Predisposing and Facilitating Factors of Severe Psychological Distress among Frail Elderly Adults

Prevalence and Factors Associated with Psychological Distress among Older Adults Admitted to Hospitals After Fall Injuries in Vietnam

Although psychological distress is one of the major health issues among aging populations, little is known about how this challenge affects older patients after falls. A cross-sectional study was conducted in Thai Binh province, Vietnam, to explore the prevalence of psychological distress and associated factors among 405 older patients after falls. The 6-item Kessler Psychological Distress Scale (K6) was used to measure psychological distress. Socio-demographic and clinical characteristics were collected using a structured questionnaire. Multivariate Tobit and Logistic regressions were used to determine factors associated with psychological distress. The prevalence of psychological distress among participants was 26.2%. Patients who were alone or older had a higher likelihood of psychological distress. Patients with a history of falls in the past 12 months were more likely to suffer from psychological distress (OR = 2.87, 95%CI = 1.74; 4.72). Having two and three comorbidities was significantly associated with greater K6 scores and a higher risk of psychological distress. This study underlined a significantly high prevalence of psychological distress among older patients after falls. Providing frequent mental health monitoring, screening, treatment, and facilitating social engagements are important implications to improve the mental health of this population.

Genetic diversity contributes to abnormalities in pain behaviors between young and old rats

Aging has profound yet unpredictable effects on pain perception and incidence of anxiety disorders. However, the mechanisms underlying age-related pathologies are confounded by contradictory observations in rodent models. Therefore, the goal of our study was to test the hypothesis that genetic variability contributes to age-related pain behaviors and susceptibility to anxiety. To address this hypothesis, we examined pain and anxiety-like behavior in young or old Brown Norway (BN), Fisher 344, and BN/F344 (F1), three rat strains used in studies to evaluate the effect of aging. Mechanosensitive thresholds were assessed using the Von Frey assay, and visceral pain sensitivity was measured via the visceromotor response to colorectal distension. Anxiety-like behavior and exploration was quantified in the elevated plus maze. In the BN strain, old rats exhibited increased mechanosensitive thresholds compared to young rats; however, age did not affect visceral sensitivity in this strain. In F344-BN rats, the number of abdominal contractions induced by the highest colonic distension pressure was significantly lower in old rats. However, following colonic sensitization, a difference was no longer apparent. In the F-344 strain, visceral hypersensitivity following afferent sensitization was evident in young rats at all distension pressures but was not observed in older animals at 20 mmHg. Aging significantly reduced maze exploration across all strains. Our data demonstrate that age- and strain-related alterations exist in pain behavior and highlight the effects of aging on exploratory behavior. These findings suggest that strain differences contribute to the controversial data on the effects of aging on pain perception.

Reciprocal relationship between social support and psychological distress among a national sample of older adults: an autoregressive cross-lagged model

In this study we examined the longitudinal relationships between five dimensions of social support and psychological distress to determine whether (1) social support was related to subsequent psychological distress levels; or (2) if distress levels were related to subsequent social support levels; or (3) if distress and support had a reciprocal (bi-directional) relationship across time. Using bivariate autoregressive cross-lagged models, we analysed data from 2,564 older adults. We found support for the reciprocal relationship between affectionate support and distress. Higher psychological distress was related to subsequently higher levels of positive social interaction, and significantly related to subsequently higher emotional/informational support. No significant relationship was found between tangible and structural support and psychological distress. This study demonstrates that different types of support are associated in correspondingly different ways with psychological distress, and that psychological distress may be important in predicting levels of social support two years later.

Persistence and remission of psychiatric disorders in the quebec older adult population

OBJECTIVE

To document the remission and persistence of psychiatric disorders in Quebec's older adult population.

METHOD

Data came from the Enquête sur la santé des aînés (ESA) study conducted in 2005-2008 using a representative sample (n = 2784) of community-dwelling older adults.

RESULTS

The ESA study results indicate that 12% of respondents met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for depression, mania, anxiety disorders, or benzodiazepine drug dependency at the baseline interview. The results also indicate that the 12-month rate of patients with a persistent psychiatric condition was 19.4%. Sixty-seven percent of the patients in remission experienced a total recovery of their symptoms during the following year. The probability of presenting a persistent psychiatric condition or a partial remission after 1 year of follow-up, compared with those in total remission, did not vary according to sociodemographic characteristics. The results also showed that social support and the number of chronic health problems did not influence mental health at follow-up. However, results indicated that the use of health services (OR 7.4; 95% CI 3.72 to 14.55) and the change in the number of chronic health problems reported between baseline and the second interview (OR 1.2; 95% CI 1.06 to 1.34) increased the probability of patients with prevalent disorders at Time 1 having persistent disorders at Time 2.

CONCLUSION

Results suggest that a deterioration of physical health status was associated with the persistence of DSM-IV disorders in the elderly. These results also suggest that the use of mental health services is associated with severity of the mental illness.

One-year incidence of psychiatric disorders in Quebec's older adult population

OBJECTIVE

To examine the incidence of psychiatric disorders in the Quebec older adult population.

METHOD

Data from the Enquête sur la Santé des Aînés (ESA) study conducted in 2005 to 2008 using a representative sample (n = 2784) of community-dwelling adults aged 65 years and older were used.

RESULTS

The ESA study's results indicate that 12.0% of the respondents met the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for depression, mania, anxiety disorders, or benzodiazepine drug dependency at the baseline interview. Our results also indicate that the 12-month rate of incident cases of DSM-IV disorders was 6.2%. The proportion of incident cases was higher for the depression group (3.4%) than for the anxiety disorders group (2.3%). The results showed that the probability to develop an incident psychiatric condition after 1 year of follow-up, compared with the noncases group, varied according to sex (OR 2.18; 95% CI 1.39 to 3.44). Our results also showed that the number of chronic health problems (OR 1.20; 95% CI 1.09 to 1.33) and the change in the number of chronic health problems reported between the baseline and the second interview (OR 1.14; 95% CI 1.01 to 1.30) increased the probability to be an incident case at Time 2. The results indicated that social support did not influence the probability to develop a psychiatric disorder.

CONCLUSION

These results indicate that sex and physical health status have an impact on the incidence of DSM-IV disorders in the elderly. This finding underscores the need for improved recognition and treatment of psychiatric disorders associated with physical illness in the older population.

Anxiety and the aging brain: stressed out over p53?

We propose a model in which cell loss in the aging brain is seen as a root cause of behavioral changes that compromise quality of life, including the onset of generalized anxiety disorder, in elderly individuals. According to this model, as stem cells in neurogenic regions of the adult brain lose regenerative capacity, worn-out, dead, or damaged neurons fail to be replaced, leaving gaps in function. As most replacement involves inhibitory interneurons, either directly or indirectly, the net result is the acquisition over time of a hyper-excitable state. The stress axis is subserved by all three neurogenic regions in the adult brain, making it particularly susceptible to these age-dependent changes. We outline a molecular mechanism by which hyper-excitation of the stress axis in turn activates the tumor suppressor p53. This reinforces the loss of stem cell proliferative capacity and interferes with the feedback mechanism by which the glucocorticoid receptor turns off neuroendocrine pathways and resets the axis.

Prevalence and correlates of obsessive-compulsive disorder among older adults living in the community

The purpose of this study was to determine OCD prevalence among older adults living in the community and to examine its correlates. Data were drawn from a large population survey using a representative sample of older adults aged 65 years and over (N=2798). The 12-month prevalence rate of OCD was 1.5%. Results showed that older adults with OCD were more likely to be men compared to those having another anxiety disorder or a mood disorder. They were also more afflicted with difficulties in social functioning than respondents presenting another anxiety disorder. In spite of social disabilities, respondents with OCD had the lowest rate of health services use among those reporting anxiety or mood disorders. It is suggested that older adults with OCD did not feel the need to seek treatment because they perceived their physical and mental health more positively than others and because they were surrounded by supportive peers.

Distress in older patients with cancer

PURPOSE

To determine the predictors of distress in older patients with cancer.

PATIENTS AND METHODS

Patients age >or= 65 years with a solid tumor or lymphoma completed a questionnaire that addressed these geriatric assessment domains: functional status, comorbidity, psychological state, nutritional status, and social support. Patients self-rated their level of distress on a scale of zero to 10 using a validated screening tool called the Distress Thermometer. The relationship between distress and geriatric assessment scores was examined.

RESULTS

The geriatric assessment questionnaire was completed by 245 patients (mean age, 76 years; standard deviation [SD], 7 years; range, 65 to 95 years) with cancer (36% stage IV; 71% female). Of these, 87% also completed the Distress Thermometer, with 41% (n = 87) reporting a distress score of >or= 4 on a scale of zero to 10 (mean score, 3; SD, 3; range, zero to 10). Bivariate analyses demonstrated an association between higher distress (>or= 4) and poorer physical function, increased comorbid medical conditions, poor eyesight, inability to complete the questionnaire alone, and requiring more time to complete the questionnaire. In a multivariate regression model based on the significant bivariate findings, poorer physical function (increased need for assistance with instrumental activities of daily living [P = .015] and lower physical function score on the Medical Outcomes Survey [P = .018]) correlated significantly with a higher distress score.

CONCLUSION

Significant distress was identified in 41% of older patients with cancer. Poorer physical function was the best predictor of distress. Further studies are needed to determine whether interventions that improve or assist with physical functioning can help to decrease distress in older adults with cancer.

Psychological distress and its correlates in older care-dependent persons living at home

OBJECTIVES

This study examined psychological distress in older people receiving home nursing care. The influence of risk factors and personal resources on their perceived psychological distress was also examined.

METHOD

A linear regression analysis was applied in a cross-sectional sample of 214 patients aged 75 years and older. Psychological distress was measured using the General Health Questionnaire (GHQ). The independent variables were sex, education, age, living arrangement, household composition, reported illnesses, Barthel ADL Index, self-rated health, Subjective Health Complaints, Clinical Dementia Rating Scale, Sense of Coherence and Revised Social Provision Scale.

RESULTS

Of the 214 participants, 23 (10.7%) reported experiencing psychological distress using a cutoff point of 4 or more on a GHQ case score. Sense of coherence, education and subjective health complaints were the only factors that were significantly related to psychological distress in the multivariate analysis.

CONCLUSION

The general level of psychological distress was low. Low psychological distress was related to an inner strength conceptualized as sense of coherence. Commonly reported risk factors such as sex, household composition and perceived social support, and objective measures of somatic and mental health and bodily dysfunctions were not related to psychological distress. Suggested reasons for this are greater acceptance of bodily and functional shortcomings and of changes related to goal achievement in old age, according to the model of selective optimization with compensation.

Life strain and psychological distress of older women and older men in Hong Kong

This study examined the life strain and psychological distress among a group of older adults (N = 1034, 51.2% female) in Hong Kong. Data were collected through individual interviews in which a standardized questionnaire was administered. The results indicated that older women had more somatic complaints and poorer self-rated health. Family network and interdependent relationships were significantly poorer among the older women than in the older men. Women were also found to experience a higher level of psychological distress (as measured by GDS-15 and GHQ-12) than did men. Perceived financial strain and poor physical health had similar direct effect on the psychological distress of both older women and older men. In contrast to Western findings, a poor family network was observed to exert a greater direct effect on psychological distress than an inadequate social network of friends. Generally, a good social network was found to mitigate the negative impact of life strain factors among older men, but not among older women.

Psychological distress in older adults with low functional independence: A multidimensional perspective

The objective of this study was to explore the relationships between psychological distress and sociodemographic, clinical and psychosocial variables in the elderly who experienced a loss in functional independence. A secondary analysis from the Quebec Longitudinal Study on Aging (QUELSA) database was conducted using 155 individuals aged 60 years and over with low functional independence. The dependent variable was psychological distress, measured with the Psychological Distress Index. Nine independent variables were tested through a multiple linear regression analysis: age, coping: self-control, coping: escape/avoidance, functional autonomy, actualization of potential, perceived social support, psychological autonomy, self-perceived health, and level of stress caused by the event. The final model included coping: escape/avoidance, functional autonomy, and perceived social support and explained 34.6% of the total variance in psychological distress. This model indicates that a person with high psychological distress uses more escape/avoidance strategies, is less functionally independent and perceives less social support. Although the model found in this study is not fully stable, the findings demonstrate the importance of integrating physical, psychological and social interventions to reduce or prevent psychological distress in older adults with low functional independence.

Correlates of suicide in the older adult population in Quebec

This study was undertaken to describe the characteristics of adults aged 60 years and over who committed suicide in Quebec in 1998-1999. In this study, 42.6% of the suicide cases presented mental disorders at the time of their death, mainly depression. Sixty-five (65.3%) percent of the suicide cases would have been considered as having a mental health disorder if sub-threshold depression cases were included. Only 27.7% of the cases did not express any idea of death during the 6-month period preceding their suicide. One interesting finding was that 53.5% of the suicide cases consulted a general practitioner or specialist during the 2-week period preceding their death. Our results showed that only 8.1% had a severe level of functional limitations at the time of their death. This result leads us to interpret with caution the conclusion of some studies suggesting that physical frailty is a major causal factor associated with suicide among the elderly.

Utilisation des anxiolytiques, sédatifs et hypnotiques chez les personnes âgées vivant dans la communauté : construction d’un cadre conceptuel

La consommation non appropriée d’anxiolytiques, de sédatifs et d’hypnotiques (ASH) chez les personnes âgées est un problème de santé publique important. Près de 35 % de la population âgée vivant à domicile consomment ces médicaments, en moyenne 206 jours par an. Selon les données québécoises, les personnes âgées de plus de 65 ans consomment cinq fois plus d’ASH que les individus âgés entre 18 et 64 ans. L’utilisation des ASH ne serait pas uniquement déterminée par la présence de symptômes, mais aussi par les caractéristiques psychosociales des sujets. En outre, plusieurs chercheurs ont suggéré que l’entourage et le système de soins étaient des facteurs environnementaux pouvant faciliter ou inhiber la consommation de ces médicaments chez les personnes âgées. Un cadre conceptuel est proposé pour aider à spécifier adéquatement les diverses hypothèses explicatives de ce comportement social de santé et, par conséquent, pour aider à mieux cibler les interventions visant à le modifier.