Comparative assessment of psychosocial status of elderly in urban and rural areas, Karnataka, India

Unraveling the Tapestry of Depression: A Cross-Sectional Study

BACKGROUND

An often-occurring and severely disabling mental illness that mostly affects older people living in urban slums is depression. Developing successful therapies requires an understanding of the complex interactions between the different factors that contribute to depression in this susceptible population.

OBJECTIVES

This study aimed to find the prevalence of depression and identify the factors associated with depression in the geriatric population aged ≥60 years in the study area during the study period in Gujarat, India.

METHODS

This study was carried out among 450 participants aged ≥60 years. Face-to-face interviews and standardized assessment tools, including the Geriatric Depression Scale (GDS) for depression and the Mini-Cog test for cognitive impairment, were used to collect data on depression levels, sociodemographic characteristics, behavioral factors, medical conditions, life events, and psychiatric history. Statistical analyses, including chi-squared tests, were performed to assess the associations.

RESULTS

Significant associations were found between various factors and depression levels, which were lower education (11.11% severe depression among non-literate vs. 2.11% among literate, p<0.001) and widowhood (11.56% severe depression among widowed vs. 4.53% among married, p<0.001), which were linked to higher depression severity. Behavioral risk factors like short sleep duration (<6 hours at night: 21.71% severe depression, p<0.001), tobacco snuffing (16.24% severe depression, p<0.001), and lack of physical activity (28.71% severe depression, p<0.001) were strongly associated with increased depression. Medical conditions such as hypertension (10.36% severe depression, p<0.001) and stressful life events like family conflicts (16.67% severe depression, p<0.001) exhibited strong associations. A personal history of depression (38.82% severe depression, p<0.001) was a potent predictor.

CONCLUSIONS

The study highlights the multifaceted nature of depression in the geriatric population of the study area, underscoring the necessity of all-encompassing measures to tackle the recognized possible risk factors. The results provide valuable insights for developing targeted prevention strategies, healthcare policies, and support systems to enhance the mental well-being of this vulnerable population.

Determinants of depression in Indian tribal adults: Evidence from the Longitudinal Ageing Study in India Wave-I survey

BACKGROUND OBJECTIVES

The tribal populations are vulnerable to mental health issues owing to various reasons. However, limited research has been conducted to assess depression and related determinants among tribal adults aged ≥45 yr (45 years and older). The present study aimed to assess the prevalence and sociodemographic and health determinants of depressive symptoms among the scheduled tribe (ST) population aged ≥45 yr in India.

METHODS

The present study analyzed the Wave I data of the Longitudinal Ageing Study in India conducted between April 2017 to December 2018. The outcome variables in the present study were self-reported depressive symptoms. Two internationally recognised tools, the Centre for Epidemiologic Studies Depression scale (CES-D) and Composite International Diagnostic Interview-Short Form (CIDI-SF), were used to obtain the data, however, only the CES-D data are utilized in this study. The present study focused on 12,215 ST individuals aged ≥45 yr from whom information about depressive symptoms was collected and analyzed.

RESULTS

Nearly 25 per cent ST population aged 45 yr or older experienced depressive symptoms. The likelihood of experiencing depressive symptoms among the ST population aged ≥45 yr was negatively associated with 10 or more years of education and living with children and others and positively associated with experiencing multiple morbidity conditions.

INTERPRETATION CONCLUSIONS

Given the substantial burden of depression among the adult ST population, the present study lays emphasis on raising the awareness about depressive symptoms and strengthen the availability of mental health services among the ST community through intensive campaigns and engagement of ST individuals along with other key stakeholders. Higher education, living with spouse and children and a physically active lifestyle can play a crucial role in limiting depressive symptoms among the tribal adults (≥45 yr). It is paramount to regularly screen depressive symptoms and conduct more microlevel studies to evaluate socioeconomic and health determinants of depressive symptoms among ST communities living in different geographic regions.

Efficacy of Psychosocial Care Training Programme for the Staff Working in Old Age Homes

Background

Training the old-age home staff is essential in raising geriatric mental health care standards in India. Inadequate knowledge on ageing and psychosocial interventions is a significant issue in old-age homes. Old-age home staff must know how to provide individualized psychosocial care and support for older adults. Hence this study aimed to test the feasibility of the psychosocial care training program for the staff working in old-age homes.

Methods

A quasi-experimental research design (pre-post without a control group) was used. Forty-two staff members participated. Mary Starke Harper Aging Knowledge Exam (MSHAKE) and structured checklist to measure the staff's knowledge on ageing, psychosocial interventions, welfare legislations, schemes, and support services were administered before, immediately after, and two months after the program and the self-efficacy checklist was administered immediately and two months after the program, to examine the efficacy of the program.

Results

Significant improvement was found in the ageing knowledge and the knowledge of psychosocial intervention and psychosocial care. These improvements continued for two months (p < .001). Similarly, their self-efficacy in managing such problems was also sustained across two post-measurements (p = .045).

Conclusions

Face-to-face training programs would enhance the knowledge of the old age home staff. This Psychosocial Care Training module can be used for training old age home staff to address various psychosocial needs, concerns and other psychosocial problems of the residents.

Urban-rural and gender differential in depressive symptoms among elderly in India

Background

To date, evidence remained inconclusive explaining rural-urban and male-female differential in depression. Unlike other previous research on the association of several risk factors with depressive symptoms among the elderly, this study focussed on the socio-economic status-related inequality in the prevalence of depression among the elderly along with focussing urban-rural and male-female gradients of depression among the elderly.

Methods

This study used data from Longitudinal Ageing Study in India (LASI) Wave-I, 2017-18, survey. The outcome variable for this study was self-reported depression. Bivariate analysis was used to understand the prevalence by sociodemographic clusters. Fairlie decomposition analysis has been done to measures rural-urban inequalities for depression among older men and women.

Results

Results found that around 22 percent of urban elderly and 17 percent of rural elderly reported depression. A higher proportion of female elderly (22.6% vs. 18.4%) reported depression than male elderly. Almost one in every five elderly (20.6%) reported depression in India. The results found that a higher percentage of women in rural and urban areas reported depression than their male counterparts. While examining SES-related inequality in the prevalence of depression, education was a significant factor explaining the SES-related inequality in the prevalence of depression among female elderly and not in male elderly.

Conclusion

Given the large proportion of elderly reporting depression, this study highlights the need for improving health care services among the elderly. The increasing burden of depression in specific sub-populations also highlights the importance of understanding the broader consequences of depression among rural and female elderly.

Applications of new measures of population ageing using quantity and quality of remaining life years to India and selected states

In the latter part of the third stage, India is in demographic transition with declining fertility and mortality. This marked decline in death rates is driven by improvements in health conditions due to medical progress and better living conditions. The conventional measures of ageing do not account for the significant improvements in health and life expectancy, thus leading to a tendency to overestimate the impact of population ageing when these indicators are used. The old-age threshold in the conventional measures of ageing depends on chronological age. The present study estimated the multi-dimensional old-age thresholds (MOAT) based on the remaining life expectancy (RLE), self-rated health, activities of daily living (ADL), handgrip strength, and cognition in India and selected states. The standard population was derived for each dimension for 50 and over in states using the WHO Study on Global AGEing and Adult Health data. Keeping the dimensional characteristics as of the standard population, the estimated MOAT for India was 67 years where Maharashtra stands at the top (68.6), followed by, West Bengal (66.5) and Karnataka (66). A 64 year old woman was similar to 68.8 year old man, and a 66 year old rural person was equivalent to 68 year old urban person. The study suggests implications of MOATs on reducing the burden of ageing and increment in retirement age.

Effectiveness of Serious Games for Improving Executive Functions Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis

BACKGROUND

Executive functions are one of the known cognitive abilities that decline with age. They are the high-order cognitive processes that enable an individual to concentrate, plan, and take action. Serious games, which are games developed for specific purposes other than entertainment, could play a positive role in improving executive functions. Several systematic reviews have pooled the evidence about the effectiveness of serious games in improving executive functions; however, they are limited by some weaknesses.

OBJECTIVE

This study aims to investigate the effectiveness of serious games for improving executive functions among older adults with cognitive impairment.

METHODS

A systematic review of randomized controlled trials (RCTs) was conducted. To retrieve relevant studies, 8 electronic databases were searched. Further, reference lists of the included studies and relevant reviews were screened, and we checked studies that cited our included studies. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, assessed the risk of bias, and appraised the quality of the evidence. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies.

RESULTS

Of 548 publications identified, 16 RCTs were eventually included in this review. Of the 16 studies, 14 studies were included in 6 meta-analyses. Our meta-analyses showed that serious games are as effective as no or passive interventions at improving executive functions (P=.29). Surprisingly, conventional exercises were more effective than serious games at improving executive functions (P=.03). Our subgroup analysis showed that both types of serious games (cognitive training games, P=.08; exergames, P=.16) are as effective as conventional exercises at improving executive functions. No difference was found between adaptive serious games and nonadaptive serious games for improving executive functions (P=.59).

CONCLUSIONS

Serious games are not superior to no or passive interventions and conventional exercises at improving executive functions among older adults with cognitive impairment. However, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Accordingly, until more robust evidence is available, serious games should not be offered by health care providers nor used by patients for improving executive functions among older adults with cognitive impairment. Further reviews are needed to assess the long-term effect of serious games on specific executive functions or other cognitive abilities among people from different age groups with or without cognitive impairment.

TRIAL REGISTRATION

PROSPERO CRD42021272757; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272757.

Effectiveness of Serious Games for Improving Executive Functions Among Older Adults With Cognitive Impairment: Systematic Review and Meta-analysis (Preprint).. [DOI: 10.2196/preprints.36123]

BACKGROUND

Executive functions are one of the known cognitive abilities that decline with age. They are the high-order cognitive processes that enable an individual to concentrate, plan, and take action. Serious games, which are games developed for specific purposes other than entertainment, could play a positive role in improving executive functions. Several systematic reviews have pooled the evidence about the effectiveness of serious games in improving executive functions; however, they are limited by some weaknesses.

OBJECTIVE

This study aims to investigate the effectiveness of serious games for improving executive functions among older adults with cognitive impairment.

METHODS

A systematic review of randomized controlled trials (RCTs) was conducted. To retrieve relevant studies, 8 electronic databases were searched. Further, reference lists of the included studies and relevant reviews were screened, and we checked studies that cited our included studies. Two reviewers independently checked the eligibility of the studies, extracted data from the included studies, assessed the risk of bias, and appraised the quality of the evidence. We used a narrative and statistical approach, as appropriate, to synthesize results of the included studies.

RESULTS

Of 548 publications identified, 16 RCTs were eventually included in this review. Of the 16 studies, 14 studies were included in 6 meta-analyses. Our meta-analyses showed that serious games are as effective as no or passive interventions at improving executive functions (<i>P</i>=.29). Surprisingly, conventional exercises were more effective than serious games at improving executive functions (<i>P</i>=.03). Our subgroup analysis showed that both types of serious games (cognitive training games, <i>P</i>=.08; exergames, <i>P</i>=.16) are as effective as conventional exercises at improving executive functions. No difference was found between adaptive serious games and nonadaptive serious games for improving executive functions (<i>P</i>=.59).

CONCLUSIONS

Serious games are not superior to no or passive interventions and conventional exercises at improving executive functions among older adults with cognitive impairment. However, our findings remain inconclusive due to the low quality of the evidence, the small sample size in most included studies, and the paucity of studies included in the meta-analyses. Accordingly, until more robust evidence is available, serious games should not be offered by health care providers nor used by patients for improving executive functions among older adults with cognitive impairment. Further reviews are needed to assess the long-term effect of serious games on specific executive functions or other cognitive abilities among people from different age groups with or without cognitive impairment.

CLINICALTRIAL

PROSPERO CRD42021272757; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=272757

Depression among older adults: a systematic review of South Asian countries

The world's population has been evolving rapidly; every country in the world is facing this drastic progression in the number and the percentage of the elderly in their net population. As the chronological age advances, physiological and psychosocial decline will be evident among all older adults. The potentially relevant literature was identified using appropriate search terms in electronic databases such as PubMed MEDLINE, Scopus, ProQuest, Web of Science, CINAHL, IndMed, and Google Scholar. Articles published from 2006 to 2019, reported the prevalence and the risk factors for depression among older adults living in the community, old age homes, or hospitals of the South Asian countries. Articles were published in the languages other than English and those reporting the categorised or mean depressive scores were excluded from the review. After quality check for all the retrieved articles from different databases, 120 articles were included for the meta-analysis. The data were extracted based on a validated data extraction form, and the reviewer contacted the authors for clarification of the missing data whenever required. The estimates were pooled using the random effect model for meta-analyses. Sub-group and sensitivity analyses were also performed. The overall pooled estimate (random effect models) of the prevalence of depression among the elderly was 42.0% (95% CI: 0.38-0.46), Chi-squared P-value <0.001, and I² 99.14%. The pooled estimate of the prevalence was higher in the community settings than the old age homes (44.0%; 95% CI: 39.0-49.0 vs. 42.0%; 95% CI: 34.0-49.0). Depression is a common problem among the elderly population and the pooled estimate of depression would give directions to the healthcare providers, policymakers, and future researchers to plan some measures (either pharmacological or non-pharmacological interventions) to effectively tackle the burden of geriatric depression in the future.

Differences in the Potential Accessibility of Home-Based Healthcare Services among Different Groups of Older Adults: A Case from Shaanxi Province, China

With the increase of the aging population and the lack of family care, home-based healthcare services have gradually become the main model to cope with aging, so local governments have invested heavily in the construction of home-based healthcare services. However, healthcare services still have problems such as low resource utilization and imbalanced development. The reason is that the supply and demand of healthcare services are not matched and the potential accessibility is low. Therefore, based on the supply and demand of healthcare services, this article pulls out the spatial and social factors that affect the potential accessibility, and tests the influence of individual factors on the potential accessibility among different groups of older adults. It is found that the perceived vulnerability of the older adults will reduce the potential accessibility of healthcare services. The psychosocial status, income and education level with the willingness to use healthcare services of the older adults are directly proportional, while residence has a negative impact on the potential accessibility. Finally, based on this finding, this article puts forward feasible suggestions from the perspective of policy content, publicity, and implementation.

Why are our elderly distressed? A cross-sectional study in a rural community of West Bengal

Context:

Population across the globe are aging rapidly due to demographic transition. More than 50% of the elderly in India suffer from one or more chronic diseases and psychological distress is one of the most common morbidities among them.

Aims and Objective:

This study was conducted with the objective to assess the status of psychological distress among the elderly.

Settings and Design:

A community based, cross-sectional study among 347 elderly aged 60 years and above.

Methods and Materials:

This study was done in 30 villages (clusters) in Singur block of West Bengal. A predesigned and pretested schedule was used to collect data.

Statistical Analysis:

Data were analysed by univariate and multivariate analyses.

Results:

The mean (± SD) age of the elderly was 67.67 (± 7.15) years, majority (67.4%) were in the 60–69 years age group. Most (62.8%) of the elderly were suffering from psychological distress which is significantly associated with below primary education level [AOR (95% CI)] = [25.09 (11.88-52.96)], living without spouse and child [AOR (95% CI) =7.88 (3.90-15.89)], financial dependence [AOR (95% CI) =20.23 (7.58-54.00)], dependent functional activity (assessed by ADL) [AOR (95% CI) =3.84 (1.25-11.76)], and decision for healthcare taken by others [AOR (95% CI)] = [3.84 (1.25-11.76)].

Conclusions:

Alarmingly, the proportion of psychological distress was found to be high among the elderly of this rural area. Therefore, all steps must be taken with special focus on the mental health of the old people so that they may continue to contribute to the upliftment of the society.

Prevalence and determinants of geriatric depression in North India: A cross-sectional study

Context:

“Aging India” has become a phenomenon of public health importance. Old age is beset with physical, mental, and social challenges. Among these, mental health concerns are least prioritized in most of the developing countries with depression being the most common and easy to screen.

Aims:

To assess the burden of geriatric depression and determine its association with sociodemographic factors such as religion, age, gender, education, marital status, and family type.

Settings and Design:

A cross-sectional study was conducted in July-August 2018 in village Kirpind in north India.

Methodology:

162 subjects aged 60 years or more, both males and females participated in the study. Depression was assessed using the 15-item Geriatric Depression Scale and those with a GDS score >=5 were categorized as depressed.

Statistical Analysis Used:

Pearson's Chi-square test and binary logistic regression were used for analysis.

Results:

Nearly 59.3% of subjects had no depression, 33.9% were suffering from mild to moderate depression whereas 6.8% were severely depressed. The mean age of subjects was 69 (±7.4) years. Chi-square test was used to study the association of various factors with depression and only female gender showed a positive statistical association. On using binary logistic regression analysis, being female again emerged to be a significant predictor of depression while no other factor was significantly associated with the outcome.

Conclusions:

There is a need to sensitize primary care workers and physicians to identify and manage geriatric depression early. It also points towards the need for multicentric, longitudinal studies evaluating various aspects of geriatric depression.

Prevalence of psychiatric disorders among older adults in Jodhpur and stakeholders perspective on responsive health system

Background:

Ageing is an inescapable reality of human existence. The elderly population of India is steadily increasing with growing mental health needs which pose many challenges for the health care system. The aim of this study is to assess anxiety, depression, and cognitive disorders among urban and rural elderly and to explore the availability of social support mechanisms and a responsive health system for elderly.

Methods:

This study is a mixed-method approach. For a quantitative study, a community-based cross-sectional survey is conducted in Jodhpur, Rajasthan. A total of 330 elderly persons aged 60 years and above are randomly screened for depression (GDS), anxiety (GAD), and cognitive impairment (HMSE). Further for a qualitative study, in-depth interviews are conducted with 7 key informants including policy and program managers, service providers, and facilitators from the state. For quantitative data analysis, Excel and SPSS are used and for Qualitative data analysis, Thematic Framework Approach is used.

Results:

The mean age of the respondents is 67.9 ± 7.8. The prevalence of severe depression is 17%, severe anxiety is 10.3%, and cognitive impairment is 51.2%. The prevalence of all the three is more in rural elderly as compared to urban elderly as well as more in female individuals as compared to males. Qualitative analysis revealed that there are challenges in early identification of mental disorders at both the levels: service providers and elderly. Psychological and financial issues are also seen in elderly who are not supported by their children. There are cases of fear for elder abuse and influence of western culture in the society.

Conclusion:

There is a sizeable prevalence of psychological issues in elderly population. Therefore, there is a need to adopt holistic and integrated psychogeriatric services for the improvement of quality of life in elderly.