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Hannon K, Bijsterbosch J. Challenges in Identifying Individualized Brain Biomarkers of Late Life Depression. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2024; 5:e230010. [PMID: 38348374 PMCID: PMC10861244 DOI: 10.20900/agmr20230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Research into neuroimaging biomarkers for Late Life Depression (LLD) has identified neural correlates of LLD including increased white matter hyperintensities and reduced hippocampal volume. However, studies into neuroimaging biomarkers for LLD largely fail to converge. This lack of replicability is potentially due to challenges linked to construct variability, etiological heterogeneity, and experimental rigor. We discuss suggestions to help address these challenges, including improved construct standardization, increased sample sizes, multimodal approaches to parse heterogeneity, and the use of individualized analytical models.
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Affiliation(s)
- Kayla Hannon
- Department of Radiology, Washington University in St Louis, St Louis MO, 63110, USA
| | - Janine Bijsterbosch
- Department of Radiology, Washington University in St Louis, St Louis MO, 63110, USA
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Newmark J, Gebara MA, Aizenstein H, Karp JF. Engaging in Late-Life Mental Health Research: a Narrative Review of Challenges to Participation. ACTA ACUST UNITED AC 2020; 7:317-336. [PMID: 32837830 PMCID: PMC7242610 DOI: 10.1007/s40501-020-00217-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose of review This narrative review seeks to ascertain the challenges older patients face with participation in mental health clinical research studies and suggests creative strategies to minimize these obstacles. Recent findings Challenges to older adults’ engagement in mental health research include practical, institutional, and collaboration-related barriers applicable to all clinical trials as well as more personal, cultural, and age-related patient barriers specific to geriatric mental health research. Universal research challenges include (1) institutional barriers of lack of funding and researchers, inter-researcher conflict, and sampling bias; (2) collaboration-related barriers involving miscommunication and clinician concerns; and (3) practical patient barriers such as scheduling issues, financial constraints, and transportation difficulties. Challenges unique to geriatric mental health research include (1) personal barriers such as no perceived need for treatment, prior negative experience, and mistrust of mental health research; (2) cultural barriers involving stigma and lack of bilingual or culturally matched staff; and (3) chronic medical issues and concerns about capacity. Summary Proposed solutions to these barriers include increased programmatic focus on and funding of geriatric psychiatry research grants, meeting with clinical staff to clarify study protocols and eligibility criteria, and offering transportation for participants. To minimize stigma and mistrust of psychiatric research, studies should devise community outreach efforts, employ culturally competent bilingual staff, and provide patient and family education about the study and general information about promoting mental health.
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Affiliation(s)
- Jordyn Newmark
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA
| | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Bellefield Towers 726, Pittsburgh, PA 15213 USA.,Center for Interventions to Enhance Community Health, University of Pittsburgh, Pittsburgh, USA
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Hoell A, Weyerer S, Maier W, Wagner M, Scherer M, Stark A, Kaduszkiewicz H, Wiese B, König HH, Bock JO, Stein J, Riedel-Heller SG. The impact of depressive symptoms on utilization of home care by the elderly: Longitudinal results from the AgeMooDe study. J Affect Disord 2016; 204:247-54. [PMID: 27543722 DOI: 10.1016/j.jad.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/16/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression is the most common psychiatric disease in older people, often accompanied by co-morbidities and functional limitations. In cross-sectional studies, depression is associated with an increased use of health care resources, including informal care and home care. Longitudinal data are needed to better understand the causal links between depression, functional impairments, and health care utilization. METHODS Data were obtained at baseline and follow-up of the multicenter, prospective cohort study "Late life depression in primary care: needs, health care utilization and costs" (AgeMooDe). A sample of 955 primary care patients aged 75 years and older was interviewed twice. The primary outcomes were the average respective amounts of time spent utilizing home care, professional nursing care, domestic help and informal care. These outcomes were analyzed with Generalized Linear Mixed Models (GLMM). RESULTS GLMM analysis revealed that the amount of time utilizing home care over the study period was positively associated with depression, higher age, and functional and cognitive impairments, but negatively associated with living alone. In-depth analyses revealed that these associations were particularly obvious for the utilization of informal care. LIMITATIONS The generalizability of our findings may be limited due to use of a dimensional instrument to determine depressive symptoms. CONCLUSIONS Over the study period, the average amount of time receiving home care and especially informal care increased in the group of patients with depression only. People with depressive symptoms experience a growing number of functional limitations over time, increasing their dependency on others. Functional limitations, depression and dependency appear to form a vicious cycle.
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Affiliation(s)
- Andreas Hoell
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Michael Wagner
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Stark
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Medical Faculty, Kiel University, Kiel, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
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Peer volunteer perspectives following a complex social cognitive intervention: a qualitative investigation. Int Psychogeriatr 2016; 28:1545-54. [PMID: 26888653 DOI: 10.1017/s1041610216000144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Peer volunteers can be key to delivering effective social cognitive interventions due to increased potential for social modeling. We consulted peer volunteers who had just taken part in an 8-week social and nutritional mealtime intervention with older adults living alone, to seek their evaluation of the intervention. METHODS Semi-structured focus groups were used with a total of 21 volunteers (17 female) and two facilitators. Thematic analysis was used to interrogate the data. RESULTS Six themes (16 sub-themes) are discussed. Peer volunteers described the importance of the socializing aspect of the intervention, of pairing considerations and compatibility in peer interventions, of considering the needs of the participant, of benefits to the volunteers, and of the practical considerations of conducting an intervention. Volunteers also discussed considerations for future research and services for older adults living alone. CONCLUSIONS Volunteers found their involvement in the intervention to be personally beneficial, and revealed some valuable considerations for the researchers to take forward to future research. Results are pertinent to intervention design and could inform future social cognitive and other peer-oriented interventions for older adults living alone.
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Hultsch DF, MacDonald SW, Hunter MA, Maitland SB, Dixon RA. Sampling and generalisability in developmental research: Comparison of random and convenience samples of older adults. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2016. [DOI: 10.1080/01650250143000247] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Research in the developmental sciences is based largely on samples of convenience rather than samples drawn at random from the population. The important question of whether results observed in samples of convenience generalise to the larger population has not been studied directly. Because of demographic growth in the proportion of older adults in the population and increases in diversity across the lifespan, it is especially important to address this issue in aging adults. We compared the performance of older adults (65–100 years) on demographic and psychological measures for a random sample of community dwelling adults and two samples of convenience. Significant differences were observed on less than half the variables. When differences were present, participants in the convenience samples were advantaged compared to participants from the random sample. Differences were larger in some domains than others but remained small to moderate in magnitude. There were minimal differences in between-person variability and patterns of correlations among variables between the convenience and random samples. Results indicate the need for additional studies contrasting random and convenience samples to explore the parameters of external validity in psychological aging research.
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Piercy KW, Fauth EB, Norton MC, Pfister R, Corcoran CD, Rabins PV, Lyketsos C, Tschanz JT. Predictors of dementia caregiver depressive symptoms in a population: the Cache County dementia progression study. J Gerontol B Psychol Sci Soc Sci 2012; 68:921-6. [PMID: 23241850 DOI: 10.1093/geronb/gbs116] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Previous research has consistently reported elevated rates of depressive symptoms in dementia caregivers, but mostly with convenience samples. This study examined rates and correlates of depression at the baseline visit of a population sample of dementia caregivers (N = 256). METHOD Using a modified version of Williams (Williams, I. C. [2005]. Emotional health of black and white dementia caregivers: A contextual examination. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 60, P287-P295) ecological contextual model, we examined 5 contexts that have contributed to dementia caregiver depression. A series of linear regressions were performed to determine correlates of depression. RESULTS Rates of depressive symptoms were lower than those reported in most convenience studies. We found fewer depressive symptoms in caregivers with higher levels of education and larger social support networks, fewer health problems, greater likelihood of using problem-focused coping, and less likelihood of wishful thinking and with fewer behavioral disturbances in the persons with dementia. DISCUSSION These results suggest that depression may be less prevalent in populations of dementia caregivers than in clinic-based samples, but that the correlates of depression are similar for both population and convenience samples. Interventions targeting individuals with small support networks, emotion-focused coping styles, poorer health, low quality of life, and those caring for persons with higher numbers of behavioral problems need development and testing.
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Affiliation(s)
- Kathleen W Piercy
- Correspondence should be addressed to Kathleen Piercy, Department of Family, Consumer, and Human Development, 2905 Old Main Hill, Utah State University, Logan, UT 84322-2905. E-mail:
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Mamplekou E, Bountziouka V, Psaltopoulou T, Zeimbekis A, Tsakoundakis N, Papaerakleous N, Gotsis E, Metallinos G, Pounis G, Polychronopoulos E, Lionis C, Panagiotakos D. Urban environment, physical inactivity and unhealthy dietary habits correlate to depression among elderly living in eastern Mediterranean islands: the MEDIS (MEDiterranean ISlands Elderly) study. J Nutr Health Aging 2010; 14:449-55. [PMID: 20617287 DOI: 10.1007/s12603-010-0091-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS To evaluate factors associated with depression in elderly. METHODS During 2005-2007, 553 men and 637 women (aged 65 to 100 yrs) living in various Greek islands and in Cyprus participated in the study. The sampling was random and multistage (according to age sex distribution of the referent population). Depressive symptoms were evaluated using the Geriatric Depression Scale (GDS). RESULTS Twenty five per cent of men and 35% of women were classified in the highest GDS category (i.e. GDS score > 10), indicating intense depressive symptoms, while 54% of men and 70% of women scored above the depression cut-off (i.e. GDS score > 5) indicating mild-to-severe depressive symptoms. Among the investigated characteristics, living in urban environment, physical inactivity and history of hypertension were correlated with the presence of depressive symptoms (p < 0.05), after adjusting for various confounders. Moreover, the consumption of fish, vegetables and cereals is more prevalent among people with low or moderate depression (p < 0.05). CONCLUSIONS The prevalence of depression is quite high between elderly people living in Greek islands and Cyprus. Urban environment that may also interact with sedentarism and unhealthy dietary habits seems to promote depression in the studied population. Efforts to lower the prevalence of depression in the elderly should target on the aforementioned factors that employ functional impairment, social environment and dietary habits.
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Affiliation(s)
- E Mamplekou
- Department of Nutrition Science-Dietetics, Harokopio University, Athens, Greece
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Ridda I, MacIntyre CR, Lindley RI, Tan TC. Difficulties in recruiting older people in clinical trials: an examination of barriers and solutions. Vaccine 2009; 28:901-6. [PMID: 19944149 DOI: 10.1016/j.vaccine.2009.10.081] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 08/17/2009] [Accepted: 10/14/2009] [Indexed: 11/19/2022]
Abstract
Limited information exists regarding optimal methods for the recruitment and retention of older people in clinical trials. The aim of this review is to identify common barriers to the recruitment of older people in clinical trials and to propose solutions to overcome these barriers. A review of literature was performed to identify common difficulties in recruiting older people. This in combination with our experience during recruitment for a randomized control trial, have highlighted numerous barriers. Population-specific recruitment strategies, simple informed-consent processes, and effective communication between the researcher and subject are effective strategies to overcome these barriers.
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Affiliation(s)
- I Ridda
- National Centre for Immunisation Research and Surveillance Sydney, NSW, Australia.
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Pirkis J, Pfaff J, Williamson M, Tyson O, Stocks N, Goldney R, Draper B, Snowdon J, Lautenschlager N, Almeida OP. The community prevalence of depression in older Australians. J Affect Disord 2009; 115:54-61. [PMID: 18817976 DOI: 10.1016/j.jad.2008.08.014] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 08/22/2008] [Accepted: 08/22/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To estimate the prevalence of depression among older adults in Australia. METHOD All general practitioners in Australia's five most populous states who satisfied certain eligibility criteria (e.g., sufficient weekly working hours, sufficient numbers of elderly patients) were invited to participate. Those who consented were asked to identify all of their patients aged 60+ and invite them (either directly or via the study team) to complete a questionnaire. The questionnaire identified those who had experienced 'clinically significant depression' and those who had experienced a 'major depressive episode' in the past two weeks, via the Patient Health Questionnaire (PHQ-9). Consenting patients completed the questionnaire and returned it to the study team in a reply-paid envelope. RESULTS In total, 22,251 patients returned questionnaires. Overall, the age-adjusted rate of clinically significant depression was 8.2% (95%CI=7.8%-8.6%), with the age-adjusted rates for males being 8.6% (95%CI=7.9%-9.2%) and for females being 7.9% (95%CI=7.4%-8.4%). The overall, male and female age-adjusted rates for a major depressive episode were 1.8% (95%CI=1.6%-2.0%), 1.9% (95%CI=1.6%-2.2%) and 1.7% (95%CI=1.5%-2.0%), respectively. DISCUSSION Our study suggests that depression among older people is a major public health problem. The above estimates provide guidance for efficient planning of services, and establish a baseline against which preventive and treatment interventions can be assessed. Armed with this information, we can progress efforts at reducing this major health problem and its consequences.
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Affiliation(s)
- Jane Pirkis
- Centre for Health Policy, Programs and Economics, School of Population Health, University of Melbourne, Melbourne, Australia.
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Pfaff JJ, Draper BM, Pirkis JE, Stocks NP, Snowdon JA, Sim MG, Byrne GJ, Lautenschlager NT, Flicker LA, Kerse NM, Goldney RD, Almeida OP. Medical morbidity and severity of depression in a large primary care sample of older Australians: the DEPS‐GP project. Med J Aust 2009; 190:S75-80. [DOI: 10.5694/j.1326-5377.2009.tb02475.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 11/18/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Jon J Pfaff
- Western Australian Centre for Health and Ageing, Perth, WA
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA
| | - Brian M Draper
- School of Psychiatry, University of New South Wales, Sydney, NSW
| | - Jane E Pirkis
- School of Population Health, University of Melbourne, Melbourne, VIC
| | - Nigel P Stocks
- Discipline of General Practice, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, SA
| | - John A Snowdon
- Discipline of Psychological Medicine, University of Sydney, Sydney, NSW
| | - Moira G Sim
- School of Nursing, Midwifery and Postgraduate Medicine, Edith Cowan University, Perth, WA
| | - Gerard J Byrne
- Discipline of Psychiatry, School of Medicine, University of Queensland, Brisbane, QLD
| | - Nicola T Lautenschlager
- Western Australian Centre for Health and Ageing, Perth, WA
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA
- Academic Unit for Psychiatry of Old Age, St Vincent's Health, University of Melbourne, Melbourne, VIC
| | - Leon A Flicker
- Western Australian Centre for Health and Ageing, Perth, WA
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA
| | - Ngaire M Kerse
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, NZ
| | - Robert D Goldney
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA
| | - Osvaldo P Almeida
- Western Australian Centre for Health and Ageing, Perth, WA
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA
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van Goor H. [Selective loss of participants as a consequence of under-coverage and non-response in research among the aged: an overview]. Tijdschr Gerontol Geriatr 2009; 40:2-16. [PMID: 19326697 DOI: 10.1007/bf03088471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This article presents an overview of biases in studies among the aged as a consequence of under-coverage and non-response. The question studied is whether participants and non-participants in research differed in their socioeconomic status (education; income; SES of neighbourhood), social integration (marital status; living arrangements; social participation; ethnicity) and health (general health situation; mortality in the period after study; lifestyle and risk factors, namely obesity and alcohol abuse; contact with physicians). In all, 65 studies were reviewed. The results showed that research participants had a higher socioeconomic status, were more integrated socially and in better health than research non-participants. The differences (effect sizes) were small to moderate. On the basis of these results, we can conclude that univariate distributions and prevalence estimates as well as relationships between variables in published research will frequently be biased.
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Affiliation(s)
- H van Goor
- Vakgroep Sociologie, Faculteit Gedrags- en Maatschappijwetenschappen, Rijksuniversiteit Groningen, Groningen.
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Abstract
BACKGROUND Inadequate recognition of depression in old age in primary care and the consequences for individuals are now well reported, but little research has been undertaken on its impact on healthcare costs. It is not known whether these costs (i) differ between GP-recognized and -unrecognized depressed individuals, and (ii) differ between these groups and non-depressed individuals. METHODS 451 primary care patients aged 75+ were interviewed face-to-face regarding depressive symptoms (Geriatric Depression Scale), chronic medical illness (Chronic Disease Score), resource utilization and healthcare costs (questionnaire of service utilization and costs). A general practitioner (GP) questionnaire was used to measure GPs' recognition of depression. Resource utilization was valued in monetary terms using 2004/2005 prices. RESULTS Thirty-eight (60%) of the 63 depressed patients were not identified by the GPs. From a societal perspective, mean annual healthcare costs were euro 5,582 for unrecognized depressed and euro 4,722 for recognized depressed patients with no significant difference. Healthcare costs of recognized and unrecognized depressed exceeded the healthcare costs of non-depressed patients (euro 3,648) by 23% and 35% respectively (p < 0.05). CONCLUSION Although mean annual healthcare costs for GP-unrecognized depressed patients exceed the costs of GP-recognized depressed patients in absolute numbers, differences were not found to be statistically significant. Both groups differ from non-depressed individuals regarding their healthcare costs. Results encourage further research into the effect of recognition on healthcare costs of depression in large-scale studies.
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Subjective Quality-of-Life Predictors for Older Adults with Physical Disabilities. Am J Phys Med Rehabil 2008; 87:830-41. [DOI: 10.1097/phm.0b013e318186b5bd] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Shirley A. Thomas
- From the Division of Rehabilitation & Ageing (S.A.T.) and the Institute of Work, Health, & Organizations (N.B.L.), University of Nottingham, UK
| | - Nadina B. Lincoln
- From the Division of Rehabilitation & Ageing (S.A.T.) and the Institute of Work, Health, & Organizations (N.B.L.), University of Nottingham, UK
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Bjerkeset O, Nordahl HM, Larsson S, Dahl AA, Linaker O. A 4-year follow-up study of syndromal and sub-syndromal anxiety and depression symptoms in the general population: the HUNT study. Soc Psychiatry Psychiatr Epidemiol 2008; 43:192-9. [PMID: 18064394 DOI: 10.1007/s00127-007-0289-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Accepted: 11/05/2007] [Indexed: 12/27/2022]
Abstract
BACKGROUND Our aims were to examine the stability of self-rated anxiety and depression symptoms and the predictors for change in case-level status after 4 years in a general population sample. METHODS Prospective cohort study. Based on the total score on the Hospital Anxiety and Depression rating scale (HADS-T) in HUNT 2 (1995-1997), three groups were identified: Level 3 (n = 654, score >or= 25 points), Level 2 (n = 654, score 19-24 points), and Level 1 (n = 1,308, score < 19 points). The groups were followed up with a mailed questionnaire after 4 years. RESULTS Among the 1,326 (53% response rate) who participated in the follow-up, 816 (62%) had not changed symptom level. The number of participants that had crossed the HADS-T caseness level (19 points) was the same in both directions. In non-cases at baseline (Level 1), lack of friends (OR 2.34, 95% CI 1.28-4.27, P = 0.006) and previous episodes of depression (OR 2.90, 95% CI 1.76-4.78, P < 0.001) predicted HADS-T caseness at follow-up, while higher educational level (OR 0.66, 95% CI 0.46-0.96, P = 0.028) protected from developing caseness level of anxiety and depression. In HADS-T cases (Levels 2 and 3) at baseline, previous episode(s) of depression (OR 0.36, 95% CI 0.19-0.68, P = 0.002) and being unemployed (OR 0.58, 95% CI 0.34-1.00, P = 0.050) predicted HADS-T caseness at follow-up, whereas a higher educational level (OR 1.83, 95% CI 1.24-2.70, P = 0.002) was associated with remission from HADS-T caseness after 4 years. CONCLUSIONS Though symptom fluctuation was considerable, conventional HADS-T caseness (>or=19 points) was a reliable and valid predictor for high long-term symptom stability of anxiety and depression in our general population sample.
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Affiliation(s)
- Ottar Bjerkeset
- Dept. of Psychiatry, Levanger Hospital, Nord-Trøndelag Health Trust, 7600 Levanger, Norway.
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Luppa M, Heinrich S, Matschinger H, Sandholzer H, Angermeyer MC, König HH, Riedel-Heller SG. Direct costs associated with depression in old age in Germany. J Affect Disord 2008; 105:195-204. [PMID: 17568683 DOI: 10.1016/j.jad.2007.05.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 05/14/2007] [Accepted: 05/14/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression in old age is common. Only few studies, exclusively conducted in the USA, have examined the impact of depression on direct costs in the elderly (60+). This study aims to determine the effect of depression on direct costs of the advanced elderly in Germany from a societal perspective. METHODS 451 primary care patients aged 75+ were investigated face-to-face regarding depressive symptoms (Geriatric Depression Scale), chronic medical illness (Chronic Disease Score) and resource utilisation and costs (cost diary). Resource utilisation was monetarily valued using 2004/2005 prices. RESULTS Mean annual direct costs of the depressed (euro5241) exceeded mean costs of non-depressed individuals (euro3648) by one third (p<.01). Significant differences were found for pharmaceutical costs, costs for medical supply and dentures, and for home care. Only few costs were caused by depression treatment. Depression has a significant impact on direct costs after controlling for age, gender, education, chronic medical illness and cognitive functions. A one-point increase in the GDS-Score was associated with a euro336 increase in the annual direct costs. LIMITATIONS Reported costs can be considered as rather conservative estimates. There were no nursing home residents and no patients with dementia disorders in the sample. Furthermore, recall bias cannot be ruled out completely. CONCLUSION Depression in old age is associated with a significant increase of direct costs, even after adjustment for chronic medical illness. Future demographic changes in Germany will lead to an increase in the burden of old age depression. Therefore health policy should promote the development and use of cost-effective treatment strategies.
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Affiliation(s)
- Melanie Luppa
- Department of Psychiatry, University of Leipzig, Johannisallee 20, D-04317 Leipzig, Germany.
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Abstract
OBJECTIVE To offer an update on prevalence and predictors of old age depression in populations of elderly Caucasians. METHOD The databases MEDLINE and Psychinfo were searched and relevant literature from 1993 onwards was reviewed. RESULTS The prevalence of major depression ranges from 0.9% to 9.4% in private households, from 14% to 42% in institutional living, and from 1% to 16% among elderly living in private households or in institutions; and clinically relevant depressive symptom 'cases' in similar settings vary between 7.2% and 49%. The main predictors of depressive disorders and depressive symptom cases are: female gender, somatic illness, cognitive impairment, functional impairment, lack or loss of close social contacts, and a history of depression. CONCLUSION Depression is frequent in populations of elderly. Methodological differences between the studies hinder consistent conclusions about geographical and cross-cultural variations in prevalence and predictors of depression. Improved comparability will provide a basis for consistent conclusions.
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Affiliation(s)
- J K Djernes
- The Northern Jutland Psychiatry Unit, Department of Old Age Psychiatry, Brønderslev, Psychiatric Hospital, Brønderslev, Denmark.
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Horowitz A, Reinhardt JP, Boerner K. The effect of rehabilitation on depression among visually disabled older adults. Aging Ment Health 2005; 9:563-70. [PMID: 16214704 DOI: 10.1080/13607860500193500] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There has been a great deal of interest in identifying the impact of rehabilitation on psychological well-being, as well as functional ability, among elders with disabilities, but empirical data remain limited. This descriptive study of participants in vision rehabilitation service examines the effect of specific vision rehabilitation services (low vision clinical services, skills training, counseling, optical device use, and adaptive device use) on change in depression among a sample of older adults with age-related vision impairments. Participants (N = 95) were interviewed at application for services and then approximately two years later. Findings from hierarchical regression analyses indicated that low vision clinical services, counseling, and use of optical devices, in separate models, each significantly contributed to a decline in depression, after controlling for age, health status, vision status, functional disability, as well as baseline depression. When all service variables were entered into the same equation, they explained an additional 10% of the variance in change in depression. Given the well documented robust relationship between disability and depression, findings point to the influence of vision rehabilitation interventions on both physical and psychological functioning, and underscore the need for future, controlled research on rehabilitation service models that address mental health issues.
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Affiliation(s)
- A Horowitz
- Arlene R. Gordon Research Institute, Lighthouse International, New York, New York 10023, USA.
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Chouliara Z, Kearney N, Worth A, Stott D. Challenges in conducting research with hospitalized older people with cancer: drawing from the experience of an ongoing interview-based project. Eur J Cancer Care (Engl) 2004; 13:409-15. [PMID: 15606707 DOI: 10.1111/j.1365-2354.2004.00543.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Older people with cancer often face the prospect of cognitive and physical frailty, increased vulnerability of psychological distress and limited access to resources. These factors present ethical and methodological challenges for conducting research in such patients, especially interviews in acute care settings. This paper discusses these challenges using experiences from an ongoing research project. The project is a patient-focused study on the perceptions of older people with cancer regarding information provided to them, decision making and treatment. Interviews with patients aged 65 or over with a cancer diagnosis are conducted in two clinical settings, care of the elderly wards and a cancer centre whilst they are in-patients. Patients' cognitive and physical status are assessed using clinical measures, whereas socio-demographic and medical data are obtained from patient files. Ethical challenges, including procedures to obtain valid consent, as well as methodological choices, including recruitment procedures and patient conditions are presented and debated with reference to previous literature. Suggestions for future research with older people with cancer are made based both on current experience and previous literature.
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Affiliation(s)
- Z Chouliara
- Cancer Care Research Centre, Department of Nursing and Midwifery, University of Stirling, Stirling, UK.
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Nichols L, Martindale-Adams J, Burns R, Coon D, Ory M, Mahoney D, Tarlow B, Burgio L, Gallagher-Thompson D, Guy D, Arguelles T, Winter L. Social marketing as a framework for recruitment: illustrations from the REACH study. J Aging Health 2004; 16:157S-76S. [PMID: 15448292 PMCID: PMC2579268 DOI: 10.1177/0898264304269727] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recruitment is often the most challenging aspect of research with older persons. Social marketing--applying marketing techniques to influence the behavior of target audiences to improve their welfare--can help researchers identify factors that influence recruitment. METHODS Illustrations of social marketing principles are provided from the Resources for Enhancing Alzheimer's Caregiver Health project, a national Alzheimer's caregivers study that targeted ethnic and racial minorities. RESULTS Social marketing principles--the six Ps of participants, product, price, place, promotion, and partners--provide a theoretical framework for organizing and planning recruitment activities, including developing varying strategies to define the target audience (participants), develop the intervention (product), manage time and trouble (price), target the audience, improve accessibility (place), promote the study, and develop and work with partners. DISCUSSION Strategies to enhance recruitment are often undertaken without a comprehensive plan. A social marketing plan provides a framework to map out the steps in recruitment that will be needed and to plan for allocations of time, staff, and resources.
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Affiliation(s)
- Linda Nichols
- Memphis VA Medical Center, 1030 Jefferson Avenue, Memphis, TN 38104 and University of Tennessee Health Science Center, USA
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Speer DC, Schneider MG. Mental health needs of older adults and primary care: Opportunity for interdisciplinary geriatric team practice. ACTA ACUST UNITED AC 2003. [DOI: 10.1093/clipsy.10.1.85] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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der Wiel ABV, van Exel E, de Craen AJM, Gussekloo J, Lagaay AM, Knook DL, Westendorp RGJ. A high response is not essential to prevent selection bias: results from the Leiden 85-plus study. J Clin Epidemiol 2002; 55:1119-25. [PMID: 12507676 DOI: 10.1016/s0895-4356(02)00505-x] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We tested the hypothesis that an additional effort to increase the response rate would diminish selection bias in a community-based cohort study. In the Leiden 85-plus Study, all subjects of the town of Leiden who had reached their 85th birthday were informed of the study by mail and then asked to participate by telephone. In an additional recruitment stage, those subjects who did not participate directly were visited and personally asked to participate. When these subjects refused, some nonresponse questions were asked. In this way we collected data on the whole source population. Of 691 eligible elderly subjects, 511 subjects (74%) participated directly. Of those who did not participate directly, 88 subjects participated after the additional effort. The response rate increased from 74% to 87%. Compared to the 511 subjects who directly participated, the 88 subjects who entered the study after the additional effort had poorer health and lower survival. The subjects who refused were more healthy and had poorer mood. The direct sample did not differ from the source population with respect to socio-demographics, health, and mortality. In conclusion, we showed that given a moderately high direct response the additional effort was effective in increasing the response rate, but was also selective and was not necessary to prevent selection bias.
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Affiliation(s)
- A Bootsma-van der Wiel
- Leiden 85-plus Study, Leiden University Medical Center, C2-R Gerontology and Geriatrics, Department of Internal Medicine, P.O. Box 9600, The Netherlands
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Ory MG, Lipman PD, Karlen PL, Gerety MB, Stevens VJ, Singh MAF, Buchner DM, Schechtman KB. Recruitment of older participants in frailty/injury prevention studies. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2002; 3:1-22. [PMID: 12002555 DOI: 10.1023/a:1014610325059] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Despite the lifelong health benefits of physical activity, frailer older adults have typically been excluded from studies promoting more active lifestyles. This study documents the recruitment process and costs from a multisite study to identify effective strategies for recruiting older adults in frailty/injury prevention research. Randomized controlled clinical trials were conducted at 7 sites; an 8th site was a compliance study. Interventions reflected center- and home-based health promotion programs. Site objectives, eligibility criteria, and contact and screening methods were obtained from manuals of operation. Recruitment results (number screened, eligibility rates, randomized to screened ratios) were ascertained from recruitment data. Sites furnished estimated recruitment costs (nonlabor expenses, investigator and staff time, fringe benefits) up to signing the consent form. The sites targeted diverse populations and sample sizes. The majority revised recruitment methods to meet their recruitment goals. Most sites estimated costs of recruitment at over $300 per participant randomized. Recruitment costs were affected by staff time spent alleviating concerns about participants' health, essential interactions with family members, and arranging for transportation. Neither frailty nor intervention intensity was found to be a major predictor of recruitment outcomes. Recruitment expense was associated with selection criteria and frailty status of the target population. Older people can be successfully recruited into beneficial health promotion programs, but it is often challenging. In planning health promotion studies, investigators need to be aware of the numbers of older people they may need to screen and different strategies for increasing recruitment success.
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Affiliation(s)
- Marcia G Ory
- Behavioral and Social Research Program, National Institute on Aging, Bethesda, Maryland, USA
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Neumark DE, Stommel M, Given CW, Given BA. Research design and subject characteristics predicting nonparticipation in a panel survey of older families with cancer. Nurs Res 2001; 50:363-8. [PMID: 11725938 DOI: 10.1097/00006199-200111000-00006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND While recognized that loss of subjects over time may introduce bias and complicate statistical analysis in panel studies, it is seldom acknowledged that sampling bias starts with subjects who are eligible but do not participate. OBJECTIVES Community-based recruiters identified 1,948 subjects as eligible to participate in a descriptive panel survey of older families with cancer. Focusing on the time between identification of eligible subjects until contact for the first interview for consenting subjects, the purpose of this study was to determine if subject or research design factors predicted who was more prone to nonparticipation. METHOD A multivariate model explored the simultaneous effects of subject and research design characteristics on nonparticipation. Demographic and cancer characteristics, as well as features of the study protocol, were used as predictors in a multinomial logit regression model to enable a three-way comparison between nonconsenters (n = 748), consenters who dropped out prior to data collection (n = 208), and consenters who participated in the intake interview (n = 992). RESULTS Age and cancer diagnosis played roles in whether consent was obtained, whereas race did not affect consent but raised odds of drop out after consent. Powerful evidence emerged that design features, such as if a caregiver participated, recruitment staff roles, and payment to recruiters, affected the probability of subjects not participating or dropping out before being interviewed. CONCLUSIONS Findings suggest that both subject and research design characteristics affect the likelihood of nonparticipation in a panel study of older cancer patients and family caregivers. Future research involving testing of strategies addressing access and accrual issues, research staff roles, reimbursements, and responsiveness to the needs of research personnel, ill participants, and family members is warranted.
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Affiliation(s)
- D E Neumark
- Department of Family and Child Ecology, College of Human Ecology, Michigan State University, East Lansing, USA.
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Abstract
BACKGROUND Late-life bipolar II depression has not been well studied. The aim of the present study was to find the prevalence of late-life (50 years or more) bipolar II depression among unipolar and bipolar depressed outpatients, and to compare it with bipolar II depression in younger patients, looking for differences supporting the subtyping of bipolar II depression according to age at onset. METHODS Consecutive 525 patients presenting for treatment of a major depressive episode were interviewed with the Structured Clinical Interview for DSM-IV, the Montgomery Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale. RESULTS Among patients less than 50 years, 53.4% had bipolar II depression. Among patients 50 years or more, 32.9% had bipolar II depression (significant difference). Atypical features were present in 60.9% of bipolar II patients less than 50 years, and in 26.1% of those 50 years or more (significant difference). Bipolar II patients 50 years or more had significantly higher age at onset than those less than 50 years. Bipolar II and unipolar patients 50 years or more were not significantly different, apart from comorbidity. Bipolar II patients less than 50 years had significantly more atypical features than unipolar ones. LIMITATIONS Single interviewer, single nonblind assessment, cross-sectional assessment, exclusion of substance abuse and severe personality disorder patients, comorbidity not systematically assessed, modification of DSM-IV duration criterion for hypomania. CONCLUSIONS Findings suggest that bipolar II depression and atypical features are less common in late life. Differences in age at onset and atypical features support the subtyping of bipolar II depression according to age at onset.
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Affiliation(s)
- F Benazzi
- Department of Psychiatry, Public Hospital Morgagni, 47100 Forlì, Italy.
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Jeffe DB, Binder EF, Williams DB, Kohrt WM. Frail older women's participation in a trial of hormone replacement therapy: perceived benefits and concerns. Menopause 2001; 8:127-34. [PMID: 11256873 DOI: 10.1097/00042192-200103000-00008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify the reasons that were important to frail older women's decisions to participate or not participate in a clinical trial of hormone replacement therapy (HRT). DESIGN We conducted a cross-sectional study of a community-based sample of physically frail women > or = 75 years old, who were recruited to participate in an intervention trial of HRT. Participants were randomized 2:1 to either HRT or placebo, respectively. Questionnaires measured participants' reasons for participation and nonparticipants' reasons for declining. Five-point scaled responses to questionnaire items ranged from least to most important or least to most concerned. RESULTS Sixty-nine women participated (84% white, 16% African American) in the trial. Nonparticipants (n = 41) were older, on average, than participants (83.8+/-4.2 vs. 82.2+/-3.6 years; p = 0.04). Important reasons for participation were reducing risk for Alzheimer's disease and osteoporosis, having more energy, improving self-care ability, and benefiting other women. Fear of cancer from postmenopausal estrogen was the predominant concern of 46% of nonparticipants and 78% of participants (p = 0.08). Recommendation against participation or use of estrogen by a woman's personal physician was the most prevalent additional reason given for nonparticipation. CONCLUSIONS Disease prevention and improving self-care abilities were most important to participants. Fear of cancer was not a greater concern for nonparticipants than for participants. The role of the physician in older women's decision-making about use of postmenopausal estrogen seems to be important.
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Affiliation(s)
- D B Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63108, USA
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Abstract
OBJECTIVES This study examined the cost and outcomes associated with multiple recruitment strategies used to enroll participants in an Alzheimer's disease (AD) caregiver study. METHODS Recruitment data were collected as part of an AD caregiving intervention study and examined for number of referrals and participants, yield, personnel cost, materials cost, total cost, and cost per participant. RESULTS Recruitment rates varied by method implemented and referral source. Overall, 100 participants were enrolled for a total cost of $10,127, yielding an average per participant cost of $101.00. The Formal Recruitment Method, used at agencies with large participant pools, emerged as the most cost-effective strategy. DISCUSSION Recruitment costs varied greatly, depending on the referral sites and their available pool of participants. Substantial time, money, and personnel need to be budgeted for recruitment efforts given the expected costs, the competing pressures in the health care region, and the variability of participant response.
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Affiliation(s)
- B A Tarlow
- Research and Training Institute, Hebrew Rehabilitation Center for Aged, Boston, MA, USA
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Riedel-Heller SG, Schork A, Matschinger H, Angermeyer MC. Recruitment procedures and their impact on the prevalence of dementia. Results from the Leipzig Longitudinal Study of the Aged (LEILA75+). Neuroepidemiology 2000; 19:130-40. [PMID: 10705231 DOI: 10.1159/000026248] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Recruitment procedures may exert a considerable influence on the outcome of health surveys in the elderly. Their impact on the prevalence of dementia will be measured in an epidemiological field study in a sample of 1,692 randomly selected individuals (75+). Face-to-face interviews were conducted using SIDAM (structured interview for the diagnosis of dementia of Alzheimer type, multi-infarct dementia and dementias of other etiology according to ICD-10 and DSM-III-R). Furthermore, proxy interviews were performed with relatives of fragile and functionally dependent individuals. Considering face- to-face interviews of community-dwelling individuals, a prevalence of moderate and severe dementia of 5.3% was found. When including information on respondents by proxy and institutionalized individuals, the prevalence rate increased to 6.3 and 10.5%, respectively. It will be argued that covering the whole population in question and ensuring high response rates are central issues to minimize selection bias.
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Abstract
OBJECTIVE Aims of the study were to find the prevalence of chronic depression in elderly patients compared with younger patients, and to compare chronic depression between elderly and younger patients, to find if there were clinical differences. A major feature of the study was the inclusion of a large number of bipolar II patients, usually not included in previous studies. METHODS Three hundred and ninety-nine consecutive unipolar (N=200) and bipolar II (N=199) depression outpatients were interviewed with the Structured Clinical Interview for DSM-IV and depression rating scales in a private practice. RESULTS Chronic depression was more common in elderly patients than in younger patients (53.6% vs 40.1%, p=0.0299). Late-life chronic depression patients had later age at onset, longer duration of illness, fewer bipolar II cases, more unipolar cases and more relapses than younger chronic depression patients. CONCLUSIONS Results suggest that late-life depression is more likely to be chronic than depression in younger patients. The subtyping of chronic depression according to age seems supported by a different age at onset and some clinical differences.
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Affiliation(s)
- F Benazzi
- Department of Psychiatry, National Health Service, Public Hospital 'Morgagni', Forlì, Italy.
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Speer DC, Kennedy M, Watson M, Meah J, Nichols J, Watson B. Ethnic, demographic, and social differences among middle and older adults with HIV/AIDS. AIDS Patient Care STDS 1999; 13:615-24. [PMID: 19555274 DOI: 10.1089/apc.1999.13.615] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although the prevalence of AIDS among middle and older adults is increasing, little is known about them. The objective of this study was to obtain basic demographic and social information about people with HIV/AIDS (PWAs) over the age of 44 years. This was a descriptive, cross-sectional survey of convenience samples of 76 African-American (AA) and 80 White older PWAs. Participants were interviewed by trained peer interviewers using a structured and largely objective schedule. Participants and interviewers were each paid $35 per completed interview. The schedule consisted of wide-ranging demographic, HIV/AIDS, stressor, coping, social, and support questions. Although both ethnic groups had incomes significantly below national norms and poverty rates three times their national rates, AA PWAs were markedly disadvanted socioeconomically relative to White PWAs. Although over 60% of all PWAs reported that having enough money to live on was a problem, AAs also reported significantly more Stressors, many related to economics, then White PWAs. AA PWAs reported being predominantly heterosexual, while the largest group of Whites was homosexual or bisexual. Sources of infection paralleled sexual orientation. Both groups used relatively effective coping strategies and reported moderate levels of social support and activity. It was concluded that the course of illness, treatment, and quality of life of middle and older PWAs are likely to be complicated by economic factors, and this will be particularly serious among AA PWAs.
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Affiliation(s)
- D C Speer
- Louis de la Parte Florida Mental Health Institute Department of Aging and Mental HealthUniversity of South Florida13301 Bruce B. Downs BlvdTampa, FL, USA.
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Sandberg JG, Harper JM. Depression in mature marriages: impact and implications for marital therapy. JOURNAL OF MARITAL AND FAMILY THERAPY 1999; 25:393-406. [PMID: 10405923 DOI: 10.1111/j.1752-0606.1999.tb00256.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Recent reviews of MFT literature have shown a failure to address mental health issues of the aging. Chief among these issues is depression, one of the most common psychological disorders found in older people. Although the relationship between depression and aging is a well-researched topic, few studies approach this common problem from a systemic perspective. Using data from a national survey of preretirement- and retirement-aged couples, this paper discusses the association between depression and marital quality in mature marriages as well the possibility of mediating variables such as the personality construct hardiness. Implications for marital therapy with older couples experiencing depression and future research are discussed.
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Affiliation(s)
- J G Sandberg
- MFT Programs, Syracuse University, NY 13244-1250, USA
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Recruitment Methods for Intervention Research in Bereavement-Related Depression: Five Years' Experience. THE AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY 1998. [DOI: 10.1097/00019442-199802000-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE To establish the prevalence of late-life depression in unipolar/bipolar depressed outpatients in private practice, to compare it with depression in younger patients and to compare its early/late-onset subtypes. METHODS Two hundred and three consecutive unipolar/bipolar depressed outpatients presenting for treatment of depression were interviewed with the Comprehensive Assessment of Symptoms and History structured interview and depression severity was assessed with the Montgomery and Asberg Depression Rating Scale and the Global Assessment of Functioning Scale. RESULTS Prevalence was 21%. Late-life depression had significantly more unipolar/fewer bipolar patients, higher age at onset, longer duration of illness and lower psychiatric comorbidity than depression in younger patients. Severity, psychosis, chronicity and recurrences were not significantly different. Early-onset late-life depression had significantly lower age at baseline, longer duration of illness and more recurrences than late-life depression. CONCLUSIONS Findings support suggested age subdivisions of depression and provide a picture of private practice late-life depression.
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Affiliation(s)
- F Benazzi
- Department of Psychiatry, Public Hospital Morgagni, Forli, Italy.
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Cronan TA, Durkin KA, Groessl E, Tomita M. Health care costs for volunteers and non-volunteers in an intervention for people with osteoarthritis. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1997; 10:36-42. [PMID: 9313388 DOI: 10.1002/art.1790100106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine whether older people who volunteered for a health intervention study used the health care system differently from a randomly selected group of eligible non-volunteers. METHODS Three hundred sixty-three volunteers and 92 non-volunteers were compared; both groups were members of a large health maintenance organization (HMO). RESULTS Volunteers were more educated and had been members of the HMO longer. Volunteers used the health care system significantly more at all time periods, but their cost per contact was significantly lower than that for non-volunteers. Non-volunteers were more likely to have a comorbid condition and had fewer arthritis-related health care contacts. CONCLUSIONS There will always be problems in generalizing results of studies with volunteers, but volunteers are, nevertheless, the most appropriate controls if the experimental participants are also volunteers. Designs should ideally include both volunteer and non-volunteer controls.
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Affiliation(s)
- T A Cronan
- Department of Psychology, San Diego State University, CA 92182-4611, USA
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Thomas MR, Stoyva J, Rosenberg SA, Kassner C, Fryer GE, Giese AA, Dubovsky SL. Selection bias in an inpatient outcomes monitoring project. Gen Hosp Psychiatry 1997; 19:56-61. [PMID: 9034813 DOI: 10.1016/s0163-8343(96)00118-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Managed care organizations increasingly tout clinical outcomes assessment as the mechanism by which we will ensure quality and compare providers. The authors report on their experience with a multisite inpatient outcomes monitoring project by comparing patients who accepted (N = 51), refused (N = 36), or were not asked (N = 110) to participate in the project. The patients who were asked to participate had significantly longer inpatient stays compared with the unasked group (11.2 vs 6.9 days). Patients who agreed to participate in the project were more likely to have a bipolar (43.1% vs 19.2%) or any affective disorder (94.1% vs 79.5%), and less likely to have a schizophrenic disorder (2.0% vs 11.6%) than the refused and unasked groups. The project participants also had higher 90-day readmit rates (27.5% vs 9.6%), more readmissions (0.51 vs 0.16), and more education (14.59 vs 13.51 years) than nonparticipating patients. In this preliminary study, patient-related variables were found to influence who the staff asked and who consented to participate in this clinical outcomes monitoring project. The authors distinguish clinical outcomes monitoring from treatment effectiveness research and discuss the need to develop methodologies that deal with nonrepresentative patient sampling and intersite variability in recruitment practices.
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Affiliation(s)
- M R Thomas
- Department of Psychiatry, Colorado Psychiatric Hospital, UCHSC, Denver 80220, USA
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Heun R, Hardt J, Müller H, Maier W. Selection bias during recruitment of elderly subjects from the general population for psychiatric interviews. Eur Arch Psychiatry Clin Neurosci 1997; 247:87-92. [PMID: 9177954 DOI: 10.1007/bf02900198] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of the present study was to determine and assess a possible selection bias in an epidemiologic investigation in the elderly. A stratified sample of 1305 probands aged 60-99 years was initially contacted by mail and then by telephone to obtain their consent to participate in a psychiatric interview. A liberal recruitment procedure led to interview participation of only 291 subjects. The proportion of younger, male, and married subjects participating in the study was greater than that of elderly, female, and single or widowed subjects. Subjects without a psychiatric lifetime diagnosis were more cooperative than those with a psychiatric disorder. The latter finding demonstrates the need to determine and assess the selection bias in psychiatric epidemiologic studies in elderly subjects.
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Affiliation(s)
- R Heun
- Department of Psychiatry, University of Mainz, Germany
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Slater SL, Katz IR. Prevalence of depression in the aged: formal calculations versus clinical facts. J Am Geriatr Soc 1995; 43:78-9. [PMID: 7806747 DOI: 10.1111/j.1532-5415.1995.tb06248.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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