Health behaviors influencing depressive symptoms in older Koreans living alone: secondary data analysis of the 2014 Korean longitudinal study of aging

Latent class analysis of health lifestyle among older adults living alone and associations with life satisfaction and depressive symptoms

BACKGROUND

Little is known about the collective patterns of health-related behaviors of older adults living alone. We aimed to identify subgroups of older adults living alone based on their health lifestyle and examine the relationship between these subgroups and sociodemographic characteristics, life satisfaction, and depressive symptoms.

METHODS

A total of 3137 older adults living alone were sampled from the 2020 National Survey of Older Koreans. Latent class analysis was performed using 11 health-related behaviors: smoking; alcohol consumption; fruit, vegetable, and dairy product consumption; exercise; cultural leisure; social groups; educational activities; health check-ups; and dementia screening. Multinomial logistic and multiple linear regression analyses were performed.

RESULTS

Three classes were identified: Consistently Healthy (CH), Moderately Healthy but Inactive (MHI), and Unhealthy but Active (UA). Compared to the CH, members of the MHI tend to have no formal education and rarely meet relatives. Members of the UA were more likely to be male and employed. The MHI and UA were more likely to have lower incomes, meet with children less frequently or have no children, and rarely meet friends, neighbors, and acquaintances when compared to the CH. Members of the UA group had the highest risk of reduced life satisfaction and increased depressive symptoms.

LIMITATIONS

The cross-sectional design precluded causal inferences.

CONCLUSION

Our study sheds light on the heterogeneity of health lifestyles among older adults living alone and highlights the need for tailored interventions to promote healthy aging in this population.

Association of the Type of Public Pension With Mental Health Among South Korean Older Adults: Longitudinal Observational Study

BACKGROUND

As income and health are closely related, retirement is considered undesirable for health. Many studies have shown the association between pension and health, but no research has considered the association between contribution-based public pensions or their types and health.

OBJECTIVE

This study investigates the association between the type of contributory public pension and depressive symptoms among older adults.

METHODS

We analyzed the data of 4541 older adults who participated in the South Korea Welfare Panel Study (2014-2020). Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression scale. Public pensions in South Korea are classified into specific corporate pensions and national pensions. For subgroup analyses, pensioners were categorized according to the amount of pension received and the proportion of public pension over gross income. Analyses using generalized estimating equations were conducted for longitudinal data.

RESULTS

Individuals receiving public pension, regardless of the pension type, demonstrated significantly decreased depressive symptoms (national pension: β=-.734; P<.001; specific corporate pension: β=-.775; P=.02). For both pension types, the higher the amount of benefits, the lower were the depression scores. However, this association was absent for those who received the smaller amount among the specific corporate pensioners. In low-income households, the decrease in the depressive symptoms based on the amount of public pension benefits was greater (fourth quartile of national pension: β=-1.472; P<.001; second and third quartiles of specific corporate pension: β=-3.646; P<.001).

CONCLUSIONS

Our study shows that contributory public pension is significantly associated with lower depressive symptoms, and this association is prominent in low-income households. Thus, contributory public pensions may be good income sources for improving the mental health of older adults after retirement.

Global prevalence and risk factors of depression in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis from 2000 to 2022

OBJECTIVE

This study aims to assess the global and regional prevalence and the potential risk factors for depression among COPD patients.

METHODS

Web of Science, EMBASE, PubMed, and PsycINFO databases were searched for the literature related to the prevalence and risk factors of depression in COPD. Random-effect models were performed to pool the global prevalence. Sub-group analysis and meta-regression were conducted to investigate the potential heterogeneity. Meta-analysis was performed only on the risk factors that have been reported in a minimum of three studies.

RESULTS

A total of 79 studies from 25 countries were included. The pooled global prevalence of variably defined depression among COPD patients was 34.5% (95% CI: 30.9-38.1). The odds of depression in COPD patients were 3.53 times higher than in non-COPD participants (95% CI: 2.35-5.29). Meta-regression results showed that region, income level, and research setting are the main sources of heterogeneity. Female sex (OR=1.92), living alone (OR=2.29), BODE index (OR=1.48), dyspnea (OR=3.02), impaired quality of life (OR=1.26), and GOLD stage III∼IV (OR=1.96) were found to be significant risk factors for depression in meta-analyses.

CONCLUSIONS

More than one-third of COPD patients experience depression, with marked variations in prevalence across countries and regions. This study further highlights the need for the consolidation of mental health considerations into COPD treatments. High-quality, longitudinal studies and further research are needed to gain a better understanding of risk and protective factors.

Do living arrangements and health behaviors associate with anxiety symptoms among Chinese older people? Differences between urban and rural areas

Living arrangements and health behaviors are considered to be associated with mental health, but their relationship has been less investigated by national survey data in China. The purpose of this study is to explore the relationship of living arrangements and health behaviors with anxiety among Chinese older people and to compare the results between urban and rural areas. The study was based on the Chinese Longitudinal Healthy Longevity Survey conducted in 2018, and a total of 12 726 old-aged respondents were included. Ordinal logistic regression was used to analyze the associations between living arrangements, health behaviors and anxiety. This study found that people living in nursing institutions are likely to be more anxious than their dwelling counterparts. Although we found no significant relationships of health behaviors such as smoking, drinking alcohol and exercise with anxiety, older adults with greater dietary diversity were less likely to experience anxiety. Furthermore, different trends between living arrangements and anxiety, smoking and anxiety were also found among urban versus rural respondents. The findings of this study help to better understand anxiety among Chinese older people and shed light on health policy on older people protection and services.

Modeling suicidal ideation in Korean older adults based on their social relationships and mental health: a meta-analytic path analysis

OBJECTIVES

Elder suicide is a serious concern in many countries, including South Korea. Various policies and programs to prevent elder suicide are essential; however, further understanding of this phenomenon is necessary. The current study, therefore, developed a model for understanding the underlying mechanism of suicidal ideation in older adults in South Korea. The model was based on Andersen's theory (2021), which explains the path from social relationships to mental health.

METHODS

This study was conducted utilizing meta-analytic structural equation modeling in accordance with a pooled correlation matrix. We used data from 93 existing studies systematically identified in nine academic databases.

RESULTS

The fit statistics show that our model fits the data well. The results demonstrated that suicidal ideation was directly affected by abuse, depression, and self-esteem but not by family relationships. Depression significantly mediated the relationship between abuse and suicidal ideation and between family relationships and suicidal ideation.

CONCLUSION

Social relationships play an important role in determining mental health among Korean older adults, consistent with Andersen's theory. Prevention of elder abuse and depression is essential in preventing suicide among older adults in South Korea.

Prevalence and determinants of depressive symptoms among community-dwelling older adults in China based on differences in living arrangements: a cross-sectional study

BACKGROUND

Older adults with different living arrangements may have different mental health statuses and different factors that influence their mental health. The aim of the present study is to investigate the prevalence and determinants of depressive symptoms among community-dwelling older adults in China based on differences in their living arrangements.

METHODS

Participants were 6,055 older adults from the 2015 China Health and Retirement Longitudinal Study. Depressive symptoms and their determinants were evaluated using the 10-item Center for Epidemiologic Studies Depression Scale and multivariate logistic regression analysis, respectively.

RESULTS

The prevalence of depressive symptoms among older adults living alone, as a couple, and with children was 47.8%, 33.2%, and 39.5%, respectively. The common risk factors for depressive symptoms were shorter sleep duration, poorer activities of daily living, and poorer self-rated health. Women, those with lower educational levels, and those suffering from chronic diseases had a higher risk of depressive symptoms among older adults living as a couple and those living with children. Smoking and participation in economic activities were also risk factors of depressive symptoms among older adults living with children and those living alone, respectively.

CONCLUSIONS

The findings suggest that older adults living as couples had the lowest prevalence of depressive symptoms, while those living alone had the highest prevalence of depressive symptoms. The determinants of depressive symptoms differed by living arrangement; hence, they should be considered in future interventions.

The association between living alone and depressive symptoms and the role of pet ownership among Japanese workers

BACKGROUND

Living alone has been positively associated with the prevalence of depressive symptoms. We examined how a combination of living alone and pet ownership relates to depressive symptoms.

METHODS

As part of the Japan Epidemiology Collaboration on Occupational Health Study, we conducted a survey on health-related lifestyles, including living arrangements and pet ownership, among 12,763 employees of five companies in 2018-2021. Depressive symptoms were assessed using the 11-item Center for Epidemiological Studies-Depression Scale (cutoff score ≥ 9). A Poisson regression model with a robust variance estimator was used to calculate prevalence ratio and 95% confidence interval (CI) while adjusting for covariates.

RESULTS

Among the participants, 30.9% were depressed, 17.7% had pets, and 29.1% lived alone. Compared to individuals living with others but not with a pet, those living alone and not with a pet had a 1.17 times higher prevalence ratio of depressive symptoms (95% CI: 1.08-1.26). The corresponding figures were 1.03 (95% CI: 0.95-1.11) for those living with others and pet(s) and 1.42 (95% CI: 1.18-1.69) for those living alone but with pet(s).

CONCLUSION

Living alone was significantly associated with a higher prevalence of depressive symptoms. The association was rather stronger among individuals with vs. without pets. Pet ownership may not be associated with decreased depressive symptoms.

Moderators of the Association Between Contact Frequency With Non-Cohabitating Adult Children and Depressive Symptoms Among Community-Dwelling Older Adults

OBJECTIVE

Contact frequency with adult children plays a critical role in late-life depression. However, evidence on possible moderators of this association remains limited. Moreover, considering alterations in contact modes after the coronavirus disease-2019 pandemic, there is a need to investigate this association post-pandemic to develop effective therapeutic interventions.

METHODS

This study included 7,573 older adults who completed the Living Profiles of the Older People Survey in Korea. Participants' contact frequency and depressive symptoms were analyzed. Regression analysis was performed after adjusting for covariates. The moderating effects of variables were verified using a process macro.

RESULTS

Multivariable logistic regression analysis revealed that infrequent face-to-face (odd ratio [OR]=1.86, 95% confidence interval [CI]=1.55-2.22) and non-face-to-face contact (OR=1.23, 95% CI=1.04-1.45) in the non-cohabitating adult children group was associated with a higher risk of late-life depression compared to that in the frequent contact group. Linear regression analysis indicated consistent results for face-to-face and non-face-to-face contact (estimate=0.458, standard error [SE]=0.090, p<0.001 and estimate=0.236, SE= 0.074, p=0.001, respectively). Moderation analysis revealed that the association between late-life depression and frequency of face-toface contact was moderated by age, household income quartiles, number of chronic diseases, physical activity frequency, presence of spouse, nutritional status, and whether the effect of frequency of non-face-to-face contact on late-life depression was increased by participation in social activity, frequent physical activity, and good cognitive function (p for interaction<0.05).

CONCLUSION

Frequent contact with non-cohabitating children lowers the risk of depression later in life. Several variables were identified as significant moderators of contact frequency and depression symptoms.

A nurse-led mHealth intervention to alleviate depressive symptoms in older adults living alone in the community: A quasi-experimental study

BACKGROUND

The prevalence of geriatric depression has increased worldwide, becoming a major contributor to the burden of health care costs. Geriatric depression is difficult to detect in daily life because of its atypical presentation for each person. Therefore, there is an emerging need to develop personalised mHealth interventions for older adults with depression based on data from an ecological momentary assessment.

OBJECTIVE

To develop and evaluate the effect of a nurse-led mHealth intervention of geriatric depression in older adults living alone.

DESIGN

A quasi-experimental research design was used, and the study followed the transparent reporting of evaluations with a nonrandomised design statement.

SETTING

The nurse-led mHealth intervention was developed and evaluated in a community senior centre in Seoul, Korea.

PARTICIPANTS

Sixty-four older adults living alone with depressive symptoms were recruited between 1 October 2018 and 1 October 2019.

METHODS

Study participants were randomly assigned to the intervention or control groups by drawing lots. In the intervention group, nurses repeatedly assessed older adults' depressive symptoms using an ecological momentary assessment via a mobile tablet. The intervention consisted of weekly sessions, which included (1) standardised mHealth device training, (2) a nurse-led mHealth programme, and (3) art activities. The control group received care as usual. Intra- and inter-group differences were evaluated using paired t-tests and analysis of covariance was used to assess subjective depression symptoms. A linear mixed-model was used to analyse the relationship between groups and momentary scores over time.

RESULTS

The average age of the final sample was 76.2 years (SD = 6.06), 63.6 % (28/44) of whom were female. Compared with the control group (n = 23), the intervention group (n = 21) showed a decreased depression score (t = 4.041, p = .027). There was no statistical difference between the intervention and control groups based on traditional scales and the ecological momentary assessment. However, our data from the ecological momentary assessment captures clear fluctuating patterns across the days during the study, which traditional scales could not measure.

CONCLUSIONS

Most of the older adults successfully participated in a nurse-led mHealth intervention that included multiple components of a non-pharmacological approach to address depression. Mental health nurses should perform critical roles to personalise mHealth activities considering the older adult's autonomy and supportive decision-making, specifically when using high-technological intervention. Future research should maximise the methodological and clinical advantage of an ecological momentary assessment of geriatric depression.

REGISTRATION

Clinical Research Information Service number KCT0005073.

Gender-based depression factors of older adults living alone during the COVID-19 pandemic: A cross-sectional and secondary data approach

The coronavirus disease 2019 (COVID-19) pandemic negatively affected the mental health of older adults living alone. This study aimed to examine the differences in factors that influence depression among older adults based on gender. This study was a cross-sectional study employing the secondary data of 3581 older adults living alone at the early stage of COVID-19, collected from the 2020 Korea Community Health Survey, and used multiple linear regression analyses to identify factors associated with depression. We found that women had a higher level of depressive status than men. Low subjective health status was most significantly related to depression in both older men and older women. For women, body mass index and more changes in daily life due to COVID-19 were predictors of depression. Conversely, for men, a lower level of monthly income and smoking were significant predictors of depression. Depressive status caused by COVID-19 was likely to be frailer for older women who were living alone. There were differences in the factors related to depression due to COVID-19 by gender.

Feasibility and efficacy of TouchCare system using application for older adults living alone: a pilot pre-experimental study

BACKGROUND

With the number of older people living alone continuously rising, health-monitoring systems using information and communication technology (ICT) have been developed to manage their health issues. Life logging and human body communication sensor, types of ICT, have been adapted to manage and monitor health status of the elderly. However, its feasibility and efficacy remain unclear. This study aimed to examine the feasibility of TouchCare system which combined life logging with human body communication technology and its effect on the physical and psychological status of older adults living alone.

METHODS

The TouchCare system, which consisted of a wearable watch, touchpad sensors, TouchCare application, and context-aware artificial intelligence, was developed by DNX Co. Ltd and used by the participants for 5 months. Out of the 111 selected participants, 91 replied to the satisfaction survey, and 22 participated in further investigation regarding their physical and psychological status. Finally, health assessment from 14 participants and sensor data from 13 participants (mean age = 77.4; SD = 3.8) were analyzed to compare their health status and health-related behaviors before and after use of the system.

RESULTS

Out of the 91 participants who took the survey, 51.6% were satisfied with the system. Nutritional status (pre-intervention (10.6 ± 2.0) vs. post-intervention (11.8 ± 1.9), P = 0.04) and fall efficacy (pre-intervention (89.2 ± 15.3) vs. post-intervention (99.9 ± 0.5), P = 0.001) significantly improved after use of the system. Chronic pain (pre-intervention (4.8 ± 2.5) vs. post-intervention (4.4 ± 3.7), P = 0.78) and depressive symptoms (pre-intervention (5.7 ± 3.9) vs. post-intervention (5.4 ± 3.1), P = 0.60) reduced, while cognitive function (pre-intervention (4.1 ± 1.4) vs. post-intervention (4.6 ± 1.1), P = 0.15) and physical performance related to walking improved (pre-intervention (3.9 ± 0.2) vs. post-intervention (4.0 ± 0), P = 0.35), but were not significant. Behaviors related to physical activity and gait improved after use of the system; touch counts of refrigerator and microwave also increased with a decrease in night touch counts.

CONCLUSIONS

The TouchCare system was acceptable to older people living alone, and it efficiently managed their daily living while promoting their health-related behaviors. Further experimental studies are required to verify the effectiveness of the system, and to develop the system which meet the individualized needs of older people living alone.

Factors related to the accumulation of healthy behavior among older adults attending primary Health Care

The adoption and maintenance of healthy behaviors contribute for its accumulation throughout life, which require more than information disclosure and recommendations. Biopsychosocial factors may work as barriers to adherence to healthier behaviors, and yet have been underexplored. The objective was to investigate the factors related to the accumulation of healthy behavior among older adults attending Primary Health Care. Cross-sectional analysis with 201 older adults from baseline of Longitudinal Investigation of Functioning Epidemiology (LIFE) was performed in a Southeastern Brazilian city. The Healthy Behavior Score (HBS), ranging from 0 to 8, was calculated by the sum of the following habits: Physical activity practice, healthy eating, water consumption, night sleep time, not smoking, not drinking alcohol, frequent social relations, and spirituality. A linear multivariate regression was performed to test the influence of biopsychosocial aspects on HBS, with 95% confidence interval. Higher number of healthy behaviors was related to high social support, better cognitive status, less depressive symptoms and lower functional performance. Additionally, age and resilience score were correlated to healthy behaviors, which were higher among women and those with sufficient income. Multivariate analysis revealed depressive symptoms, functional performance and education as independent predictors of HBS. Depressive symptoms, functional performance and education are predictors of accumulation of health behaviors, independently of health status, contextual and sociodemographic aspects. Higher social support partially contributed to the higher number of healthy behaviors, and should be considered in public health policies for healthy longevity.

Association between Healthy Eating Index and Mental Health in Middle-Aged Adults Based on Household Size in Korea

This study examined the association between dietary lifestyle and mental health outcomes among middle-aged individuals (40−60-year-olds) living alone, using the Korean Healthy Eating Index (KHEI). The participants were selected (1334 men and 2185 women) from the Korea National Health and Nutrition Examination Survey 2016−2018 and categorized into single/multi-person households. The KHEI scores were calculated based on the 24 h recall data of dietary intake. Among both sexes, single-person households had significantly lower subjective health status scores (p = 0.015 for men; p < 0.001 for women), lower EuroQol-5D index scores (p = 0.011 for men; p = 0.003 for women), and higher Patient Health Questionnaire-9 index scores (p = 0.004 for men; p < 0.001 for women), compared to multi-person households. Men had a higher risk of depression in single-person households compared to multi-person households (OR, 3.5; 95% CI, 1.2−10.1). For women, the ORs for stress perception with the first tertile group of KHEI scores in single-person and multi-person households compared to the third tertile group were 3.5 (95% CI, 1.3−9.0) and 1.4 (95% CI, 1.0−1.8), respectively. The results of this study are expected to be used as baseline data to establish nutrition, healthy eating behavior, and health policies for the middle-aged living alone.

Arthritis status changes and depressive symptoms among middle-aged and older Koreans: Analysis of data from the Korean Longitudinal Study of Aging survey

OBJECTIVE

Arthritis can negatively affect physical and mental health, especially among middle-aged and older people. This study investigated the longitudinal association between changes in arthritis status and depressive symptoms among Korean adults aged ≥45 years.

METHODS

We analyzed data from the Korean Longitudinal Study of Aging 2008-2018, using a generalized estimating equation model to investigate associations between arthritis status change and depressive symptoms, which were assessed using five categories according to measurements based on the Center for Epidemiological Studies Depression Scale (CES-D-10).

RESULTS

Both men and women whose arthritis status changed to "worse" or remained "same" scored higher for depressive symptoms than those who reported "no symptoms of arthritis" (men, worse = β: 1.07, P ≤ .001, same = β: 0.25 P = .031; women, worse = β: 0.99, P ≤ .001, same = β: 0.13, P = .049). Conversely, men with a "better" arthritis status (β: -0.71, P ≤ .001) and women with a "recovered" arthritis status (β: -0.56, P = .031) scored lower for depressive symptoms than those who reported "no symptoms of arthritis."

CONCLUSIONS

Arthritis status changes are associated with depressive symptoms in middle-aged and older Koreans. Therefore, mental health evaluation and management interventions are recommended for patients with arthritis and changes in disease status.

Psychosocial risk profiles among older adults living alone in South Korea: A latent profile analysis

OBJECTIVES

This study explored the psychosocial risk profiles and various characteristics associated with profile membership among Korean older adults living alone.

METHODS

Our analyses were based on a cross-sectional cohort of 1030 community-dwelling older adults (≥ 65 years) living alone in one Korean city. Latent profile analysis was used to identify psychosocial risk profiles across a wide range of psychosocial dimensions (depressive symptoms, suicidal ideation, cognitive dysfunction, loneliness, and perceived social support). We then explored the characteristics associated with distinct profiles by conducting bivariate and regression analyses.

RESULTS

The three-profile was selected as the best solution: a group with high cognitive dysfunction, high loneliness, and low social support (profile 1), a group with low psychological risks and high social support (profile 2), and a group with high depression and high suicidal ideation (profile 3). Regression analyses showed that a lower frequency of interaction with neighbors or families, a greater frailty score, and lower quality of life were significantly associated with profile 1 or profile 3 than with profile 2 (p < .05). Further, being male and having a poorer nutritional status was more significantly related to profile 3 than profile 2 (p < .05).

CONCLUSIONS

Findings provide evidence for healthcare professionals when developing interventions to prevent and reduce these psychosocial risks for older individuals living alone. In particular, factors associated with profile membership identified in the study may facilitate more tailored interventions.

Mental Health Status of Adults with Cardiovascular or Metabolic Diseases by Gender

This study aimed to compare mental health in people with cardiovascular or metabolic diseases and the general adult population in each gender. Cardiovascular and metabolic diseases affect mental health, and the prognosis and incidence rates of these diseases differ by age. To date, studies comparing mental health in adults with cardiovascular or metabolic diseases by gender and with the general population have been insufficient. This work is a cross-sectional study. Data from 9828 men and 13,389 women aged 19 years or older from the Korea National Health and Nutrition Examination Survey V and VI (2010–2013) were used. Men and women with cardiovascular diseases showed high risks of stress, depression, and suicidal ideation. Men with metabolic diseases had worse mental health in relation to depression and suicidal ideation, and women with metabolic diseases in relation to stress and depression, indicating a need for intervention and management of mental health by gender for these individuals. There is a need to develop a clear perception and understanding, both among practitioners and the general population, of mental health issues associated with having cardiovascular or metabolic diseases. Active, specific health improvement and training programmes considering gender differences are necessary.

Effects of smoking behaviour changes on depression in older people: a retrospective study

OBJECTIVE

This study aimed to identify the effects of changes in smoking behaviour on the presence of depression in participants aged 65 years and over.

METHODS

Data from the 1st to 6th Korean Longitudinal Study of Aging were used in this study. The participants comprised 374 older adults aged 65 years and over, who had smoked in the past. Logistic regression analysis was conducted to identify the effects of smoking behaviour change on the presence of depression.

RESULTS

Changes in smoking behaviour were categorised into three groups: (1) dramatically reduced (66.8%), (2) slightly reduced (19.8%), and (3) increased (13.4%). Those participants who showed significantly reduced smoking were more likely to have depression than those who increased smoking.

CONCLUSION

It is necessary to develop practical protocols and educational programs aimed at preventing and managing depression in older adults aged 65 years and above.

Factors associated with different numbers of health behaviors by living arrangements

BACKGROUND

As the number of individuals living alone increases, it becomes clear that health disparities vary according to a person's living arrangement. However, very few studies have investigated the characteristics of individuals who improve or maintain multiple healthy behaviors based on their living arrangements. This study aimed to explore the differing individual characteristics and multiple health behaviors in Korean adults living alone compared to those living with others and to identify the factors significantly associated with these behaviors.

METHODS

This study utilized a secondary analysis, using 2013-2015 Korea National Health and Nutrition Examination Survey data, with a cross-sectional and descriptive correlational design (N = 15,934). Multiple health behaviors, based on the comparison of past and present behaviors, included smoking, alcohol consumption, and weight control. The total number of health behaviors was calculated as the sum of each single health behavior. The different numbers of health behaviors were categorized into four levels: from 0, none of the three health behaviors to 3, all three health behaviors. Descriptive statistics and generalized ordinal logistic regression analysis were used.

RESULTS

People living alone engaged in fewer healthy behaviors (p <  0.05) and reported lower rates of maintenance of abstinence from smoking and weight control compared to those living with others, but they maintained a status of abstaining from alcohol consumption more than those living with others (p ≤ 0.001). In particular, higher self-rated health statuses (Adjusted Odds Ratio [aOR] = 2.03, 95% Confidence Interval [CI] = 1.04-3.97), being overweight (aOR = 1.46, 95% CI = 1.11-1.92), and having shorter sleep durations per day (aOR = 0.74, 95% CI = 0.55-0.99) were significantly associated with 0, 1 versus 2, 3 levels of healthy behaviors in those living alone.

CONCLUSIONS

Korean adults who lived alone had different factors associated with different combinations of multiple healthy behaviors compared to those living with others. Therefore, we need to manage healthy behaviors by considering associated factors for those living alone. Specifically, clinicians should consider the vulnerability of health behaviors in people living alone and provide customized approaches and multidimensional interventions based on their living arrangements.

Loneliness, hopelessness and suicide in later life: a case-control psychological autopsy study in rural China

AIMS

Loneliness is increasingly recognised as a serious public health issue worldwide. However, there is scarce research addressing the association between loneliness and suicide in older adults in rural China. We set out to examine loneliness and other psychosocial factors in elderly suicide cases and explore their interaction effects.

METHODS

Using a 1 : 1 matched case-control design, data were collected from 242 elderly suicide cases and 242 living community controls by psychological autopsy method in rural China, including demographic characteristics, loneliness, depression, hopelessness and social support. The chi-square automatic interaction detection (CHAID) tree model and multivariable logistic regression analysis were used to explore the relationships of these factors and suicide.

RESULTS

The CHAID tree model showed that loneliness, hopelessness and depressive symptoms were closely associated with completed suicide and that loneliness and hopelessness interacted with each other. The result of multivariable logistic regression showed that individuals who were unemployed [odds ratio (OR) = 2.344; 95% confidence interval (CI): 1.233-4.457], living alone (OR = 2.176; 95% CI: 1.113-4.254), had lower levels of subjective social support (OR = 2.185; 95% CI: 1.243-3.843), experienced depressive symptoms (OR = 6.700; 95% CI: 3.405-13.182), showed higher levels of hopelessness (OR = 7.253; 95% CI: 3.764-13.974) and felt higher levels of hopelessness × higher levels of loneliness (OR = 2.446; 95% CI: 1.089-5.492) were significantly associated with an elevated suicide risk in older people in rural China.

CONCLUSIONS

Regular evaluation of loneliness, hopelessness and depression can help detect older adults who are at risk of committing suicide. Interventions should target social support systems, particularly among people living alone, to alleviate feelings of loneliness and hopelessness. Treating depression is also key to preventing suicide among elderly people in rural China.

Depression Prediction by Using Ecological Momentary Assessment, Actiwatch Data, and Machine Learning: Observational Study on Older Adults Living Alone

BACKGROUND

Although geriatric depression is prevalent, diagnosis using self-reporting instruments has limitations when measuring the depressed mood of older adults in a community setting. Ecological momentary assessment (EMA) by using wearable devices could be used to collect data to classify older adults into depression groups.

OBJECTIVE

The objective of this study was to develop a machine learning algorithm to predict the classification of depression groups among older adults living alone. We focused on utilizing diverse data collected through a survey, an Actiwatch, and an EMA report related to depression.

METHODS

The prediction model using machine learning was developed in 4 steps: (1) data collection, (2) data processing and representation, (3) data modeling (feature engineering and selection), and (4) training and validation to test the prediction model. Older adults (N=47), living alone in community settings, completed an EMA to report depressed moods 4 times a day for 2 weeks between May 2017 and January 2018. Participants wore an Actiwatch that measured their activity and ambient light exposure every 30 seconds for 2 weeks. At baseline and the end of the 2-week observation, depressive symptoms were assessed using the Korean versions of the Short Geriatric Depression Scale (SGDS-K) and the Hamilton Depression Rating Scale (K-HDRS). Conventional classification based on binary logistic regression was built and compared with 4 machine learning models (the logit, decision tree, boosted trees, and random forest models).

RESULTS

On the basis of the SGDS-K and K-HDRS, 38% (18/47) of the participants were classified into the probable depression group. They reported significantly lower scores of normal mood and physical activity and higher levels of white and red, green, and blue (RGB) light exposures at different degrees of various 4-hour time frames (all P<.05). Sleep efficiency was chosen for modeling through feature selection. Comparing diverse combinations of the selected variables, daily mean EMA score, daily mean activity level, white and RGB light at 4:00 pm to 8:00 pm exposure, and daily sleep efficiency were selected for modeling. Conventional classification based on binary logistic regression had a good model fit (accuracy: 0.705; precision: 0.770; specificity: 0.859; and area under receiver operating characteristic curve or AUC: 0.754). Among the 4 machine learning models, the logit model had the best fit compared with the others (accuracy: 0.910; precision: 0.929; specificity: 0.940; and AUC: 0.960).

CONCLUSIONS

This study provides preliminary evidence for developing a machine learning program to predict the classification of depression groups in older adults living alone. Clinicians should consider using this method to identify underdiagnosed subgroups and monitor daily progression regarding treatment or therapeutic intervention in the community setting. Furthermore, more efforts are needed for researchers and clinicians to diversify data collection methods by using a survey, EMA, and a sensor.

Association of living arrangements with depressive symptoms among older adults in China: a cross-sectional study

Background

Depression is regarded as a major public health concern in our society. While living arrangements as a structural factor of social support may contribute to older adults’ depression. Our study aims to investigate the association between living arrangements and depressive symptoms among older adults in the whole China, and to explore whether such influences differ by genders.

Methods

Data were obtained from the 2015 China Health and Retirement Longitudinal Study. The sample was comprised of 6001 individuals aged ≥60 years. Depressive symptoms were measured by the 10-item Short-Form Center for Epidemiological Studies Depression. Independent variables were divided into 4 groups, considering living with/without a spouse and living with/without a child. The multivariate logistic regression was used to estimate the relationship between living arrangements and depressive symptoms in four models.

Results

Compared with living only with a spouse, people living with a spouse and child, or living alone were more likely to have depressive symptoms (odds ratio = 1.23 95% CI 1.06–1.42 and 1.40 95% CI 1.03–1.92, respectively). Women were more associated with depressive symptoms (odds ratio = 2.13), but there were no significant associations between living arrangements and depressive symptoms among women. Men living with a spouse and a child had stronger positively depressive symptoms (odds ratio = 1.37).

Conclusions

Older adults living alone, or living with both a child and spouse were more likely to have depressive symptoms. It is important to provide more social services for those older adult, particularly for men living with a spouse and child.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7350-8) contains supplementary material, which is available to authorized users.