Religious attendance and depressive symptoms among community dwelling elderly in Taiwan

Religious social capital and minority health: A concept analysis

OBJECTIVE

Optimizing resources within environments where people live, work, and pray can aid nurses in improving public health. Religion and social capital significantly influence the health of individuals and communities, particularly among racial and ethnic minorities in the United States. A concept analysis of religious social capital was conducted to clarify how this resource is used in the context of health.

DESIGN AND SAMPLE

Rodgers' evolutionary concept analysis method guided this analysis. A search of PubMed, CINAHL, and PsycINFO, using keywords "religious social capital" and "health" yielded 152 publications.

RESULTS

Antecedents were "defined religious social network," "voluntary membership," "shared values," and "trust." Attributes were "relationships (bonding bridging, and linking)," "information exchange and resource sharing," and "reciprocal participation." Consequences were "increased productivity," "increased resources," "better personal and community health," and "trust." A model case of African American women and HIV prevention was included to illustrate how religious social capital can be developed and optimized to promote health.

CONCLUSION

Religious social capital is defined as increased individual and collective capabilities that result from voluntary and reciprocal participation in bonding, bridging, or linking social network relationships and activities. Religious social capital is an accessible resource that can be leveraged to improve minority health.

Participation in Physical, Social, and Religious Activity and Risk of Depression in the Elderly: A Community-Based Three-Year Longitudinal Study in Korea

BACKGROUND

We examined the longitudinal association between participation in individual or combinations of physical, social, and religious activity and risk of depression in the elderly.

METHODS

Elderly subjects aged ≥ 60 years who completed the Living Profiles of Older People Survey in Korea (n = 6,647) were included. The baseline assessment, Wave 1, was conducted in 2008, and a follow-up assessment, Wave 2, was conducted in 2011. We defined participation in frequent physical activity as ≥ 3 times weekly (at least 30 minutes per activity). Frequent participation in social and religious activity was defined as ≥ 1 activity weekly. The primary outcome was depression at 3-year follow up.

RESULTS

Multivariable logistic regression analysis showed that subjects who participated in frequent physical, social, and religious activity had an adjusted odds ratio of 0.81 (95% confidence interval [CI], 0.69-0.96), 0.87 (95% CI, 0.75-1.00), and 0.78 (95% CI, 0.67-0.90), respectively, compared with participants who did not participate in each activity. Participants who participated in only one type of activity frequently and participants who participated in two or three types of activities frequently had an adjusted odds ratio of 0.86 (95% CI, 0.75-0.98) and 0.64 (95% CI, 0.52-0.79), respectively, compared with participants who did not participate in any type of physical, social, and religious activity frequently.

CONCLUSION

Participation in physical, social, and religious activity was associated with decreased risk of depression in the elderly. In addition, risk of depression was much lower in the elderly people who participated in two or three of the above-mentioned types of activity than that in the elderly who did not.

A change in social activity and depression among Koreans aged 45 years and more: analysis of the Korean Longitudinal Study of Aging (2006-2010)

BACKGROUND

The aim of this study is to examine a relationship between a change in social activity and depression among Koreans aged 45 years or more.

METHODS

Data came from the Korean Longitudinal Study of Aging (KLoSA) (2006-2010), with 5,327 participants aged 45 years or more. The generalized estimating equation (GEE) with the logit link was used to investigate an association between a change in social activity during 2006-2008 (or 2008-2010) and depression among respondents in year 2008 (or Y2010). Depression was measured by Center for Epidemiological Studies Depression scale (CES-D10) and a change in social activity was classified with four categories, i.e. "consistent participation", "consistent non-participation", "participation to non-participation", and "non-participation to participation". Social activity was divided into various elements and the same analysis was conducted for each of these elements.

RESULTS

Those with consistent non-participation and from participation to non-participation were more likely to be depressed than those with consistent participation and from non-participation to participation in social activities (OR 1.44 [95% CI 1.22-1.71], OR 1.35 [95% CI 1.15-1.58] vs. OR 1.00 [Reference], OR 1.27 [95% CI 1.09-1.48]). In addition, the strength of the negative association between consistent or new participation in social activity and depression was different across different elements of social activity. The negative association was particularly strong for leisure, culture or sports clubs, and for family or school reunion.

CONCLUSION

For improving the mental health of the population aged 45 years or more, the promotion of their continued or new participations in leisure/culture clubs and family/school reunion might be needed in South Korea.

Synergistic effect of interaction between perceived health and social activity on depressive symptoms in the middle-aged and elderly: a population-based longitudinal study

OBJECTIVE

To examine the synergistic effect of interaction between perceived health and social activity on depressive symptoms.

METHODS

We investigated whether the interaction between perceived health and social activity has a synergistic effect on depressive symptoms in the middle-aged and elderly using data from 6590 respondents aged 45 and older in the Korean Longitudinal Study on Aging (KLoSA), 2006-2012. A generalised linear mixed-effects model was used to investigate the association in a longitudinal data form. Depressive symptoms were measured using the Center for Epidemiological Studies Depression 10 Scale (CES-D10). Perceived health and level of social activity were categorical variables with three values. Participation in six social activities was assessed.

RESULTS

Interactions between perceived health status and social activity were statistically significant for almost all social activity/perceived health combinations. Addition of the interaction term significantly decreased CES-D10 scores, confirming the synergistic effect of the interaction between perceived health status and social activity ('normal×moderate', β=-0.1826; 'poor×moderate', β=-0.5739; 'poor×active', β=-0.8935). In addition, we performed stratified analyses by region: urban or rural. In urban respondents, the additional effect of the interaction term decreased CES-D10 scores and all social activity/perceived health combinations were statistically significant ('normal×moderate', β=-0.2578; 'normal×active', β=-0.3945; 'poor×moderate', β=-0.5739; 'poor×active', β=-0.8935). In rural respondents, only one social activity/perceived health combination was statistically significant, and the additional effect of the interaction term showed no consistent trend on CES-D10 scores.

CONCLUSIONS

The interaction between perceived health and social activity has a synergistic effect on depressive symptoms; the additional effect of the interaction term significantly decreased CES-D10 scores in our models.

The cross-sectional and longitudinal association between perceived neighborhood walkability characteristics and depressive symptoms in older Latinos: the "¡Caminemos!" study

OBJECTIVE

Evaluate the cross-sectional and longitudinal association between perceived walkability-related neighborhood characteristics (e.g., traffic safety) and depressive symptoms among community-dwelling older Latino adults.

METHOD

We used baseline, 12-month, and 24-month in-person interview data collected from Latinos aged ≥ 60 years participating in an exercise intervention at 27 senior centers (N = 570).

RESULTS

In cross-sectional analyses, lower perceived neighborhood crime, indicative of greater neighborhood walkability, was associated with a lower odds of elevated symptoms of depression (odds ratio [OR] = 0.90; 95% confidence interval [CI] = [0.82, 0.996]; p = .04) after adjusting for demographic characteristics, linguistic acculturation, and medical comorbidities. Associations between Neighborhood Environment Walkability scales and incident depressive symptoms at 12- and/or 24-months were not statistically significant, but the point estimate for crime safety was consistent with cross-sectional findings (OR = 0.83; 95% CI = [0.64, 1.07]; p = .16), suggesting a protective effect for lower perceived neighborhood crime.

DISCUSSION

Lower perceived neighborhood crime is associated with reduced presence of elevated symptoms of depression in older Latinos.

Routine depression screening and diagnosing strategy for cancer inpatients

BACKGROUND

Clinical practice guidelines frequently recommend systematic screening for depression in cancer patients to improve recognition and prompt appropriate management. We aimed to screen major depressive disorder (MDD) in cancer inpatients using a structured tool and explore its applicability.

METHODS

Cancer inpatients were routinely screened by nurses using the Taiwanese Depression Questionnaire (TDQ), and for those screened positive, this was followed by a non-mandated referral to a psychiatrist for clinical evaluation and diagnosis. Patients who completed this two-stage procedure comprised the analysis sample.

RESULTS

Routine screening of 8800 patients in a period of 27 months yielded 1087 (26.9%) positive first-time screens. Of them, 298 (27.4%) completed the psychiatric consultation. Depressive disorders were diagnosed in 185 patients (62.1%), mainly adjustment disorder (23.8%) and MDD (21.5%). The estimated prevalence of MDD was 21.5%. Area under the curve was 0.72, a result produced by the receiver operating characteristic curve of the TDQ scores relative to the clinical psychiatric diagnoses of MDD. A TDQ cutoff score of ≧26 provided an optimal diagnostic accuracy for MDD.

CONCLUSIONS

This two-stage depression screening and diagnosing strategy is practical for improving recognition of MDD and other depressive disorders in cancer patients and could be routinely applied, rather than selectively, in a comprehensive cancer care system.

Social relations and depression in late life-a systematic review

OBJECTIVE

Social relations have become the focus of much research attention when studying depressive symptoms in older adults. Research indicates that social support and being embedded in a network may reduce the risk for depression. The aim of the review was to analyze the association of social relations and depression in older adults.

METHODS

Electronic databases were searched systematically for potentially relevant articles published from January 2000 to December 2012. Thirty-seven studies met the inclusion criteria for this review.

RESULTS

Factors of social relations were categorized into 12 domains. Factors regarding the qualitative aspects of social relations seem to be more consistent among studies and therefore provide more explicit results. Thus, social support, quality of relations, and presence of confidants were identified as factors of social relations significantly associated with depression. The quantitative aspects of social relations seem to be more inconsistent. Cultural differences become most obvious in terms of the quantitative aspects of social relations.

CONCLUSION

Despite the inconsistent results and the methodological limitations of the studies, this review identified a number of factors of social relations that are significantly associated with depression. The review indicates that it is needful to investigate social relations in all their complexity and not reduce them to one dimension. Simultaneously, it is important to conduct longitudinal studies because studies with cross-sectional design do not allow us to draw conclusions on causality. Beyond that, cultural differences need to be considered.

Improving quality-of-life outcomes for patients with cancer through mediating effects of depressive symptoms and functional status: a three-path mediation model

AIMS AND OBJECTIVES

To test a hypothetical three-path mediation model evaluating the effects of functional status and depressive symptoms on the relationship between fatigue and quality of life in patients with cancer on the basis of the Theory of Unpleasant Symptoms.

BACKGROUND

Patients with cancer often experience two or more concurrent, interrelated, mutually influential symptoms. Multiple unpleasant symptoms that have been proposed as mediating variables affecting quality of life in a model proposed in recent cancer studies are scanty.

DESIGN

This study was a cross-sectional, descriptive, correlational design.

METHODS

Three hundred and twenty-six patients with cancer from oncology clinics were recruited in Taiwan between 2010-2011. Mediation models were tested and confirmed by applying structural modelling using Analysis of Moment Structures and the joint significance test.

RESULTS

Fatigue affects patient quality of life directly or indirectly through functional status and depressive symptoms. These two mediating variables exhibited direct effects on quality of life. A path analysis approach revealed that 47·28 and 67·70% of the total effects of functional status and depressive symptoms, respectively, on the quality-of-life mediation models are attributable to 29·6 and 44·7% of the total effects between fatigue and quality of life, which mediated through two mediators, respectively.

CONCLUSION

Quality of life may be enhanced by simultaneously improving physiological and psychological factors.

RELEVANCE TO CLINICAL PRACTICE

An understanding of mediating effects is valuable in nursing care of patients with cancer, particularly in the early phase of treatment or in newly diagnosed stages I-III or recently treated patients with cancer in different disease stages.

The relationship between social integration and depression in non-demented primary care patients aged 75 years and older

BACKGROUND

Social integration seems to be associated with depression in late life. But the measurement of social integration still lacks a strong consensus. To date in most studies the different domains of social integration have been examined separately.

AIMS

In order to improve comparability among studies, we used the social integration index (SII), which covers all domains of social integration, to examine the association of social integration and depression in non-demented primary care patients aged 75 years and older.

METHOD

Data were derived from the longitudinal German study on Aging, Cognition and Dementia in primary care patients. Included in the cross-sectional survey were 1028 non-demented subjects aged 75 years and older. The GDS-15 Geriatric Depression Scale was used to measure depression with a threshold of ≥6. Associations of the SII and further potential risk factors and depression were analysed using multivariate logistic regression models.

RESULTS

The SII was significantly associated with depression in the elderly. After full adjustment for all variables, odds of depression were significantly higher for lower levels of the SII, having a care level, impaired vision and mobility and subjective memory complaints.

CONCLUSION

Because the social integration index covers several aspects of social integration, the results seem to be more significant than considering only one of these domains alone. Further research is needed to prove the practicability of the social integration index and to supply the literature with consistent results regarding the association of social integration and depression. Elderly with depression could benefit from increased social networks and enhanced social integration, which points to the development of social programs and social policies that maximize the engagement of older adults in social activities and volunteer roles.

Neighborhood characteristics and depressive mood among older adults: an integrative review

BACKGROUND

There is growing evidence that neighborhood environments are related to depressive mood in the general population. Older adults may be even more vulnerable to neighborhood factors than other adults. The aim of this paper is to review empirical findings on the relationships between neighborhood characteristics and depressive mood among older adults.

METHODS

A search of the literature was undertaken in PsycINFO and MEDLINE.

RESULTS

Nineteen studies were identified. Study designs were most often cross-sectional, included large sample sizes, and controlled for major individual characteristics. Mediational effects were not investigated. Statistical analysis strategies often included multilevel models. Spatial delimitations of neighborhood of residence were usually based on administrative and statistical spatial boundaries. Six neighborhood characteristics were assessed most often: neighborhood socioeconomic disadvantage, neighborhood poverty, affluence, racial/ethnic composition, residential stability, and elderly concentration. Selected neighborhood characteristics were associated with depressive mood after adjusting for individual variables. These associations were generally theoretically meaningful.

CONCLUSIONS

Neighborhood variables seem to make a unique and significant contribution to the understanding of depressive mood among older adults. However, few studies investigated these associations and replication of results is needed. Several substantive neighborhood variables have been ignored or neglected in the literature. The implications of neighborhood effects for knowledge advancement and public health interventions remain unclear. Recommendations for future research are discussed.

Predictors of and health services utilization related to depressive symptoms among elderly Koreans

While the prevalence, comorbidity, risk profile and health care utilization for late-life depression have been described for many Western countries, much less is known about the recent epidemiology of late-life depression in East Asian countries such as Korea. We investigated predictors for depressive symptoms and the association between depressive symptoms and the utilization of both medical care and preventive services in elderly Koreans. Data were obtained from a nationally representative sample of Koreans aged 60 and above (2226 men, 2911 women) who participated in the 2008 wave of the Korean Longitudinal Study of Ageing. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression scale. Risk factors considered included sociodemographics, health behaviors, chronic diseases, and physical function. Health care utilization factors included hospitalization, outpatient clinic use and basic medical checkup. Being female, being unmarried, and having less education, lower household income, physical inactivity and lower weight were associated with depressive symptoms. Presence of chronic diseases and limited physical function also showed a significant association with depressive symptoms. Depressive symptoms were associated with increased odds of hospitalization and outpatient visits, but decreased the odds of utilization of basic medical checkup after controlling for potential confounders. Findings on most risk factors, except lower weight, were consistent with reports from Western countries. It is important to recognize the burden of depressive symptoms in the elderly. The interaction of such symptoms with chronic diseases should be acknowledged and considered in the clinical setting as well as in health care planning and policymaking.

Relationship between religiosity and psychopathology in patients with depression

OBJECTIVE

To compare the psychopathology between depressed patients with low religiosity and those with high religiosity and to correlate the level of religiosity with the psychopathology in the psychiatric clinic of a general hospital in Chandigarh, North India.

MATERIALS AND METHODS

Thirty depressed patients with low religiosity and 30 patients with high religiosity were assessed on the Religiosity Scale, Beck Depression Inventory, Hamilton Depression Rating Scale, Beck Hopelessness Scale and Suicidal Intent Questionnaire.

RESULTS

In the patients with depression, hopelessness and suicidal intent correlated negatively with the level of religiosity.

CONCLUSION

In depressed patients, hopelessness and suicidal intent are inversely related to the level of religiosity.

Health perception and health behaviors of elder Tibetans living in India and Switzerland

Tibetan elders have lived in exile since the failed uprising against Chinese rule in 1959. Using mixed methods approach, this study explored the perceived health and health behaviors of 30 older Tibetans living in India and Switzerland using Bronfenbrenner's Ecological Systems Model. Results indicate that elder Tibetans living in Switzerland enjoyed better health and well-being than those living in India. Because of the availability of old age benefits, pensions, and health insurance, participants in Switzerland had greater financial independence, and fewer problems with healthcare access and affordability than those in India. In addition to financial reimbursement, the contribution and importance of personal, familial, community, and religious factors to participant's health behaviors are examined. The study is a case example depicting the impact of different factors from micro to macro on the health and well-being of a refugee group. Its implications such as the implementation of old age benefits for older persons living in developing countries are discussed.

The impact of foreign caregiving on depression among older people in Taiwan: model testing

AIM

  This article is a report of a study of predicting the factors that influence depression in the older people in Taiwan. Background.  In 1991, Taiwan opened the labour market to foreign caregivers for the older people who needed long-term care. With the differences in language, culture and lifestyle between foreign caregivers and older people in Taiwan, it was hypothesized that the older people would not be able to relate to them, and therefore become depressed.

METHODS

  The data were collected from 116 Taiwanese older people from July to September, 2005. Path analysis using multiple regression analyses was conducted to estimate the direct and indirect effects of caregiving communication, activities of daily living, income and social support on depression among older people in Taiwan. To evaluate the hypotheses for this research, bi-variate linear regression and multiple regression analyses were used.

RESULTS/FINDINGS

  The results indicated that the level of activities of daily living (β = -0·201, P = 0·010), care-giving communication (β = -0·272, P = 0·002) income (β = -0·305, P = 0·000) and social support (β = -0·276, P = 0·002) were the predictors of depression in older people in Taiwan. Social support was a mediating factor for caregiving communication and depression. Furthermore, foreign caregiver care was not correlated with depression among older people in Taiwan.

CONCLUSIONS

  The findings influence the public awareness of depression in older people, and provide the foundational information to influence the policy makers of Taiwan to evaluate the foreign caregiver policy.

Active job, healthy job? Occupational stress and depression among hospital physicians in Taiwan

This study assessed the levels and association of occupational stress and depression rate among physicians, and to compare physicians' occupational stress with that of Taiwanese employees in other occupations. The subjects were physicians employed at 14 participating regional hospitals in the Around Taiwan Health Care Alliance. Self-administered questionnaires capturing data on demographics, occupational characteristics, occupational stress measured using Job Content Questionnaire (C-JCQ), and health status measured using Taiwanese Depression Questionnaire (TDQ) were sent to eligible physicians. Results revealed that the depression rate (13.3%) was higher than that found in the general population (3.7%) of Taiwan. The mean scores of the JCQ dimensions "work demands" and "job control" were both much higher than those in most occupations in Taiwan. Higher depression scores were found in subjects with higher work demands, 8-10 d of being on duty per month, and more frequent alcohol consumption, while lower depression scores were found in subjects working in the east Taiwan area, with higher job control and with greater workplace social support. On the other hand, gender, smoking, and working hour were not independently correlated with depression, but the interaction of gender and job control also had an independent effect on depression. This study suggests that job stress plays an important role in depression in physicians; it is necessary to pay attention to physicians at high risk of depression, as well as their work environments, for early detection and intervention.

Attitudes toward and education about complementary and alternative medicine among adult patients with depression in Taiwan

AIMS

To investigate patients' attitudes toward complementary and alternative medicine, the education nurses provided about complementary and alternative medicine for treating depression and to test whether such education mediates the effect of complementary and alternative medicine use and attitudes toward complementary and alternative medicine.

BACKGROUND

Although we know that attitudes influence behaviour, very few studies simultaneously explore the relationship between attitudes, education and complementary and alternative medicine use.

DESIGN

Survey.

METHODS

This study was conducted as part of a larger survey, using face-to-face survey interviews with 206 adult patients aged 50 years or over and hospitalised in conventional hospitals in Taiwan for treatment of depression. The attitudes toward complementary and alternative medicine and patient education about complementary and alternative medicine instruments were specially developed for the study.

RESULTS

Participants expressed slightly favourable attitudes toward complementary and alternative medicine. Many participants (50%) expressed that they were willing to try any potential treatment for depression. They believed that complementary and alternative medicine helped them to feel better and to live a happier life. However, 66.5% of participants reported that they had inadequate knowledge of complementary and alternative medicine. Participants with a higher monthly income, longer depression duration and religious beliefs hold more positive attitudes toward complementary and alternative medicine. Most participants were not satisfied with the education they received about complementary and alternative medicine. Patient education about complementary and alternative medicine was found to be a mediator for the use of complementary and alternative medicine.

CONCLUSION

Patient education from nurses may predict patients' attitudes toward complementary and alternative medicine. Continuing nursing education is needed to enable nurses to respond knowledgeably to concerns patients may have about complementary and alternative medicine and treatment options.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the potential role of patient education about complementary and alternative medicine as an effective way of adjusting patients' attitudes toward complementary and alternative medicine and to link both patients' preferences for complementary and alternative medicine and health professionals' concerns about the proper use of complementary and alternative medicine for depression management and adverse drug interactions.

Prevalence and correlates of clinically significant depressive symptoms among elderly people in Sri Lanka: findings from a national survey

BACKGROUND

Elderly Sri Lankans (11.2% of the nation's population) have witnessed many years of ethnic conflict, a destructive tsunami and increasing emigration of young adults. However, very little is known about the prevalence and correlates of depression among them. The present study utilizes data from a national aging survey to document the prevalence and correlates of clinically significant depressive symptoms among community-dwelling elderly Sri Lankans (aged > or =60 years).

METHODS

The 15-item Geriatric Depression Scale (GDS-15) was administered to 1181 elderly Sri Lankans; the presence of clinically significant depressive symptoms was defined as a GDS-15 score of > or =6. Sociodemographic and health correlates of depressive symptoms were assessed using logistic regression analysis. Interactions between gender and other correlates were also assessed.

RESULTS

The prevalence of depressive symptoms was observed to be 27.8% overall: 24.0% for men, and 30.8% for women. Certain subgroups of the elderly, i.e. those with disabilities, functional limitations, perceived income inadequacy, minorities, and elderly living alone, were significantly more likely to report depressive symptoms. There was a significant interaction between gender and ethnicity.

CONCLUSION

The prevalence of depressive symptoms among Sri Lankan elderly people is higher than that reported for most Asian countries. Clinicians and caregivers need to be aware of the potential presence of depressive symptoms among the elderly, especially among those with lower educational levels, functional limitations, hearing difficulty, physical disability, perceived income inadequacy, and among those who live alone, and ethnic minority males.

The effects of church attendance and marital status on the longitudinal trajectories of depressed mood among older adults

Objective. The present study investigated the potential effects of church attendance and marital status on mood trajectories among older adults and whether these effects varied by gender. Method. Data from the Australian Longitudinal Study of Aging were used to examine the effects of church attendance and marital status on changes in depressed mood. Participants included 791 older adults (42.4% men; mean age at study entry = 75.62) who were interviewed at three time points over 8 years. Results. Using multilevel modeling to assess change, church attendance was found to have a protective effect against the emergence of mood problems among older adults. Also, although becoming married was associated with a decrease in depressed mood, becoming nonmarried was associated with an increase in depressed mood. Discussion. A sense of purpose as a potential explanation for the association between church attendance and changes in depressed mood in old age was discussed.

Effectiveness of religious activity on the quality of life and healthcare outcomes of adults aged 65 and older: a systematic review

BACKGROUND

The impact of religious activities on individual's health and well-being has attracted the interest of the scientific community and scholars involved in religion-inspired cultural phenomena. As such, several observational studies investigated the relationship between these variables but findings were inconsistent to generate definitive conclusion regarding the link between religion and health/quality of life.

OBJECTIVES

The objective of this systematic review was to evaluate the impact of religious attendance on healthcare outcomes and quality of life of older adults aged 65 and older, living in either residential care units or the wider community.

SEARCH STRATEGY

Studies were identified by electronic searches of Medline, CINAHL, PsychLit, EMBASE, Cochrane Collaboration Controlled Trials Register, Australian Medical Index, AUSThealth. Unpublished articles and the reference lists of included studies were also searched.

SELECTION CRITERIA

Quantitative studies such as randomized controlled trials, before and after studies, cohort studies, cross-sectional studies and case control studies or case reports/series published in the English language between 1995-2007 were eligible for inclusion. Participants of interest included older adults aged 65 and over who were involved in some form of religious activity. Studies that evaluated at least one health variable, morbidity or mortality data were included. For evaluation of quality of life, validated single or multidimensional tools that addressed spiritual, physical, mental and/or emotional measures of well-being were considered.

DATA COLLECTION AND ANALYSIS

Studies were assessed for eligibility by the primary reviewer. Quality appraisal was carried out independently by the two reviewers where differences in opinion were resolved by discussion. Data extraction was performed by the primary reviewer. Heterogeneity of the studies prevented pooling of data for meta-analysis. A narrative summary of the study findings was presented.

MAIN RESULTS

A total of 34 observational studies were included in this review. In terms of physical health, frequent participation in religious activities appeared to be beneficial. Older persons who participate more frequently in religious activities were significantly less likely to smoke than those who engaged less frequently. In terms of alcohol use, however, studies revealed conflicting results. Participants who have higher religious participation rates demonstrated a slower rate of cognitive decline and dysfunction. Substantial evidence was found that religious service attendance had a protective effect against depression and poor mental health. Greater participation in religious activities is likewise associated with higher levels of life satisfaction. Furthermore, religious participation was associated with higher incidence of survival or lower rates of mortality.

CONCLUSION

Despite limitations in the studies that have been included, the evidence tends to support the salutary effects of religion on health and older persons' quality of life. Health care practitioners should consider the value of incorporating religious activities in the care of older adults. From the research perspective, there is still a need to conduct empirical controlled trials investigating the cause and effect relationship of religion and health and well-being of elderly people.

Use of Complementary and Alternative Medicine among adult patients for depression in Taiwan

BACKGROUND

This descriptive exploratory study investigated the prevalence and type of Complementary and Alternative Medicine (CAM) use among older Taiwanese patients with a diagnosis of depression.

METHOD

Self-report questionnaire.

RESULTS

A convenience sample of 206 in-patients (98% response rate) completed the survey. Nearly 70% (69.9%) reported using at least one form of CAM in the past 12 months. Twenty-one kinds of CAM were identified in the treatment of depression, the most common being herbal medicines, spiritual healing, and folk remedies. Only one-third (35.4%, n=73) had discussed CAM use with their psychiatrists. Participants with mild to moderate depression tended to use more CAM than participants with severe depression (GDS-SF: Cramer's V=-.233; HDRS: Cramer's V=.201).

CONCLUSIONS

This study confirms the high prevalence of CAM use among older adults with a diagnosis of depression in Taiwan. The popularity of CAM appears to be a consequence of people's preference for a more holistic approach to health care. CAM use needs to be explicitly discussed between patients and health professionals as part of ongoing assessment, patient education and management.

Late-life depression, religiosity, cerebrovascular disease, cognitive impairment and attitudes towards death in the elderly: Interpreting the data

Geriatric depression is considered to be a major health problem in the elderly. Passing the age, the speed of mental process is decreasing and personality obtains more mature functioning (better coping) while most of its traits remain stable. Empirical studies have shown that fear of death is most prominent during midlife and not late-life. Neuroimaging studies led to the "vascular depression" hypothesis. Depression was found to be a strong predictive factor leading to stroke, while religiosity seemed to be a 'protective' factor. A possible interpretation of these reports could consider late-life depression to be an early symptomatology of an undergoing vascular disease. Religiosity could be interpreted as absence of depression, and therefore, mainly as absence of vascular lesions. The above have profound implications in the understanding of late-life depression and to the therapeutic design, especially in the primary care setting.

Síntomas depresivos en personas mayores. Prevalencia y factores asociados

OBJECTIVES

To estimate the prevalence of depressive symptoms in people older than 64 and to analyze their association with sociodemographic factors, frailty markers, and disabling diseases.

METHODS

A survey-based, cross-sectional descriptive study was carried out. The sample was composed of 417 elderly people living in Guadalajara (Spain), selected on the basis of health cards. Depressive symptoms were assessed using Yesavage's test (cut-off: 6 or more items). The questionnaire contained sociodemographic and clinical items and evaluation scales for cognitive impairment, disability, and social risk. The frailty markers studied were age over 80 years old, female sex, cognitive impairment, disability, polypharmacy, comorbidity, and social risk.

RESULTS

The prevalence of depressive symptoms was 19.7% (95% CI, 15.9-23.4) and clinical depression was diagnosed in 5% (95% CI, 2.3-7.7). Depressive symptoms were more frequent in elderly individuals living in rural environments than in those living in urban areas (p < 0.05). These symptoms increased with age (p linear trend < 0.001) and were associated with social risk (p < 0.001), comorbidity (p < 0.001), cognitive impairment (p < 0.01), and disability (p < 0.05). When a multivariate statistical analysis was applied using logistic regression models, only comorbidity (odds ratio [OR] = 2.38; 95% CI, 1.35-4.20) and social risk (OR = 2.69; 95% CI, 1.50-4.83) were significantly associated.

CONCLUSIONS

The prevalence of depressive symptoms is very high in the elderly, four times higher than a diagnosis of clinical depression. Social risk and comorbidity are strongly associated with depressive symptoms.