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Lu Y, Murakami Y, Nishi D, Tsuji I. Association between psychological distress and disability-free life expectancy in the older Japanese adults. J Affect Disord 2023; 337:195-201. [PMID: 37263359 DOI: 10.1016/j.jad.2023.05.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Our study aimed to investigate the association between psychological distress and disability-free life expectancy (DFLE). METHODS In 2006, a cohort study was conducted of 12,365 Japanese individuals aged ≥65 years, who were followed-up for 13 years. Psychological distress was measured using the Kessler 6-item psychological distress scale and was categorized into no (0-4), mild (5-9), moderate (10-12), and serious distress (13-24). The number of participants was 1277 (22.4 %) for mild distress, 330 (5.8 %) for moderate, and 208 (3.6 %) for serious in men, and was 1635 (24.6 %), 467 (7.0 %), and 384 (5.8 %) in women. Sex-specific DFLE was defined as the mean years a person could expect to live without disability and calculated by Interpolated Markov Chain (IMaCh) software. RESULTS Compared to no distress, DFLE loss per person was 1.21, 2.61, and 4.43 years for mild, moderate, and serious distress respectively in men. At population level, DFEL loss (i.e., DFLE loss per person×number of participants) was 1545.17, 861.30, and 921.44 years for mild, moderate, and serious distress respectively in men. Accordingly, 46.4 % of the total DFLE loss was attributable to mild distress, 25.9 % to moderate, and 27.7 % to serious in men. Similarly, the results were 42.2 %, 25.4 %, and 32.4 % in women. LIMITATIONS Psychological distress was measured only once at baseline, and 2409 participants were excluded from the analysis because of missing data on exposure. CONCLUSIONS At population level, almost half of the total DFLE loss could be attributable to mild distress, underscoring the importance of population strategy for all levels of distress in promoting healthy aging.
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Affiliation(s)
- Yukai Lu
- Division of Epidemiology, Department of Health Informatics and Public Health, School of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshitaka Murakami
- Department of Medical Statistics, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Health Informatics and Public Health, School of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Gao W, Dai P, Wang Y, Zhang Y. Associations of walking impairment with visual impairment, depression, and cognitive function in U.S. older adults: NHANES 2013-2014. BMC Geriatr 2022; 22:487. [PMID: 35668382 PMCID: PMC9169344 DOI: 10.1186/s12877-022-03189-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Walking impairment, a common health problem among older adults, has been linked to poor vision and mental health. This study aimed to investigate the associations of walking impairment with visual impairment, depression, and cognitive function in older adults. METHODS A total of 1,489 adults aged 60 years and older who had participated in the National Health and Examination Survey (NHANES) 2013-2014 in the United States were included. Multivariate logistic regression models were used to examine the associations of walking impairment with visual impairment, depression, and four subdomains of cognitive function. Sample weights were used to ensure the generalizability of the results. RESULTS Among all the participants (median age = 68 years; 53.7% women), 17.5% reported walking impairment. Walking impairment was significantly associated with visual impairment (adjusted odds ratio [aOR] = 2.76; 95% CI: 1.47-5.20) and depression (aOR = 4.66; 95% CI: 3.11-6.99). Walking impairment was only associated with the Digit Symbol Substitution (DSST) subdomain of cognitive function in total participants (aOR = 0.97; 95% CI: 0.95-0.99) and in non-Hispanic white adults (aOR = 0.96; 95% CI: 0.94-0.98). Participants with two or three impairment indicators had a higher OR of walking impairment (aOR = 3.64, 95% CI = 2.46-5.38) than those with 0-1 (reference group) impairment indicator. CONCLUSIONS Walking impairment was associated with visual impairment, depression, and cognitive impairment in American older adults and also positively associated with the number of impairment indicators. The association between walking impairment and cognitive impairment varied according to race. Evaluations of vision, cognition, and depression should be conducted among older adults with walking impairment, and the needs of older adults should be provided in the evaluations alongside information on the biological aspects of their particular race.
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Affiliation(s)
- Wei Gao
- Department of Ophthalmology, Xi'an People's Hospital (Xi'an Fourth Hospital), 21 Jiefang Road, Xi'an, Shaanxi, 710061, China.
| | - Pengfei Dai
- Department of Ophthalmology, Xi’an People’s Hospital (Xi’an Fourth Hospital), 21 Jiefang Road, Xi’an, Shaanxi 710061 China
| | - Yuqian Wang
- Department of Ophthalmology, Xi’an People’s Hospital (Xi’an Fourth Hospital), 21 Jiefang Road, Xi’an, Shaanxi 710061 China
| | - Yurong Zhang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, China.
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Yahirun J, Sheehan C, Mossakowski K. Black-White Differences in the Link Between Offspring College Attainment and Parents' Depressive Symptom Trajectories. Res Aging 2022; 44:123-135. [PMID: 33678079 PMCID: PMC8423861 DOI: 10.1177/0164027521997999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines whether the relationship between children's college attainment and their parents' mental health differs for Black and White parents as they age. Data come from the U.S. Health and Retirement Study (HRS) and multilevel growth curve models are used to assess parents' depressive symptom trajectories. Results indicated that parents over age 50 whose children all completed college had significantly lower initial levels of depressive symptoms than those with no college-educated children. The initial benefit was stronger for Blacks than Whites. Results stratified further by parents' education show that Black parents at nearly all levels of schooling experienced stronger returns to their mental health from children's college completion compared to White parents, for whom only those with a high school education showed an inverse association between offspring education and depression symptoms. The findings underscore how offspring education is a potential resource for reducing disparities in health across families.
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Affiliation(s)
- Jenjira Yahirun
- Department of Sociology, 1888Bowling Green State University, Bowling Green, OH, USA
| | - Connor Sheehan
- Sanford School of Social and Family Dynamics, 7864Arizona State University, Phoenix, AZ, USA
| | - Krysia Mossakowski
- Department of Sociology, 3949University of Hawaii at Manoa, Honolulu, HI, USA
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Lourida I, Bennett HQ, Beyer F, Kingston A, Jagger C. The impact of long-term conditions on disability-free life expectancy: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000745. [PMID: 36962577 PMCID: PMC10021208 DOI: 10.1371/journal.pgph.0000745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
Abstract
Although leading causes of death are regularly reported, there is disagreement on which long-term conditions (LTCs) reduce disability-free life expectancy (DFLE) the most. We aimed to estimate increases in DFLE associated with elimination of a range of LTCs. This is a comprehensive systematic review and meta-analysis of studies assessing the effects of LTCs on health expectancy (HE). MEDLINE, Embase, HMIC, Science Citation Index, and Social Science Citation Index were systematically searched for studies published in English from July 2007 to July 2020 with updated searches from inception to April 8, 2021. LTCs considered included: arthritis, diabetes, cardiovascular disease including stroke and peripheral vascular disease, respiratory disease, visual and hearing impairment, dementia, cognitive impairment, depression, cancer, and comorbidity. Studies were included if they estimated HE outcomes (disability-free, active or healthy life expectancy) at age 50 or older for individuals with and without the LTC. Study selection and quality assessment were undertaken by teams of independent reviewers. Meta-analysis was feasible if three or more studies assessed the impact of the same LTC on the same HE at the same age using comparable methods, with narrative syntheses for the remaining studies. Studies reporting Years of Life Lost (YLL), Years of Life with Disability (YLD) and Disability Adjusted Life Years (DALYs = YLL+YLD) were included but reported separately as incomparable with other HE outcomes (PROSPERO registration: CRD42020196049). Searches returned 6072 unique records, yielding 404 eligible for full text retrieval from which 30 DFLE-related and 7 DALY-related were eligible for inclusion. Thirteen studies reported a single condition, and 17 studies reported on more than one condition (two to nine LTCs). Only seven studies examined the impact of comorbidities. Random effects meta-analyses were feasible for a subgroup of studies examining diabetes (four studies) or respiratory diseases (three studies) on DFLE. From pooled results, individuals at age 65 without diabetes gain on average 2.28 years disability-free compared to those with diabetes (95% CI: 0.57-3.99, p<0.01, I2 = 96.7%), whilst individuals without respiratory diseases gain on average 1.47 years compared to those with respiratory diseases (95% CI: 0.77-2.17, p<0.01, I2 = 79.8%). Eliminating diabetes, stroke, hypertension or arthritis would result in compression of disability. Of the seven longitudinal studies assessing the impact of multiple LTCs, three found that stroke had the greatest effect on DFLE for both genders. This study is the first to systematically quantify the impact of LTCs on both HE and LE at a global level, to assess potential compression of disability. Diabetes, stroke, hypertension and arthritis had a greater effect on DFLE than LE and so elimination would result in compression of disability. Guidelines for reporting HE outcomes would assist data synthesis in the future, which would in turn aid public health policy.
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Affiliation(s)
- Ilianna Lourida
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Holly Q Bennett
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona Beyer
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew Kingston
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Carol Jagger
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Implications of COVID-19 Mitigation Policies for National Well-Being: A Systems Perspective. SUSTAINABILITY 2021. [DOI: 10.3390/su14010433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The ongoing COVID-19 crisis and measures aimed at curbing the pandemic have a widespread impact on various aspects of well-being, such as housing, social connections, and others. Moreover, COVID-19 does not affect all population groups equally. This study analyzes the impact of major COVID-19 non-pharmaceutical interventions (NPIs) on a set of national well-being indicators from the most recent version of the OECD Well-Being Framework. Using causal loop diagrams (systems maps), we consider direct and indirect effects of these policies on various components of the national well-being system. Our results show that business closures directly and/or indirectly impact more national well-being components than any other policy. The most affected national well-being components by all policies are life satisfaction, perceived health, and prevalence of depressive symptoms. In addition, we specify how the impact of the anti-pandemic measures differs for various population strata, using the degree of income and employment loss as key stratifying variables. Our insights can be helpful to identify and promote measures that can alleviate the adverse effects of the COVID-19 crisis on the national well-being.
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Bennett HQ, Kingston A, Lourida I, Robinson L, Corner L, Brayne CEG, Matthews FE, Jagger C. The contribution of multiple long-term conditions to widening inequalities in disability-free life expectancy over two decades: Longitudinal analysis of two cohorts using the Cognitive Function and Ageing Studies. EClinicalMedicine 2021; 39:101041. [PMID: 34386756 PMCID: PMC8342913 DOI: 10.1016/j.eclinm.2021.101041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND : Disability-free life expectancy (DFLE) inequalities by socioeconomic deprivation are widening, alongside rising prevalence of multiple long-term conditions (MLTCs). We use longitudinal data to assess whether MLTCs contribute to the widening DFLE inequalities by socioeconomic deprivation. METHODS : The Cognitive Function and Ageing Studies (CFAS I and II) are large population-based studies of those ≥65 years, conducted in three areas in England. Baseline occurred in 1991 (CFAS I, n=7635) and 2011 (CFAS II, n=7762) with two-year follow-up. We defined disability as difficulty in activities of daily living, MLTCs as the presence of at least two of nine health conditions, and socioeconomic deprivation by area-level deprivation tertiles. DFLE and transitions between disability states and death were estimated from multistate models. FINDINGS : For people with MLTCs, inequalities in DFLE at age 65 between the most and least affluent widened to around 2.5 years (men:2.4 years, 95% confidence interval (95%CI) 0.4-4.4; women:2.6 years, 95%CI 0.7-4.5) by 2011. Incident disability reduced for the most affluent women (Relative Risk Ratio (RRR):0.6, 95%CI 0.4-0.9), and mortality with disability reduced for least affluent men (RRR:0.6, 95%CI 0.5-0.8). MLTCs prevalence increased only for least affluent men (1991: 58.8%, 2011: 66.9%) and women (1991: 60.9%, 2011: 69.1%). However, DFLE inequalities were as large in people without MLTCs (men:2.4 years, 95%CI 0.3-4.5; women:3.1 years, 95% CI 0.8-5.4). INTERPRETATION : Widening DFLE inequalities were not solely due to MLTCs. Reduced disability incidence with MLTCs is possible but was only achieved in the most affluent.
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Affiliation(s)
- Holly Q Bennett
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Andrew Kingston
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Ilianna Lourida
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Lynne Corner
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Carol EG Brayne
- Cambridge Institute of Public Health, Forvie site, University of Cambridge School of Clinical Medicine, Cambridge Biomedical campus, Cambridge CB2 0SR, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Carol Jagger
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Edwardson Building, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
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Chiu CT, Yong V, Chen HW, Saito Y. Disabled life expectancy with and without stroke: a 10-year Japanese prospective cohort study. Qual Life Res 2019; 28:3055-3064. [PMID: 31309398 DOI: 10.1007/s11136-019-02246-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE A stroke is a debilitating condition that can cause lifelong disability, severely limiting the ability of individuals to perform daily activities. In Japan, strokes are the fourth leading cause of death; however, no previous studies have examined the influence of strokes on a disabled or disability-free life for older Japanese residents. This study aims to address this gap. METHODS The study used data from the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) and incidence-based multistate life tables to estimate disabled and disability-free life expectancy based on the stroke status of Japanese residents aged 65 and older. RESULTS Japanese stroke survivors aged 65 who experienced an initial disability-free state could expect to live approximately 3 fewer total years of life, 4-5 fewer years in a disability-free state, and 1-2 more years in a disabled state compared to those without history of a stroke (p < 0.05). For those disabled at the beginning of the survey interval, the differences between individuals with and without stroke history were also similar to those disability-free at the beginning of the survey interval (2-4 and 5-6 fewer total and disability-free years, respectively) (p < 0.05). The same pattern was observed for older age groups. CONCLUSION Older adults who have experienced a stroke could experience a shorter total life expectancy, shorter disability-free life expectancy, and longer disabled life expectancy than those who have not experienced a stroke. These results can inform policymakers and rehabilitation practitioners on stroke survivor long-term care needs and their post-stroke health status.
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Affiliation(s)
- Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, No. 128, Sec. 2, Academia Rd., Taipei, Taiwan.
| | - Vanessa Yong
- Population Research Institute, Nihon University, Tokyo, Japan
| | - Hsiao-Wen Chen
- Institute of European and American Studies, Academia Sinica, No. 128, Sec. 2, Academia Rd., Taipei, Taiwan
| | - Yasuhiko Saito
- Population Research Institute, Nihon University, Tokyo, Japan
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Seng JJB, Kwan YH, Goh H, Thumboo J, Low LL. Public rental housing and its association with mortality - a retrospective, cohort study. BMC Public Health 2018; 18:665. [PMID: 29843652 PMCID: PMC5975624 DOI: 10.1186/s12889-018-5583-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/22/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) is a well-established determinant of health status and home ownership is a commonly used composite indicator of SES. Patients in low-income households often stay in public rental housing. The association between public rental housing and mortality has not been examined in Singapore. METHODS A retrospective, cohort study was conducted involving all patients who utilized the healthcare facilities under SingHealth Regional Health (SHRS) Services in Year 2012. Each patient was followed up for 5 years. Patients who were non-citizens or residing in a non-SHRS area were excluded from the study. RESULTS A total of 147,004 patients were included in the study, of which 7252 (4.9%) patients died during the study period. The mean age of patients was 50.2 ± 17.2 years old and 7.1% (n = 10,400) of patients stayed in public rental housing. Patients who passed away had higher utilization of healthcare resources in the past 1 year and a higher proportion stayed in public rental housing (p < 0.001). They also had higher rates of co-morbidities such as hypertension, hyperlipidaemia and diabetes. (p < 0.001) After adjustment for demographic and clinical covariates, residence in public rental housing was associated with increased risk of all-cause mortality (Adjusted hazard ratio: 1.568, 95% CI: 1.469-1.673). CONCLUSION Public rental housing was an independent risk factor for all-cause mortality. More studies should be conducted to understand health-seeking behavior and needs of public rental housing patients, to aid policymakers in formulating better plans for improving their health outcomes.
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Affiliation(s)
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Hendra Goh
- Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Julian Thumboo
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Regional Health System, Singapore Health Services, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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Gillen M, Zurlo KA, Kim H. Do Financial Constraints Affect Depressive Symptomatology Among Mid-Aged and Older Adults? Int J Aging Hum Dev 2017; 85:438-455. [PMID: 29098890 DOI: 10.1177/0091415017697724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The relationship between financial constraints and depressive symptomatology among adults aged 50 and greater was examined. The mediating effect of perceived control over one's financial circumstances on this relationship was assessed. Ordinary least square hierarchical regression models were estimated using data from the Health and Retirement Study. As an aggregated measure, financial constraints were positively associated with depression in mid-age and late life, and this relationship was partially accounted for by the pathway of perceived control over one's financial circumstances. When disaggregated as a measure, financial constraints at the individual level had a significant effect on depression, while financial constraints at the family and public levels did not have a significant effect. When added to the model, perceived control over one's financial circumstances had a significant effect on depressive symptomatology, financial constraints remained significant at the individual level.
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Wharton T, Watkins DC, Mitchell J, Kales H. Older, Church-Going African Americans' Attitudes and Expectations About Formal Depression Care. Res Aging 2016; 40:3-26. [PMID: 27784820 DOI: 10.1177/0164027516675666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This phenomenological study involved focus groups with church-affiliated, African American women and men ( N = 50; ages 50 and older) in southeast Michigan to determine their attitudes and expectations around formal mental health care. Data analysis employed a constant comparative approach and yielded themes related to formal mental health care, along with delineating concerns about defining depression, health, and well-being. Health and well-being were defined as inclusive of physical and spiritual aspects of self. Churches have a central role in how formal mental health care is viewed by their attendees, with prayer being an important aspect of this care. Provider expectations included privacy and confidentiality; respect for autonomy and need for information, having providers who discuss treatment options; and issues related to environmental cleanliness, comfort, and accessibility. Implications include providing effective, culturally tailored formal depression care that acknowledges and integrates faith for this group.
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Affiliation(s)
| | | | | | - Helen Kales
- 2 University of Michigan, Ann Arbor, MI, USA
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Steensma C, Loukine L, Orpana H, McRae L, Vachon J, Mo F, Boileau-Falardeau M, Reid C, Choi BC. Describing the population health burden of depression: health-adjusted life expectancy by depression status in Canada. Health Promot Chronic Dis Prev Can 2016; 36:205-213. [PMID: 27768557 PMCID: PMC5158123 DOI: 10.24095/hpcdp.36.10.01] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Few studies have evaluated the impact of depression in terms of losses to both premature mortality and health-related quality of life (HRQOL) on the overall population. Health-adjusted life expectancy (HALE) is a summary measure of population health that combines both morbidity and mortality into a single summary statistic that describes the current health status of a population. METHODS We estimated HALE for the Canadian adult population according to depression status. National Population Health Survey (NPHS) participants 20 years and older (n = 12 373) were followed for mortality outcomes from 1994 to 2009, based on depression status. Depression was defined as having likely experienced a major depressive episode in the previous year as measured by the Composite International Diagnostic Interview Short Form. Life expectancy was estimated by building period abridged life tables by sex and depression status using the relative risks of mortality from the NPHS and mortality data from the Canadian Chronic Disease Surveillance System (2007-2009). The Canadian Community Health Survey (2009/10) provided estimates of depression prevalence and Health Utilities Index as a measure of HRQOL. Using the combined mortality, depression prevalence and HRQOL estimates, HALE was estimated for the adult population according to depression status and by sex. RESULTS For the population of women with a recent major depressive episode, HALE at 20 years of age was 42.0 years (95% CI: 40.2-43.8) compared to 57.0 years (95% CI: 56.8-57.2) for women without a recent major depressive episode. For the population of Canadian men, HALE at 20 was 39.0 years (95% CI: 36.5-41.5) for those with a recent major depressive episode compared to 53.8 years (95% CI: 53.6-54.0) for those without. For the 15.0-year difference in HALE between women with and without depression, 12.3 years can be attributed to the HRQOL gap and the remaining 2.7 years to the mortality gap. The 14.8 fewer years of HALE observed for men with depression equated to a 13.0-year HRQOL gap and a 1.8-year mortality gap. CONCLUSION The population of adult men and women with depression in Canada had substantially lower healthy life expectancy than those without depression. Much of this gap is explained by lower levels of HRQOL, but premature mortality also plays a role.
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Affiliation(s)
- C Steensma
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - L Loukine
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
| | - H Orpana
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - L McRae
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
| | - J Vachon
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
| | - F Mo
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
| | - M Boileau-Falardeau
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - C Reid
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
| | - B C Choi
- Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Government of Canada, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Injury Prevention Research Center, Shantou University Medical College, Shantou, China
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Andrade FCD, Wu F, Lebrão ML, Duarte YADO. Life expectancy without depression increases among Brazilian older adults. Rev Saude Publica 2016; 50:12. [PMID: 27143612 PMCID: PMC4902655 DOI: 10.1590/s1518-8787.2016050005900] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 05/30/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate life expectancy with and without depressive symptoms in older adults for the years 2000 and 2010. METHODS We evaluated individuals aged 60 years or older (n = 1,862 in 2000 and n = 1,280 in 2010), participants of the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Aging) study in in Sao Paulo, Southeastern Brazil. Depression was measured using the shorter version of the Geriatric Depression Scale (GDS-15); respondents scoring ≥ 6 were classified as having depression. Estimates of life expectancy with and without depression were obtained using the Sullivan method. RESULTS Data from 2000 indicate that 60-year-old men could expect to live, on average, 14.7 years without depression and 60-year-old women could expect to live 16.5 years without depression. By 2010, life expectancy without depression had increased to 16.7 years for men and 17.8 years for women. Expected length of life with depression differed by sex, with women expected to live more years with depression than men. CONCLUSIONS Between 2000 and 2010, life expectancy without depression in Sao Paulo increased. However, older adults in Brazil, especially older women, still face a serious burden of mental illness.
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Affiliation(s)
- Flávia Cristina Drumond Andrade
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, EUA
| | - Fan Wu
- San Francisco Department of Public Health, Community Behavioral Health Services, San Francisco, CA, EUA
| | - Maria Lúcia Lebrão
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
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14
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Opdebeeck C, Quinn C, Nelis SM, Clare L. Is cognitive lifestyle associated with depressive thoughts and self-reported depressive symptoms in later life? Eur J Ageing 2015; 13:63-73. [PMID: 27034645 PMCID: PMC4769311 DOI: 10.1007/s10433-015-0359-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Key components of cognitive lifestyle are educational attainment, occupational complexity and engagement in cognitively stimulating leisure activities. Each of these factors is associated with experiencing fewer depressive symptoms in later life, but no study to date has examined the relationship between overall cognitive lifestyle and depressive symptoms. This task is made more complex because relatively few older participants in cross-sectional studies will be currently experiencing depression. However, many more will show evidence of a depressive thinking style that predisposes them towards depression. This study aimed to investigate the extent to which cognitive lifestyle and its individual components are associated with depressive thoughts and symptoms. Two hundred and six community-dwelling participants aged 65+ completed the depressive cognitions scale, the geriatric depression scale and the lifetime of experiences questionnaire, which assesses cognitive lifestyle. Correlational analysis indicated that each of the individual lifestyle factors—education, occupational complexity and activities in young adulthood, mid-life and later life—and the combined cognitive lifestyle score was positively associated with each other and negatively with depressive symptoms, while all except education were negatively associated with depressive thoughts. Depressive thoughts and symptoms were strongly correlated. Cognitive lifestyle score explained 4.6 % of the variance in depressive thoughts and 10.2 % of the variance in depressive symptoms. The association of greater participation in cognitive activities, especially in later life, with fewer depressive symptoms and thoughts suggests that preventive interventions aimed at increasing participation in cognitively stimulating leisure activity could be beneficial in decreasing the risk of experiencing depressive thoughts and symptoms in later life.
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Affiliation(s)
- Carol Opdebeeck
- Research in Ageing and Cognitive Health (REACH), School of Psychology, Bangor University, Bangor, Gwynedd LL572AS UK
| | - Catherine Quinn
- REACH: The Centre for Research in Ageing and Cognitive Health, School of Psychology, University of Exeter, Exeter, EX44QG UK
| | - Sharon M Nelis
- REACH: The Centre for Research in Ageing and Cognitive Health, School of Psychology, University of Exeter, Exeter, EX44QG UK
| | - Linda Clare
- Research in Ageing and Cognitive Health (REACH), School of Psychology, Bangor University, Bangor, Gwynedd LL572AS UK ; REACH: The Centre for Research in Ageing and Cognitive Health, School of Psychology, University of Exeter, Exeter, EX44QG UK
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15
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Pongiglione B, De Stavola BL, Ploubidis GB. A Systematic Literature Review of Studies Analyzing Inequalities in Health Expectancy among the Older Population. PLoS One 2015; 10:e0130747. [PMID: 26115099 PMCID: PMC4482630 DOI: 10.1371/journal.pone.0130747] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/23/2015] [Indexed: 11/21/2022] Open
Abstract
Aim To collect, organize and appraise evidence of socioeconomic and demographic inequalities in health and mortality among the older population using a summary measure of population health: Health Expectancy. Methods A systematic literature review was conducted. Literature published in English before November 2014 was searched via two possible sources: three electronic databases (Web of Science, Medline and Embase), and references in selected articles. The search was developed combining terms referring to outcome, exposure and participants, consisting in health expectancy, socioeconomic and demographic groups, and older population, respectively. Results Of 256 references identified, 90 met the inclusion criteria. Six references were added after searching reference lists of included articles. Thirty-three studies were focused only on gender-based inequalities; the remaining sixty-three considered gender along with other exposures. Findings were organized according to two leading perspectives: the type of inequalities considered and the health indicators chosen to measure health expectancy. Evidence of gender-based differentials and a socioeconomic gradient were found in all studies. A remarkable heterogeneity in the choice of health indicators used to compute health expectancy emerged as well as a non-uniform way of defining same health conditions. Conclusions Health expectancy is a useful and convenient measure to monitor and assess the quality of ageing and compare different groups and populations. This review showed a general agreement of results obtained in different studies with regard to the existence of inequalities associated with several factors, such as gender, education, behaviors, and race. However, the lack of a standardized definition of health expectancy limits its comparability across studies. The need of conceiving health expectancy as a comparable and repeatable measure was highlighted as fundamental to make it an informative instrument for policy makers.
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Affiliation(s)
- Benedetta Pongiglione
- Medical Statistics Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Bianca L De Stavola
- Medical Statistics Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - George B Ploubidis
- Centre for Longitudinal Studies, Institute of Education, London, United Kingdom
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16
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Laditka JN, Laditka SB. Associations of multiple chronic health conditions with active life expectancy in the United States. Disabil Rehabil 2015; 38:354-61. [DOI: 10.3109/09638288.2015.1041614] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- James N. Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Sarah B. Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
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17
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Yokota RTC, Berger N, Nusselder WJ, Robine JM, Tafforeau J, Deboosere P, Van Oyen H. Contribution of chronic diseases to the disability burden in a population 15 years and older, Belgium, 1997-2008. BMC Public Health 2015; 15:229. [PMID: 25879222 PMCID: PMC4361141 DOI: 10.1186/s12889-015-1574-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 02/19/2015] [Indexed: 11/23/2022] Open
Abstract
Background Age-associated disability reduces quality of life in older populations and leads to wide-range implications for social and health policy. The identification of diseases that contribute to the disability burden is crucial to the development of prevention and intervention strategies to reduce disability. In this study, we assessed the contribution of chronic diseases to the prevalence of disability in Belgium. Methods Data from 35,837 individuals aged 15 years or older who participated in the 1997, 2001, 2004, or 2008 Belgian Health Interview Surveys were used. Disability was defined as difficulties in doing at least one of six activities of daily living (transfer in and out of bed, transfer in and out of chair, dressing, washing hands and face, feeding, and going to the toilet) and/or mobility limitations (ability to walk without stopping less than 200 m). Multiple additive regression models were fitted separately for men and women to estimate the age-specific background disability rate (experienced by everyone, independent of the presence of specific diseases) and disease-specific disability rates (disability rate in subjects who reported selected chronic diseases). Results Musculoskeletal, cardiovascular, and respiratory diseases were the main contributors to the disability burden in Belgium. Musculoskeletal diseases were the most prevalent diseases in men and women in all age groups. Neurological diseases and stroke were the most disabling diseases, i.e. caused the highest level of disability among the diseased individuals, in all age groups for men and women, respectively. Back pain was the main cause of disability in men aged 15 to 64 years, while heart attack was the major contributor to the disability prevalence in men aged 65 or older. Likewise, arthritis was the main cause of disability among women across all age groups. Depression was also an important contributor in young subjects (15–54 years). Cancer was not an important contributor to the disability prevalence in Belgium. Conclusions To reduce the burden of disability in Belgium, interventions should target musculoskeletal, cardiovascular and respiratory diseases especially among elderly. Furthermore, attention should also be given to depression in young individuals. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1574-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Renata T C Yokota
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050, Brussels, Belgium. .,Department of Social Research, Interface Demography, Vrije Universiteit Brussel, 1050, Brussels, Belgium.
| | - Nicolas Berger
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050, Brussels, Belgium. .,Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK.
| | - Wilma J Nusselder
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
| | - Jean-Marie Robine
- French Institute of Health and Medical Research (INSERM), Montpellier, France. .,École Pratique des Hautes Études, Paris, France.
| | - Jean Tafforeau
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050, Brussels, Belgium.
| | - Patrick Deboosere
- Department of Social Research, Interface Demography, Vrije Universiteit Brussel, 1050, Brussels, Belgium.
| | - Herman Van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050, Brussels, Belgium. .,Department of Public Health, Ghent University, Ghent, Belgium.
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18
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Schure MB, Goins RT. An Examination of the Disablement Process Among Older American Indians: The Native Elder Care Study. THE GERONTOLOGIST 2015; 56:948-55. [PMID: 26035880 DOI: 10.1093/geront/gnv001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/29/2014] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Older American Indians disproportionately suffer from poorer physical and mental health and have greater disability compared to their racial and ethnic counterparts. The purpose of this study was to examine the disablement process among older American Indians. DESIGN AND METHODS Data analyzed were from the Native Elder Care Study, which included in-person interviews with 505 community-dwelling American Indians aged ≥55 years. We used structural equation modeling to examine the contributive direct and indirect effects of health, demographic, and psychosocial risk factors on disability. RESULTS Pathology had direct and indirect effects through social support and depressive symptoms on chronic pain intensity. Pathology also had direct and indirect effects on disability. Chronic pain intensity was a significant mediator between pathology and functional limitations. With contributive effects of older age and female sex, greater functional limitations were associated with increased disability. IMPLICATIONS Our results support the theorized main pathway of the Disablement Process Model with our sample of older American Indians. Our findings support the importance of taking into account intra and extraindividual factors in assessing the prevalence and incidence of disability for older American Indians.
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Affiliation(s)
- Marc B Schure
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington.
| | - R Turner Goins
- Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina
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Elbejjani M, Fuhrer R, Abrahamowicz M, Mazoyer B, Crivello F, Tzourio C, Dufouil C. Hippocampal atrophy and subsequent depressive symptoms in older men and women: results from a 10-year prospective cohort. Am J Epidemiol 2014; 180:385-93. [PMID: 25086051 PMCID: PMC4128769 DOI: 10.1093/aje/kwu132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 04/29/2014] [Indexed: 11/12/2022] Open
Abstract
Several studies have reported smaller hippocampal volume in patients with depression. However, the temporality of the association is undetermined. One hypothesis is that hippocampal atrophy might be a susceptibility factor for depression. In the present study, we assessed whether hippocampal atrophy was associated with subsequent depressive symptoms in a cohort of older French adults (n = 1,309) who were 65-80 years of age and enrolled into the study in 1999-2001 in Dijon, France. Subjects were followed for more than 10 years. Participants underwent 2 cerebral magnetic resonance imaging scans, one at baseline and one at the 4-year follow-up. We used linear mixed models to estimate the associations of hippocampal atrophy with 1) the average depressive symptom scores over follow-up (using the Center for Epidemiologic Studies-Depression scale) measured biennially over the subsequent 6 years and 2) changes in symptom scores over follow-up. In women, a 2-standard-deviation increase in annual hippocampal atrophy was associated with a 1.67-point (95% confidence interval: 0.59, 2.77) increase in the average depressive symptom score over follow-up and with a 1.97-point (95% confidence interval: 0.68, 3.24) increase in scores over the 2 subsequent years but not with later changes in symptoms. No association was detected in men. Accounting for potential selective attrition (using inverse probability weights) did not alter results. Hippocampal atrophy was associated with more subsequent depressive symptoms and with shorter-term worsening of symptoms in women.
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Affiliation(s)
| | - Rebecca Fuhrer
- Correspondence to Dr. Rebecca Fuhrer, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2 (e-mail: )
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20
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Shin JY, Sims RC, Bradley DL, Pohlig RT, Harrison BE. Prevalence of depressive symptoms and associated factors in older adult public housing residents. Res Gerontol Nurs 2014; 7:249-55. [PMID: 25036530 DOI: 10.3928/19404921-20140708-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 06/13/2014] [Indexed: 11/20/2022]
Abstract
The purpose of this pilot study was to identify the prevalence of and risk factors associated with depressive symptoms among older adult residents of a public housing apartment. Self-reported depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D) 8. A self-report questionnaire was used to collect data on risk factors of sociodemographic information, cardiovascular health history, and history of depression. Fifty-eight of 171 residents responded, and 31% of residents met the CES-D 8 criterion for depression (total score ≥7). Sequential multiple regression models identified age, loss of loved ones in the past year, and financial worries as significant predictors of CES-D 8 scores. These study results have implications for future studies of depressive symptoms in older adults, suggesting that grief and financial assistance programs may help reduce risks associated with depressive symptoms among community-dwelling older adults living in public housing.
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Chen H, Wang H, Crimmins EM, Chen G, Huang C, Zheng X. The contributions of diseases to disability burden among the elderly population in China. J Aging Health 2013; 26:261-82. [PMID: 24368296 DOI: 10.1177/0898264313514442] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To assess the contributions of diseases to disability burden among older persons in China. METHOD Based on the 2006 China Disability Survey (n = 354,859), we used the attribution method and Sullivan method to obtain disability prevalence and life expectancy with disability (LED) by disease, respectively. RESULTS At disease group level, ear, eye, circulatory and musculoskeletal diseases, injury, and poisoning were the five leading causes of disability burden in terms of their contributions to disability prevalence and LED. At individual disease level, presbycusis, cataracts, cerebrovascular disease, osteoarthritis, and unclassified injuries were the five leading conditions, which accounted for 64% of disabilities and caused males and females aged 60 to have 3.04 and 3.76 years of LED, respectively. DISCUSSION Along with the epidemiologic transition, chronic conditions have become the predominant contributor to disability burden among elderly persons in China. And, presbycusis, cataracts, cerebrovascular disease, osteoarthritis, and unclassified injuries should be the priorities in ameliorating disability.
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Affiliation(s)
- He Chen
- Peking University, Beijing, China
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22
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Zivin K, Wharton T, Rostant O. The economic, public health, and caregiver burden of late-life depression. Psychiatr Clin North Am 2013; 36:631-49. [PMID: 24229661 PMCID: PMC4024243 DOI: 10.1016/j.psc.2013.08.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article reviews the burden of late-life depression (LLD) from several perspectives, including costs of depression treatment and treatment of other comorbid psychiatric and medical conditions; the impact of LLD on job functioning, disability, and retirement; and how LLD influences others, such as family members and caregivers.
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Affiliation(s)
- Kara Zivin
- Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, Department of Veterans Affairs, Plymouth Road, Ann Arbor, MI 48109, USA; Department of Psychiatry, University of Michigan Medical School, Plymouth Road, Ann Arbor, MI 48109, USA; Institute for Social Research, University of Michigan Medical School, Thompson Street, Ann Arbor, MI 48104, USA.
| | - Tracy Wharton
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Ola Rostant
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
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Cuevas AG, Reitzel LR, Cao Y, Nguyen N, Wetter DW, Adams CE, Watkins KL, Regan SD, McNeill LH. Mediators of discrimination and self-rated health among African Americans. Am J Health Behav 2013; 37:745-54. [PMID: 24001623 DOI: 10.5993/ajhb.37.6.3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To examine whether stress and depressive symptoms mediated relationships of perceived discrimination and self-rated health among African Americans. METHODS A nonparametric bootstrapping procedure was used to assess mediation, controlling for sociodemographic variables, among 1406 cohort study adults (age=45.5±12.6, 25.1% male). RESULTS Greater discrimination was associated with poorer self-rated health (β =-.010, SE=.003, p = .001). Stress and depressive symptoms were each significant mediators of this relationship in single and multiple mediator models (ps ≤ 05). CONCLUSIONS Perceived discrimination may contribute to poorer self-rated health among African Americans through heightened levels of stress and depression. Interventions addressing these mechanisms might help reduce the impact of discrimination on health. Definitive results await longitudinal study designs to assess causal pathways.
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Affiliation(s)
- Adolfo G Cuevas
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Prevalence and correlates of depression among HIV-infected and -affected older people in rural South Africa. J Affect Disord 2013; 151:31-8. [PMID: 23726780 PMCID: PMC3781323 DOI: 10.1016/j.jad.2013.05.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/03/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about depression in older people in sub-Saharan Africa, the associated impact of HIV, and the influence on health perceptions. OBJECTIVES Examine the prevalence and correlates of depression; explore the relationship between depression and health perceptions in HIV-infected and -affected older people. METHODS In 2010, 422 HIV-infected and -affected participants aged 50+ were recruited into a cross-sectional study. Nurse professionals interviewed participants and a diagnosis of depressive episode was derived from the Composite International Diagnostic Interview (Depression module) using the International Classification of Diseases diagnostic criteria and categorised as major (MDE) or brief (BDE). RESULTS Overall, 42.4% (n=179) had a depressive episode (MDE: 22.7%, n=96; BDE: 19.7%, n=83). Prevalence of MDE was significantly higher in HIV-affected (30.1%, 95% CI 24.0-36.2%) than HIV-infected (14.8%, 95% CI 9.9-19.7%) participants; BDE was higher in HIV-infected (24.6%, 95% CI 18.7-30.6%) than in HIV-affected (15.1%, 95% CI 10.3-19.8%) participants. Being female (aOR 3.04, 95% CI 1.73-5.36), receiving a government grant (aOR 0.34, 95% CI 0.15-0.75), urban residency (aOR 1.86, 95% CI 1.16-2.96) and adult care-giving (aOR 2.37, 95% CI 1.37-4.12) were significantly associated with any depressive episode. Participants with a depressive episode were 2-3 times more likely to report poor health perceptions. LIMITATIONS Study limitations include the cross-sectional design, limited sample size and possible selection biases. CONCLUSIONS Prevalence of depressive episodes was high. Major depressive episodes were higher in HIV-affected than HIV-infected participants. Psycho-social support similar to that of HIV treatment programmes around HIV-affected older people may be useful in reducing their vulnerability to depression.
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Coleman SM, Katon W, Lin E, Von Korff M. Depression and death in diabetes; 10-year follow-up of all-cause and cause-specific mortality in a diabetic cohort. PSYCHOSOMATICS 2013; 54:428-36. [PMID: 23756124 DOI: 10.1016/j.psym.2013.02.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 02/14/2013] [Accepted: 02/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND When depression co-occurs with type 2 diabetes, adverse bidirectional interactions increase the burden of both illnesses. In addition to affecting patient's health, functioning, and quality of life, this relationship also results in increased mortality compared with those with depression or diabetes alone. OBJECTIVE The purpose of this study was to examine the relationship between depression and all-cause as well as cause-specific mortality in patients with type 2 diabetes by extending findings from our 5-year mortality study. Specifically, we re-examined the risk of depression and all-cause, cardiovascular, cancer, and non-cardiovascular, non-cancer related deaths. METHOD We used an ICD-10 algorithm combined with death certificate data to classify mortality types among type 2 diabetic patients who participated in the Pathways Epidemiologic Study. Cox proportional hazard modeling was used to examine the relationships between depression status and mortality over a 10-year period. RESULTS We found a significant positive relationship between depression and all-cause as well as non-cardiovascular, non-cancer mortality in this sample (n = 4128). Cardiovascular mortality failed to reach significance in fully adjusted models and, in contrast to the 5-year data, no trend or significant relationship was observed between depression status and cancer related deaths. CONCLUSIONS Our study confirmed a significant positive relationship between depression and mortality in patients with type 2 diabetes. Major depression demonstrated a stronger relationship than did minor depression, and among cause-specific groups, non-cardiovascular, non-cancer death types demonstrated the largest magnitude of association with depression status.
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Affiliation(s)
- Shane M Coleman
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA.
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Lee MJ, Hasche LK, Choi S, Proctor EK, Morrow-Howell N. Comparison of major depressive disorder and subthreshold depression among older adults in community long-term care. Aging Ment Health 2013; 17:461-9. [PMID: 23227913 PMCID: PMC3605212 DOI: 10.1080/13607863.2012.747079] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study extends existing knowledge regarding the continuum between major depression (MD) and subthreshold depression (SD) by examining differences in symptomology and associative factors for a subpopulation of older adults with functional disability. METHOD Our sample consisted of clients age 60 and above entering public community long term care derived from the baseline survey of a longitudinal study (315 non-depressed, 74 MD, and 221 SD). We used the Diagnostic Interview Schedule to establish diagnoses of MD, the Center for Epidemiological Studies Depression Scale (CES-D) to assess SD, and other self-report measures to explore potential associative factors of demographics, comorbidity, social support, and stressors. RESULTS No differences in CES-D identified symptoms occurred between the two groups. MD and SD were both associated with lower education, poorer social support, more severe medical conditions, and higher stress when compared to non-depressed older adults. Younger age and being female were associated solely with MD; whereas, worse perceived health and more trouble affording food were associated solely with SD. The only associative factor significantly different between MD and SD was age. Those with MD were more likely to be younger than those with SD. CONCLUSION Our findings of symptom profiles and associative factors lend support to the continuum notion of depression. Identification of only older adults within the community long-term care service system who meet criteria for MD would leave many older adults, who also face multiple comorbidities, high levels of stress and social isolation, and substantial depressive symptoms undiagnosed and untreated.
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Affiliation(s)
- Mi Jin Lee
- Department of Social Welfare, Konkuk University, Danwol-dong, Chungju-si, South Korea.
| | - Leslie K. Hasche
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Sunha Choi
- College of Social Work, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Enola K. Proctor
- George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA
| | - Nancy Morrow-Howell
- George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA
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Qian J, Simoni-Wastila L, Langenberg P, Rattinger GB, Zuckerman IH, Lehmann S, Terrin M. Effects of depression diagnosis and antidepressant treatment on mortality in Medicare beneficiaries with chronic obstructive pulmonary disease. J Am Geriatr Soc 2013; 61:754-61. [PMID: 23617752 PMCID: PMC3656143 DOI: 10.1111/jgs.12220] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To estimate the effects of depression diagnosis and antidepressant treatment on 2-year all-cause mortality in Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) and determine whether Social Security Disability Insurance (SSDI) eligibility modifies these relationships. DESIGN Retrospective cohort study. SETTING A 5% random sample of Medicare beneficiaries aged 65 and older in stand-alone Part D plans in 2006 to 2008. PARTICIPANTS Beneficiaries diagnosed with COPD and continuously enrolled in Medicare Parts A, B, and D (N = 75,699). MEASUREMENTS Depression diagnosis was assessed at baseline (2006). Evidence of antidepressant treatment was measured across time. Covariates included baseline characteristics, comorbidities, and disease severity. Survival analyses using Cox proportional hazards models estimated 2-year mortality associated with depression diagnosis or antidepressant treatment (in beneficiaries with depression). Interaction terms of SSDI eligibility with baseline depression and time-dependent antidepressant treatment were tested. RESULTS More than one-fifth (21.6%) of beneficiaries with COPD had a depression diagnosis at baseline, and 82.1% of those received antidepressants. Nearly one-sixth (16.3%) of the sample were SSDI eligible. Baseline depression heightened risk of death (hazard ratio = 1.13, 95% confidence interval = 1.09-1.18) in beneficiaries who were not eligible for SSDI. In beneficiaries with depression, the association between antidepressant treatment and lower mortality was different according to SSDI eligibility status. CONCLUSION Social Security Disability Insurance eligibility modifies the effects of depression and antidepressant treatment on mortality in Medicare beneficiaries with COPD. These data suggest that clinicians should identify and treat depression in individuals with COPD, but further studies are needed to determine the effect of these interventions.
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Affiliation(s)
- Jingjing Qian
- Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, Auburn, Alabama 36849, USA.
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Park M, Katon WJ, Wolf FM. Depression and risk of mortality in individuals with diabetes: a meta-analysis and systematic review. Gen Hosp Psychiatry 2013; 35:217-25. [PMID: 23415577 PMCID: PMC3644308 DOI: 10.1016/j.genhosppsych.2013.01.006] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To estimate risk of comorbid depression on all-cause mortality over time among individuals with diabetes. METHODS The Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase and Science Direct databases were searched through September 30, 2012. We limited our search to longitudinal or prospective studies reporting all-cause mortality among those having depression and diabetes, compared with those having diabetes alone that used hazard ratios (HRs) as the main outcome. Two reviewers independently extracted primary data and evaluated the quality of studies using predetermined criteria. The pooled random effects adjusted HRs were estimated using meta-analysis. The impact of moderator variables on study effect size was examined with meta-regression. RESULTS A total of 42,363 respondents from 10 studies were included in the analysis. Depression was significantly associated with risk of mortality (pooled HR=1.50, 95% confidence interval=1.35-1.66). Little evidence for heterogeneity was found across the studies (Cochran Q=13.52, P=.20, I(2)=26.03). No significant possibility of publication bias was detected (Egger's regression intercept=0.98, P=.23). CONCLUSION Depression significantly increases the risk of mortality among individuals with diabetes. Early detection and treatment of depression may improve health outcomes in this population.
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Affiliation(s)
- Mijung Park
- Department Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, USA.
| | - Wayne J. Katon
- Dept. Psychiatry and Behavioral Sciences, University of Washington School of Medicine
| | - Fredric M. Wolf
- Dept. Biomedical Informatics and Medical Education, University of Washington School of Medicine.
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Somme D, Rousseau C. [Standardized geriatric assessment or comprehensive gerontological assessment: where do we stand?]. Rev Med Interne 2012; 34:114-22. [PMID: 23154109 DOI: 10.1016/j.revmed.2012.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 10/07/2012] [Indexed: 11/17/2022]
Abstract
The concept of comprehensive gerontological assessment is a foundation of modern geriatrics. Our focus was to try to clarify the underlying concepts, assess the level of evidence and clarify the issues still under debate. The concept implies the definition of an interdisciplinary process for a multidimensional assessment in order to produce a coordinated plan. The central notion is that the systematization of this multidimensionality and interdisciplinarity needs the establishment of dedicated process (meeting tools, clinical information system, etc.). Following dimensions should be covered: health, social, economic, environmental and psychological. Any assessment process that could lead to forgetting one of its dimensions cannot be viewed as a comprehensive gerontological assessment. The level of evidence is higher in hospital acute inpatient unit but it is still low in all other areas of health care but the scattered data in the literature argues for qualitative benefits (improved quality of care or quality of life). The questions that remain are numerous including the choice of strategy for initial evaluation (maximum versus minimum; from the outset by many professionals versus graduated based on the minimum initial evaluation), the choice of tool, the optimal location, the required intensity of monitoring and the ideal target population.
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Affiliation(s)
- D Somme
- Service de gériatrie, centre hospitalier universitaire de Rennes, France.
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Abstract
CONTEXT : Depression is a treatable illness that disproportionately places older adults at increased risk for mortality. OBJECTIVE : We sought to examine whether there are patterns of course of depression severity among older primary care patients that are associated with increased risk for mortality. DESIGN AND SETTING : Our study was a secondary analysis of data from a practice-based randomized controlled trial within 20 primary care practices located in greater New York City, Philadelphia, and Pittsburgh. PARTICIPANTS : The study sample consisted of 599 adults aged 60 years and older recruited from primary care settings. Participants were identified though a two-stage, age-stratified (60-74 years; older than 75 years) depression screening of randomly sampled patients. Severity of depression was assessed using the 24-item Hamilton Depression Rating Scale (HDRS). MEASUREMENTS : Longitudinal analysis via growth curve mixture modeling was carried out to classify patterns of course of depression severity across 12 months. Vital status at 5 years was ascertained via the National Death Index Plus. RESULTS : Three patterns of change in course of depression severity over 12 months were identified: 1) persistent depressive symptoms, 2) high but declining depressive symptoms, 3) low and declining depressive symptoms. After a median follow-up of 52.0 months, 114 patients had died. Patients with persistent depressive symptoms were more likely to have died compared with patients with a course of high but declining depressive symptoms (adjusted hazard ratio 2.32, 95% confidence interval [1.15-4.69]). CONCLUSIONS : Persistent depressive symptoms signaled increased risk of dying in older primary care patients, even after adjustment for potentially influential characteristics such as age, smoking status, and medical comorbidity.
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Volicer L, Frijters DHM, Van der Steen JT. Relationship between symptoms of depression and agitation in nursing home residents with dementia. Int J Geriatr Psychiatry 2012; 27:749-54. [PMID: 21956820 DOI: 10.1002/gps.2800] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 08/12/2011] [Accepted: 08/15/2011] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this study is to analyze modifiable factors related to agitation of nursing home residents with dementia. METHODS Relationship of agitation with three modifiable factors (depression, psychosis, and pain) was explored using longitudinal Minimum Data Set (MDS) information from 2032 residents of Dutch nursing homes. Presence of agitation and depression was ascertained using validated scales based on MDS information. Presence of psychosis and pain was ascertained from the individual MDS items. RESULTS There was a significant correlation between MDS depression and agitation scores. Depression scores increased in residents whose agitation worsened and decreased in residents whose agitation improved. Psychosis scores (combination of delusions and hallucinations) also correlated with MDS depression scores, and psychosis scores increased in residents whose agitation worsened. Pain scores correlated with agitation scores, but the pain scores did not change with changes in agitation. Depression symptoms were present in 51% of residents, while psychotic symptoms were present only in 15% of residents, and two-thirds of these residents were also depressed. CONCLUSION These results indicate that depression may be the most common factor associated with agitation in nursing home residents with dementia.
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Affiliation(s)
- Ladislav Volicer
- School of Aging Studies, University of South Florida, Tampa, FL, USA
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Naismith SL, Norrie LM, Mowszowski L, Hickie IB. The neurobiology of depression in later-life: Clinical, neuropsychological, neuroimaging and pathophysiological features. Prog Neurobiol 2012; 98:99-143. [DOI: 10.1016/j.pneurobio.2012.05.009] [Citation(s) in RCA: 169] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 05/03/2012] [Accepted: 05/09/2012] [Indexed: 02/07/2023]
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Mystakidou K, Parpa E, Tsilika E, Panagiotou I, Zygogianni A, Giannikaki E, Gouliamos A. Geriatric depression in advanced cancer patients: the effect of cognitive and physical functioning. Geriatr Gerontol Int 2012; 13:281-8. [PMID: 22694340 DOI: 10.1111/j.1447-0594.2012.00891.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM The aims of the current study were to evaluate geriatric depression and its risk factors in advanced cancer patients. METHODS A cross-sectional study was carried out in a palliative care unit in Greece. Patients completed the Geriatric Depression Scale, the M. D. Anderson Symptoms Instrument (MDASI), the Activities of Daily Living and the Mini-Mental State Examination. Patients were included if they were aged >65 years, if they had cancer, were able to communicate and had agreed to sign informed consent. The final sample consisted of 92 elderly advanced cancer patients. RESULTS The prevalence of depression was found to be 67.4%. The univariate comparison between the depressed elderly and non-depressed group showed that patients with metastases were found to be 2.2-fold more likely to suffer from geriatric depression compared with those without metastases (P = 0.074). Patients with moderate or severe cognitive impairment were found to be 3.61-fold more likely to suffer from geriatric depression in comparison with those with normal cognitive function (P = 0.019). In the multiple logistic regression analysis, elderly with cognitive impairment were 3.3-fold more likely to have geriatric depression than those without (adjusted odds ratio = 3.3 [95% CI 0.99-10.74], P = 0.052) and MDASI factor 1 was consistently a significant risk factor for depression in the elderly; when MDASI factor 1 increased by 1 unit, the odds of being classified as depressed increased by 7.6%. CONCLUSIONS The present study found that cognitive impairment and symptoms such as enjoyment of life, walking, relationship with people, general activity, sadness and pain (MDASI F1) are strong independent predictors of depression in the elderly.
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Affiliation(s)
- Kyriaki Mystakidou
- Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, Athens, Greece.
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Clinical Predictors of Mortality in Adults with Intellectual Disabilities with and without Down Syndrome. Curr Gerontol Geriatr Res 2012; 2012:943890. [PMID: 22666243 PMCID: PMC3361991 DOI: 10.1155/2012/943890] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 11/26/2011] [Accepted: 02/22/2012] [Indexed: 01/08/2023] Open
Abstract
Background. Mood, baseline functioning, and cognitive abilities as well as psychotropic medications may contribute to mortality in adults with and without Down Syndrome (DS). Methods. Population-based (nonclinical), community-dwelling adults with intellectual disabilities (IDs) were recruited between 1995 and 2000, assessed individually for 1–4 times, and then followed by yearly phone calls. Results. 360 participants (116 with DS and 244 without DS) were followed for an average of 12.9 years (range 0–16.1 years as of July 2011). 108 people died during the course of the followup, 65 males (31.9% of all male participants) and 43 females (27.6% of all female participants). Cox proportional hazards modeling showed that baseline practical skills, seizures, anticonvulsant use, depressive symptoms, and cognitive decline over the first six years all significantly contributed to mortality, as did a diagnosis of DS, male gender, and higher age at study entry. Analysis stratified by DS showed interesting differences in mortality predictors. Conclusion. Although adults with DS have had considerable improvements in life expectancy over time, they are still disadvantaged compared to adults with ID without DS. Recognition of potentially modifiable factors such as depression may decrease this risk.
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Ungvari Z, Csiszar A. The emerging role of IGF-1 deficiency in cardiovascular aging: recent advances. J Gerontol A Biol Sci Med Sci 2012; 67:599-610. [PMID: 22451468 DOI: 10.1093/gerona/gls072] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This review focuses on cardiovascular protective effects of insulin-like growth factor (IGF)-1, provides a landscape of molecular mechanisms involved in cardiovascular alterations in patients and animal models with congenital and adult-onset IGF-1 deficiency, and explores the link between age-related IGF-1 deficiency and the molecular, cellular, and functional changes that occur in the cardiovascular system during aging. Microvascular protection conferred by endocrine and paracrine IGF-1 signaling, its implications for the pathophysiology of cardiac failure and vascular cognitive impairment, and the role of impaired cellular stress resistance in cardiovascular aging considered here are based on emerging knowledge of the effects of IGF-1 on Nrf2-driven antioxidant response.
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Affiliation(s)
- Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1303, Oklahoma City, OK 73104, USA.
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Abstract
The ageing of the population brings particular challenges to psychiatric practice. Although the clinical presentation of common psychiatric disorders such as mood and psychotic disorders is largely similar to those in younger adults, late life presentations tend to be more complex as co-morbidity with dementia and physical illness is common. Suicide tends to increase with age in most countries. In this chapter we argue that the aetiology of disorders may be best understood within a stress vulnerability model in which neurobiological and psychosocial factors interplay. We further present that management strategies need to be comprehensive, incorporating physical, social, pharmacological, and psychological treatments appropriate to each case. We close with a call for the use of specialised multi-disciplinary services to improve the overall quality of care.
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Affiliation(s)
- C Wijeratne
- School of Psychiatry, University of New South Wales, Sydney, Australia
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Volicer L, Frijters D, van der Steen J. Underdiagnosis and undertreatment of depression in nursing home residents. Eur Geriatr Med 2011. [DOI: 10.1016/j.eurger.2011.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
OBJECTIVES To determine whether depression status is associated with an increased risk of coronary heart disease (CHD) events, defined as CHD death or nonfatal acute myocardial infarction (MI). DESIGN Prospective cohort study. SETTING An urban primary care practice. PARTICIPANTS Two thousand seven hundred twenty-eight adults (71.4% women, 65.5% black), age 60 years and older, who were screened for depression between 1991 and 1993. MEASUREMENTS Depressive symptom severity at baseline was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Data regarding baseline demographic and clinical variables, as well as laboratory evidence of acute MI, were obtained from an electronic medical record system. All-cause mortality and CHD death were determined from the National Death Index through 2006. RESULTS A total of 423 (15.5%) participants reported elevated symptoms of depression (CES-D score ≥16). During the 13 to 16 years of follow-up, 1,646 (60.3%) individuals died from any cause, and 727 (26.6%) died from CHD or suffered an acute MI. Cox proportional hazards models revealed that individuals with elevated depressive symptoms were more likely to experience a CHD event, even after adjustment for demographics and comorbid health conditions (relative risk = 1.46, 95% confidence interval: 1.20-1.77). Depression status was also a significant predictor of all-cause mortality in adjusted models. CONCLUSIONS We report the longest prospective study to date to examine depression status as an independent risk factor for CHD among a cohort of older adults including large numbers of women and underrepresented minorities. The present findings underscore the need to consider depression as a common and modifiable risk factor for CHD events among older adults.
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Akincigil A, Olfson M, Walkup JT, Siegel MJ, Kalay E, Amin S, Zurlo KA, Crystal S. Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005. J Am Geriatr Soc 2011; 59:1042-51. [PMID: 21649631 DOI: 10.1111/j.1532-5415.2011.03447.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer-generation antidepressants. DESIGN Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005. SETTING Community, usual care. PARTICIPANTS Older Medicare fee-for-service beneficiaries. MEASUREMENTS Depression diagnoses and psychotherapy use identified from Medicare claims; antidepressant use identified from detailed medication inventories conducted by interviewers. RESULTS The proportion of older adults who received a depression diagnosis doubled, from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups. Of those diagnosed, the proportion receiving antidepressants increased from 53.7% to 67.1%, whereas the proportion receiving psychotherapy declined from 26.1% to 14.8%. Adjusting for other characteristics, odds of antidepressant treatment in older adults diagnosed with depression were 86% greater for women, 53% greater for men, 89% greater for whites, 13% greater for African Americans, 84% greater for metropolitan-area residents, and 55% greater for nonmetropolitan-area residents. Odds of antidepressant treatment were 54% greater for those diagnosed with major depressive disorder (MDD) and 83% greater for those with other depression diagnoses, whereas the odds of receiving psychotherapy was 29% lower in those with MDD diagnoses and 74% lower in those with other depression diagnoses. CONCLUSION Overall diagnosis and treatment rates increased over time. Antidepressants are assuming a more-prominent and psychotherapy a less-prominent role. These shifts are most pronounced in groups with less-severe depression, in whom evidence of efficacy of treatment with antidepressants alone is less clear.
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Affiliation(s)
- Ayse Akincigil
- School of Social Work, Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers, State University of New Jersey, New Brunswick, New Jersey 08901, USA.
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Rainero I, Ostacoli L, Rubino E, Gallone S, Picci LR, Fenoglio P, Negro E, Rosso C, De Martino P, De Marchi M, Furlan PM, Pinessi L. Association between major mood disorders and the hypocretin receptor 1 gene. J Affect Disord 2011; 130:487-91. [PMID: 21071097 DOI: 10.1016/j.jad.2010.10.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 10/13/2010] [Accepted: 10/14/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent studies suggested a role for hypocretins in the neurobiology of Major Mood Disorders (MMD). The purpose of this study was to investigate hypocretin involvement in MMD evaluating whether particular alleles or genotypes of the hypocretin pathway genes (HCRT, HCRTR1 and HCRTR2) would modify the occurrence and clinical features of the disease. METHODS We selected for the study 229 MMD patients and 259 healthy age-, sex- and ethnicity-matched controls. Cases and controls were genotyped for several single-nucleotide polymorphisms (SNPs) of the HCRT, HCRTR1, and HCRTR2 genes. RESULTS We found that allelic and genotypic frequencies of the rs2271933 G>A polymorphism (Ile408Val) in the HCRTR1 gene were significantly different between cases and controls (p=0.003 and p=0.0004, respectively). The carriage of the A allele was associated with a significantly increased disease risk (OR:1.60, 95% C.I. 1.22-2.10). In addition, we found a significant association between HCRTR1 haplotypes and the disease (permutation p<0.0001). In the analysis of subgroups we confirmed the association only in patients with unipolar depression. LIMITATIONS Our sample was relatively small and included only cases and controls recruited from Northern Italy. Analysis of the disease subgroups warrants reexamination with more subjects. Finally, the effects of the rs2271933 G>A polymorphism on the hypocretin-1 receptor function are unknown. CONCLUSIONS Our study suggests that the HCRTR1 gene or a linked locus may modulate the risk for Major Mood Disorders and supports recent studies suggesting an involvement of hypocretin neurotransmitter system in affective disorders.
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Affiliation(s)
- Innocenzo Rainero
- Neurology II, Department of Neuroscience, University of Turin, Italy.
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Mitschelen M, Yan H, Farley JA, Warrington JP, Han S, Hereñú CB, Csiszar A, Ungvari Z, Bailey-Downs LC, Bass CE, Sonntag WE. Long-term deficiency of circulating and hippocampal insulin-like growth factor I induces depressive behavior in adult mice: a potential model of geriatric depression. Neuroscience 2011; 185:50-60. [PMID: 21524689 DOI: 10.1016/j.neuroscience.2011.04.032] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 03/28/2011] [Accepted: 04/13/2011] [Indexed: 12/21/2022]
Abstract
Numerous studies support the hypothesis that deficiency of insulin-like growth factor I (IGF-1) in adults contributes to depression, but direct evidence is limited. Many psychological and pro-cognitive effects have been attributed to IGF-1, but appropriate animal models of adult-onset IGF-1 deficiency are lacking. In this study, we use a viral-mediated Cre-loxP system to knockout the Igf1 gene in either the liver, neurons of the CA1 region of the hippocampus, or both. Knockout of liver Igf1 reduced serum IGF-1 levels by 40% and hippocampal IGF-1 levels by 26%. Knockout of Igf1 in CA1 reduced hippocampal IGF-1 levels by 13%. The most severe reduction in hippocampal IGF-1 occurred in the group with knockouts in both liver and CA1 (36% reduction), and was associated with a 3.5-fold increase in immobility in the forced swim test. Reduction of either circulating or hippocampal IGF-1 levels did not alter anxiety measured in an open field and elevated plus maze, nor locomotion in the open field. Furthermore, local compensation for deficiencies in circulating IGF-1 did not occur in the hippocampus, nor were serum levels of IGF-1 upregulated in response to the moderate decline of hippocampal IGF-1 caused by the knockouts in CA1. We conclude that adult-onset IGF-1 deficiency alone is sufficient to induce a depressive phenotype in mice. Furthermore, our results suggest that individuals with low brain levels of IGF-1 are at increased risk for depression and these behavioral effects are not ameliorated by increased local IGF-1 production or transport. Our study supports the hypothesis that the natural IGF-1 decline in aging humans may contribute to geriatric depression.
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Affiliation(s)
- M Mitschelen
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, The University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1303, Oklahoma City, OK 73104, USA
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Perrino T, Brown SC, Huang S, Brown CH, Gómez GP, Pantin H, Szapocznik J. Depressive symptoms, social support, and walking among Hispanic older adults. J Aging Health 2011; 23:974-93. [PMID: 21508305 DOI: 10.1177/0898264311404235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Depressive symptoms and physical inactivity are health risks among minority older adults. This study examined whether social support moderated the relationship of depressive symptoms to walking behavior among 217 community-dwelling, Hispanic older adults. METHOD Cross-sectional analyses were used to test whether different forms of social support interacted with depressive symptoms to affect both likelihood and amount of walking. RESULTS Analyses showed a significant interaction between depressive symptoms and instrumental support related to the likelihood of walking and a marginally significant interaction between depressive symptoms and instrumental social support related to the amount of walking. Depressive symptoms were associated with a lower likelihood and lower amount of walking among participants receiving high levels of instrumental social support (e.g., help with chores) but not low instrumental support. Emotional and informational support did not moderate the depression to walking relationship. CONCLUSION Receiving too much instrumental support was related to sedentary behavior among depressed older adults.
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Kiosses DN, Teri L, Velligan DI, Alexopoulos GS. A home-delivered intervention for depressed, cognitively impaired, disabled elders. Int J Geriatr Psychiatry 2011; 26:256-62. [PMID: 20665555 PMCID: PMC3039046 DOI: 10.1002/gps.2521] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Problem Adaptation Therapy (PATH) is a new home-delivered intervention designed to reduce depression and disability in depressed, cognitively impaired, disabled elders. A new intervention is needed in this population as antidepressant treatment is effective in only a minority of these patients. METHODS PATH focuses on the patient's ecosystem, which includes the patient, the caregiver, and the home environment, to address the needs of depressed, cognitively impaired, disabled elders. It builds on the therapeutic framework of Problem Solving Therapy (PST), which has been efficacious in decreasing depression and disability in cognitively intact depressed elders. To address the needs of depressed elders with advanced cognitive impairment, PATH incorporates environmental adaptations and invites caregiver participation. RESULTS To illustrate the administration of PATH, two case studies with varying degrees of cognitive impairment and caregiver participation are presented. Both patients were administered 12 weeks of PATH at their home. At the end of treatment their depression and disability was significantly reduced. CONCLUSIONS PATH is a new home-delivered intervention for depressed elders with cognitive impairment and disability focusing on reducing depression and disability by employing environmental adaptations and inviting caregiver participation. This intervention may provide a treatment alternative for a population with limited success of antidepressant treatment.
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Abstract
In a context of the potentially epidemic nature of both diabetes mellitus and depression, and the negative effects reported in cases of comorbidity, this review suggests that the association of the two conditions is multifaceted. Increased risks of prevalent depression and incident depression among diabetic patients have been reported in community studies. Even more consistent is the finding supporting psychosomatic hypotheses regarding the increased risk of diabetes among depressed patients. A recent relevant finding is the increased risk of diabetes reported in depression that is commonly found in the community, namely nonsevere, persistent, untreated depression. In view of the negative implications of the comorbidity of depression and diabetes, the suggestion that all clinically relevant cases of depression found in the community should be treated seems logical. However, new studies seem mandatory to document the efficacy of treatment of depression and the safety of antidepressant use in cases of comorbidity.
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Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, Billinger SA. Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient. Stroke 2010; 41:2402-48. [PMID: 20813995 DOI: 10.1161/str.0b013e3181e7512b] [Citation(s) in RCA: 458] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Perlmutter MS, Bhorade A, Gordon M, Hollingsworth HH, Baum MC. Cognitive, Visual, Auditory, and Emotional Factors That Affect Participation in Older Adults. Am J Occup Ther 2010; 64:570-9. [DOI: 10.5014/ajot.2010.09089] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. To determine whether changes in hearing, cognition, depression, and vision affect daily life participation and whether screening tests that identify problems could be used in the home.
METHOD. Interviewers assessed presence of medical conditions, social class, distance acuity, cognition, hearing, depression, and participation using valid screening tools. Participation scores were subgrouped according to negative or positive results. Multiple regression analysis determined association of screening tests with participation.
RESULTS. Eighty-eight older adults, ages 62–90, participated. Positive screening tests were found in 43% of participants for distance acuity, 9% for cognitive problems, 8% for depression, and 15% for hearing loss. Relationships were found among age, cognition, depression, and vision and participation.
CONCLUSION. Mild levels of decreased vision, depression, and decreased cognition are associated with lower participation. These conditions can be screened by occupational therapists and managed to help older adults remain active and maintain their health.
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Affiliation(s)
- Monica S. Perlmutter
- Monica S. Perlmutter, MA, OTR/L, is Instructor of Occupational Therapy and Ophthalmology, Program in Occupational Therapy, Washington University School of Medicine, 660 South Euclid, Box 8505, St. Louis, MO 63110;
| | - Anjali Bhorade
- Anjali Bhorade, MD, is Assistant Professor of Ophthalmology, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Mae Gordon
- Mae Gordon, PhD, is Professor of Ophthalmology and Biostatistics, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
| | - Holly H. Hollingsworth
- Holly H. Hollingsworth, PhD, is Research Associate Professor of Occupational Therapy, Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO
| | - M. Carolyn Baum
- M. Carolyn Baum, PhD, OTR/L, is Professor of Occupational Therapy, Program in Occupational Therapy, and Professor of Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, MO
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Hasche LK, Morrow-Howell N, Proctor EK. Quality of life outcomes for depressed and nondepressed older adults in community long-term care. Am J Geriatr Psychiatry 2010; 18:544-53. [PMID: 20220587 PMCID: PMC2875292 DOI: 10.1097/jgp.0b013e3181cc037b] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare outcomes of mortality, institutionalization, physical and mental quality of life, overall life satisfaction, and satisfaction with living arrangements, for depressed and nondepressed clients after 1 year of community long-term care (CLTC) services. DESIGN Prospective cohort study with repeated assessments at 6 and 12 months. SETTING A publicly funded CLTC agency that coordinates in-home care such as meal delivery, personal care, and nursing care to functionally disabled and low-income adults throughout a Midwestern State. PARTICIPANTS Adults aged 60 years and older, starting CLTC services with minimal or no cognitive impairment (N = 551). MEASUREMENTS Outcomes included the Medical Outcome Study's Short-Form for physical and mental quality of life and single items for life satisfaction and satisfaction with living arrangements. Diagnostic Interview Schedule and the Center for Epidemiologic Studies Depression Scale determined clients' depression status. RESULTS Depressed clients (N = 266) had significantly worse scores for all outcomes than nondepressed clients (N = 285), but mortality and institutionalization were not significantly related to depression. Depression was significantly associated with more positive change in mental health (mean change: depressed group = 4.60, standard deviation [SD] = 14.0; nondepressed group = -1.50, SD =11.2) and overall life satisfaction (mean change: depressed group = 0.10, SD = 1.1; nondepressed group = -0.10, SD = 0.8). CONCLUSION After 1 year of CLTC services, depressed clients experienced more improvement in quality of life and life satisfaction, but their outcomes remained significantly lower than nondepressed clients. Depression was consistently and negatively associated with quality of life and satisfaction outcomes.
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Affiliation(s)
- Leslie K Hasche
- School of Social Welfare, University of Kansas, Lawrence, KS 66044, USA.
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Engin S, Ozturk M, Engin N, Kulaksizoglu IB. Dark side of the town: depressive symptoms in disadvantaged senior citizens. J Nutr Health Aging 2010; 14:483-7. [PMID: 20617293 DOI: 10.1007/s12603-010-0035-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Depression is frequently overlooked in older adults. Detection of depressive symptoms (DS) is important in primary care. This study aimed to detect the rate, risk factors and effects of DS in a disadvantaged older population. DESIGN Descriptive study. SETTING Community based rehabilitation centers and Sehzadebasi medical center of Istanbul Metropolitan Municipality (IMM). PARTICIPANTS 1163 Consecutive patients at least 60 years old, and applied to IMM; mostly poor and/or without health insurance. MEASUREMENTS Detailed history and geriatric scales were obtained. Depressive symptoms (DS) were defined as 14 or more points in 30 item Geriatric Depression Scale. Relations of DS and ordinal variables were tested by Chi-square; DS and numeric variables by T-test. Multiple regressions followed. RESULTS Younger old and women subjects were in majority. The rate of DS was 52%, while 9.1% have depression diagnosis in their history. After multiple regressions, lack of health insurance was found to be the strongest independent risk factor for DS (p < 0.0001). Other variables that remained significant were: Limited mobility, lower Instrumental Activities of Daily Living and Tinetti Balance scores, onset insomnia, nightly awakenings and reported dizziness (p values = 0.008; 0.021; 0.005; 0.022; 0.04 and 0.03 respectively). CONCLUSION These results indicate the need for comprehensive geriatric assessment in primary care to detect DS, in addition to negative effect of DS on sleep and independency. Health insurance coverage of the senior citizens also is an important challenge.
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Affiliation(s)
- S Engin
- Istanbul Metropolitan Municipality Department of Health Services, Kayisdagi nursing home, Kayisdagi street No: 65 Kucukbakkalkoy, Kadikoy/Istanbul, Turkey.
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Abstract
SummaryAppropriate social and medical interventions may help maintain independence in older people. Determinants of functional decline, disability and reduced independence are recognized and specific interventions target the treatment of clinical conditions, multiple health problems and geriatric conditions, prevention of falls and fractures, and maintenance of physical and cognitive function and social engagement.Preventive strategies to identify and treat diverse unmet needs of older people have been researched extensively. We reviewed systematically recent randomized controlled trials evaluating these ‘complex’ interventions and incorporated the findings of 21 studies into an established meta-analysis that included 108,838 people in 110 trials. There was an overall benefit of complex interventions in helping older people to live at home, explained by reduced nursing home admissions rather than death rates. Hospital admissions and falls were also reduced in intervention groups. Benefits were largely restricted to earlier studies, perhaps reflecting general improvements in health and social care for older people. The wealth of high-quality trial evidence endorses the value of preventive strategies to help maintain independence in older people.
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