Depression in older patients: recognition and treatment

Low tongue pressure and depression using Kihon Checklist for assessing frailty status among community-dwelling Japanese older adults: A pilot study

BACKGROUND

Evaluation of low tongue pressure is used to diagnose oral hypofunction. The pathophysiology of oral hypofunction is hypothesized to be associated with oral dysfunction related to ageing. Depression in older adults is a major problem and is related to handgrip strength, which is related to tongue pressure. We hypothesized that low tongue pressure could indicate depression mood in community-dwelling older adults.

OBJECTIVES

This study aimed to measure maximum tongue pressure and compare it to the responses to the Kihon Checklist (KCL), which is used to check mental and physical deterioration of community-dwelling older adults.

METHODS

A total of 49 community-dwelling independent older adults with stable dental condition (23 men, 26 women; median age, 79 years) answered the KCL, which contained questions on frailty status, cognitive function, nutritional and sarcopenia status. Oral function was measured to assess oral hypofunction. The relationship between tongue pressure differences and frailty status, cognitive function, nutritional and sarcopenia status was analysed using logistic regression analyses after adjusting for age and sex.

RESULTS

Nine participants (6 men and 3 women; median age, 81 years) had a tongue pressure <23.0 kPa, which was the lowest limit of the standard value of maximum tongue pressure in patients aged ≥70 years. Logistic regression analyses showed that only Question 21, which is related to a lack of fulfilment in daily life, was significantly associated with low tongue pressure (p = .027).

CONCLUSION

Low tongue pressure may be associated with sociopsychological factors in older adults.

'It was the deepest level of companionship': peer-to-peer experience of supporting community-dwelling older people with depression - a qualitative study

BACKGROUND

There is an ample body of literature examining the experiences and outcomes of peer support services for mental health recovery in western countries. However, formal peer support is only recently adapted and piloted to alleviate depression among older people, and little is known about how the peer-to-peer model might be lived out in the older Chinese population. This qualitative study investigated peer supporters' (PS) perspectives of their roles and experiences of rendering formal peer support to community-dwelling older adults at risk of or living with depression in Hong Kong.

METHODS

The study adopted a qualitative design. Five semi-structured focus groups were conducted with 27 trained peer supporters between ages 54-74 (21 females and 6 males) who had provided peer-to-peer support to older adults at risk of or living with depression in the community for at least 12 months. Thematic analysis was employed to derive content and meanings from the focus group transcripts.

RESULTS

Participants' mean age was 61.9 years; two-thirds of them were retired and the rest still engaged in part-time or full-time employment. Four themes were identified in relations to the roles and experiences in rendering the peer support services: (1) peerness in health and age-related lived experiences; (2) companionship, social and emotional ties beyond formal support; (3) meaningful roles to facilitate older people's functional ability; and (4) hopes and actions against the undesirable outcomes of aging. Being a PS might provide meaningful roles for persons in transition to or living in late adulthood, and enable community-dwelling older adults with depression to maintain functional ability. On the other hand, defining the concept of 'peer' beyond the shared experience of mental distress, ensuring a healthy boundary between the peers and the service users, maintaining a careful balance between time-limited formal support and stable social ties, and providing self-management training and on-going support appear crucial.

CONCLUSIONS

This study of PS' perspectives and experiences offer insights into the age-specific dimension of the peer relationship. Despite the promising effects it might offer, careful implementation of peer support among older adults is warranted to safeguard against the ensuing loss of meaningful social ties and the potential emotional distress.

Correlation between Handgrip Strength and Depression in Older Adults-A Systematic Review and a Meta-Analysis

Background: Depression remains an important health problem among older adults and it may be correlated with the deterioration of physical fitness, whose chief indicator is hand grip strength (HGS). The aim of the study was to investigate the relationship between depression and HGS among older populations using the available literature. Methods: PubMed, Web of Science and Science Direct databases were searched. The inclusion criteria were as follows: written in English and published after 2009, subject age: ≥60 years, HGS measured using a hand dynamometer, assessment of the depressive symptoms using a validated tool. The following articles were excluded: studies conducted among institutionalized subjects and/or populations with a specific disease. Results: The total combined effect of 33 results presented in 16 studies included in the meta-analysis, converted to the correlation coefficient, was OEr = −0.148 (SE = 0.030, 95%CI: −0.206–−0.091), indicating a weak, negative correlation between HGS and depressive symptoms. Conclusions: The review of the literature and the meta-analysis demonstrated a relationship between low muscle strength and intensified depressive symptoms in older populations. Bearing in mind that depression is often unrecognized or underdiagnosed among older patients, lowered muscle strength should be an important sign for physicians and an incentive to screen them for depression.

Developing a cardiology-oncology clinical practice guideline

Clinical Practice Guidelines (CPG) have become an increasingly common method to assist practitioner and patient decisions about health care for specific medical problems. CPGs generally address a single medical diagnosis or syndrome leaving practitioners and patients with little guidance when two major medical diagnoses exist such as in the case of heart disease and cancer. As cancer and heart disease are both diseases of the elderly and share many common risk factors it is likely they will coexist in many patients. Thus screening for and preventing and treating heart disease in the cancer patient assumes increasing importance as aggressive cancer therapies are applied to older patients and as a growing number of cardiovascular side effects of anti-cancer therapy are described. Careful evaluation of heart disease in the cancer patient will likely improve quality of life but may also improve mortality as the presence or development of heart disease may significantly limit life-saving cancer therapies. The rationale, potential problems, and important steps in developing a cardiology-oncology guideline are discussed.

A systematic review of depression in adults with heart failure: instruments and incidence

Heart failure (HF) is a life-threatening condition affecting 2.5% of Americans. Depression is reported to be present in 9.5% of the general population, but its incidence is higher in individuals with HF. The aims of this systematic review of older adults with HF were to examine the literature to: (1) identify instruments used to evaluate depression/depressive symptoms; and (2) determine the incidence of depression/depressive symptoms reported. Sixteen articles met inclusion criteria. Six self-reporting screening instruments and two diagnostic-interviews for depression were identified. Depression/depressive symptoms were reported in 14-60% of adults with HF. Use of screening instruments resulted in higher frequencies of depression/depressive symptoms (21-60%) than did diagnostic interviews (14-39%). Screening instruments established prior to the 1987 diagnostic guidelines may not reflect the current definition of depression. Depression screening instruments appear to overestimate the incidence of depression in older adults with heart failure. A complete diagnostic interview for depression should be performed prior to the treatment of older adults with HF.