Depressive symptoms and all-cause mortality in Korean older adults: A 3-year population-based prospective study

Association of changes in self-reported vision and hearing impairments with depressive symptoms in middle-aged and older adults: Evidence from a nationwide longitudinal study in China

OBJECTIVE

This study assessed the longitudinal relationship between changes in self-reported vision impairment (VI) and hearing impairment (HI), and depressive symptoms in adults aged ≥45 years.

METHODS

Data from the China Health and Retirement Longitudinal Study for 2015 and 2018 were used, with a sample size of 10,050. VI and HI were self-reported. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D10) was used to assess depressive symptoms. Total scores and clinically significant depressive symptoms (CES-D10 scores ≥ 10) were used as outcomes and analyzed using generalized estimating equations with identity link and logit link functions.

RESULTS

Of all changes in HI with good vision, only persistent HI was associated with higher CES-D10 scores (OR 95% CI: 1.09-3.30). Both new-onset and persistent VI with good hearing were associated with CES-D10 scores (OR 95% CI, new-onset: 1.70-3.52; persistent: 1.58-2.78) and clinically significant depressive symptoms (OR 95% CI, new-onset: 1.41-2.56; persistent: 1.36-2.27). Persistent dual sensory impairment (DSI) was associated with the highest CES-D10 scores (OR 95% CI: 3.63-5.97) and the highest risk of clinically significant depressive symptoms (OR 95% CI: 1.78-2.85). Those who self-reported improvements in vision and hearing still had higher CES-D10 scores (OR 95% CI: 1.35-2.83) and a higher risk of clinically significant depressive symptoms (OR 95% CI: 1.03-2.02) than those maintaining good vision and hearing.

CONCLUSION

Self-reported VI and DSI are closely associated with depressive symptoms. Because VI and DSI are modifiable, interventions for them could also prevent depressive symptoms.

Depression Symptoms and Mortality in Elderly Peruvian Navy Veterans: A Retrospective Cohort Study

Our study was design to determine the association between depressive symptoms and mortality in adults over 60 years old Navy Peruvian Veterans. We performed a retrospective cohort study based on a previous cohort study. A total of 1681 patients over 60 years old were included between 2010–2015. Demographic information, self-reported information about falls, physical frailty assessment, tobacco consumption, hypertension, Type 2 Diabetes Mellitus, Chronic Obstructive Pulmonary Disease and was collected. Depression was assessed by the short form of the Geriatric Depression Scale. We found that depressive symptoms were present in 24.9% of the participants and 40.5% of them died. Mortality risk in patients with depressive symptoms, physical frailty, and male sex was: RR of 23.1 (95% CI: 11.7–45.7), 3.84 (95% CI: 2.16–6.82), and 1.37 (95% CI: 1.07–1.75) respectively. We concluded that depressive symptoms in Peruvian retired military personnel and their immediate relatives are high and are significatively associated with mortality. Also, being male and frail was associated with an increased risk of death. This reinforces that early detection and assessment of depressive symptoms could be an opportunity to improve the health status of older adults.

The depressed frail phenotype as a risk factor for mortality in older adults: A prospective cohort in Peru

INTRODUCTION

Frailty and depression can coexist as depressed frail phenotype, useful for the comprehensive evaluation of older adults and prevention of adverse outcomes. The objective of this study was to evaluate the role of the depressed frail phenotype and its components as risk factors for mortality in older adults of the Centro Médico Naval (CEMENA) of Peru during 2010-2015.

MATERIAL AND METHODS

We carried out a secondary data analysis of a prospective cohort that included older adults (60 years and older) treated in the Geriatrics service of CEMENA between the years 2010-2015. Frailty was defined as the presence of three or more Fried phenotype criteria and depression was determined using a Yesavage ultrashort scale score of three or more. The presence of both conditions was defined as depressed frail phenotype. In addition, sociodemographic characteristics, medical and personal history, and performance-based measures were included. We employed crude and adjusted Cox regression models to evaluate the association of interest and estimate Hazard Ratios (HR) with their respective 95% confidence intervals (95% CI).

RESULTS

946 older adults were included in the analysis, with a mean age of 78.0 ± 8.5 years. 559 (59.1%) were male, 148 (15.6%) were found to be frail, 231 (24.4%) had depressive symptoms, 105 (11.1%) had depressed frail phenotype, and 79 (8.3%) participants died during follow-up. The adjusted Cox regression analysis revealed that depressed frail phenotype (HR = 3.53; 95%CI: 2.07-6.00; p < 0.001) was a risk factor for mortality in older adults.

CONCLUSIONS

The depressed frail phenotype was associated with a higher risk of mortality in older adults. It is necessary to develop longitudinal studies that allow estimating this phenotype's impact on mortality and evaluate interventions to improve quality of life and reduce the risk of adverse outcomes.

Social frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao Longevity and Aging Study

AIM

To explore the cross-sectional and longitudinal associations between social frailty (SF) and incident depressive symptoms in a Chinese population.

METHODS

SF was measured with 6 questions (6 points maximum; 0-1 = non-SF, 2-3 = pre-SF, 4-6 = SF). Depressive symptoms were defined as a score of ≥6 on the Geriatric Depression Scale. Compared to baseline, participants with a ≥2-point increase in the Geriatric Depression Scale score were considered to have worsening depressive symptoms.

RESULTS

At baseline, among 1764 participants, 9.9% (n = 175) had depressive symptoms, 3.6% (n = 61) were SF, and 38.2% (n = 650) were pre-SF. The percentage of depressive symptoms increased with SF status from 5.1% (non-SF) to 12.9% (pre-SF), to 41.0% (SF). In cross-sectional analysis, after adjustments for multiple covariates, depressive symptoms were significantly associated with both pre-SF (odds ratio (OR) = 2.94, 95% confidence interval (CI) 2.01-4.32) and SF (OR = 16.70, 95% CI 8.80-31.71). During the 3-year follow-up period, 10.0% (n = 117) of the participants developed depressive symptoms. In longitudinal analyses, after multiple adjustments, SF and pre-SF were associated with a 2.31-fold (95% CI 1.10-4.88) and 1.58-fold (95% CI 1.05-2.38) increased risk of incidence of depressive symptoms, respectively. Among participants without depressive symptoms at baseline, 23.2% had worsening depressive symptoms, and SF was associated with increased risk of worsening depressive symptoms (OR = 2.07, 95% CI 1.18-3.65).

CONCLUSIONS

Our findings suggested that SF may be a predictor of depression among Chinese community-dwelling older adults. In addition, in elders with no depressive symptoms at baseline, those with SF had greater odds of worsening depressive symptoms 3 years later.

Cardiorespiratory Fitness without Exercise Testing Can Predict All-Cause Mortality Risk in a Representative Sample of Korean Older Adults

This study examined the association between cardiorespiratory fitness (CRF) without exercise testing and all-cause mortality in Korean older adults. The present study was carried out using data from the 2008 and 2011 Living Profiles of Older People Survey. A total of 14,122 participants aged 60 years and older (57% women) completed the 2008 baseline and 2011 follow-up assessments (i.e., socioeconomic status, health behaviors and conditions, and prevalence of chronic diseases), and they were included for the final analyses. CRF was estimated (eCRF) with sex-specific algorithms and classified as lower (lowest 25%), middle (middle 50%), and upper (highest 25%). Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) across eCRF categories. In total, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.059 (0.814~1.378) for the middle eCRF group, and 1.714 (1.304~2.253) for the lower eCRF group. In men, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.011 (0.716~1.427) for the middle eCRF group, and 1.566 (1.098~2.234) for the lower eCRF group. In women, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.064 (0.707~1.602) for the middle eCRF group, and 1.599 (1.032~2.478) for the lower eCRF group. The current findings suggest that eCRF may have an independent predictor of all-cause mortality, underscoring the importance of promoting physical activity to maintain a healthful level of CRF in Korean geriatric population.

Handgrip strength, depression, and all-cause mortality in Korean older adults

Background

Decreased muscle strength and/or depression with aging are emerging as important public health concerns in both developed and developing countries. This study investigated the effects of low handgrip strength (HGS) and depression on the risk of all-cause mortality in Korean older adults.

Methods

Data from 13,901 Korean adults (57% women) who participated in the 2008 baseline survey and completed the 2011 follow-up assessments were used.

Results

In total, the current findings showed that individuals with depression only and individuals with low HGS plus depression had significantly higher risks of all-cause mortality (hazard ratio (HR) = 1.366, 95% confidence interval (CI) = 1.033–1.807, p = 0.029 and HR = 1.961, 95% CI = 1.409–2.736, p < 0.001, respectively) even after adjustments for all the measured covariates, compared with individuals with high HGS plus no depression (HR = 1). Gender-stratified analysis showed that men with depression only and men with depression plus low HGS had significantly higher risks of all-cause mortality (HR = 1.376, 95% CI =1.029–1.841, p = 0.031 and HR = 1.861, 95% CI = 1.306–2.651, p = 0.001, respectively) even after adjustments for all the measured covariates, compared with individuals with no depression plus high HGS (HR = 1). In women, however, the joint effect of depression and low HGS only remained significant at borderline (HR = 2.603, 95% CI = 0.981–6.908, p = 0.055) when adjusted for all the confounders.

Conclusion

The current finding suggested that depression and low HGS were significantly and synergistically associated with the increased risk of premature death from all causes in the Korean geriatric population.

The excess mortality risk associated with anticholinergic burden among older patients discharged from acute care hospital with depressive symptoms

BACKGROUND

The relationship between anticholinergic burden and mortality is controversial, and the impact of anticholinergic burden on prognosis may vary in presence of other conditions common in old age. We aimed at investigating the role of depressive symptoms as potential effect modifiers in the association between anticholinergic burden and 1-year mortality in older patients discharged from hospital.

METHODS

Our series consisted of 576 older patients consecutively admitted to seven geriatric and internal medicine acute care wards in the context of a prospective multicenter observational study. Overall anticholinergic burden was assessed by Anticholinergic Cognitive Burden (ACB) score. Depressive symptoms were assessed by 15-item Geriatric Depression Scale (GDS). The study outcome was all-cause mortality during 12-months follow-up. Statistical analysis was carried out by Cox regression analysis.

RESULTS

After adjusting for potential confounders, discharge ACB score = 2 or more was significantly associated with the outcome among patients with GDS > 5 (HR = 3.70; 95%CI = 1.18-11.6), but not among those with GDS ≤ 5 (HR = 2.32; 95%CI = 0.90-6.24). The association was confirmed among depressed patients after adjusting for ACB score at 3-month follow-up (HR = 3.58; 95%CI = 1.21-10.7), as well as when considering ACB score as a continuous variable (HR = 1.42; 95%CI = 1.10-1.91). The interaction between ACB score at discharge and BADL dependency was statistically significant (p < .005).

CONCLUSIONS

ACB score at discharge may predict mortality among older patients discharged from acute care hospital carrying high GDS score e. Hospital physician should be aware that prescribing anticholinergic medications in such a vulnerable population may have negative prognostic implications.