symptoms remains unclear.

METHOD

Middle-aged and older adults (>45 years) were selected from the China Health and Retirement Longitudinal Study during the four waves of interviews. The concentrations of PM2.5 and its major constituents were calculated using near real-time data at a spatial resolution of 10 km during the study period. The depressive symptom was evaluated by the Depression Center for Epidemiologic Studies Depression (CES-D)-10 score. The fix-effect model was applied to evaluate the association between PM2.5 and its major constituents with depressive symptoms. Three three-step methods were used to explore the modification role of sleep duration against the depressive symptoms caused by PM2.5 exposure.

RESULTS

In our study, a total of 52,683 observations of 16,681 middle-aged and older adults were assessed. Each interquartile range (IQR) level of PM2.5 concentration exposure was longitudinally associated with a 2.6 % (95 % confidence interval [CI]: 1.3 %, 4.0 %) increase in the depression CES-D-10 score. Regarding the major components of PM2.5, OM, NO3-, and NH4+ showed the leading toxicity effects, which could increase the depression CES-D-10 score by 2.2 % (95 %CI: 1.0 %, 3.4 %), 2.2 % (0.6 %, 3.9 %), and 2.0 % (95 %CI: 0.6 %, 3.4 %) correspondingly. Besides, males were more susceptible to the worse depressive symptoms caused by PM2.5 and its major components exposure than female subpopulations. Shortened sleep duration might be the mediator of PM2.5-associated depressive symptoms.

CONCLUSION

Our results suggest that long-term exposure to PM2.5 and its major components were associated with an increased risk for depressive symptoms in middle-aged and older adults. Reducing the leading components of PM2.5 may cost-effectively alleviate the disease burden of depression and promote healthy longevity in heavy pollutant countries.

Abuse and other factors related to depression in older Ecuadorian adults

Objective

To identify abuse and other risk factors associated with depression in older Ecuadorian adults using data from the 2012 Ecuador's Survey of Health, Welfare, and Aging (SABE).

Methods

This cross-sectional study analyzed data from the 2012 SABE survey, which included 5235 adults aged 60 and above. The study evaluated residence, education level, ethnic self-identification, self-perceived health and memory, loneliness, cognitive status, and abuse. Depression was assessed using the Yesavage Depression Scale, short version (YDS-SV). Categorical variables were analyzed with the Chi-square test, differences between groups were calculated with the Kruskal-Wallis test, and multiple linear regression analysis was performed. A p-value of ≤0.05 was considered statistically significant.

Results

The mean age was 71.39 ± 8.59 years and 55.10% of the sample were women. Abuse was absent in 72.1% (3.773) of the population. The Chi-square test indicated significant associations between depression and poor self-reported health (P = 0.000) and indigenous ethnicity (P = 0.000). Multiple linear regression analysis revealed that age (P < 0.001), abuse (p < 0.001), cognitive status (P = 0.002), and living alone (P = 0.034) significantly contributed to mood as assessed by the YDS-SV. No statistically significant association was found for perceived health status or place of residence (urban or rural).

Conclusions

Risk factors associated with depression in older Ecuadorian adults include advanced age, living alone, cognitive decline, poor self-perception of health and cognition, and abuse.

Predictors of and healthcare utilisation of depressive symptoms among middle-aged and older adults in Thailand: a national cross-sectional community-based study in 2015

OBJECTIVE

The prevalence of depressive symptoms and healthcare utilisation among the ageing population in Thailand is unclear. The study assessed the predictors of and healthcare utilisation of depressive symptoms among an ageing population in Thailand.

DESIGN

Cross-sectional, population-based study.

SETTING

National sample of people aged 45 years and older in Thailand from the 2015 Health, Ageing and Retirement in Thailand (HART) study.

PARTICIPANTS

The sample included 5135 individuals (≥45 years) with complete depressive symptoms data from the 2015 HART study.

OUTCOME MEASURES

Depressive symptoms were measured with the Centre for Epidemiological Studies Depression Scale. Logistic regression was used to estimate the associations between sociodemographic factors, health factors and depressive symptoms, and the associations between depressive symptoms and different types of healthcare utilisation.

RESULTS

The study population included 5135 participants with a median age of 66 years. The prevalence of depressive symptoms was 13.9%. The proportion of past 2 year hospital admission was 12.8%, hospital outpatient 49.7%, health centre outpatient 26.2%, private clinic 8.4%, traditional medical practitioner 2.8%, medical home visit 4.9% and past-year medical check-up 50.3%. In adjusted logistic regression analysis, low income, residing in the Southern region, history of a cardiovascular disease, brain diseases and/or psychiatric problems and functional disability were positively associated with depressive symptoms. Male sex, being a Buddhist, urban residence, high religious involvement, moderate and high physical activity were negatively associated with depressive symptoms. In fully adjusted logistic regression models, depressive symptoms were positively associated with hospital inpatient utilisation, hospital outpatient utilisation, health centre utilisation and utilisation of a traditional medicine practitioner.

CONCLUSIONS

More than one in 10 participants had depressive symptoms. Chronic conditions, sociodemographic factors, physical inactivity and low religious involvement increased the odds of depressive symptoms. Furthermore, depressive symptoms increased the odds of conventional and traditional healthcare utilisation.

Life satisfaction, positive affect, depression and anxiety symptoms, and their relationship with sociodemographic, psychosocial, and clinical variables in a general elderly population sample from Chile

Background

This study aims to describe the relationship between life satisfaction, positive affect, depression and anxiety symptoms with sociodemographic, psychosocial and clinical variables, and to identify the relative importance of these predictor groups.

Methods

We evaluated life satisfaction (SWLS), positive affect (PANAS), depressive (PHQ-9), and anxiety (GAI) symptoms and their association with sociodemographic, psychosocial and clinical variables in a multistage, random general population sample of fully functioning individuals aged 60-80 years from the Concepción province and Gran Santiago, Chile (n = 396). We performed weighted multiple regression analysis, considering the complex sample structure with age group, sex, and geographical area, complemented with general and conditional dominance analyses to estimate the relevance of the predictor groups.

Results

We found significant associations with the geographical area, sex, age, education level, household members, having a partner, employment status, caregiver status, economic satisfaction, presence of chronic diseases, medication use, and alcohol use. Satisfaction with health was the most important predictor for positive affect (p < 0.001), depressive (p < 0.001), and anxiety (p < 0.001) symptoms, while alcohol use was the most significant predictor for life satisfaction (p < 0.001).

Conclusion

Simultaneously studying the positive and negative dimensions of wellbeing and mental health in older adults allows for a more comprehensive perspective on the challenges faced during this stage of life. This study accounts for previously unknown associations and contributes to the identification of common and specific predictors in both dimensions.

The Effects of a Beauty Program on Self-Perception of Aging and Depression among Community-Dwelling Older Adults in an Agricultural Area in Taiwan

This study aimed to investigate the effects of a beauty program on the self-perception of aging and depression among the community-dwelling older adults in an agricultural area in Taiwan. Twenty-nine older adults aged 65 and above in one agricultural community care center completed the program. Based on cosmetic therapy, the beauty program consisted of 13 sessions focused on facial skin care, make-up application, and massage with essential oils. Each 90 min session of the program was conducted in groups once a week for 13 weeks. This study applied the mixed methods approach, and data were gathered through questionnaire surveys, interviews, and observation. Before and after the beauty program, the elderly individuals' self-perceptions of aging and depression were assessed using the Attitudes towards Old People Scale (ATOPS) and Taiwanese Depression Questionnaire (TDQ), respectively. The participants' ATOPS scores after the program were significantly higher than those examined before the program (p < 0.001), and their TDQ scores were significantly lower than those before the program (p < 0.001). Additionally, the participants' body images were improved, the participants disrupted their stereotypes about makeup, and they were willing to gradually maintain their appearance. Overall, the beauty program was effective for enhancing the self-perceptions of aging and reducing depression in older adults in rural Taiwan. Further research with a larger population of older individuals, male older adults, or frail older adults is needed to examine the specific effects of the beauty program.

Predicting Depression in Older Adults after the COVID-19 Pandemic Using ICF Model

This study aimed to test a predictive model for depression in older adults in the community after the COVID-19 pandemic and identify influencing factors using the International Classification of Functioning, Disability, and Health (ICF). The subjects of this study were 9920 older adults in South Korean local communities. The analysis results of path analysis and bootstrapping analysis revealed that subjective health status, instrumental activities of daily living (IADL), number of chronic diseases, social support satisfaction, household economic level, informal support, and participation in social groups were factors directly influencing depression, while formal support, age, gender, education level, employment status, and participation in social groups were factors indirectly affecting it. It will be needed to prepare measures to prevent depression in older adults during an infectious disease pandemic, such as the COVID-19 pandemic, based on the results of this study.

The multiple mediating effect of family health and perceived social support on depressive symptoms in older adults: A cross-sectional national survey in China

BACKGROUND

Depression harms older adults' physical health and quality of life, especially for those with disabilities. This study aims to investigate the epidemiological characteristics of depressive symptoms in older adults and influencing factors involving neuroticism in China.

METHODS

A multistage random sampling method was adopted to recruit older adults. We conducted a multiple mediating analysis to explore how overall family health and perceived social support affect the relationship between neuroticism and depressive symptoms in older adults.

RESULTS

A total of 1122 older adults were included in this study, and 529 individuals reported suffering from depressive symptoms (47.1 %). Mediation analysis results indicated that neuroticism had a direct predictive effect on depressive symptoms in older adults. Family health and perceived social support partly mediated the relationship between neuroticism and depressive symptoms in older adults. Moreover, depressive symptoms in older adults with high neuroticism was directly affected by decreasing family health and indirectly and cumulatively aggravated by the mediation of lower perceived social support.

LIMITATIONS

The cross-sectional study design limits the conclusion about causation and directionality.

CONCLUSIONS

Family health and perceived social support can prevent depressive symptoms in older adults with high neuroticism.

Allostatic load and depressive symptoms in older adults: An analysis of 12-year panel data

BACKGROUND

Whether changes in allostatic load (AL) and depressive symptoms relate over time has not been yet fully explored. This study evaluated the association between AL and depressive symptoms over 12 years among community-dwelling older adults.

METHODS

Panel data from 8291 participants in the English Longitudinal Study of Ageing were analysed. Depressive symptoms were assessed with the 8-item Centre for Epidemiologic Studies Depression Scale (CES-D). The AL score was derived from nine metabolic, cardiovascular and immune biomarkers. The association between AL and depressive symptoms was modelled in a linear hybrid model adjusting for time-invariant (sex, ethnicity) and time-variant confounders (age, marital status, education, wealth, physical activity, smoking status, alcohol intake, limitations in daily living, comorbidities).

RESULTS

The mean AL score was 3.1 (SD: 2.1), 3.5 (2.3), 3.2 (2.3) and 3.3 (2.5) whereas the mean CES-D score was 1.4 (SD: 1.8), 1.2 (1.8), 1.2 (1.8) and 1.2 (1.7) in waves 2, 4, 6 and 8, respectively. In the adjusted model, the between-person differences (coefficient: 0.02, 95% CI: 0.01, 0.04) but not the within-individual differences (0.01; 95% CI: -0.01, 0.03) in the AL score were associated with CES-D score. The between-person coefficient indicates that participants with greater AL scores also had slightly higher CES-D scores. The within-person coefficient indicates that changes in the AL score were not associated with changes in the CES-D score.

CONCLUSION

AL was associated with depressive symptoms. However, most of the association was driven by differences in AL between individuals rather than changes in AL over time.

Recognizing Depression in the Elderly: Practical Guidance and Challenges for Clinical Management

Depression is one of the most common mood disorders in the late-life population and is associated with poor quality of life and increased morbidity, disability and mortality. Nevertheless, in older adults, it often remains undetected and untreated. This narrative review aims at giving an overview on the main definitions, clinical manifestations, risk and protective factors for depression in the elderly, and at discussing the main reasons for its under/misdiagnosis, such as cognitive decline and their overlapping symptomatology. A practical approach for the global and multidisciplinary care of the older adult with depression, derived from cross-checking evidence emerging from the literature with everyday clinical experience, is thus provided, as a short and flexible "pocket" guide to orient clinicians in recognizing, diagnosing and treating depression in the elderly.