Screening for Depression in Old Age With Very Short Instruments: The DIA-S4 Compared to the GDS5 and GDS4

Prevalence and factors associated with probable depression among the oldest old during the Covid-19 pandemic: evidence from the large, nationally representative 'Old Age in Germany (D80+)' study

BACKGROUND

To date, most studies examining the prevalence and determinants of depression among individuals aged 80 and over have used geographically limited samples that are not generalisable to the wider population. Thus, our aim was to identify the prevalence and the factors associated with probable depression among the oldest old in Germany based on nationally representative data.

METHODS

Data were taken from the nationally representative 'Old Age in Germany (D80+)' study (n = 8386; November 2020 to April 2021) covering both community-dwelling and institutionalised individuals aged 80 and over. The Short Form of the Depression in Old Age Scale was used to quantify probable depression.

RESULTS

Probable depression was found in 40.7% (95% CI: 39.5% to 42.0%) of the sample; 31.3% were men (95% CI: 29.7% to 32.9%) and 46.6% women (95% CI: 44.9% to 48.3%). The odds of probable depression were positively associated with being female (odds ratio (OR): 1.55, 95% CI: 1.30 to 1.84), being divorced (compared to being married, OR: 1.33, 95% CI: 1.01 to 1.76), being widowed (OR: 1.14, 95% CI: 1.00 to 1.30), having a low education (e.g., medium education compared to low education, OR: 0.86, 95% CI: 0.74 to 0.99), living in an institutionalised setting (OR: 2.36, 95% CI: 1.84 to 3.02), living in East Germany (OR: 1.21, 95% CI, 1.05 to 1.39), not having German citizenship (German citizenship compared to other citizenship, OR: 0.55, 95% CI: 0.31 to 0.95), poor self-rated health (OR: 0.31, 95% CI: 0.28 to 0.34), and the number of chronic conditions (OR: 1.12, 95% CI: 1.09 to 1.14).

CONCLUSION

About four out of 10 individuals aged 80 and over in Germany had probable depression, underlining the importance of this challenge. Knowledge of specific risk factors for this age group may assist in addressing older adults at risk of probable depression.

Determinants of psychosocial factors amongst the oldest old: Longitudinal evidence based on the representative "survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia"

OBJECTIVES

There are few studies investigating the determinants of psychosocial outcomes using data exclusively from the oldest old; and even fewer that use longitudinal data. Thus, our aim was to explore the determinants of psychosocial factors (in terms of life satisfaction, loneliness, and depressive symptoms) amongst the oldest old (also stratified by sex) based on representative, longitudinal data from Germany.

METHODS/DESIGN

Data from "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" were used. This study includes community-dwelling and institutionalized individuals aged 80 years and above (n = 1760 observations in the analytical sample) located in North Rhine-Westphalia (the most populous state in Germany). The mean age was 86.6 years (SD: 4.3 years). Established instruments were used to quantify life satisfaction, loneliness, and depressive symptoms. Linear FE regressions were used in this study to mitigate the challenge of unobserved heterogeneity. Sex-stratified regressions were also conducted.

RESULTS

Regressions showed that the loss of a spouse was significantly associated with worsening psychosocial factors (in terms of increases in depressive symptoms and loneliness). Furthermore, regressions revealed that increases in functional impairment were significantly associated with poorer psychosocial outcomes.

CONCLUSIONS

This longitudinal study enhanced our understanding of the factors contributing to poorer psychosocial outcomes among the oldest old. Efforts to avoid or postpone functional impairment may contribute to more favorable psychosocial outcomes. Moreover, our current study underlines the importance of spousal relationships for psychosocial outcomes in the oldest age group.

The Relationship Between Internet Use for Social Purposes, Loneliness, and Depressive Symptoms Among the Oldest Old

The internet enables communication with social partners and has been found to be related to higher psychological well-being among older adults. Using data from the representative German North Rhine-Westphalia 80+ (NRW80+) study (n = 1,698, Mage = 84.86), we conducted linear regression and mediation analyses to compare levels of loneliness and depressive symptoms of onliners using the internet for social or other purposes with offliners. Oldest old onliners used the internet mostly for social purposes, and this type of internet use was related to a significantly lower level of loneliness and fewer depressive symptoms compared to offliners. The mediation analysis revealed that internet use for social purposes was related to lower levels of loneliness, which in turn was associated with a lower number of depressive symptoms. The findings suggest that internet use for social purposes may help the oldest old to reduce feelings of loneliness and depressive symptoms.

WWII trauma impacts physical and mental health in the oldest old: results from a German population-based study

INTRODUCTION

Epidemiological studies in different traumatised samples indicate an increased risk for numerous physical and mental diseases. It is suspected that this is due to chronic changes in fundamental processes in the immune, nervous, and endocrine systems, which take years to manifest pathologically. Previous studies have considered intervals of a few decades. However, little is known about whether a link between trauma and physical and mental health can be established over very long periods of time and in the oldest old population.

MATERIALS AND METHODS

A total of 1,299 German citizens aged 80 and above were interviewed about on-going suffering from the effects of traumatic World War II (WWII) events as well as about physical and mental health. Multiple linear and logistic regression models were used to assess the impact of suffering from the effects of traumatic events on general health, several medical conditions, multimorbidity, pain, and depression.

RESULTS

43.94% of the oldest old were still suffering from the effects of traumatic events in connection with WWII. Participants who were still suffering from the effects of traumatic events were more likely to be treated for heart failure, blood diseases, bladder problems, back pain, respiratory or lung diseases, and sleep disorders. They also had poorer general health, higher multimorbidity, more pain, and higher depression scores.

DISCUSSION

Findings suggest that chronic psychological suffering from the effects of traumatic events in early life is associated with impaired physical and mental health even seven decades after the events.

Elder abuse in the oldest old: prevalence, risk factors and consequences

BACKGROUND

Experiences of abuse in relationships with an expectation of trust are a common phenomenon among older people and is called elder abuse (EA). This can take various forms, such as physical, verbal, emotional, psychological, financial, sexual abuse or neglect. Due to their high vulnerability and difficulties in receiving support, people aged over 80 years old have been pointed out as a group that needs special focus in research.

OBJECTIVE

Prevalence, risk factors and consequences of EA for different aspects of quality of life are explored among the oldest old.

MATERIAL AND METHODS

Computer-assisted personal interviews were conducted in a representative sample of the oldest old in North Rhine-Westphalia (Germany). 988 self-report interviews without third persons present of the NRW80+ study are used to assess EA with the help of the elder abuse and emotional consequences scale (EACS). The EACS describes EA in six dimensions that give a broad understanding of EA.

RESULTS

Prevalence of experiences of EA within the last 12 months was 54.1%. In logistic regression, multimorbidity, lower functioning, age below 90 years, smaller social network size, and aggressive behaviorwere significant risk factors for EA. People experiencing EA showed less life satisfaction and autonomy and increased loneliness and depressive symptoms.

CONCLUSION

EA is prevalent among the oldest old. Serious consequences of EA on life results can be shown with a broad operationalization of EA. Future research should focus on a deeper understanding of reasons for EA and reflect on the relationship between and the perspectives of perpetrators and victims.

Multimorbidity in old age and its impact on life results

BACKGROUND

High prevalence diseases, such as high blood pressure, dementia and depression in old age can lead to multimorbidity, which is often defined as the presence of more than one health condition in an individual. Multimorbidity has negative consequences on health-related quality of life and healthcare utilization. As many age-associated diseases are not curable, therapeutic goals like preservation of autonomy, functioning, and life satisfaction become more important in old age patients.

OBJECTIVE

The prevalence of multimorbidity dementia and depressive symptoms and the consequences of multimorbidity on autonomy, functioning, and life satisfaction among the oldest old were examined.

MATERIAL AND METHODS

In personal computer-assisted interviews, participants of the representative study NRW80+ were asked for which health issues they received medical treatment.

RESULTS

On average, people above the age of 80 years were treated for 3.62 diseases and 31.4% of older people received medical treatment for 5 or more diseases. A connection between multimorbidity and age group could not be shown. Autonomy, functioning, and life satisfaction are reduced in association with multimorbidity.

CONCLUSION

Multimorbidity is a frequent phenomenon among old people. A lack of diagnostic procedures and medical treatment can be a reason for the missing age trends. The results illustrate the importance of multimorbidity for patient-relevant outcomes and reveal the need to identify patients with multimorbidity.

WWII traumatic events, subjective well-being and valuation of life in the very old

Background

Experiencing war is a major trigger for physical and mental health problems. People in the German population who are currently over 80 years of age experienced the Second World War (WWII) as children or adolescents, at a time when psychological vulnerability is high. Empirical results show that positive subjective well-being (SWB) and valuation of life (VoL) in older cohorts are widespread; however, when confronted with existential age-associated changes, many older adults experience increased burden, sometimes bringing biographical vulnerabilities to the forefront. This study investigated SWB and VoL in the very old and examined the influence of negative WWII experiences on these outcomes.

Method

Cross-sectional data from the “Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)” are presented. Multiple regression models, adjusted for gender, age, physical health, and full inpatient care, were computed to assess the impact of suffering from the effects of WWII traumatic experiences on SWB and VoL.

Results

Over 13% spontaneously reported suffering from the effects of WWII events and an additional 29% reported negative experiences when explicitly asked about them. Multiple regression models showed elevated depression scores for participants suffering from the effects of WWII traumatic events. No association with positive affect was found. Suffering from the effects of WWII traumatic events did not influence VoL engagement with life or VoL optimism.

Discussion

Many very old adults still seem to struggle with the repercussions of WWII traumatic experiences. Future studies could further examine if the missing association with positive affect and VoL is a sign of resilience.