Health, financial stresses, and life satisfaction affecting late-life depression among older adults: a nationwide, longitudinal survey in Taiwan

The association between functional disability and depressive symptoms among older adults: Findings from the China Health and Retirement Longitudinal Study (CHARLS)

BACKGROUND

Previous research has shown that depressive symptoms in older adults was associated with functional disability, including basic activities of daily living (BADLs) and instrumental activities of daily living (IADLs). However, little is known about the impact of different patterns of functional disability and new-onset functional disability on subsequent depressive symptoms.

OBJECTIVE

To determine the effect of various patterns of functional disability and new-onset functional disability on depressive symptoms among Chinese older adults aged 60 years and above.

METHOD

The study included 3242 older adults from the China Health and Retirement Longitudinal Study (CHARLS), which was conducted from 2011 to 2018. Cox proportional hazards models were used to investigate the associations between patterns of functional disability and depressive symptoms. The associations were also examined in the population with new-onset functional disability.

RESULT

During 15,321 person-years of follow-up, 946 depressive symptoms occurred. The hazard ratios (HRs) of depressive symptoms were 1.29 (95 % confidence intervals [CI]: 1.05-1.58) for IADLs disability, 1.22 (95 % CI: 0.75-1.55) for BADLs disability, and 1.78 (95 % CI: 1.41-2.22) for both IADLs and BADLs disabilities. In the analysis of new-onset functional disability, the HRs were 1.50 (95 % CI: 1.06-2.13) for onset IADLs disability, 1.28 (95 % CI: 0.85-1.91) for onset BADLs disability, and 1.69 (95 % CI: 1.03-2.76) for both onset BADLs and IADLs disabilities.

LIMITATIONS

Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale, which has limitations in diagnosing clinical depression.

CONCLUSION

Functional disability increases the risk of depressive symptoms, particularly impaired IADLs function. Psychological care for older adults with functional disability should be strengthened.

Qualities of Older Adults' Family and Friendship Relationships and Their Association with Life Satisfaction

While family and friendship relationship qualities are associated with life satisfaction, evidence on how these types of relationships interact to contribute to older adults' life satisfaction is sparse. This study examined how family and friendship relationship qualities may be supportive of (compensatory) or conflict with (competing) older adults' life satisfaction. We adopted a cross-sectional design to analyze data from the Health and Retirement Study (n = 1178, females = 54.8%, mean age = 67.9 years, SD = 9.3 years) to examine compensatory (as in social support) and competing (as in social strain) qualities of family and friendship social relationships and their association with life satisfaction in older adults. For greater explanatory power, we also controlled for life satisfaction by sociodemographic variables of age, gender, education, self-reported general health, physical health and activity, depression, and personality traits. Our findings indicate that the spouse/partner support relationship contributes to older adults' life satisfaction overall and is associated with greater social support and less social strain. Friendship support is associated with improved life satisfaction for older adults reporting spouse/partner strain. Relationship support for the life satisfaction of older adults should consider their need for social support from their social network while minimizing the risk of social strain from adversarial relationships in life situations.

Does Empty Nest Elderly Experience More Depressive Symptoms than Non-Empty Nest Elderly? Evidence from Longitudinal Aging Study in India

India experienced a growing burden of elderly population associated with both physical and mental health challenges. Among the mental health problems, dementia, depression, anxiety and sleep disorder are of significant concern. This present study investigates the association between the types of living arrangement and the mental health of elderly in India. Comparison has been done between empty nest and non-empty nest elderlies. Data from first wave of Longitudinal Aging Study in India (2017-18) has been used. It is a nationally representative data which collected data from over 72,000 individuals aged 45 and above and their spouses irrespective of age. We used the Center for Epidemiological Studies Depression Scale (CES-D) to measure depression while living arrangement was self-reported by the respondents. Univariate and multivariate analyses were carried out to find significant association of the outcome and independent variables. Among the total elderlies, 11% were from empty nest single households, 20% were from empty nest couple households and others were from the non-empty households. At national level, 30% elderly suffered from depression. It was more among the elderly of empty nest single households (43%), compared to elderly of empty nest couple households (30%) and non-empty nest households (28%). Gender, socio economic status, self-rated health status, financial stability, place of residence plays a crucial role in the experience of depression among the elderlies. Results portray that household structure, especially living arrangement and familial support in old age can be associated with the overall health and wellbeing, more specifically depressive symptoms among the elderly.

The association between intergenerational relationships and depression among older adults: A comprehensive systematic literature review

OBJECTIVE

This systematic review aims to comprehensively examine the relationship between intergenerational relationships and depression among older adults in Eastern Asian countries.

METHODS

For this research, a systematic search was conducted on several electronic databases including PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar search engine up until June 2023.

RESULTS

Out of 953 articles initially identified, 33 met the inclusion criteria. Emotional support and financial support emerged as crucial factors that can significantly reduce depressive symptoms among older individuals. However, there are diverse and sometimes contradictory results regarding the impact of intergenerational instrumental support on depression in older adults.

CONCLUSION

Promoting positive intergenerational relationships and enhancing support systems can greatly benefit the mental health of older adults by addressing depression within this population. This review enhances our understanding of the complex relationship between intergenerational relationships and depression among older adults. The diverse findings on intergenerational instrumental support and depression in older adults suggest the need for further research to clarify this relationship and its nuances. This research may have practical implications for policies and interventions aimed at improving the mental well-being of older adults in Eastern Asian countries.

Analysis of depression status and influencing factors in middle-aged and elderly patients with chronic diseases

Objectives

To explore prevalence of depression and its influencing factors in middle-aged and elderly patients with chronic diseases.

Method

Data were extracted from the 2018 China Health and Retirement Tracking Survey (CHARLS) for 6,704 middle-aged and elderly patients ≥45 years with chronic diseases. The influencing variables were selected based on LASSO-logistic regression model, and a nomogram was further drawn to visualize regression results.

Results

Comorbidity between chronic diseases and depression symptoms were detected in 3058 individuals (45.6%). Female, rural, lower education, poor, insomnia, multiple chronic disease, and functional impairment were associated with a higher proportion of depression. Meanwhile, family interaction, intergenerational financial support, social activity intensity, and satisfaction with life can protect against depression.

Conclusion

Depressive symptoms are common in Chinese older adults with chronic diseases. They need regular assessment and intervention, especially those with multiple diseases, female, rural, alone, impaired, poor sleep, or poor economy. These high-risk elders also need family, medical, and social support and care.

Looking back on life: An updated meta-analysis of the effect of life review therapy and reminiscence on late-life depression

BACKGROUND

Twenty years ago, we confirmed the effectiveness of life review therapy and reminiscence (LRT-REM) to treat late-life depression in a meta-analysis. In the current study, we aimed to examine the most updated evidence on the effects of LRT-REM in older adults with depression.

METHODS

We systematically searched records in English and Chinese databases up to December 2022 and included randomized controlled studies comparing LRT-REM with control conditions in older adults with depression. Outcomes included depression, anxiety, quality of life, and life satisfaction. Effect sizes (Hedges' g) at post-treatment were pooled with random effects meta-analyses.

RESULTS

42 studies with 3361 depressed older adults (≥60 years) met the selection criteria. We found a significant and large effect of LRT-REM (g = 1.41, p < 0.001) on late-life depression, corresponding to a number-needed-to-treat (NNT) of 1.98. Heterogeneity shrunk from high (I2 = 86.78) to moderate (I2 = 46.87) after excluding eight detected outliers. There were no significant differences between the examined subgroups except for the type of control condition. The effects of LRT-REM were not statistically significant at follow-up when corrected for publication bias. The quality of many included studies was not optimal.

LIMITATIONS

The quality of many included studies was not optimal, with a high risk of bias.

CONCLUSIONS

LRT-REM may be effective for treating late-life depression, but long-term effects are unclear. More research is needed on the effects of LRT-REM, especially when guided by (para)professional or lay therapists in low- and middle-income countries.

Screening of Geriatric Depression in Makkah, Saudi Arabia: A Pilot Study

OBJECTIVE

There is currently limited evidence about the prevalence of depression among elderly people residing in Makkah, Saudi Arabia. This study aims to report the magnitude of depression among the older population in Makkah, Saudi Arabia, and the related risk factors.

METHODS

An online cross-sectional pilot survey was carried out in Makkah City, Saudi Arabia. Data were collected using an online self-administered questionnaire.

RESULTS

The study questionnaire was completed by 191 older people. The participants' ages varied from 60 to 88 years. 55.5% were women, 47.9% were married, and 21.5% were divorced/widowed. 46.6% had hypertension, 42.4% had diabetes, 17.3% had hypothyroidism, 7.9% had cardiovascular diseases (CVDs), and 6.3% reported psychiatric problems. 44.5% of the subjects had no depression, 23.5% had mild, 15.2% had moderate, and 16.8% had severe depression. The sample included 32% who had been classified as having major depression. Elderly participants with insomnia, cognitive diseases, and chronic diseases showed a high risk for experiencing severe depression (OR=2.74; 95% CI: 1.42-5.28),(OR=2.63; 95% CI: 1.29-5.40), and (OR=2.62; 95% CI: 1.11-6.14) respectively.

CONCLUSION

Depression was common among the elderly population in Makkah, particularly among those with a documented history of insomnia, cognitive diseases, and chronic diseases. Depression screening and treatment for old people in medical settings is recommended.

The trajectory of non-depressed suicidal ideation in community-dwelling older people in a rural area in Japan: a prospective longitudinal study with a 3-year follow-up

BACKGROUND

Suicidal ideation is closely related to severe suicidal behaviour and is an important predictor of suicide attempt and completion, including in older people. Older people tend to have many opportunities to be conscious of death, and may have vague suicidal ideation because of various loss experiences, even if they are not depressed. We hypothesised that suicidal ideation among older people might be a risk factor for later transition to depression. The present study aimed to clarify risk factors that predict the incidence of depression in older people 3 years post-baseline in a rural area of Japan, and to examine the subsequent course of depression among non-depressed older people with suicidal ideation.

METHODS

In 2015 and 2018, survey questionnaires were mailed to residents aged 65 years and over living in a rural area in Japan. Participants were divided into a depression group and a non-depression group using 15-item Geriatric Depression Scale scores 3 years post-baseline. Logistic regression analysis was used to identify predictive factors of late-life depression 3 years post-baseline.

RESULTS

We received 597 valid responses, with a 3-year follow-up rate of 78.8%. Regarding suicidal ideation, 6.7% of non-depressed older people exhibited suicidal ideation at baseline. Of these, 9.8% exhibited depression after 3 years post-baseline. Logistic regression analysis indicated that development of late-life depression is significantly associated with suicidal ideation, being female, and poor health-related quality of life (HRQOL).

CONCLUSIONS

The results revealed that suicidal ideation, being female, and poor HRQOL were predictive factors of the development of late-life depression 3 years post-baseline in a rural area of Japan. These findings provide novel information regarding the transition to depression among community-dwelling older people who are not depressed but have suicidal ideation. Whereas suicidal ideation is considered to be a symptom of depression, the current results suggest that suicidal ideation may precede depression in some older people.

Addressing the mental health needs of India's aging population: Understanding depression prevalence and social risk factors in tertiary care outpatients

Background

Depression is a major public health problem among older persons. Identifying the prevalence and recognizing modifiable risk factors of depression in older persons is essential for early diagnosis and appropriate management. Apart from traditional risk factors, medical comorbidities, chronic illness, and social factors can contribute to depression in the older person. This study aimed to estimate the prevalence of depression and identify the medical and social risk factors associated with depression in older persons attending a geriatric outpatient clinic.

Methods

Consecutive patients aged over 60 years presented to the geriatric outpatient clinic of the Christian Medical College (CMC) and Hospital, Vellore, were screened using the Physical Health Questionnaire-2 (PHQ-2) and Geriatric Depression Scale (GDS). Medical, social, and financial information were collected. Following a detailed clinical interview, the Clinical Interview Schedule-Revised (CIS-R) was administered and the ICD-10 diagnosis of depression was derived.

Results

A total of 171 participants were recruited. The prevalence of depression was found to be 53.2% with PHQ-2 and 35.6% with GDS. Using CIS-R, 41.5% had an ICD-10 diagnosis of depression. The risk factors associated with depression in older persons were female gender, financial insecurity, lack of pension, and financial dependence.

Conclusion

This study revealed a high prevalence of depression among older persons attending a geriatric outpatient clinic. Financial insecurities, particularly lack of pension or financial dependence, were identified as significant social risk factors for depression. Addressing these risk factors may help prevent the onset or progression of depression, thus improving their quality of life.

Investigating the relationship between spiritual well-being, resilience, and depression: a cross-sectional study of the elderly

BACKGROUND

Mental health of the elderly is one of the health problems in most societies. This study aimed to investigate the relationship between spiritual well-being (SWB), resilience, and depression among the elderly.

METHODS

This descriptive-correlational study was conducted on 384 elderly selected by convenience-sampling method. Abbreviated Mental Test (AMT), SWB, Connor-Davidson Resilience Scale (CD-RISC), and Geriatric Depression Scale (GDS) were used to collect the data. Pearson correlation coefficient, analysis of variance and independent t-test were used to analyze the data. A path analysis was also run to test the direct and indirect effects of SWB and resilience on the depression variable.

RESULTS

The results showed a statistically significant positive correlation between SWB and resilience (r = 0.458, P < 0.001), a statistically significant negative correlation between SWB and depression (r = -0.471, P < 0.001) and between resilience and depression (r = -0.371, P < 0.001). Path analysis showed that SWB and resilience directly affected depression while SWB indirectly affected depression.

CONCLUSIONS

The results indicated there was an inverse relationship between SWB and resilience with depression. Religious programs and appropriate educational programs can help improve SWB and promote resilience in the elderly, which will reduce their depression symptoms.

The cross-sectional relationship among omega-3 fatty acid levels, cardiorespiratory fitness, and depressive symptoms from the Cooper Center Longitudinal Study

OBJECTIVE

Omega-3 polyunsaturated fatty acids (omega-3 PUFAs) are implicated in numerous illnesses including depression. The literature is mixed regarding the relationship between n-3 PUFA levels and depression, and studies based on self-reported dietary n-3 PUFA intake may not accurately reflect in vivo levels.

METHOD

The current cross-sectional analysis examined the relationship between erythrocyte levels (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and depressive symptoms (Center for Epidemiologic Studies Depression Scale; CESD), adjusting for health-related factors and omega-3 supplement use in 16,398 adults assessed at the Cooper Clinic in Dallas, Texas for preventative medical examinations between April 6, 2009, and September 1, 2020. A three-stage hierarchical linear regression was conducted to examine the EPA and DHA levels on CES-D before and after inclusion of cardiorespiratory fitness (CRF) and high sensitivity C-reactive protein (hs-CRP) in the model.

RESULTS

DHA level, but not EPA level, was significantly associated with CES-D scores. Taking omega-3 supplements was associated with lower CES-D scores even when adjusting for CRF, while hs-CRP was non-significantly associated with CES-D scores. These findings suggest that DHA levels are related to depressive symptom severity. Omega-3 PUFA supplement use was associated with lower CES-D scores when controlling for EPA and DHA levels.

CONCLUSION

The findings from this cross-sectional study suggest that lifestyle and/or other contextual factors unrelated to EPA and DHA levels may also be associated with depressive symptom severity. Longitudinal studies are needed to evaluate the role of health-related mediators among these relationships.

Changes in Generalized and Particularized Trust and Their Link to Depressive Symptoms: Exploring the Roles of Changes in Self-Rated Health, Family Support and Life Satisfaction Among Chinese Older Adults

This study aimed to examine whether changes in generalized trust (GT) and particularized trust (PT) predict changes in depressive symptoms (CES-D 8), and whether changes in self-rated health (SRH), family support (FS), and life satisfaction (LS) mediate the relationship between changes in the two types of trust and depressive symptoms in Chinese older adults. Structural equation modeling was employed to analyze two-wave data on 3770 participants aged 65 and over. Our results showed that in a context where GT was low and PT was high, an increase in GT was associated with more depressive symptoms, while an increase in PT was associated with fewer depressive symptoms. As such, GT cannot be viewed as protective against depression in older adults in a given context. LS partially mediated the relationship between changes in PT and depressive symptoms. The findings support psychosocial processes rather than health-problem and support pathways.

Development of Telemedicine Simulations Addressing Social Determinants of Health

BACKGROUND

Five telemedicine simulations were created during the coronavirus disease 2019 (COVID-19) pandemic to elucidate implicit biases and enhance awareness of social determinants of health among nursing students. Social determinants affect overall health, functioning, and quality-of-life outcomes and risks. Implicit biases are related to patient-provider interactions, treatment decisions and adherence, and ultimately patient health outcomes.

PURPOSE

This article explains the simulation development and content, describes the student learning outcomes, and presents faculty insights that highlight the necessity of simulation experiences in nursing education.

METHOD

Five telemedicine simulations that presented different social determinants of health and implicit biases were created for undergraduate nursing students.

RESULTS

Nursing students increased knowledge related to social determinants and their own implicit biases.

CONCLUSION

Telemedicine simulations were effective in assisting nursing students recognize their own implicit biases and the economic challenges of individuals living in poverty, as well as the potential influence of social determinants of health. [J Nurs Educ. 2023;62(1):58-61.].

Trajectories of Instrumental and Emotional Social Support and the Associated Risk of Mortality in Bereaved Older Adults in Taiwan

This study identified the trajectories of instrumental and emotional perceived social support (PSS) from 1996 to 2003 and investigated the associated risk of mortality in bereaved older adults in Taiwan. The study analyzed 1,188 bereaved older adults who had experienced loss of a spouse, a child, or both before 1996 from the Taiwan Longitudinal Study on Aging. More favorable trajectories of PSS are associated with lower mortality risk in bereaved older adults. Compared with the spousal or dual bereavement, the parental bereavement benefited more from consistently high instrumental PSS. The present study revealed that consistently high emotional PSS had a stronger protective effect on mortality risk for a widow or widower than did consistently high instrumental support. The findings of this study can serve as an empirical reference to inform social policies and clinical practices for bereaved older adults in culturally similar societies.

The Effects of Multidimensional Poverty on Life Satisfaction Among Older Adults in Hong Kong

Poverty indicators such as income-based poverty, material deprivation, asset-based poverty, and expenditure-based poverty each carries an aspect of economic deprivation. This current study examined and compared the unique effects of each poverty dimension on life satisfaction during old age. We measured four poverty indicators—life satisfaction, social resources, physical health, and mental well-being—in a three-wave sample of older Hong Kong adults ( N = 563). Panel data were fitted to a structural model that involved the constraints of the path coefficients (e.g., effects of poverty indicators on life satisfaction). The model results indicate that while material deprivation and asset-based poverty reduce life satisfaction, income-based poverty and expenditure-based poverty do not significantly shape life satisfaction. Based on these findings, we suggest implementing future-oriented interventions into policy agendas to promote current working adults’ financial preparation for retirement to reduce their risk of falling into asset-based poverty and thus material deprivation after retirement.

Cardiorespiratory Fitness and Depression Symptoms among Adults During the COVID-19 Pandemic: Cooper Center Longitudinal Study

This study examined the relation between cardiorespiratory fitness (fitness) and depression symptoms prior to and during COVID-19 among adults seeking preventive medical care. Participants consisted of 967 patients attending the Cooper Clinic (Dallas, TX) pre-pandemic (March 2018-December 2019) and during the pandemic (March-December 2020). The outcome, depression symptoms, was based on the Center for Epidemiological Studies-Depression (CES-D). Maximal metabolic equivalents task (MET) levels for fitness were determined from the final treadmill speed and grade. Multiple linear regression models were computed by sex. Analysis revealed that mean fitness decreased from 11.4 METs (SD=2.1) prior to the pandemic to 10.9 METs (SD=2.3) during the pandemic (p-value<0.001). The mean CES-D score increased from 2.8 (SD= 3.1) before to pandemic to 3.1 (SD=3.2) during the pandemic (p-value=0.003). Results from multiple linear regression indicate that increased fitness was associated with a statistically significant decrease in depression scores in men (-0.17 per MET; 95%CI -0.33, -0.02) but not women. This modest decrease may have been tempered by high fitness levels and low depression scores at baseline in this well-educated sample.

Longitudinal Dyadic Associations between Depressive Symptoms and Life Satisfaction among Chinese Married Couples and the Moderating Effect of Within-Dyad Age Discrepancy

Family systems theory defines the family unit as a complex social system in which individual members influence and are influenced by each other. The current study aimed to investigate the longitudinal dyadic associations between life satisfaction and depressive symptoms among a sample of Chinese married couples and the moderating effect of within-dyad age discrepancy. The current sample included 5773 married couples who completed three waves of assessments of the China Family Panel Studies (CFPS) in 2012, 2016, and 2018. The sample was categorized into two groups based on the within-dyad age discrepancy: the younger-wife-older-husband dyads (n = 4280, 74.13%) and the older-wife-younger-husband dyads (n = 1493, 25.86%). The longitudinal actor-partner interdependence models with multiple-group analysis were used to analyze the data. The results showed that a majority of actor effects were significant across time, and the two groups exhibited the same pattern among the actor effects. The older-wife-younger-husband dyads showed fewer significant partner effects than the younger-wife-older-husband dyads, and most partner effects indicated mutual rather than unidirectional influence. These findings yielded support for the statement of family systems theory that family members interconnect and that the development of one's well-being needs to be understood in the context of the spouse's well-being.

The Association Between Depression and Death Anxiety Among Older Adults: Moderating Effect of Ego-Integrity

This study verifies the relationship between depression and death anxiety in older adults and the moderating effect of ego-integrity on this relationship. The survey was conducted with 236 participants aged 65 years and older through a combination of online and offline surveys. The final data were analyzed using the PROCESS macro for SPSS 2.16. The main findings of this study are as follows: First, depression in old age was positively related to anxiety about death. Second, the moderating effect of ego-integrity was observed on the relationship between depression and death anxiety. Third, on examining the moderating effect of each sub-variable of ego-integrity, the moderating effect of satisfaction with one's life was observed to be significant. Conversely, the moderating effect of attitude toward life and acceptance of old age was not significant. The results of this study are meaningful in examining the moderating effect of ego-integrity on the relationship between depression and death anxiety. Furthermore, the results of this study can provide basic data for the development and application of psychological intervention programs for older adults experiencing psychological problems due to depression and death anxiety in old age.

Incidence and risk factors of depressive symptoms in the highest age groups and competing mortality risk. Evidence from the AgeCoDe-AqeQualiDe prospective cohort study

INTRODUCTION

Only a few studies have investigated incidence and risk factors of depression in the highest age groups. This study aims to determine incidence rates as well as risk factors of incident depressive symptoms in latest life, adjusting for the competing event of mortality.

METHODS

Data of a prospective, longitudinal, multi-centered cohort study conducted in primary care - the AgeCoDe-/AgeQualiDe study. 2436 GP patients aged 75+ years were assessed from baseline to sixth follow-up every 18 months and from seventh to ninth follow-up every 10 months. Depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (cut-off ≥6). Competing risk regression models were used to assess determinants of incident depressive symptoms, taking care of accumulated mortality.

RESULTS

The incidence of depressive symptoms was 39 per 1000 person-years (95% CI 36-42; last observed exit 13.26 person-years at risk). In a competing risk regression model, female sex, unmarried family status, subjective cognitive decline as well as vision and mobility impairment were significant risk factors of incident depression.

LIMITATIONS

Excluding individuals with a lack of ability to provide informed consent at baseline may have influenced the incidence of depression. Depressive symptoms were not assessed by DSM criteria. Furthermore, in studies with voluntary participation, participation bias can never be completely avoided.

CONCLUSION

Findings provide a better understanding of risk and protective factors of depressive symptoms in the oldest age taking mortality as a competing event into account. Addressing this aspect in future research may yield new insights in that research field.

The Role of Contact Care by Adult Children in Relieving Depression in Older Adult Individuals

The purpose of this study is to investigate how contact care by adult children influences the effect of caring for grandchildren on depression in older adult individuals. Studies have shown that caring for grandchildren either increases or decreases the symptoms of depression in older adult individuals, while other studies have shown no effect. The reason for these inconsistent results is that the key control variable, contact care by adult children, has been omitted from these previous studies. An analysis of panel data consisting of observations from 162 older adult respondents in the Korean Longitudinal Study of Aging over the 2008-2016 period confirms that the positive effect of caring for grandchildren on depression in older adults increased as the number of adult children who visited their older adult parents after entrusting their children to them increased. As more of their adult children visited the older adult individuals, the latter were more likely to feel that caring for their grandchildren was healing rather than stressful.

Impact of economic factors, social health and stressful life events on physical health-related quality of life trajectories in older Australians

PURPOSE

Physical health-related quality of life (HRQoL) is associated with adverse health outcomes, including hospitalizations and all-cause mortality. However, little is known about how physical HRQoL changes over time in older people and the predictors of this trajectory. This study (a) identified trajectories of physical HRQoL among older people and (b) explored whether economic factors, social health or stressful life events impact physical HRQoL trajectories.

METHOD

A cohort of 12,506 relatively 'healthy' community-dwelling Australians aged ≥ 70 years (54.4% females), enrolled in the ASPREE Longitudinal Study of Older Persons (ALSOP) study and was followed for six years. Economic factors, social health and life events in the last 12 months were assessed through a questionnaire at baseline. Physical HRQoL was measured by using the 12-item short form at baseline and annual follow-ups. Growth mixture and structural equation modelling were used to identify physical HRQoL trajectories and their predictors.

RESULTS

Four physical HRQoL trajectories were identified-stable low (7.1%), declining (9.0%), stable intermediate (17.9%) and stable high (66.0%). Living in more disadvantaged areas, having a lower household income, no paid work, no voluntary work, loneliness and stressful life events (i.e. spousal illness, friend/family illness, financial problem) were associated with a 10%-152% higher likelihood of being in the stable low or declining physical HRQoL trajectory than the stable high group.

CONCLUSION

Specific stressful life events had a greater impact on adverse physical HRQoL trajectories in older people than other factors. Volunteering may prevent physical HRQoL decline and requires further investigation.

Longitudinal association between perceived stress and depression among community-dwelling older adults: Findings from the Irish Longitudinal Study on Ageing

BACKGROUND

Older adults may be particularly vulnerable to the negative effects of stress on depression. However, the impact of perceived stress on late-life depression is understudied in large community samples. Thus, the present study used data from a population-based sample of Irish older adults to examine the longitudinal association between perceived stress and late-life depression.

METHODS

Data from Wave 1 (2009-2011) and Wave 2 (2012-2013) of the Irish Longitudinal Study on Ageing (TILDA) were analyzed. Depression was assessed with the Center for Epidemiologic Studies Depression (CES-D), while the 4-item version of the Perceived Stress Scale was used for perceived stress. Multivariable logistic regression was used to assess the association between perceived stress (exposure) and depression (outcome).

RESULTS

The analytical sample consisted of 5238 individuals aged ≥50 years [mean (SD) age 63.2 (9.1) years; 49.4% females] who did not have depression at Wave 1. The mean perceived stress score at baseline was much lower among those who did not develop depression at Wave 2 compared to those who did (3.85 vs. 6.33). Compared to those in the lowest quartile of levels of perceived stress at baseline, those in the highest quartile had 2.65 (95%CI=1.56-4.49) times higher risk for depression onset.

LIMITATIONS

Some baseline information including that of perceived stress could have changed within the two-year follow-up period.

CONCLUSIONS

Greater levels of perceived stress at baseline was associated with higher risk for depression onset at two-year follow-up among older adults in Ireland. Individualized interventions addressing stress may be beneficial in the prevention of depression among older adults.

Depression trajectories among older community dwelling adults: Results from the Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

This study investigated the role of a large range psychological, attitudinal and health related variables as predictors of depression trajectories amongst older adults over a 4-year time period.

METHODS

Data from three consecutive waves of the TILDA survey of older community dwelling adults aged 50+ in Ireland were combined for analysis. Depression symptom scores were assessed using the Center for Epidemiological Studies- Depression scale (CES-D). Changes in depression scores over three time points were modelled as distinct trajectory classes using group-based trajectory modelling, whilst simultaneously controlling for demographic, attitudinal and health related predictors of these trajectory classes using multinomial regression.

RESULTS

Four distinct depression trajectories were identified as (1) a stable low symptom level group (79%), (2) a moderate but deteriorating symptoms group (7.6%), (3) a moderate but improving group (10.1%) and (4) a vulnerable group with consistently high symptoms (3.1%). Multinomial logistic regression indicated that limiting pain, mobility impairments, perceived stress and loneliness predicted membership of the moderate and higher depressive symptom classes. Retirement status and higher reported levels of worry were associated with a greater likelihood of membership of the moderate symptom classes only.

LIMITATIONS

Use of the CES-D is open to bias due to subjective nature of respondent reporting.

CONCLUSIONS

Results concur with previous studies on the development of depression among older people and highlight the key health related and psychological variables that may inform interventions aimed at mitigating risks of developing depression among older adults.

The association of widowhood and living alone with depression among older adults in India

Widowhood is a catastrophic event at any stage of life for the surviving partner particularly in old age, with serious repercussions on their physical, economic, and emotional well-being. This study investigates the association of marital status and living arrangement with depression among older adults. Additionally, the study aims to evaluate the effects of factors such as socio-economic conditions and other health problems contributing to the risk of depression among older adults in India. This study utilizes data from the nationally representative Longitudinal Ageing Study in India (LASI-2017-18). The effective sample size was 30,639 older adults aged 60 years and above. Descriptive statistics and bivariate analysis have been performed to determine the prevalence of depression. Further, binary logistic regression analysis was conducted to study the association between marital status and living arrangement on depression among older adults in India. Overall, around nine percent of the older adults suffered from depression. 10.3% of the widowed (currently married: 7.8%) and 13.6% of the older adults who were living alone suffered from depression. Further, 8.4% of the respondents who were co-residing with someone were suffering from depression. Widowed older adults were 34% more likely to be depressed than currently married counterparts [AOR: 1.34, CI 1.2-1.49]. Similarly, respondents who lived alone were 16% more likely to be depressed compared to their counterparts [AOR: 1.16; CI 1.02, 1.40]. Older adults who were widowed and living alone were 56% more likely to suffer from depression [AOR: 1.56; CI 1.28, 1.91] in reference to older adults who were currently married and co-residing. The study shows vulnerability of widowed older adults who are living alone and among those who had lack of socio-economic resources and face poor health status. The study can be used to target outreach programs and service delivery for the older adults who are living alone or widowed and suffering from depression.

Life satisfaction and depressive symptoms of mentally active older adults in Poland: a cross-sectional study

Background

For older adults, life satisfaction and depressive symptoms are related to quality of life. In this group of society, life satisfaction is particularly associated with the emotional area. The notion of life satisfaction is related to many factors, such as personality traits, moods and various life events, and poses challenges in various aspects of everyday life. Given that mental health is one of the determinants of the quality of life of older adults, it is reasonable to conduct research among this growing group of the population. The aim of this study was to assess life satisfaction and depressive symptoms in mentally active older adults in Poland.

Methods

The study covered 125 attendees at the University of Healthy Senior (UHS) and 125 auditing students at the University of Psychogeriatric Prophylaxis (UPP), organised by the Faculty of Health Sciences at the Medical University of Bialystok, of whom 78.3% were female and 21.7% male. The study was conducted using four standardised scales: the Satisfaction with Life Scale (SWLS), Beck Depression Inventory, Geriatric Depression Scale (GDS), and Hospital Anxiety and Depression Scale (HADS).

Results

Seniors who participated in the study were satisfied with their lives; the average SWLS score was 23 points. Men rated their level of satisfaction higher than women: the median score on the SWLS was 26 points for men and 23 points for women. Life satisfaction and mental disorders did not differ on the basis of sex, age, or education (the type of place of education attended). As the level of depression increased, life satisfaction decreased. Statistically significant correlations of average strength were found between the point values of the four measures of depression under consideration and were evenly distributed from 0.57 to 0.69.

Conclusions

The high level of life satisfaction and a low level of mental disorders should be maintained in this population, and additional educational activities should be organised among seniors on a large scale. There were no differences in the distribution of psychometric measure scores among the three compared age groups of respondents in this study. Each of the questionnaires used measured of different aspects of depressive conditions, and it is worth using them in parallel rather than interchangeably.

Association between sources of stress and depressive mood in Korean adults

OBJECTIVE

The present study investigated the association between different sources of stress and depressive mood in Korean adults.

METHODS

A total of 4464 adults who completed the 2018 Korean National Health and Nutrition Examination Survey were included in the analysis. Data included sources of stress, depressive mood assessed by the nine-item Patient Health Questionnaire, sociodemographic characteristics, and health-related habits. Multiple logistic regression models were applied to calculate the odds ratio for depressive mood according to each source of stress and stratified by sex and age.

RESULTS

Fully adjusted models revealed that individuals who reported a financial problem or health concern as their main source of stress were more likely to experience depressive mood; when data were stratified by sex, these associations remained significant among females only. An age-stratified analysis indicated that financial problems were associated with depressive mood in middle-aged individuals and health concerns were associated with depressive mood in elderly.

CONCLUSION

Korean adults with specific sources of stress should be monitored for the development of emotional distress.

Risk factors and protective factors of depression in older people 65+. A systematic review

OBJECTIVES

Identifying risk factors of depression can provide a better understanding of the disorder in older people. However, to minimize bias due to the influence of confounders and to detect reverse influence, a focus on longitudinal studies using multivariate analysis is required.

DESIGN

A systematic literature search was conducted by searching the databases MEDLINE, Cochrane, PsycINFO and Web of Science for all relevant articles published from January 2000 to the end of March 2020. The following inclusion criteria were used: prospective design, nationally or regionally representative sample, published in English or German, analyzed risk factors for depression of individuals 65+ identified by multivariate analysis, and provided validity of diagnostic instrument. All results of multivariate analysis were reported and summarized.

RESULTS

Thirty articles were identified. Heterogeneous results were found for education, female gender, self-rated health, cognitive impairment and older age, although significant in several studies. Findings hinted at a protective quality of physical activity. In terms of physical health, chronic disease and difficulty initiating sleep homogeneously increased risk of depression. Mobility impairment resulted as a risk factor in three studies. IADL impairment and vision impairment were mostly identified as significant risk factors. Alcohol consumption and smoking behavior yielded heterogenous results. Psychosocial factors were assessed similarly in multiple studies and yielded heterogenous results.

LIMITATIONS

Research was limited to articles published in English or German. Length of follow up was not considered for the presentation of results. Adjustments for and inclusion of different variables in the studies may distort results.

CONCLUSION

Our findings demonstrate the necessity of refined, more comparable assessment tools for evaluating potential risk factors.

A lifetime of challenges: real-life decision outcomes in early- and late-onset suicide attempters

BACKGROUND

People who have attempted suicide display suboptimal decision-making in the lab. Yet, it remains unclear whether these difficulties tie in with other detrimental outcomes in their lives besides suicidal behavior. We hypothesize that this is more likely the case for individuals who first attempted suicide earlier than later in life.

METHODS

A cross-sectional case-control study of 310 adults aged ≥ 50 years (mean: 63.9), compared early- and late-onset attempters (first attempt < 55 vs. ≥ 55 years of age) to suicide ideators, non-suicidal depressed controls and non-psychiatric healthy controls. Participants reported potentially avoidable negative decision outcomes across their lifetime, using the Decision Outcome Inventory (DOI). We employed multi-level modeling to examine group differences overall, and in three factor-analytically derived domains labeled Acting Out, Lack of Future Planning, and Hassles.

RESULTS

Psychopathology predicted worse decision outcomes overall, and in the more serious Acting Out and Lack of Future Planning domains, but not in Hassles. Early-onset attempters experienced more negative outcomes than other groups overall, in Lack of Future Planning, and particularly in Acting Out. Late-onset attempters were similar to depressed controls and experienced fewer Acting out outcomes than ideators.

LIMITATIONS

The cross-sectional design precluded prospective prediction of attempts. The assessment of negative outcomes may have lacked precision due to recall bias.

CONCLUSIONS

Whereas early-onset suicidal behavior is likely the manifestation of long-lasting decision-making deficits in several serious aspects of life, late-onset cases appear to function similarly to non-suicidal depressed adults, suggesting that their attempt originates from a more isolated crisis.

An Exploratory Study of the Relative Effects of Various Protective Factors on Depressive Symptoms Among Older People

Objective: The present study investigated the relative importance of various factors found to be negatively associated with depressive symptoms in older adults and assessed the potential moderating effect of sociodemographic characteristics for each factor.

Method: Depressive symptoms were measured with the Center of Epidemiological Studies Depression Scale. Psychological, social, and physical health measures relating to the following factors were also administered: personal growth, purpose in life, self-esteem, self-efficacy, social support, self-rated health, life satisfaction, and physical activity. Multivariate linear regression analysis was used to investigate the most important factors associated with depressive symptoms, and moderation analyses were employed to identify any moderating effects of sociodemographic factors.

Results: Life satisfaction, self-esteem, and purpose in life were found to be negatively associated with depressive symptoms. Only one moderating effect was observed—the negative relationship between life satisfaction and depressive symptoms was significantly stronger among the younger respondents.

Conclusion: These findings suggest that strategies for the prevention or amelioration of depressive symptoms across subgroups of the senior population could be optimized by focusing on enhancing life satisfaction, self-esteem, and purpose in life.

Risk factors for depressive symptoms among older Chinese adults: A meta-analysis

BACKGROUND

The study aims to explore the risk factors for depressive symptoms among older Chinese adults.

METHODS

PubMed, PsycINFO, Cochrane Library, EMbase, Google Scholar, Chinese National Knowledge Infrastructure (CNKI), Chinese BioMedical Literature Database, and Wanfang data were searched for potentially relevant articles published before September 1^st, 2019. Stata/IC 15 was used to perform a meta-analysis and subgroup analysis to compute the pooled odds ratio.

RESULTS

The retrieve strategy yielded 11 studies that met the inclusion criteria. The total sample size was 31528 across seven districts, including Mainland China, Hong Kong, and Taiwan. Patients with depression were included in the sample size. Fourteen risk factors were extracted for at least having two or more relative studies. The combined odds ratio ranged from 0.70 to 4.75. Female, poor self-perceived financial condition, single, average and poor self-perceived health status, diabetes, adverse life events, poor social support, two or more numbers of cardiovascular diseases, and functional disability are risk factors of depressive symptoms among older Chinese adults. Fair or good social support is a protective factor.

LIMITATIONS

These findings may be somewhat limited by (i) quality of studies included, (ii) a finite number of studies met inclusion criteria.

CONCLUSIONS

Despite the methodological limitations of the studies and this meta-analysis, average or poor self-perceived health status, functional disability, poor social support, poor self-perceived financial condition, negative life events, and diabetes appear to be significant risk factors for depressive symptoms among the aged population in China. Social support can mitigate depressive symptoms.

Factors associated with incidence of depressiveness among the middle-aged and older Estonian population

OBJECTIVE

Relatively scant research among older Estonian population describes factors associated with the incidence of depressive symptoms. This study identifies factors associated with the incidence of depressiveness among middle-aged and older Estonians over 2- and 4-year periods.

METHOD

In this cross-sectional analysis, logistic regression models are used to identify the factors associated with the incidence of depressiveness over 2- and 4-year periods. The data were drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE) 2011-2015 which included Estonian population aged 53 years and older in 2013. After excluding those younger than 53 years, not interviewed 2 years later, those with depressive symptoms at baseline in 2013, and missing values for depressiveness or other variables, our analytical sample comprised 2513 people.

RESULTS

Among those who were not depressive in 2013, 21.9% became depressive within 2 years; 16.1% of non-depressive individuals since 2011 became depressive by 2015. No age differences in incidence remained in adjusted models. Women have almost 50% higher odds of becoming depressive. A previous history of depressiveness and the presence of everyday activity limitations were important factors increasing the incidence of depression.

DISCUSSION

Changes related to the individual's unique ageing experience are important explanatory factors related to the likelihood of developing depressive symptoms, rather than age itself. To diminish the incidence of depressive symptoms among older Estonian population, public health interventions should attempt to address factors which complicate existing health problems and facilitate continued independence and community involvement, both of which contribute to overall satisfaction with life.

Exploring Language Learning as a Potential Tool against Cognitive Impairment in Late-Life Depression: Two Meta-Analyses and Suggestions for Future Research

Late-life depression (LLD) affects about an eighth of community-dwelling seniors. LLD impacts well-being, with loneliness and small social networks being typical. It has also been linked to cognitive dysfunction and an increased risk of developing dementia. Safety and efficacy of pharmacological treatments for LLD have been debated, and cognitive dysfunction often persists even after remission. Various cognitive interventions have been proposed for LLD. Among these, one has received special attention: foreign language learning could serve as a social intervention that simultaneously targets brain structures affected in LLD. Lifelong bilingualism may significantly delay the onset of cognitive impairment symptoms by boosting cognitive reserve. Even late-life foreign language learning without lifelong bilingualism can train cognitive flexibility. It is then counterintuitive that the effects of language learning on LLD have never been examined. In order to create a theoretical basis for further interdisciplinary research, this paper presents a status quo of current work through two meta-analyses investigating cognitive functioning in LLD on the one hand and in senior bilinguals or seniors following a language course on the other hand. While LLD was consistently associated with cognitive dysfunction, inconsistent results were found for bilingualism and language learners. Possible reasons for this and suggestions for future research are subsequently discussed.

Reciprocal effects of depressive symptoms and life satisfaction among Chinese older married couples from 2010 to 2014: evidence from the China Family Panel Studies

Objectives: Depressive symptoms and life satisfaction are closely related among the older adults. However, investigation of the dyadic influence of depressive symptoms and life satisfaction among Chinese older married couples is limited. The current study aimed to investigate the reciprocal effects of life satisfaction and depressive symptoms longitudinally among a sample of Chinese older married couples.Method: The current sample consisted of 1,877 older married couples from the China Family Panel Studies (CFPS). Depressive symptoms and life satisfaction were measured at the 2010 baseline and the 2014 assessment. Age, income, education, physical health, and length of marriage measured at baseline were included as the controlled variables. Data was analyzed with the longitudinal actor-partner interdependence models.Results: One's life satisfaction and depressive symptoms were significantly associated with his/her own life satisfaction and depressive symptoms longitudinally. In addition, higher levels of wives' depressive symptoms in 2010 were associated with higher levels of depressive symptoms and lower levels of life satisfaction among their husbands in 2014. Higher levels of husbands' life satisfaction in 2010 were associated with higher levels of wives' life satisfaction in 2014.Conclusion: The current study found both actor and partner effects in the long-term association between depressive symptoms and life satisfaction. Among these older married couples, husbands were the 'receivers' of their wives' depressive symptoms and the 'senders' of life satisfaction. Practitioners aiming to promote the well-beings of older married adults need to consider the dyadic influences given the significant partner effects found in the current study.

Effect of cognitive and structural social capital on depression among older adults in Ghana: A multilevel cross-sectional analysis

Evidence from existing studies suggests social capital has mixed effects on depression and other common mental disorders. There is little knowledge of the possible association between social capital and depression among the growing older population in sub-Saharan Africa. This study investigates the effect of cognitive social capital (trust and sense of safety) and structural social capital (social participation or engagement in social activities) on depression among older adults in Ghana. Utilizing multilevel mixed-effect analysis, we investigate the effect of individual-level and neighborhood-level social capital (cognitive and structural) on depression using data from the World Health Organization Study on Global Ageing and Adult Health (WHO-SAGE) survey (Wave 1). The findings show that at an individual level, older adults who felt safe at home were less likely to have depression. We observed mixed results for elements of structural social capital at the individual level. Older adults who frequently engaged in club or group meetings, worked with neighbors and engaged in social outings were more likely to have depression; while attending public meetings and socializing with co-workers were associated with reduced likelihood of having depression. At the neighborhood level, increased trust in neighbors was associated with an increased likelihood of having depression (OR = 1.01, p < 0.05) while higher levels of neighborhood safety and structural social capital were associated with a reduced likelihood of having depression. The findings suggest that the differential associations between elements of social capital and depression may be the result of contextual factors.

Associations between Depressive Symptoms and Satisfaction with Meaningful Activities in Community-Dwelling Japanese Older Adults

The aim of this cross-sectional study was to investigate relationships between individuals' ratings of satisfaction and performance of activities that they found meaningful and depressive symptoms. Data was obtained from 806 older adults (mean age 74.9 ± 6.3 years, women = 63.0%) who participated in a community-based health check survey (Tarumizu Study 2018). Participants selected meaningful activities from 95 activities using the Aid for Decision-Making in Occupation Choice and evaluated their satisfaction and performance. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15) and defined by a GDS-15 score of ≥5. Non-linear logistic regression analyses were used separately by gender to examine the association between satisfaction and performance of meaningful activities and depressive symptoms. The prevalence of depressive symptoms was 15.8%. We found no significant difference between meaningful activity choice between older adults with depressive symptoms and those without, in both men and women. After adjusting for potential covariates, satisfaction was associated with depressive symptoms in both men (OR 0.52, 95% CI 0.35-0.77) and women (OR 0.67, 95% CI 0.49-0.91), but performance was limited in women (OR 0.87, 95% CI 0.77-0.99). Our findings suggest that depressive symptoms are associated with satisfaction in meaningful activities regardless of activity categories.

Epidemiological characteristics of subsyndromal depression in late life

OBJECTIVES

Subsyndromal depression is prevalent and associated with poor outcomes in late life, but its epidemiological characteristics have barely been investigated. The aim of this prospective cohort study is to compare the prevalence, incidence and risk factors of subsyndromal depression with those of syndromal depression including major and minor depressive disorders in community-dwelling elderly individuals.

METHODS

In a nationwide community-based study of randomly sampled Korean elderly population aged 60 years or older (N = 6640), depression was assessed with standardized diagnostic interviews. At baseline and at 2-year and 4-year follow-ups, the authors diagnosed subsyndromal depression by the operational criteria and syndromal depression by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnostic criteria. Multivariate logistic regression analyses were conducted to identify the risk factors for incident depression.

RESULTS

The age- and gender-adjusted prevalence rate of subsyndromal depression was 9.24% (95% confidence interval = [8.54, 9.93]), which was 2.4-fold higher than that of syndromal depression. The incidence rate of subsyndromal depression was 21.70 per 1000 person-years (95% confidence interval = [19.29, 24.12]), which was fivefold higher than that of syndromal depression. The prevalence to incidence ratio of subsyndromal depression was about half that of syndromal depression. The risk for subsyndromal depression was associated with female gender, low socioeconomic status, poor social support and poor sleep quality, while that of syndromal depression was associated with old age and less exercise.

CONCLUSION

Subsyndromal depression should be validated as a clinical diagnostic entity, at least in late life, since it has epidemiological characteristics different from those of syndromal depression.

Prevalence and related factors of depression and falls among the elderly living in rural communities of Guangzhou

Few studies have concentrated on the prevalence and related factors of depression and falls among the elderly living in rural communities of Guangzhou. A total of 335 participants aged ≥60 years were recruited by simple random sampling method. A structural equation model was applied to determine interrelationships between depression, falls and other variables. As high as 27.5% and 23.3% participants had reported depressive symptoms and falls, respectively. The path analysis showed the total effect (β = -0.58) of depression on quality of life (QOL) consisted of a direct effect (β = -0.51) and an indirect effect (β = -0.07), which was mediated by family function and number of falls, and the R ² was 0.36. The model fit indices were χ ² /df = 1.096, P > 0.05, Root Mean Square Error of Approximation (RMSEA) = 0.017, Tucker-Lewis Index (TLI) = 0.998 and Comparative Fit Index (CFI) = 0.999. Depression and falls were prevalent among the elderly living in rural communities of Guangzhou city. Pay attention to strengthen family function and prevent falls may prevent depression and improve the QOL among the elderly.

Geriatric Depressive Symptoms in Myanmar: Incidence and Associated Factors

Myanmar is one of many countries currently facing a growing older adult population; yet, the mental health status of the country's older adults is understudied. This is the first article to investigate the prevalence of geriatric depressive symptoms and its associated factors in Myanmar. We use data from the most recent large-scale older adult survey conducted in 2016, which employed the four-item short version of the Geriatric Depression Scale (GDS-4). Descriptive statistics reveal that, depending on the threshold applied, about 16% to 56% of the surveyed older adults have indications of depressive symptoms. We find that both economic and health status have a statistically significant association with depressive symptoms, but no basic individual characteristics are associated with it. Our findings suggest the importance of a social security system for older adults. Expanding the scope of the pension scheme and improving the provision of health care may be among the important policy options.

Personal, behavioral, and perceived environmental factors associated with late-life depression in older men and women

INTRODUCTION

Previous investigations on factors associated with depression were highly focused on personal characteristics and health behaviors; however, few studies used an ecological perspective on the issue, much less on sex differences. This study examined the factors associated with depression, including any sex differences.

METHODS

A total of 1025 Taiwanese adults older than 65 years were recruited. Their personal demographics, lifestyle behaviors, and perceived environmental factors were obtained through a telephone-based survey. The multiple factors associated with depression in older adults were examined using logistic regression analyses.

RESULTS

Fully logistic regression analyses revealed that poor self-rated health (odds ratio =2.54) was correlated with a greater likelihood of depression. Aside from poor self-rated health, being older, sufficient leisure time spent in walking, and perceptions of a safe environment were associated with lower risks of depression in older men, whereas having hypertension and excessive TV viewing were associated with higher risks of depression in older women.

CONCLUSION

Apart from self-rated health, sex differences in the associations of factors such as leisure-time walking, TV watching, and safe traffic environment with depression were observed among older adults. Strategies applied for geriatric depression prevention should take into consideration different sex group.

Effects of changes in family social capital on the self-rated health and family life satisfaction of older adults in Taiwan: A longitudinal study

AIM

The present study assessed the effect of family social capital on self-rated health and family life satisfaction among older adults aged ≥50 years.

METHODS

A logistic regression model was used to analyze the longitudinal data of 1243 older adults from the Panel Study of Family Dynamics in Taiwan.

RESULTS

The findings show that, compared with having a poor relationship with parents, respondents who were getting along with their parents have a higher likelihood of reporting good health. Frequent interaction with kin significantly promotes respondents' family life satisfaction. With regard to parental control, there is no evidence of its effect on either health or family life satisfaction.

CONCLUSIONS

The results suggest that the quality of relationships has limited effect on the health of older adults, whereas frequent interaction with kin contributes to the promotion of their family life satisfaction. Policies aiming to improve health-related quality of life should take into account the importance of a reciprocal relationships and the need to maintain family-focused networks in Chinese culture. Geriatr Gerontol Int 2019; 19: 228-232.

The role of meaning in life in community-dwelling older adults with depression and relationship to other risk factors

OBJECTIVES

The aims of this study were to examine the association of Meaning in Life (MiL) with sociodemographic and physical factors, and its association with depression in older people.

METHOD

A cross-sectional survey with a sample of N = 2104 older adults from communities of four European countries was conducted, using an age-appropriate interview for the diagnosis of depression and the Schedule for Meaning in Life Evaluation (SMiLE) questionnaire to assess MiL.

RESULTS

Overall, MiL was particularly low in old male participants, in older people from Ferrara (Italy), those with a lower religious affiliation, fewer social contacts, and poorer physical health. Furthermore, younger old age (65-69 compared to 80-84 year olds), female gender, being married, living in Geneva and poorer physical health were significantly associated with a higher risk for depression. In addition, lower MiL significantly increased the likelihood to suffer from depression in older people. An interaction effect of study center and MiL also emerged: with decreasing MiL the risk for depression significantly increases in Hamburg compared to the other study centers.

CONCLUSION

This study underlines the association of MiL and depression in old age. Integration of meaning-specific aspects in treatment for older adults with depression may be promising.

Work status, retirement, and depression in older adults: An analysis of six countries based on the Study on Global Ageing and Adult Health (SAGE)

The aim of the present study was to analyse the association between the occurrence of a major depressive episode among older adults and work status in low- and medium-income countries. A cross-sectional study was conducted with people 60 years of age and older from the six countries (Mexico, India, China, Russian Federation, Ghana and South Africa) included in the Study on Global Ageing and Adult Health (SAGE) and who participated in its first wave (2009-2010). The occurrence of a major depressive episode (MDE) over the previous 12 months was determined based on an adaptation of the ICD-10 diagnostic criteria. The association between current work status and the presence of an MDE was estimated using binary logistic regression models with country-level fixed effects, and interaction terms between the country and work status. Results showed the odds of presenting an MDE were lower for older adults who were retired with a pension than for those who were currently working, although this protective association was observed only for men in China (OR=0.23; CI 95%:0.08-0.70) and Ghana (OR=0.25; CI 95%:0.07-0.95) and for women in India (OR=0.05; CI 95%:0.01-0.51) and South Africa (OR=0.19; CI 95%:0.04-0.97). For women, being a homemaker also showed a protective association in South Africa (OR=0.09; CI95%:0.01-0.66) and Mexico (OR=0.32; CI95%:0.14-0.76). In the case of being retired without a pension, no significant association was found in any country. The previous indicates that retirement with pension has a protective association with MDE only for men in China and Ghana and women in India and South Africa. The heterogeneity of this association reflects cultural and socioeconomic differences between the analysed countries.

Assessment of late-life depression via self-report measures: a review

Depression in later life is a significant and growing problem. Age-related differences in the type and severity of depressive disorders continue to be questioned and necessarily question differential methods of assessment and treatment strategies. A host of geropsychiatric measures have been developed for diagnostic purposes, for rating severity of depression, and monitoring treatment progress. This literature review includes the self-report depression measures commonly and currently used in geropsychological practice. Each of the included measures is considered according to its psychometric properties. In particular, information about reliability; convergent, divergent, and factorial validity evidence based on data from clinical and nonclinical samples of older adults; and availability of age-appropriate norms was provided along with the strengths and weaknesses of each measure. Results highlighted that in cognitively intact or mildly impaired patients over 65 years, the Geriatric Depression Scale and the Geriatric Depression Scale-15 currently seem to be the preferred instruments. The psychometric functioning of the Beck Depression Inventory-II and the Center for Epidemiological Studies Depression Scale, instead, is mixed in this population. Most importantly, this review may be a valuable resource for practicing clinicians and researchers who wish to develop state-of-the-science assessment strategies for clinical problems and make informed choices about which instruments best suit their purposes in older populations.

Prevalence and Predictive Factors of Depression in Community-Dwelling Older Adults in South Korea

The aims of the study were to investigate the levels of depression and to identify the predictors of depression among older adults in 3 different environments based on their primary place of leisure time activity, including their homes, small community halls, and senior welfare centers. A convenience sample of 833 older adults participated in the study. Instruments for measuring functional independence, social support, life satisfaction, and depression were used. The data were analyzed using a one-way analysis of variance (ANOVA) and multiple hierarchical regressions. The level of depression in older adults at home was significantly greater than the level of depression in those in both small community halls and senior welfare centers. Life satisfaction was the strongest negative predictor of depression in older adults both at home and in senior welfare centers, whereas employment status was the one in those in small community halls. Across the 3 groups, poor subjective health was the strongest positive predictor of depression. The levels of depression and predictors differed among the settings. Nurses should have a thorough understanding of these differences when planning effective strategies for managing depression in older adults.

Gene-environment Interactions in Late Life: Linking Psychosocial Stress with Brain Aging

Gene-environment interactions (GxE) can have lasting consequences on brain structure and function, potentially contributing to diverse neuropsychiatric phenotypes. This has been extensively demonstrated by studies examining GxE in childhood and early adulthood, whereas much fewer studies have addressed this question in late life. The relative paucity of studies examining GxE in late life may stem from the working hypothesis that brains become less malleable to environmental inputs as life progresses. However, while some components of brain plasticity decline with increasing age, others are retained and may even become more pronounced in old ages. Moreover, the micro- and macro-structural brain changes that accrue as a result of aging-related morbidities are likely to accentuate the susceptibility of neural circuits to environmental stressors as life advances. Supporting this hypothesis, psychosocial stress can increase the risk for late-life neuropsychiatric syndromes, especially when afflicting genetically predisposed individuals. This article reviews evidence showing how gene-stress interactions can impact the aging brain and related phenotypes in late life, and it discusses the potential mechanisms underlying such GxE and their implications for the prevention and treatment of late-life neuropsychiatric syndromes.

Depression, Suicidal Behaviour, and Mental Disorders in Older Aboriginal Australians

Aboriginal Australians experience higher levels of psychological distress, which may develop from the long-term sequelae of social determinants and adversities in early and mid-life. There is little evidence available on the impact of these on the mental health of older Aboriginal Australians. This study enrolled 336 Aboriginal Australian participants over 60 years from 5 major urban and regional areas in NSW, utilizing a structured interview on social determinants, and life-time history of physical and mental conditions; current psychosocial determinants and mental health. Univariate and multivariate analyses were utilized to examine the link between these determinants and current depressive scores and suicidality. There was a high rate of life-time depression (33.3%), current late-life depression (18.1%), and suicidal ideation (11.1%). Risk factors strongly associated with late-life depression included sleep disturbances, a history of suicidal behaviour, suicidal ideation in late-life and living in a regional location. This study supports certain historical and psychosocial factors predicting later depression in old age, and highlights areas to target for prevention strategies.

Sources and directions of social support and life satisfaction among solitary Chinese older adults in Hong Kong: the mediating role of sense of loneliness

Based on survey data collected from 151 community-dwelling solitary Chinese older adults in Hong Kong, the present study used path analysis to examine the mediating role of sense of loneliness in the relationship between different sources and directions of social support and life satisfaction. The results showed that sense of loneliness mediated the effects of support from families, friends, and support for others on life satisfaction. In addition, a formal source of social support was not associated with life satisfaction among solitary older adults, although those with a more secure financial status had greater overall life satisfaction. These findings highlight the importance of enhancing awareness among social and health care service providers about the negative effects of insufficient social support on older adults' sense of loneliness and life satisfaction. Family and friendship networks should be expanded for solitary older adults.

Predicted factors for older Taiwanese to be healthy octogenarians: Results of an 18-year national cohort study

AIM

To identify factors that predict the 62-69 years old Taiwanese to be healthy octogenarians.

METHODS

We analyzed the 1989 (baseline), and 2003 and 2007 (end-point) datasets of the Taiwan Longitudinal Survey on Aging, a national cohort study. A total of 1977 participants aged 62-69 years at baseline were tracked for 14-18 years. The outcome measure was "being healthy octogenarians", defined as participants who were aged ≥80 years, free from activities of daily living dependency, depressive symptoms or cognitive impairment, and able to provide social support. A logistic regression model was used to identify the predictors.

RESULTS

The results showed that higher educational level, conjugal living, absence of smoking or betel quid chewing, moderate alcohol drinking, routine physical activity, more leisure activities, no hypertension, no diabetes, sleeping well and satisfied with economic condition were the positive predictors for becoming a healthy octogenarian.

CONCLUSIONS

Using a multidimensional criterion, the present study identified a list of factors in predicting older Taiwanese becoming healthy octogenarians. The findings highlight the need to identify potential factors for various populations. Many of the predictors are modifiable factors. The present results would be valuable for planning effective health promotion strategies to achieve healthy aging for older adults. Geriatr Gerontol Int 2017; 17: 2579-2585.