Depressive disorders among older residents in a Chinese rural community

Study on the trajectory of depression among middle-aged and elderly disabled people in China: Based on group-based trajectory model

Background

Previous studies have shown that middle-aged and elderly adults with disabilities are at higher risk for depressive symptoms. However, there are few studies on the long-term trajectories of depressive symptoms in the Chinese middle-aged and elderly disabled population.

Objective

This study aimed to identify the different development trajectories of depressive symptoms and their influencing factors in middle-aged and elderly people with disabilities in China.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, a longitudinal cohort was formed for the study. A total of 2053 participants underwent at least two measures of depressive symptoms, assessed using the Center for Epidemiological Studies Depression Scale (CES-D10), a depression symptom assessment scale. We constructed a Group-Based Trajectory Model (GBTM) to identify the development trajectory of depressive symptoms in 2053 middle-aged and elderly disabled individuals, screened the potential predictors using lasso regression, and analyzed the factors affecting the development trajectory of depression through multivariate logistic regression.

Results

We identified four depression symptom trajectories throughout the follow-up process: "low depressive symptom group", "worsening depressive symptom group", "relieved depressive symptom group", and "high depressive symptom group". We found that there were differences in basic characteristics among different subgroups of depression trajectory. However, middle-aged and elderly disabled women living in rural areas, with limited ADL or IADL, physical pain, poor self-reported health and self-reported memory, short sleep time, and no relatives and friends to take care of them were the key groups for the prevention and treatment of depressive symptoms.

Conclusion

There is heterogeneity in the trajectories of depressive symptoms in the Chinese middle-aged and elderly disabled population, it is necessary to focus on the characteristics of the trajectories of different subgroups.

Multiple trajectories of depressive symptoms among Chinese in middle and late life: Characterization and risk factors

BACKGROUND

Depressive symptoms, which are continuously changing, are an essential manifestation of depression and can increase the risk of mental disorders and other diseases. Because the causes and cures for depression have not yet been identified, finding the characteristics, and risk factors of depressive symptom trajectories can help us identify at-risk populations early and reduce the related public disease burden.

AIMS

Herein we aimed to figure out the specific manifestations of depressive symptom trajectories among Chinese adults, explore the risk profiles of trajectory groups with higher depression burdens, and test the longitudinal associations between blood biomarkers with depressive symptoms.

METHODS

Trajectories of participants' depressive symptoms measured by the Center for Epidemiologic Studies Depression scores were modeled with growth mixture models from 2011 to 2018. Multinomial logistic models tested associations of baseline covariates with trajectories. Generalized estimating equations were used to explore the longitudinal associations between blood data and depressive symptoms in two waves from 2011 to 2015.

RESULTS

Among the sample of 5,641 individuals aged 40 or over, four heterogeneous depressive symptom trajectories were defined: stable-low, high-decrease, stable-high, and low-increase. At baseline, demographic factors and health statuses such as gender, education, income, and self-reported health status were associated with trajectories. A significant association was found between high-density lipoprotein and depressive symptoms.

CONCLUSIONS

These findings provide clues for predicting and identifying adults with elevated depression burdens in middle and late life and may facilitate the development of targeted preventive strategies for this population.

Prevalence of depression and anxiety in older people in low- and middle- income countries in Africa, Asia and South America: A systematic review and meta-analysis

BACKGROUND

There is rapid growth of older people in Low- and Middle- Income Countries (LMICs). The aim of this review was to assess the literature on prevalence of anxiety and depression in this demographic, which to our knowledge, has not yet been conducted.

METHODS

Databases including Medline, PsychInfo, Embase, Scielo and African Journals Online were searched for terms including "mental disorders", "neurotic disorders", "mood disorders" and "anxiety disorders". Studies published between 1990 and 2020 providing data on older people (≥50 years) in LMICs (defined by World Bank Criteria) were included and quality-assessed. Meta-analysis was conducted on a subset of higher-quality studies to derive pooled prevalence estimates of depression.

RESULTS

One hundred and forty relevant studies were identified, of which thirty-two were included in meta-analysis. One hundred and fifteen studies reported depression prevalence only, 19 reported both depression and anxiety, and six reported anxiety only. In all studies identified, depression prevalence ranged from 0.5 % to 62.7 %, and Generalised Anxiety Disorder prevalence ranged from 0.2 % to 32.2 %. The pooled prevalence of depression on meta-analysis was 10.5 % (95 % CI, 8.9 % - 11.2 %). Reported prevalence rates of depression were significantly different in studies using ICD-10 compared with DSM criteria, and between community and clinical settings.

LIMITATIONS

The search strategy contained bias towards English language papers and high income country (HIC) publications. There is significant heterogeneity within the meta-analysis.

DISCUSSION

A wide range of methodologies and clinical criteria are used in prevalence studies of depression and anxiety in older people. Studies using screening tools found higher prevalence rates; clinicians and researchers should ensure diagnosis is made with gold-standard clinical criteria. Meta-analysis data suggest that rates of depression are similar in older people in LMICs compared to HICs but mental healthcare resources are limited, suggesting a large potential treatment gap.

Depression in nursing home residents and its correlation with meaning of family involvement and depression of family

OBJECTIVES

This study aimed to investigate the relationship between depression in older nursing home residents and family caregivers' (FCGs) depressive status and reasons for involvement with residents.

DESIGN

This study employed a cross-sectional design.

SETTING

Eight nursing homes in northern Taiwan.

PARTICIPANTS

A total of 139 older resident-FCG pairs were recruited.

MEASUREMENTS

Depression was measured with the Geriatric Depression Scale-Short Form for nursing home residents and the Center for Epidemiologic Studies Depression Scale-Short Form for family members. Depression and demographic data were collected with face-to-face interviews. The meaning ascribed to caregivers' nursing home visits was calibrated using the Family Meaning of Nursing-Home Visits scale. Multiple logistic regression was used to understand the factors related to residents' depressive symptoms.

RESULTS

Depressive symptoms were present in 58.3% of the nursing home residents (n = 81). Depressive status of family members (Chi-square = 1.46, p = 0.23) or family's visiting frequency (Chi-square = 1.64, p = 0.44) did not differ between residents with or without depressive symptoms. Factors associated with an increased risk of residents having depressive symptoms were age, self-perceived health status, and having a caregiver motivated to visit to assuage their guilt.

CONCLUSIONS

Visiting a family member to assuage their guilt was the only caregiver variable associated with depressive symptoms for nursing home residents. This finding suggests that developing interventions to improve personal relationships between nursing home residents and family members might facilitate the emotional support of caregivers and psychological support for older nursing home residents in Taiwan.

Associations between blood-based biomarkers of Alzheimer's disease with cognition in motoric cognitive risk syndrome: A pilot study using plasma Aβ42 and total tau

Background

Motoric cognitive risk (MCR) syndrome is a conceptual construct that combines slow gait speed with subjective cognitive complaints and has been shown to be associated with an increased risk of developing dementia. However, the relationships between the pathology of Alzheimer's disease (AD) and MCR syndrome remain uncertain. Therefore, the purpose of this study was to determine the levels of plasma AD biomarkers (Aβ42 and total tau) and their relationships with cognition in individuals with MCR.

Materials and methods

This was a cross-sectional pilot study that enrolled 25 individuals with normal cognition (NC), 27 with MCR, and 16 with AD. Plasma Aβ42 and total tau (t-tau) levels were measured using immunomagnetic reduction (IMR) assays. A comprehensive neuropsychological assessment was also performed.

Results

The levels of plasma t-tau proteins did not differ significantly between the MCR and AD groups, but that of plasma t-tau was significantly increased in the MCR and AD groups, compared to the NC group. Visuospatial performance was significantly lower in the MCR group than in the NC group. The levels of plasma t-tau correlated significantly with the Montreal Cognitive Assessment (MoCA) and Boston naming test scores in the MCR group.

Conclusion

In this pilot study, we found significantly increased plasma t-tau proteins in the MCR and AD groups, compared with the NC group. The plasma t-tau levels were also significantly correlated with the cognitive function of older adults with MCR. These results implied that MCR and AD may share similar pathology. However, these findings need further confirmation in longitudinal studies.

Factors Associated with Fear of Falling in Individuals with Different Types of Mild Cognitive Impairment

Mild cognitive impairment (MCI) is considered an intermediate state between normal aging and early dementia. Fear of falling (FOF) could be considered a risk indicator for falls and quality of life in individuals with MCI. Our objective was to explore factors associated with FOF in those with MCI due to Alzheimer’s disease (AD-MCI) and mild cognitive impairment in Parkinson’s disease (PD-MCI). Seventy-one participants were separated into two groups, AD-MCI (n = 37) and PD-MCI (n = 34), based on the disease diagnosis. FOF was assessed using the Activities-specific Balance Confidence scale. The neuropsychological assessment and gait assessment were also measured. FOF was significantly correlated with global cognitive function, attention and working memory, executive function, Tinetti assessment scale scores, gait speed, and stride length in the AD-MCI group. Moreover, attention and working memory were the most important factors contributing to FOF. In the PD-MCI group, FOF was significantly correlated with gait speed, and time up and go subtask performance. Furthermore, turn-to-walk was the most important factor contributing to FOF. We noted that FOF in different types of MCI was determined by different factors. Therapies that aim to lower FOF in AD-MCI and PD-MCI populations may address attention and working memory and turn-to-walk, respectively.

Potential predictors of quality of life in patients with venous leg ulcers: A cross-sectional study in Taiwan

Internationally, the impact of venous leg ulcers (VLUs) on the quality of life is well recognised; however, in Taiwan, the focus is only on chronic wound management. This cross‐sectional correlational study conducted at the cardiovascular and plastic surgery clinics of a regional teaching hospital between August 2019 and June 2020 investigates venous clinical severity, pain, fatigue, depression, sleep quality, quality of life, and related factors among 167 patients with VLUs. The potential predictors of the quality of life in terms of activities were venous clinical severity (P < 0.001), pain (P = 0.004), and fatigue (P < 0.001) after adjusting for covariates. The potential predictors of the quality of life in terms of the psychological domain were marital status (single/divorced) (P = 0.016), marital status (widowed) (P = 0.027), venous clinical severity (P < 0.001), pain (P = 0.001), and fatigue (P = 0.002). The potential predictors of the quality of life with regard to symptoms were venous clinical severity (P < 0.001), pain (P < 0.001), fatigue (P = 0.001), and depression (P = 0.038). These potential predictors can serve as the basis of interventions for patients with VLUs, such as those related to nutrition or training in wound dressing.

Do cognitive performance and physical function differ between individuals with motoric cognitive risk syndrome and those with mild cognitive impairment?

BACKGROUND

Motoric cognitive risk syndrome (MCR) is defined by slow gait speed combined with subjective cognitive complaint. MCR is a predementia syndrome, similar to mild cognitive impairment (MCI). However, there is currently no study comparing the differences in cognitive performance and physical function between these two types of cognitive impairment. Thus, the aim of this study is to compare cognitive performance and physical function in individuals with MCR versus MCI.

METHODS

A total of 77 participants, free of dementia, were recruited from the neurological outpatient clinic of a medical center in Taiwan. Participants were separated into 2 groups, MCR (n = 33) and MCI (n = 44) groups, based on definition criteria from previous studies. The priority was to assign a diagnosis of MCR first, followed by MCI. Hence, "pure" MCI had no overlap with MCR syndrome. Cognitive performance, including executive function, attention, working memory, episode memory, visuospatial function, and language, were measured. Physical functions such as activities in daily living, the Tinetti Assessment Scale, and the Timed Up and Go test were also measured.

RESULTS

Executive function, attention, working memory, episodic memory and language were all significantly lower in the MCR group than the MCI group. Abilities related to physical function, including those measured by the Tinetti Assessment Scale and the Timed Up and Go test, were significantly lower in the MCR group than the MCI group.

CONCLUSIONS

We noted that cognitive performance and physical function were lower in MCR individuals than MCI but without MCR syndrome. However, the conclusions were based on the enrollment procedure of participants prioritizes the MCR syndrome. Because of the overlap of MCR and MCI, future studies should use different enrollment strategies to further clarify the status of these two populations.

Predicting Cognitive Decline in Parkinson's Disease with Mild Cognitive Impairment: A One-Year Observational Study

We conducted an observational study to investigate clinical predictors of cognitive decline in patients with mild cognitive impairment (MCI), with a focus on patients with Parkinson's disease (PD) and Alzheimer's disease (AD). The study was performed with detailed neuropsychological testing, a portable device for gait analysis, and a comprehensive geriatric assessment for patients with MCI. Cognitive decline was defined as subjective cognitive impairment with an objective decline in the Mini-Mental State Examination (MMSE) ≥2 points at the one-year follow-up. Participants (n = 74) had a median age of 70 (interquartile range 60–79) years, and 45.9% of them were women. At the end of the study, 17.6% of the patients with MCI had a cognitive decline. Although no differences were observed between groups at the baseline cognitive study, patients with PD-MCI demonstrated more cognitive decline than patients with AD-MCI (28.6% vs. 7.7% p = 0.03). Patients with PD-MCI had more physical disabilities, including scores of instrumental activities of daily living (IADL), Tinetti balance, and gait scores, and some Timed Up and Go components. Initial Clinical Dementia Rating—Sum of Boxes score was a better predictor of future cognitive decline than MMSE in PD-MCI. For predicting the occurrence of cognitive decline in PD-MCI, the prediction accuracy increased from the reduced model (AUC = 0.822, p < 0.001) to the full model (a total of five independent variables, AUC = 0.974, p < 0.001). Given the potentially modifiable predictor, our findings also highlight the importance of identifying sleep quality and the ability to perform IADL.

Heterogeneity in the trajectories of depressive symptoms among elderly adults in rural China: The role of housing characteristics

Depression among older adults in rural areas, a multiply disadvantaged group, has become a severe public health issue in China. Few studies, however, examine the role of rural living conditions as a potential risk factor for depression. This study uses panel data from CHARLS, a Chinese population-based longitudinal study, and employs growth mixture modeling to examine the association between rural housing characteristics and the heterogeneous pattern of depression trajectories among elderly adults in rural areas. The results suggest that there is heterogeneity in elderly people's depression and that stably living in multifloor and high-quality houses is associated with a higher probability of being in the stably low-depression trajectory class.

Differential associations between subjective age and depressive symptoms among urban and rural Chinese older adults

Objectives: Little research has investigated the prospective association between subjective-aging-perception and depressive symptoms in Chinese older adults. The aim of this study is to evaluate the differential associations of feeling old with depressive symptoms among urban and rural community-dwelling Chinese older adults using panel data drawn from two waves of nationally representative surveys.Method: We conducted secondary data analysis and utilized the data of 5,685 urban and 5,612 rural community-dwelling older adults aged 60 years and above who participated in both the 2006 and the 2010 Sample Survey on the Aged Population in Urban/Rural China (SSAPUR). A single-item measure of subjective age was used to distinguish between feeling old and feeling not old.Results: Ordinary least regression analyses indicated that the longitudinal effect of subjective age on depressive symptoms existed only in the urban sample (p<.001) but not in the rural sample and that feeling not old was related to less depressive symptoms in the urban sample, after controlling for baseline measures of depressive symptoms and sociodemographic and health factors.Conclusion: This study provides new longitudinal evidence of the impact of subjective age on depression among Chinese older individuals. The findings provide useful information for depression interventions among urban older Chinese individuals.

Depression in Community-Dwelling Older Adults Living Alone in China: Association of Social Support Network and Functional Ability

Older adults who live alone are more likely to experience depressive symptoms compared to those who live with others. The current study aimed to investigate the prevalence of depression and identify its associated factors among community-dwelling older adults living alone in China. A cross-sectional questionnaire survey was conducted with a total of 172 older adults living alone in Nanjing city, Jiangsu province of mainland China. The prevalence of depression among this group of Chinese older adults was 18.6%. The possibility of depression among older adults who had social isolation risk was 2.59 times higher than those who had no such risk. Compared with older adults who had normal functional abilities, the possibility of depression was 3.31 times higher in older adults with mild functional impairments and 4.72 times higher in those with severe functional impairments. The results suggest that health care providers should develop effective interventions to help older adults living alone maintain their mental health by enhancing their functional abilities and increasing their social support networks and social engagement. [Research in Gerontological Nursing, 13(2), 82-90.].

Depressive symptoms in three Chinese older workforce groups: the interplay of work stress with family and community factors

BACKGROUND

More people remain in the workforce into their late life as people's life expectancy increases. This study examined the relationship between work stress and depressive symptoms of older workers in mainland China, focusing on the interplay between work stress with family and community factors in three (i.e., urban, rural, and migrant) settings.

METHODS

National representative survey data on the Chinese labor force collected by the Social Science Research Center of Sun-Yetsen University in 2014 were used. The sample consisted of 5,751 workers aged 50 and above recruited from 29 out of 31 provinces in mainland China.

RESULTS

Work stress had a consistent and robust effect on depressive symptoms across older worker groups. Moreover, it interacted with family and community factors differentially in three settings. For migrant older workers, work stress was a dominant factor affecting their depressive symptoms. Among rural older workers, the influence of work stress on depressive symptoms depended on their family debt and neighborhood cohesion levels.

CONCLUSION

Stressors from work, family, and community comprised a general model that explains depressive symptoms in Chinese older workers. Interventions or service programs aimed at reducing work stress and improving mental health among older adults should consider the complexity of intertwining family and community dynamics as well as respective strengths in urban, rural, and migrant communities.

Increased brain entropy of resting-state fMRI mediates the relationship between depression severity and mental health-related quality of life in late-life depressed elderly

BACKGROUND

Entropy analysis is a computational method used to quantify the complexity in a system, and loss of brain complexity is hypothesized to be related to mental disorders. Here, we applied entropy analysis to the resting-state functional magnetic resonance imaging (rs-fMRI) signal in subjects with late-life depression (LLD), an illness combined with emotion dysregulation and aging effect.

METHODS

A total of 35 unremitted depressed elderly and 22 control subjects were recruited. Multiscale entropy (MSE) analysis was performed in the entire brain, 90 automated anatomical labeling-parcellated ROIs, and five resting networks in each study participant.

LIMITATIONS

Due to ethical concerns, all the participants were under medication during the study.

RESULTS

Regionally, subjects with LLD showed decreased entropy only in the right posterior cingulate gyrus but had universally increased entropy in affective processing (putamen and thalamus), sensory, motor, and temporal nodes across different time scales. We also found higher entropy in the left frontoparietal network (FPN), which partially mediated the negative correlation between depression severity and mental components of the quality of life, reflecting the possible neural compensation during depression treatment.

CONCLUSION

MSE provides a novel and complementary approach in rs-fMRI analysis. The temporal-spatial complexity in the resting brain may provide the adaptive variability beneficial for the elderly with depression.

Negative association between BMI and depressive symptoms in middle aged and elderly Chinese: Results from a national household survey

The association between body size and mental health has been the focus of many studies. Results, however, varies between studies. This study aimed to investigate the association between BMI and depressive symptoms among Chinese adults. We also further explored childhood starvation as a potential mediator of this association. The China Health and Retirement Longitudinal Study data, a representative national survey of adults age 45 and older was used in this study. Results showed that the prevalence of overweight and obesity were 28.8% and 11.6%. There was a negative association between BMI and depressive symptoms for males. Obese male adults had the lowest CES-D scores, followed by overweight male adults, and underweight male adults had the highest CES-D scores. These associations also exist but are not significant for females. Furthermore, these associations were significant among males who had been exposed to food shortage during their childhood. Our results suggested a significant positive association between BMI and depression in middle aged and elderly males in China, while this association is weak in females. Childhood food shortage experience was a potential causative factor accounting for this association.

Delaying cognitive and physical decline through multidomain interventions for residents with mild-to-moderate dementia in dementia care units in Taiwan: A prospective cohort study

AIM

To develop experimental multi-domain interventions for older people with mild-to-moderate dementia, and to evaluate the effect of delaying cognitive and physical decline, and improvement or prevention of geriatric syndromes during 1-year follow up.

METHODS

Participants aged 65 years and older with mild-to-moderate dementia (clinical dementia rating [CDR] 1 or 2) were grouped as intervention in Jia-Li Veterans Home and usual care model in the community (Memory clinic). All residents in Jia-Li Veterans Home received comprehensive intervention, including Multi-disciplinary team consultation and intervention, Multi-component non-pharmacological management, geriatric syndromes survey and intervention by CGA, and a dementia friendly medical Green channel Approach (2MCGA). The decline of cognitive and physical function are determined by the change of Mini-Mental State Examination score, CDR and the sum of CDR box, as well as activities of daily living based on the Barthel Index. We also screened geriatric syndromes at baseline and 1 year later.

RESULTS

Participants in the intervention group were older and had a lower educational level, lower body mass index, poor baseline activities of daily living function, lower visual impairment, and higher rates of hearing impairment, polypharmacy and risk of malnutrition. The residents receiving 2MCGA had lower baseline Mini-Mental State Examination scores, and higher CDR. For residents in Jia-Li Veterans Home, all cognitive measurements except Mini-Mental State Examination were significantly associated with delaying the decline of cognition after analyzing by multiple linear regression, and multivariate logistic regression also showed that patients living in the community was independently associated with a higher odds ratio for activities of daily living decline (3.180, 95% CI 1.384-7.308, P = 0.006). There are also more improvement in their baseline geriatric syndromes and suffered less from new geriatric syndromes, including falls, urinary incontinence, and risk of malnutrition.

CONCLUSIONS

The 2MCGA intervention shows strong delays in the decline of cognition and physical function for older residents with mild-to-moderate dementia. Furthermore, this strategy can also improve or prevent the onset of new geriatric syndromes, especially fall episodes, urinary incontinence and risk of malnutrition. Geriatr Gerontol Int 2017; 17 (Suppl. 1): 36-43.

Prospective relationship between objectively measured light physical activity and depressive symptoms in later life

BACKGROUND

The use of self-report measures of physical activity is a serious methodological weakness in many studies of physical activity and depressive symptoms. It is still equivocal whether light physical activity protects older adults from depressive symptoms.

OBJECTIVE

This study aimed to explore whether objectively measured light physical activity, independent of sedentary and moderate-to-vigorous activity, is associated with a reduced risk of subsequent depressive symptoms in older adults.

METHODS

This was a 2-year prospective cohort study. A total of 285 community-dwelling older adults aged 65 years or older were interviewed in 2012. A second wave of assessment was carried out in 2014 involving 274 (96.1%) participants. Time spent in physical activity at different intensities was assessed using triaxial accelerometers. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. Negative binomial regression models with adjustment for baseline depressive symptoms, accelerometer wear time, socio-demographic variables, lifestyle behaviors, and chronic disease conditions were conducted.

RESULTS

Time spent in moderate-to-vigorous and light physical activities were both inversely related to depressive symptoms at follow-up. Sedentary time was associated with an increased risk of subsequent depressive symptoms. When sedentary or moderate-to-vigorous activity were included in the multivariable-adjusted regression models with light physical activity simultaneously, only light physical activity remained significant. Sensitivity analyses for assessing confounding and reverse causation provided further support for the stability of these findings.

CONCLUSION

Light physical activity, independent of sedentary and moderate-to-vigorous activity, is associated with a reduced risk of subsequent depressive symptoms in later life. Copyright © 2017 John Wiley & Sons, Ltd.

Psychiatric disorders among older prisoners: a systematic review and comparison study against older people in the community

OBJECTIVES

Despite emerging evidence that older prisoners experience poor mental health, literature in this area is still limited. In the present systematic review and meta-analysis, we report on the prevalence of psychiatric disorders among older prisoners and compare our findings against community studies on older people.

METHODS

We searched on Assia, PsycInfo, MedLine, Embase, Web of Science, Google and Gov.uk. We carried out bias assessments, rated studies for quality and ran a heterogeneity test. We meta-analysed prevalence rates of psychiatric disorders through an aggregate weighted mean and calculated relative risk (RR) and statistical significance against community studies. Sensitivity analyses were further performed.

RESULTS

We reviewed nine studies and obtained the following prevalence: 'Any psychiatric disorder' 38.4%, depression 28.3%, schizophrenia/psychoses 5.5%, bipolar disorder 4.5%, dementia 3.3%, cognitive impairment 11.8%, personality disorder 22.9%, alcohol abuse 15.9%, anxiety disorders 14.2%, PTSD 6.2%. Older prisoners were found to have higher RR for every single psychiatric disorder against older people in the community, with the sole exception of alcohol abuse (RR = 1) and dementia (RR = .75). The prevalence rates were statistically significantly higher (p < .05) among the prisoners for 'Any psychiatric disorder', depression and personality disorder. Overall, the sensitivity analyses confirmed our original results.

CONCLUSION

Our findings point at a high prevalence of every single psychiatric disorder among older prisoners, who also experience rates of dementia and alcohol abuse comparable to those reported in the community. Our results have relevant implications for policy and practice in this area. Further research is crucial to confirm findings from this study.

Development and psychometric testing of the triggers of Suicidal Ideation Inventory for assessing older outpatients in primary care settings

OBJECTIVE

The purpose of this study was to develop an instrument for assessing triggers of suicidal ideation among older outpatients and determine its psychometrics.

METHOD

Participants were recruited from older outpatients of two hospitals in northern Taiwan. The 34-item Triggers of Suicidal Ideation Inventory (TSII) was developed, and its items were validated by experts in two runs of Delphi technique survey. Pre-testing this TSII in 200 older outpatients resulted in a 12-item TSII, with three items not considered triggers but suggesting the need for further psychiatric assessment. The 9-item TSII was examined by criterion validity, construct validity, internal consistency reliability, and test-retest reliability.

RESULTS

Factor analysis of the final version of TSII yielded a three-factor solution, accounting for 68.75% of the variance. Participants with depressive tendency tended to have higher TSII scores than participants with no depressive tendency (t = 8.62, p < 0.01), indicating good construct validity. TSII scores were significantly and positively correlated with Beck Scale for Suicide Ideation (r = 0.45, p < 0.01) and UCLA Loneliness (r = 0.55, p < 0.01) scores, indicating satisfactory criterion validity. The TSII had Cronbach's α and intraclass correlation coefficient of 0.70 and 0.99, respectively, indicating acceptable internal consistency reliability and excellent test-retest reliability. Receiver operating characteristic analysis revealed an area under the curve of 0.82, indicating excellent ability to detect triggers of suicidal ideation. With a cutoff point of 2, the sensitivity and specificity were 0.76 and 0.69, respectively.

CONCLUSIONS

The TSII can be completed in 5 min, is perceived as easy to complete, and yielded highly acceptable parameters of validity and reliability. Copyright © 2016 John Wiley & Sons, Ltd.

Prevalence of and risk factors for minor and major depression among community-dwelling older adults in Taiwan

BACKGROUND

This study was conducted to estimate prevalence rates and risk factors for late-life depression in a large nationwide representative sample from Taiwan.

METHODS

A total of 5,664, randomly sampled individuals aged ≥55 years were enrolled. Clinically, relevant depressive symptoms were classified using the Center for Epidemiological Studies Depression Scale (CES-D score ≥16), and major depression was confirmed using the Primary Care Evaluation of Mental Disorders. Individuals with clinically relevant depressive symptoms, who did not meet the strict diagnostic criteria for major depression, were considered to have minor depression. Multinomial logistic regression analyses were conducted to identify risk factors for major and minor depression, including socio-demographic characteristics, medical conditions, lifestyle behaviors, social support network, and life events.

RESULTS

The prevalence rates of minor and major depression were 3.7% and 1.5%, respectively. Major depression was associated with personal vulnerability factors, such as poor social support, cognitive impairment, comorbid pain conditions, and sleep disturbance. However, minor depression was more likely to be related to adverse life events, including increased burden on families, changes in health status, or relationship problem. Approximately, 20.0% of individuals with major depression received antidepressant treatment.

CONCLUSIONS

Late-life depression was less prevalent among community-dwelling older adults in Taiwan than among populations in other countries. Our findings may aid the early detection and treatment of late-life depression and provide a basis for future investigations.

Impact of living arrangements on clinical outcomes among older patients with dementia or cognitive impairment admitted to the geriatric evaluation and management unit in Taiwan

AIM

To evaluate the impact of living arrangements on mortality and functional decline among older patients with dementia or cognitive impairment after discharge from a geriatric evaluation and management unit (GEMU) in Taiwan.

METHODS

The present retrospective cohort study used data from the Veteran Affairs Comprehensive Geriatric Assessment from January 2015 to May 2016 for analysis. Data of patients aged 65 years and older with dementia or cognitive impairment at admission to the GEMU of Taipei Veterans General Hospital during the study period were retried for study. The Veteran Affairs Comprehensive Geriatric Assessment included demographic characteristics, Clinical Frailty Scale, Braden Scale, St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients Scale, Cumulative Illness Rating Scale for Geriatrics, Barthel Index, Instrumental Activities of Daily Living, Mini-Mental State Examination, Geriatric Depression Scale-5 and Mini-Nutritional Assessment - Short Form, as well as common geriatric syndromes. All patients were categorized into the home care group and institutional care group based on their living arrangement before GEMU admissions. Six-month mortality and decline in Barthel Index were defined as adverse clinical outcomes.

RESULTS

Overall, data of 395 patients were used for analysis. The baseline comparisons showed that the institutional care group was more likely to be unmarried, have lower education, lower risk of falls and less polypharmacy, but more likely to experience functional decline at follow up than the home care group. Multivariate logistic regression showed that male (OR 3.59, 95% CI 1.04-12.38, P = 0.043) and higher Cumulative Illness Rating Scale for Geriatrics score (OR 4.08, 95% CI 1.49-11.19, P = 0.006) were associated with mortality, whereas the institutional care group (OR 0.30, 95% 0.09-0.99, P = 0.048) and lower Braden Scale (OR 0.80, 95% CI 0.67-0.94, P = 0.008) were protective against mortality. However, the institutional care group was independently associated with functional decline during the follow-up period (OR 2.19, 95% CI 1.12-4.29, P = 0.022).

CONCLUSIONS

Institutional care was associated with lower 6-month mortality risk for patients with dementia or cognitive impairment after discharge from the GEMU, but this group was more likely to experience functional decline. Further prospective study is required to clarify the clinical impact of living arrangements on long-term outcomes when people with dementia or cognitive impairment are admitted to acute hospitals. Geriatr Gerontol Int 2017: 17 (Suppl. 1): 44-49.

Relation of depression with health behaviors and social conditions of dependent community-dwelling older persons in the Republic of Chile

BACKGROUND

Depressive symptoms are a leading cause of disability and emotional suffering, particularly in old age. However, evidence on depression and old age in developing countries remains largely ignored. The aim of this study was to examine the relation between health behavior and social conditions with depression among dependent community-dwelling older persons in the Republic of Chile.

METHODS

This is a cross-sectional and inferential study, using nationally representative secondary data. Two models used logistic regression on 640 dependent community-dwelling older persons from all over Chile, who personally answered a depression assessment, excluding those taking antidepressants. The geriatric depression scale (GDS-15) was used as outcome. The first model aims at any kind of depression (GDS 5>). The second aims at severe depression (GDS 10>). As exposure, we used the health behavior and social conditions of the older persons. Socio-demographic and physical conditions were used as adjustment.

RESULTS

44.5% of the older persons presented depressive symptoms. Among them, 11% had severe depression. Logistic regression showed that significant detrimental factors for being depressed in both models were visiting the doctor five times or over because of acute diseases, feeling uncomfortable with their living arrangement, and feeling discriminated. On the other hand, every additional day of physical exercise and living alone had a beneficial and detrimental effect only in model one.

CONCLUSION

Analyses on ways to support older persons living alone and the promotion of physical exercise to avoid depression are needed, along with a deeper understanding of the comfort with their living arrangement. Finally, ways to address the discrimination among older persons should be further explored.

Self-Inflicted Hammer Blows to the Cranial Vault: An Interdisciplinary Challenge

Depression is predicted to be the most common cause of disability in the coming decade. Self-inflicted hammer blow to the cranium is a rare phenomenon seen in patients with a history of attempted suicide. The resulting comminuted depressed skull fracture of the midline vertex is life threatening. Rapid interdisciplinary communication and intervention are essential to reduce morbidity and mortality. We present a case of self-inflicted hammer blows to the head, review the relevant literature on this topic, and discuss neurosurgical and psychiatric implications.

Gray Matter Volume and Resting-State Functional Connectivity of the Motor Cortex-Cerebellum Network Reflect the Individual Variation in Masticatory Performance in Healthy Elderly People

Neuroimaging studies have consistently identified brain activation in the motor area and the cerebellum during chewing. In this study, we further investigated the structural and functional brain signature associated with masticatory performance, which is a widely used index for evaluating overall masticatory function in the elderly. Twenty-five healthy elderly participants underwent oral examinations, masticatory performance tests, and behavioral assessments, including the Cognitive Abilities Screening Instrument and the short-form Geriatric Depression Scale. Masticatory performance was assessed with the validated colorimetric method, using color-changeable chewing gum. T1-weighted structural magnetic resonance imaging (MRI) and resting-state function MRI were performed. We analyzed alterations in gray matter volume (GMV) using voxel-based morphometry and resting-state functional connectivity (rsFC) between brain regions using the seed-based method. The structural and functional MRI analyses revealed the following findings: (1) the GMV change in the premotor cortex was positively correlated with masticatory performance. (2) The rsFC between the cerebellum and the premotor cortex was positively correlated with masticatory performance. (3) The GMV changes in the dorsolateral prefrontal cortex (DLPFC), as well as the rsFC between the cerebellum and the DLPFC, were positively correlated with masticatory performance. The findings showed that in the premotor cortex, a reduction of GMV and rsFC would reflect declined masticatory performance. The positive correlation between DLPFC connectivity and masticatory performance implies that masticatory ability is associated with cognitive function in the elderly. Our findings highlighted the role of the central nervous system in masticatory performance and increased our understanding of the structural and functional brain signature underlying individual variations in masticatory performance in the elderly.

Prevalence of depressive symptoms and suicidal thoughts among elderly persons in rural Bangladesh

BACKGROUND

Depression, if broadly defined, is the commonest late-life mental disorder. We examined the distribution of depressive symptoms and suicidal thoughts, across age, sex, literacy, and marital status, among elderly individuals residing in rural Bangladesh and participating in a population-based study on health and aging.

METHODS

Prevalence figures of depressive symptoms were assessed with SRQ20 (n = 625), and possible social network and economic associations were examined. Morbidity accounts of depressive symptoms and suicidal thoughts were examined for a subsample that also underwent complete medical examination (n = 471).

RESULTS

We selected for analyses the items that corresponded to DSM-IV criteria and constructed a dichotomous variable. The prevalence was 45%, and most pronounced among the oldest women (70%). The overall prevalence of suicidal thoughts was 23%. Being a woman, illiterate or single were all risk factors for depressive symptoms and suicidal thoughts. These associations remained unaccounted for by the social network and economic variables. Co-residing with a child and having a high quality of contact were protective of both depressive symptoms and suicidal thoughts. The main findings were replicated in the subsample, where it was found that morbidities were also associated with the outcomes, independently of the four main predictors.

CONCLUSIONS

Prevalence figures for depressive symptoms among elderly in rural Bangladesh are high. Demographic, social network, and morbidity factors are independently associated with both depressive symptoms and suicidal thoughts. This is the first study to report prevalence figures for depressive symptoms in this population.

The effectiveness of group reminiscence therapy for loneliness, anxiety and depression in older adults in long-term care: a systematic review

Loneliness, anxiety and depression are common problems for older adults in long-term care. Reminiscence therapy is a non-pharmacological intervention that may be of some benefit. In comparison to individual reminiscence therapy, group reminiscence therapy is a preferred option when dealing with the resource constraints of long-term care. The aim of this paper was to systematically review the literature in order to explore the effectiveness of group reminiscence therapy for older adults with loneliness, anxiety and depression in long-term care. Results indicated that group reminiscence therapy is an effective treatment for depression in older adults, however to date, there is limited research support for its effectiveness to treat loneliness and anxiety. Further research and an improvement in methodological quality, such as using qualitative and mixed methods approaches, is recommended to help establish an evidence base and provide better understanding of the effectiveness of group reminiscence therapy.

Poor sleep quality is independently associated with physical disability in older adults

STUDY OBJECTIVE

We aimed to evaluate the association between sleep quality and physical disability in community-dwelling older adults.

METHODS

There were 213 community-dwelling adults (76 men and 137 women) aged 65 years and above participated into this investigation. The Groningen Activity Restriction Scale and the Pittsburgh Sleep Quality Index were utilized to evaluate physical disability and subjective sleep quality, respectively. Global functional capacity was measured by the 6-minute walk test (6MWT). The Mini Mental State Examination and the Chinese Geriatric Depression Screening Scale were used to evaluate cognitive function and depression.

RESULTS

Univariate analysis revealed a correlation between physical disability and poor sleep quality, older age, 2 or more comorbidities, depression, functional capacity, and poor cognitive function. However, in the multivariate analyses, depression failed to show significant association with physical disability. In contrast, an independent association was observed between poor sleep quality and physical disability (OR = 2.03; 95% CI: 1.02-4.05).

CONCLUSIONS

In community-dwelling older adults, subjective poor sleep was significantly associated with physical disability, even after controlling for the effects of other established risk factors.

Relationship of perceived environmental barriers and disability in community-dwelling elderly in Taiwan--a population-based study

Background

To identify the relationship between perceived environmental barriers and disability in community-dwelling elderly.

Methods

Cross-sectional study in two community service centers in Tainan. We enrolled 200 community-dwelling residents, aged above 65 years, who had resided in the same community for at least 12 months. Basic activity of daily living (BADL) and instrumental activity of daily living (IADL) were assessed using the Hierarchy of Care Required (HCR). There were 59 participants in BADL disability and 109 in IADL disability. Perceived environmental barriers were assessed using the Craig Hospital Inventory of Environmental Factors (CHIEF). We used multinomial logistic regression to examine the relationship of perceived environmental barriers and disability.

Results

The presence of perceived environmental barriers was related to BADL disability (OR = 4.39, 95% CI = 1.01-19.11) and IADL disability (IADL with difficulty in 1–2 tasks: OR = 9.93, 95% CI = 3.22-30.56; IADL with difficulty in more than 2 tasks: OR = 8.40, 95% CI = 1.83-38.51). The presence of physically/structurally perceived environmental barriers was related to BADL disability (OR = 4.90, 95% CI = 1.01-23.86) and IADL disability (IADL with difficulty in 1–2 tasks: OR = 4.61, 95% CI = 1.27-16.76; IADL with difficulty in more than 2 tasks: OR = 17.05, 95% CI = 2.82-103.30).

Conclusions

Perceived environmental barriers are related to disability in community-dwelling elderly.

The cross-domain correlates of subjective age in Chinese oldest-old

OBJECTIVES

This study examined subjective age and its cross-domain correlates in Chinese oldest-old.

METHOD

We conducted a secondary data analysis using cross-sectional data drawn from the 2006 Sample Survey on the Aged Population in Urban/Rural China, which consisted of a sample of 860 community-dwelling Chinese older adults aged 85 years and above.

RESULTS

A small percentage (8%) of the oldest-old participants reported that they did not feel old. Binary logistic regression analyses revealed that urban living, better physical and self-reported cognitive functioning and mental health were all related to not feeling old, whereas chronological age was found to have no association with subjective age when controlling for indicators of physical and self-reported cognitive functioning.

CONCLUSION

The findings revealed the key roles of functional limitations and mental health in the construction of subjective age in Chinese oldest-old. The possible cross-cultural similarity in the links of subjective age to mental health and physical functioning in later life suggests that maintaining a youthful subjective age may have adaptive value for the oldest-old and contribute to their successful aging.

The effect of early group psychotherapy on depressive symptoms and quality of life among residents of an apartment building for seniors

BACKGROUND

The aim of this study was to investigate the effectiveness of group psychotherapy on depressive symptoms and four domains of quality of life in the elderly.

METHODS

Ninety-six elderly persons were selected from one apartment building for seniors. The 15-question version of the Geriatric Depression Scale was used to screen for depressive symptoms. The treatment and control groups each comprised 12 subjects. The treatment group received one session of group psychotherapy each week for 8 weeks. The 24-item Hamilton Depression Rating Scale and the World Health Organization Quality of Life-BREF scale were used for assessment at the beginning of group psychotherapy and during the fourth and eighth weeks.

RESULTS

The Hamilton Depression Rating Scale score decreased significantly in the treatment group by the eighth week of group psychotherapy compared to the control group (4.9 ± 3.6 vs 17.6 ± 6.4, respectively; P < 0.0001). The World Health Organization Quality of Life-BREF score decreased significantly in the control group by the eighth week compared to the treatment group (95.3 ± 9.9 vs 80.2 ± 10.6, respectively; P = 0.002) with Hamilton Depression Rating Scale interaction (χ(2) = 2.11, P = 0.146). Analysis of the four quality of life domains showed significant differences in the psychological and social domains (P = 0.004 and P = 0.004, respectively) but not in the physical and environmental domains (P = 0.133 and P = 0.147, respectively).

CONCLUSIONS

These findings suggest that studies of the outcome of group psychotherapy must control for depressive symptoms. Quality of life may have been mediated by depression in this preliminary study.

Empirical study of the influence of a Laughing Qigong Program on long-term care residents

AIM

To determine the psychological and physiological effects of a Laughing Qigong Program on an elderly population in an institutionalized setting.

METHODS

Participants were recruited from a long-term care institution in northern Taiwan. A total of 99 residents were interviewed and 66 enrolled, there were 33 control participants and 33 experimental participants. The participants were matched according to their abilities as measured by the Barthel Index of Activities for Daily Living. Experimental participants attended the Laughing Qigong Program, twice a week for 4 weeks. Comparisons were made on the Mini-Mental State Examination, Faces Scale, Geriatric Depression Scale and cortisol levels.

RESULTS

Psychometric measures for participants in the experimental group improved, whereas those in the control group decreased. The experimental group showed the following changes: improved Mini-Mental State Examination scores (Z=-2.28; P<0.05), improved mood states (Z=-4.47; P<0.001) and decreased Geriatric Depression Scale scores (Z=3.79; P<0.001). There were no significant changes for the experimental group in cortisol levels. By comparison, the control group showed: decreased mood states (Z=2.53; P<0.011), increased Geriatric Depression Scale scores (Z=4.34; P<0.001) and significant increases in cortisol levels (Z=2.62; P<0.009).

CONCLUSIONS

The Laughing Qigong Program has shown to be an effective, cost-effective non-pharmacological therapy for cognitive impairment, mood states and elderly depression.

Social relations and depression in late life-a systematic review

OBJECTIVE

Social relations have become the focus of much research attention when studying depressive symptoms in older adults. Research indicates that social support and being embedded in a network may reduce the risk for depression. The aim of the review was to analyze the association of social relations and depression in older adults.

METHODS

Electronic databases were searched systematically for potentially relevant articles published from January 2000 to December 2012. Thirty-seven studies met the inclusion criteria for this review.

RESULTS

Factors of social relations were categorized into 12 domains. Factors regarding the qualitative aspects of social relations seem to be more consistent among studies and therefore provide more explicit results. Thus, social support, quality of relations, and presence of confidants were identified as factors of social relations significantly associated with depression. The quantitative aspects of social relations seem to be more inconsistent. Cultural differences become most obvious in terms of the quantitative aspects of social relations.

CONCLUSION

Despite the inconsistent results and the methodological limitations of the studies, this review identified a number of factors of social relations that are significantly associated with depression. The review indicates that it is needful to investigate social relations in all their complexity and not reduce them to one dimension. Simultaneously, it is important to conduct longitudinal studies because studies with cross-sectional design do not allow us to draw conclusions on causality. Beyond that, cultural differences need to be considered.

Maternal age and number of children are risk factors for depressive disorders in non-perinatal women of reproductive age

OBJECTIVE

It remains unclear whether or not the vulnerability of depression in women of reproductive age is related with pregnancy or perinatal period. The aim of the study was to determine the prevalence of depressive disorders and related factors in a large sample of non-perinatal women of reproductive age.

METHOD

This study involved 589 women of reproductive age. At baseline, sociodemographic data and premenstrual assessment forms were completed, and screening tests for the assessment of the severity of depressive symptoms were administered to all of the participants. Participants who had over scale scores of the cut-off point in the screening instruments were assessed with module A of the Structured Clinical Interview for DSM Disorders (SCID-I) to determine DSM IV Axis I disorders.

RESULTS

The prevalence of depressive disorders was 32.8%. Depressive disorders had high rates in women who were married at younger ages and who had three or more children. Although the prevalence of depressive disorders was 32.8%, only 10.4% of the women had follow-up and treatment in a psychiatric outpatient clinic.

CONCLUSION

Low education levels, early maternal age, and having more than three children and higher premenstrual symptom scores were risk factors for depressive disorders in non-perinatal reproductive age.

Validity and reliability of the modified Chinese version of the Older People's Quality of Life Questionnaire (OPQOL) in older people living alone in China

AIMS AND OBJECTIVES

This study aimed to test the validity and reliability of a modified Chinese version of the OPQOL among older people living alone in China.

BACKGROUND

China has an ageing population with an increasing number of older people living alone who may have a poorer quality of life (QoL) in the light of the traditional culture of collectivism and filial piety. An appropriate instrument is important to assess their QoL. The Older People's Quality of Life Questionnaire (OPQOL) was developed directly from the views of older people and has been validated in England. There has been no psychometric evaluation of the scale in China.

METHODS

The OPQOL was translated and modified prior to being administered to a stratified random cluster sample of 521 older people living alone. Validity was assessed through convergent validity, discriminant validity and construct validity. Reliability was assessed through internal consistency and test-retest reliability.

RESULTS

Exploratory factor analysis indicated eight factors accounting for 63.77% of the variance. The convergent validity was supported by moderate correlations with functional ability, social support and loneliness with Spearman's rho of -0.50, 0.49 and -0.53, respectively. The discriminant validity was confirmed by differentiating QoL scores between the depressed and non-depressed groups. The Cronbach's α coefficient was 0.90 for the total scale and over 0.70 for most of its dimensions. The 2-week test-retest reliability ranged from 0.53 to 0.87.

CONCLUSIONS

The modified Chinese version of the Older People's Quality of Life has acceptable validity and reliability as a useful instrument to measure the QoL of older people living alone in China.

Interactive effect between depression and chronic medical conditions on fall risk in community-dwelling elders

BACKGROUND

It is well documented that fall risk among elderly people is associated with poor health and depression. In this study, we set out to examine the combined effects of medical condition and depression status on fall incidents among community-dwelling elderly people.

METHODS

A cross-sectional study was carried out to investigate the fall history of community-dwelling elders involving 360 participants. Those who had experienced at least two falls over the previous year, or one injurious fall, were defined as "fallers." The Geriatric Depression Scale-15 was used as a screening instrument for depression status.

RESULTS

Based on a multivariate logistic regression and stratification analysis, depression was found to interact with various medical conditions on fall risk. In comparison with the non-depressive reference group, a six-fold fall risk was discernible among depressed elders with polypharmacy, while a five-fold risk was found among depressive elders using ancillary devices, along with a four-fold risk among depressive elders with diabetes or cardiovascular disease. Finally, arthritis was found to produce a nine-fold risk of falls among such populations.

CONCLUSIONS

These findings suggest that greater emphasis should be placed on the integration of depression screening as an element of fall risk assessment in elderly people.

Effect of social capital and personal autonomy on the incidence of depressive symptoms in the elderly: evidence from a longitudinal study in Mexico

OBJECTIVES

To estimate the effect of social capital (SC) and personal autonomy (PA) on the depressive symptoms (DS) in older people living in poverty.

METHOD

Longitudinal study of elderly participants in the impact evaluation study of a non-contributory pension program in Mexico. For this study we selected the group of older people without significant DS at baseline. PA, SC indicators and covariates were measured at baseline. Using the Geriatric Depression Scale, the incidence of DS was assessed at a follow-up interview after 11 months. The effect of SC and autonomy on the occurrence of DS was estimated by using a multilevel logistic regression model.

RESULTS

Of the various indicators of PA, not being dependent in daily functioning, and being able to read/write were associated with lower risk of DS. A higher level of SC at baseline was associated with lower incidence of DS in women (odds ratio; OR = 0.73, p < 0.01), while for men there was no significant association (OR = 1.04, p = 0.69).

CONCLUSIONS

PA and SC proved to be protective factors against the onset of DS in women. For men, only PA was a protective factor. Future studies need to explore in what ways that PA and SC may reduce risk of DS as well as the role of gender differences.

Self-care management and risk factors for depressive symptoms among elderly outpatients in Taiwan

BACKGROUND

Early detection and appropriate treatment interventions for depressive symptoms in the elderly are important issues for healthcare systems. However, few studies to date have focused on understanding self-care strategies to manage depressive symptoms among elderly people worldwide. The purpose of this study was to explore self-care management strategies and risk factors for depressive symptoms among elderly outpatients in Taiwan.

METHODS

A convenience sample of elderly persons (≥65 years old; N = 1054) was recruited from outpatient clinics of two hospitals in northern Taiwan.

RESULTS

In our sample, the prevalence of depressive tendency was 16.3%. The majority of participants (70.1%) managed depressive symptoms with self-care strategies. The strategy most often used to relieve depressive symptoms was "take a walk." The main information source for self-care strategies was self-learning. Depressive tendency in this sample was shown by logistic regression analysis to be significantly predicted by gender, marital status, perceived income adequacy, perceived health condition, stroke, and cancer.

CONCLUSION

Elderly people need to be made more aware of strategies to self-manage depressive symptoms. Healthcare providers can decrease/prevent the first risk factor for depressive symptoms (poor perceived health status) by improving elders' perceived health and promoting their actual health. The second risk factor (poor perceived income adequacy) can be decreased/prevented by carefully assessing patients' financial situation during clinic visits and providing suitable referral for further assistance.

Screening depression among institutionalized older Chinese men by minimum data set: we need a new instrument

OBJECTIVE

To compare the effectiveness of the Minimum Data Set-based Depression Rating Scale (MDS-DRS) and Geriatric Depression Scale (GDS) in screening depression among older institutionalized Chinese men living in Taiwan.

METHOD

MDS Nursing Home 2.1 Chinese version, Mini-Mental State Examination (MMSE), and short form Geriatric Depression Scale (GDS-15) were used among elderly residents in Banciao Veterans Home. Screening results of MDS-DRS and GDS-15, and relationship between 16 MDS Mood and Anxiety symptoms and depression were evaluated.

RESULTS

The prevalence of depression defined by MDS-DRS and GDS were 0.2% and 8.7%, respectively. Multiple logistic regression disclosed that E1a (OR: 12.9, 95% CI: 2.8-58.8, p = 0.001), E1k (OR: 15.6, 95% CI: 5.6-43.5, p < 0.001), and E1l (OR: 22.2, 95% CI: 6.1-83.3, p < 0.001) were all independent associative factors for GDS-defined depression but only explained 51.9% of all depressive subjects.

CONCLUSIONS

The effectiveness of MDS-DRS is limited, and a new MDS-based depression screening instrument is needed.

Depression and related factors in older people in China: a systematic review

China has an increasing ageing population. Depression, as one of the most common problems in older people, is a concern that merits attention. This paper reviewed published studies of the prevalence of depression and its related factors in older people in China. Seventeen papers were identified by searching the following electronic databases: Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Whilst prevalence varied across studies, health status, social support, financial status, living arrangements and some demographic factors were consistently related to older people's depression. Further well-designed studies are needed to explore depression in older people in China to identify more culture-specific contributors to maximize well-being.

Distribution of depressive disorders in the elderly

BACKGROUND

The community-based mental health studies have revealed that the point prevalence of depressive disorders in the elderly population of the world varies between 10% and 20% depending on cultural situations.

OBJECTIVE

To determine the median prevalence rates of depressive disorders in the elderly population of India and various other countries in the world.

MATERIALS AND METHODS

A retrospective study based on meta-analysis of various study reports.

SETTING

Community-based mental health surveys on geriatric depressive disorders conducted in the continents of Asia, Europe, Australia, North America, and South America.

STUDY PERIOD

All the studies that constituted the sample were conducted between 1955 and 2005.

SAMPLE SIZE

After applying the inclusion and exclusion criteria on published and indexed articles, 74 original research studies that surveyed a total of 4,87,275 elderly individuals in the age group of 60 years and above, residing in various parts of the world were included for the final analysis.

INCLUSION CRITERIA

The researchers had included only community-based cross-sectional surveys and some prospective studies that had not excluded depression on baseline. These studies were conducted on homogenous community of elderly population in the world, who were selected by simple random sampling technique.

EXCLUSION CRITERIA

All the unpublished reports and unavailable or unanalyzed or inaccessible articles from the internet were excluded from the study.

STATISTICAL ANALYSIS

The median prevalence rate and its corresponding interquartile range (IQR), Chi-square test, and Chi-square for Linear Trend were applied. A P value < 0.05 was considered as statistically significant.

RESULTS AND CONCLUSION

The median prevalence rate of depressive disorders in the world for the elderly population was determined to be 10.3% [IQR = (4.7%-16.0%)]. The median prevalence rate of depression among the elderly Indian population was determined to be 21.9% [IQR = (11.6%-31.1%)]. Although there was a significant decrease trend in world prevalence of geriatric depression, it was significantly higher among Indians in recent years than the rest of the world.

Prevalence of depressive disorders in the elderly

Community-based mental health studies have revealed that the point prevalence of depressive disorders in the elderly population of the world varies between 10% and 20%, depending on cultural situations. A retrospective study based on analysis of various study reports was conducted, to determine the median prevalence rates of depressive disorders in the elderly population of India and various other countries in the world. All the studies that constituted the sample were conducted between 1955 and 2005. Included are only community-based, cross-sectional surveys and some prospective studies that had not excluded depression at baseline. These studies were conducted on a homogenous community of the elderly population in the world, who were selected by a simple random sampling technique. After applying the inclusion and exclusion criteria on published and indexed articles, 74 original research studies that surveyed a total of 487,275 elderly individuals, in the age group of 60 years and above, residing in various parts of the world, were included for the final analysis. The median prevalence rate and its corresponding interquartile range were calculated. The chi-square test and chi-square for linear trend were applied. A P value of <.05 was considered as statistically significant. The median prevalence rate of depressive disorders in the world for the elderly population was determined to be 10.3% (interquartile range [IQR], 4.7%-16.0%). The median prevalence rate of depression among the elderly Indian population was determined to be 21.9% (IQR, 11.6%-31.1%). Although there was a significant decrease in the trend of world prevalence of geriatric depression, it was significantly higher among Indians, in recent years, than the rest of the world.

The impact of foreign caregiving on depression among older people in Taiwan: model testing

AIM

  This article is a report of a study of predicting the factors that influence depression in the older people in Taiwan. Background.  In 1991, Taiwan opened the labour market to foreign caregivers for the older people who needed long-term care. With the differences in language, culture and lifestyle between foreign caregivers and older people in Taiwan, it was hypothesized that the older people would not be able to relate to them, and therefore become depressed.

METHODS

  The data were collected from 116 Taiwanese older people from July to September, 2005. Path analysis using multiple regression analyses was conducted to estimate the direct and indirect effects of caregiving communication, activities of daily living, income and social support on depression among older people in Taiwan. To evaluate the hypotheses for this research, bi-variate linear regression and multiple regression analyses were used.

RESULTS/FINDINGS

  The results indicated that the level of activities of daily living (β = -0·201, P = 0·010), care-giving communication (β = -0·272, P = 0·002) income (β = -0·305, P = 0·000) and social support (β = -0·276, P = 0·002) were the predictors of depression in older people in Taiwan. Social support was a mediating factor for caregiving communication and depression. Furthermore, foreign caregiver care was not correlated with depression among older people in Taiwan.

CONCLUSIONS

  The findings influence the public awareness of depression in older people, and provide the foundational information to influence the policy makers of Taiwan to evaluate the foreign caregiver policy.

Risk factors for depression in older adults in Beijing

OBJECTIVE

Depression is a common mental disorder in older adults. We examined the prevalence and risk factors for depression in older adults in the Beijing area.

METHOD

We used data from a cross-sectional survey conducted in July 2006 in Beijing. As part of the national survey for older Chinese adults, 2002 older adults were interviewed. The 15-item Geriatric Depression Scale was used to assess depression. Demographics as well as other personal information were also collected.

RESULTS

Among Beijing older adults, 13.01% were categorized as depressed. Prevalence rates of depression in rural and urban older adults were 26.63% and 10.79%, respectively. Poor economic status, high activities of daily living (ADL) score, poor physical health, impious offspring, and feeling old were important predictors of depression in older adults in Beijing. For the urban sample, poor economic status, poor physical health, high ADL score, and impious offspring were risk factors for depression. For the rural sample, depression was significantly associated with poor economic status and poor physical health.

CONCLUSIONS

Depression is a common mood disorder among older adults in the Beijing area. Filial piety is a unique predictor for depression in older Chinese adults, compared with findings in Western cultures.