Depression, depressive symptoms and mortality in persons aged 65 and over living in the community: a systematic review of the literature

Sleep-wake behavioral characteristics associated with depression symptoms: findings from the Multi-Ethnic Study of Atherosclerosis

STUDY OBJECTIVES

To help prioritize target/groups for experimental intervention studies, we characterized cross-sectional associations between 24-hour sleep-wake measures and depression symptoms, and evaluated if similar sleep-wake-depression relationships existed in people with and without higher insomnia severity.

METHODS

Participants had ≥3 days of actigraphy data (n = 1884; mean age = 68.6/SD = 9.1; 54.1% female). We extracted 18 sleep, activity, timing, rhythmicity, and fragmentation measures from actigraphy. We used individual and multivariable regressions with the outcome of clinically significant depression symptoms (Center for Epidemiologic Studies Depression Scale ≥ 16). We conducted sensitivity analyses in people with higher insomnia severity (top quartile of the Women's Health Initiative Insomnia Rating Scale total score).

RESULTS

From separate models in the overall sample, the odds of having depression symptoms were higher with: later timing (e.g. activity onset time odds ratio [OR]/1 SD = 1.32; 95% confidence interval [CI]: 1.16 to 1.50), lower rhythmicity (e.g. pseudo-F OR/1 SD = 0.75; 95% CI: 0.66 to 0.85), less activity (e.g. amplitude OR/1 SD = 0.83; 95% CI: 0.72 to 0.95), and worse insomnia (OR/1 SD = 1.48, 95% CI: 1.31 to 1.68). In multivariable models conducted among people with lower insomnia severity, later timing, lower rhythmicity, and higher insomnia severity were independent correlates of depression. In people with higher insomnia symptom severity, measures of later timing were most strongly associated with depression symptoms.

CONCLUSIONS

These correlative observations suggest that experimental studies are warranted to test if: broadly promoting 24-hour sleep-wake functioning reduces depression even in people without severe insomnia, and if advancing timing leads to depression symptom reductions in people with insomnia.

Late-life depressive symptoms and white matter structural integrity within older Black adults

Introduction

Older Black adults experience a high burden of depressive symptoms and cerebrovascular disease but the specific neurobiological substrates underlying the association between late-life depressive symptoms and brain integrity are understudied, particularly in within-group designs.

Methods

Using the Center for Epidemiologic Studies Depression Scale and diffusion-tensor imaging, within-Black variation in the association between late-life depressive symptoms and white matter structural integrity was examined in 297 older Black participants without dementia that were enrolled across three epidemiological studies of aging and dementia. Linear regression models were used to test associations with DTI metrics (fractional anisotropy, trace of the diffusion tensor) as the outcomes and depressive symptoms as the predictor, while adjusting for age, sex, education, scanner, serotonin-reuptake inhibitor use, total volume of white-matter hyperintensities normalized by intracranial volume, and presence of white-matter hyperintensities at the voxel level.

Results

Higher level of self-reported late-life depressive symptoms was associated with greater diffusion-tensor trace (reduced white matter integrity) in connections between commissural pathways and contralateral prefrontal regions (superior and middle frontal/dorsolateral prefrontal cortex), association pathways connecting dorsolateral prefrontal cortex with insular, striatal and thalamic regions, and association pathways connecting the parietal, temporal and occipital lobes and the thalamus.

Discussion

This study demonstrated a discernable pattern of compromised white matter structural integrity underlying late-life depressive symptoms within older Black adults.

Investigating the Link Between IADL and Depressive Symptoms in Older Adults: A Cross-Sectional Serial Mediation Model

OBJECTIVES

There is a dearth of research on the psychological processes that underlie the negative relation between impaired instrumental activities of daily living (IADL) and depressive symptoms in older adults. Drawing on the stress process model and the resilience framework, we investigated whether purpose in life and resilience serially mediate the relationship between impaired IADL and depressive symptoms.

METHODS

We recruited 111 cognitively healthy community-dwelling older adults (ages 54-85; M = 66.5) who scored a minimum of 25 points on the Mini-Mental State Examination.

RESULTS

We found that purpose in life and resilience serially mediated the relationship between IADL and depressive symptomatology in older adults. This association held true when we controlled for covariates. Additional sensitivity analyses also supported these findings.

CONCLUSIONS

This study extends our understanding of how IADL limitations contribute to depressive symptoms. Using a community-dwelling, cognitively healthy sample, we demonstrate that functional limitations indirectly influence older adults' depressive symptoms through a decreased sense of purpose in life and decreased resilience.

CLINICAL IMPLICATIONS

Our findings have implications for intervention programs that aim to alleviate IADL limitations and mental health issues in an aging population and promote healthy aging by improving psychosocial resources (i.e., purpose in life and resilience).

Religious-based interventions for depression: A systematic review and meta-analysis of experimental studies

BACKGROUND

Depression is the most prevalent mental disorder. In the treatment of depressive symptoms, patients' religious practices and beliefs are often not considered. We carried out a systematic review and meta-analysis of RCTs to analyse the effect of religious interventions on depression.

METHODS

A literature screening was performed on August 2021, using the Cochrane Collaboration, PubMed, Scopus, and Web of Science databases. Primary source articles published from 2015 to August 2021 in peer-reviewed journals were eligible for inclusion if data were presented on religious interventions' effects on depression.

RESULTS

The literature search yielded 208 potentially relevant publications. Eight articles were identified and included in the review. One of the articles was excluded from the meta-analysis because it did not report the mean data for the baseline and follow-up assessment results. From the 7 out of 8 included studies, the results consistently indicated that religious-based interventions effectively reduced depressive symptoms among vulnerable persons with chronic medical illness, pregnant women, haemodialysis patients, elderly nursing home residents, people with major depressive disorders or dysthymia, and coronary artery bypass graft surgery patients.

LIMITATIONS

The definition of the religious-based intervention varied substantially among the trials. These differences can make interpretation and comparing implications on the treatment of depression difficult.

CONCLUSION

Compared to standard/other usual therapies for treating depression, religious-based interventions provide superior effects. This review and meta-analysis strongly suggest that patients' religious beliefs should be considered when diagnosing and treating depression.

The Influence of Depressive Mood on Mortality in Elderly with Different Health Status: Evidence from the Taiwan Longitudinal Study on Aging (TLSA)

Depression and related syndromes are well identified in older adults. Depression has been reported to increase the incidence of a multitude of somatic disorders. In older adults, the severity of depression is associated with higher mortality rates. The aim of the study is to examine whether the effect of depression screening on mortality is different between individuals with different physical health status. In order to meet this aim, we will first reprove the relationship between depression and mortality rate, and then we will set a subgroup analysis by using self-reported health (SRH) status. Our data source, Taiwan Longitudinal Study on Aging (TLSA), is a population-based prospective cohort study that was initiated by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan. The depression risk was evaluated by 10-items Center for Epidemiologic Studies Depression (CES-D-10), we set 3 CES-D-10 cutting points (5, 10, and 12) and cut our subjects into four groups. Taking mortality as an end point, we use the Taiwan National Death Registry (TNDR) record from 1999 to 2012. Self-rated health (SRH) was taken as an effect modifier between depression and mortality in the elderly group, and stratification took place into three groups (good, fair, poor). The case numbers of 4 CES-D-10 groups were 2253, 939, 285 and 522, respectively. After dividing into 4 CES-D-10 groups, the mortality prevalence rose as the CES-D-10 level grew (40.7%, 47.82%, 54.39% and 67.62%, respectively). In the subgroup analysis, although the p-value of log-rank test showed <0.05 in three groups, as the SRH got worse the Hazard Ratio became more significant (p = 0.122, 0.033, <0.001, respectively). Kaplan−Meier (K-M) survival estimates for different CES-D groups in SRH were poor, and we can see the curves representing second and third CES-D group going almost together, which may suggest the cutting point of CES-D-10 in predicting depression risk should be adjusted in the relatively unhealthy elderly. The importance of the relationship between depression and mortality is re-emphasized in our study. Moreover, through joining SRH in our analysis, we can conclude that in self-rated poor health any sign of depression may lead to a rise in mortality. Therefore, we should pay attention to the old age group’s psychological status, and remember that depressive mood should be scrutinized more carefully in the elderly who feel themselves to be unhealthy.

The association between single and multiple chronic conditions and depression among older population in India: A comparative study between men and women

OBJECTIVE

The study aimed to estimate the prevalence of depression and to explore the association of specific chronic conditions as well as multi-morbidity with depression among the older population.

METHOD

The study utilized data from the Longitudinal Ageing Study in India Wave 1 (2017-2018). The total sample size for the present study was 31,464 older adults aged 60 and above, including 14,931 males and 16,533 females. Descriptive statistics along with bivariate and multivariate analyses were performed to fulfil the objectives.

RESULTS

The overall prevalence of depression among the elderly population in India was 8.7%. Older women had shown a greater prevalence rate of depression than older men. Among chronic conditions, hypertension, stroke, and bone-related diseases were found to be significantly associated with depression in the case of both men and women. The prevalence of depression among older adults with three or more chronic conditions was higher in males (14.5%) than in females (11.2%). The association between the number of chronic conditions and depression exhibited a linear trend with an increased odds ratio indicating a higher risk of depression among older adults with multiple chronic conditions.

CONCLUSION

Older individuals with a greater number of chronic illnesses have a higher risk of depression and the risk is proportional to the number of chronic conditions. This signifies the need for the identification of depressive symptoms at an early stage by focussing on the elderly suffering from chronic conditions and educating family members and the community about effective treatments and counselling.

Impacts of depression subcase and case on all-cause mortality in older people: The findings from the multi-centre community-based cohort study in China

OBJECTIVES

It is unclear whether and to what extent depression subcases and cases in older age were associated with all-cause mortality. Little is known about gender differences in the associations. We assess these in older Chinese.

METHODS

We examined a random sample of 6124 participants aged ≥60 years across five provinces in China. They were interviewed using a standard method of the GMS-AGECAT to diagnose depression subcase and case and record sociodemographic and disease risk factors at baseline, and to follow up their vital status. We employed Cox regression models to determine all-cause mortality in relation to depression subcases and cases, with adjustment for important variables, including social support and co-morbidities.

RESULTS

Over the 10-year follow-up, 928 deaths occurred. Compared to those without depression at baseline, participants with depression subcase (n = 196) and case (n = 264) had increased risk of mortality; adjusted hazard ratios (HRs) were 1.46 (95% CI 1.07-2.00) and 1.45 (1.10-1.91). The adjusted HRs in men were 1.15 (0.72-1.81) and 1.85 (1.22-2.81), and in women 1.87 (1.22-2.87) and 1.22 (0.83-1.77) respectively. In participants aged ≥65 years, the adjusted HRs were 1.12 (0.68-1.84) and 1.99 (1.28-3.10) in men, and 2.06 (1.32-2.24) and 1.41 (0.94-2.10) in women. Increased HR in depression subcases was higher in women than man (ratio of HRs was 1.84, p = 0.034).

CONCLUSIONS

Older people with depression subcase could have increased all-cause mortality to a similar extent to those with depression case. More attention should be paid to subcases of depression in women to tackle gender inequalities and improve survival.

Loneliness, social network size, and mortality in older adults and the role of cortisol

BACKGROUND

Loneliness and social isolation have both been found to be associated with increased mortality in previous studies. One potential underlying mechanism is via the hypothalamic-pituitary-adrenal axis.

OBJECTIVE

This study aimed to examine the association between social network size and cortisol, to analyze the associations between both loneliness and social network size and mortality, and to examine to what extent the association between network size and/or loneliness and mortality is mediated by cortisol.

DESIGN

The study group consisted of 443 depressed and non-depressed participants of the Netherlands Study of Depression in the Elderly (NESDO). Cross-sectional analysis of the association between social network size and cortisol measures was followed by a survival analysis of the associations between both social network size and loneliness and mortality.

RESULTS

There were no significant associations between social network size and cortisol measures. Loneliness and small social network size were not associated with mortality. Age and partner status were more important predictors of mortality.

CONCLUSION

As people grow older the variety of factors that influence mortality risk increases, diminishing the effect of a single factor. Prevention of early morbidity and mortality in older adults should be tailored to specific needs and risks, instead of aiming at one specific factor.

AGING OF THE CHORNOBYL CATASTROPHE SURVIVORS AND PROBLEMS OF THEIR MENTAL HEALTH SURVEY

BACKGROUND

Depopulation processes in Ukraine have been affected by the Chornobyl catastrophe (ChC), but therate of demographic aging of survivors remains uncertain. Although the mental health disorders of the survivors arerecognized internationally, problems of their research remain unresolved. Thus, these areas of research are relevant.Objective is to determine the rate of demographic aging of survivors of the Chornobyl NPP (ChNPP) accident and toanalyze the state of their mental health survey, outlining solutions.

MATERIALS AND METHODS

Information and statistical sources for 1986-2019 of the Ministry of Health of Ukraine andthe State Statistics Service of Ukraine on the age of the ChC survivors are used. The results of previous own researchand other scientists using the data of the Clinical and Epidemiological Register (CER) of the State Institution«National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine»(NRCRM), the State Register of ChC survivors (SRU), and the Department of Radiation Psychoneurology, Institute ofClinical Radiology, NRCRM are integrated. Theoretical, general scientific, demographic and mathematical-statisticalresearch methods and documentary analysis are used.

RESULTS

It is shown that in 2018, compared to 1995, the number of the ChC survivors, who are under the supervi-sion of the Ministry of Health of Ukraine, decreased by almost 987 thousand. The part of people born from personsof the 1st-3rd accounting groups increased in the structure of survivors (from 13.1 % in 1995 to 13.6 %), and thisdecreased in persons living or lived in the territories subject to supervision (75.1 % and 63.1 %, respectively), butin evacuees and Chornobyl clean-up workers (liquidators) this did not change significantly. A high level of aging ofthe ChC survivors (except for the 4th group) is revealed: liquidators - 59.0 %; evacuees - 25.0 %, and residents ofradioactively contaminated territories (RCT) - 30.7 %. It has been proved that the countries of RCT differ signifi-cantly in the number of the ChC survivors and their structure. The increase in the post-accident period indicators ofthe level of aging and the average age of the RCT population indicates negative changes in age parameters and theneed to continue research to identify factors «responsible» for such changes. Long-term mental health disordersand neuropsychiatric effects in the ChC survivors have been identified - an excess of cerebrovascular pathology andneurocognitive deficits, especially in liquidators, which may indicate an accelerated aging. Radiation risks havebeen revealed for acute and chronic cerebrovascular pathology and organic mental disorders of non-psychotic andpsychotic levels. Neurophysiological and molecular-biological atypia of aging processes under an exposure to lowdoses of and low dose rate of ionizing radiation have been found. The psyche under the age of 40 years old at thetime of exposure is more vulnerable. Existing statistical and registry data underestimate the level of mental disor-ders in the population of Ukraine, including the ChC survivors by an order of magnitude.

CONCLUSIONS

The ChC survivors are aging in the country. The negative tendencies in age parameters of survival indi-cate the need to continue research to identify the factors «responsible» for such changes. Mental health disordersand neuropsychiatric effects in the ChC survivors are underestimated. It is necessary to create a national psychiatricregistry of Ukraine and long-term (lifelong) monitoring of survivors with well-planned clinical and epidemiologicalstudies of general and mental health with reliable dosimetric support based on national registries using the latest information technologies.

Older adults respond better to psychological therapy than working-age adults: evidence from a large sample of mental health service attendees

BACKGROUND

Older adults commonly experience depression and anxiety, yet are under-represented in psychological treatment services. There is uncertainty about the outcomes from psychological therapies for older adults relative to working-age adults. This study explored: pre-treatment differences between older and working-age patients with depression or anxiety disorders; whether outcomes from psychological therapy differ between groups controlling for pre-treatment clinical severity, functioning, and socio-demographics; and whether the impact of a long-term health condition (LTC) on outcome differs by age.

METHODS

Data on >100,000 patients treated with psychological therapies in eight Improving Access to Psychological Therapies services were analyzed. We compared pre-treatment characteristics and therapy outcomes for older (≥65 years) and working-age (18-64 years) patients, and investigated associations between age and outcomes.

RESULTS

Older adults had less severe clinical presentations pre-treatment. In adjusted models older adults were more likely to reliably recover (OR=1.33(95%CI=1.24-1.43)), reliably improve (OR=1.34(95%CI =1.24-1.45)), and attrition was less likely (OR=0.48(95%CI =0.43-0.53)). Effects were more pronounced in patients with anxiety disorders compared to depression. Having an LTC was associated with a much lower likelihood of reliable recovery for working-age patients but had only a modest effect for older adults.

LIMITATIONS

There are potential selection biases affecting the characteristics of older people attending these services. Residual confounding cannot be ruled out due to limits on data available.

CONCLUSIONS

Older adults experienced better outcomes from psychological treatments than working-age adults. Given the deleterious effects if mental health conditions go untreated, increasing access to psychological therapies for older people should be an international priority.

Patterns of physical activity and their relationship with depression among community-dwelling older adults in Shanghai, China: a latent class approach

Background

Few studies have explored patterns of physical activity (PA) and examined their relationship with depression among community-dwelling older adults. We aimed to identify the patterns of PA through a person-centered analytical approach and examine the association between quantity and patterns of PA, and depression among community-dwelling older adults.

Methods

We conducted a cross-sectional survey study in the Minhang district, Shanghai, China, in August 2019, and used a self-administered questionnaire to collect data through home visits. The total sample included 2525 older adults. This study used the Physical Activity Scale for the Elderly (PASE) to assess the quantity of PA in older adults. Depression was evaluated with the Geriatric Depression Scale (GDS). Latent class analysis (LCA) was used to identify subpopulations by shared item response patterns. Logistic regressions were performed to estimate the relationship between PASE score, patterns of PA, and depression. An exploratory analysis of joint levels and patterns of PA effects on depression was based on sample subgroups with combinations of levels and patterns of PA. Logistic regression was used to calculate the odds ratio for combined subgroups.

Results

Four latent classes were identified: “domestic types,” “athletic types,” “gardening/caring types,” and “walkers.” PASE scores and patterns of PA both were associated with depression. Older adults who were the most active (PASE quartile: 75–100%) and the athletic types had the strongest significant association with depression (OR = 0.19, 95% CI: 0.06–0.65), followed by those who were the most active (PASE quartile: 75–100%) and the walkers (OR = 0.28, 95% CI: 0.14–0.57) when compared with older adults with the least activity (PASE quartile: 0–25%) and domestic types.

Conclusion

This study suggests both the quantity and patterns of physical activity are associated with depressive symptoms among community-dwelling older adults. Population-level intervention should encourage community-dwelling older adults to increase their quantity of PA to reduce the risk of depression. Athletics and walkers are recommended. To develop individual-level tailored interventions, more attention should be paid to older adults who are highly engaged in gardening/caring for others.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02537-8.

Subjective perceptions of age-related gains buffer negative associations of perceived age-related losses with health, well-being, and engagement

People reflect on their own aging, and this subjective awareness has an influence on developmental outcomes. Scholars have recently operationalized subjective aging in terms of awareness of age-related change (AARC), which captures awareness of both gains and losses. We examined associations of AARC-gains and AARC-losses with physical functioning, subjective well-being, and engagement with life (enjoyable activities and sense of purpose). Importantly, we extended previous research by not only assessing main effects of gains and losses but also testing their interaction. We hypothesized that awareness of losses would be more weakly negatively associated with health and well-being among those who possessed higher awareness of gains. A total of 399 older participants aged 65 to 91 (235 women and 164 men) were recruited via Prime Panels crowd-sourcing platform to complete an online questionnaire. Greater AARC-losses was associated with poorer health, lower subjective well-being, and lower sense of purpose. AARC-gains was associated with better outcomes in general, and moderated associations of AARC-losses with physical functioning, subjective well-being, and sense of purpose (but not engagement in leisure activities). Consistent with predictions, moderation effects showed that negative associations of AARC-losses with the outcomes were weaker among those who reported higher AARC-gains. Results provided some support for a role of AARC-gains in buffering negative effects of AARC-losses on developmental outcomes.

Lifetime employment histories and their relationship with 10-year health trajectories in later life: evidence from England

Background

Employment histories influence health. However, most studies have so far investigated cross-sectional associations between employment histories and health, failing to recognize health as a dynamic process in later life.

Methods

We use Waves 3–8 of the English Longitudinal Study of Ageing, including retrospective information on respondents’ employment activities. We used dynamic hamming distances to summarize lifetime employment histories up to state pension age (64 for men and 59 for women). Multilevel growth curve models were then used to estimate the influence of lifetime employment histories on later life health trajectories over a 10-year period using quality of life (QoL), somatic health, and depression.

Results

Net of selection effect and a host of contemporaneous material and social resources, men who exited early started off with poorer health than those with continuous attachment to the labour market but had a very similar health profile by the end of the 10-year period considered. Among women, better somatic health and higher QoL were observed among those who had employment breaks for family care, and this health advantage was maintained over time. Lifetime employment histories are not related to depression for either men or women.

Conclusion

Overall, differences in health by employment histories level off only among men who left earlier and those continuously employed. Flexible arrangements for men in poor health who benefit from leaving the labour market early and supporting women who wish to take breaks for family care may help reduce health inequalities in later life.

Depressive symptoms as an independent risk factor for mortality

OBJECTIVE

To evaluate the relationship between presence of depressive symptoms and risk of death in older adults residing in a municipality in Southern Brazil.

METHODS

Between 2009 and 2014, 1,391 people participated in the EpiFloripa Aging Cohort Study, a population-based longitudinal study. Depressive symptoms were assessed through the Geriatric Depression Scale. The initial time was considered the age at the first interview, and the end time, the age at the last contact or death. Cox regression models were used to estimate the mortality risk associated with depressive symptoms, adjusted by sex, education, income, paid work, smoking status, alcohol consumption, morbidities, medication use, physical activity, disability, cognitive impairment, and body mass index.

RESULTS

The prevalence of depressive symptoms was 23.5% (95%CI 20.4-26.9). On crude analysis, the risk of mortality was 1.86 (95%CI 1.35-2.55) for individuals with depressive symptoms; in adjusted models, the risk of mortality was 1.67 (95%CI 1.15-2.40).

CONCLUSION

Depressive symptoms are an independent risk factor for mortality in older Brazilian adults. Our findings highlight the importance of screening this population for depression and the practice of preventive actions.

Leisure activity moderates the relationship between living alone and mental health among Japanese older adults

AIM

As living alone is associated with poor mental health, seeking a moderating factor in this relationship may help enhance quality of life of older people living alone. Therefore, this study examined the moderating effect of leisure activity on the relationship between living alone and mental health in older people.

METHODS

This study employed a cross-sectional analysis of questionnaire data. Research was conducted in a metropolitan Tokyo ward from September to October 2017. Participants were 314 community-dwelling Japanese individuals (158 women, 156 men) aged 70-84 years (mean ± SD, 77.7 ± 4.4). We analyzed mental health using the Japanese version of the World Health Organization-Five Well-Being Index as the outcome variable, and the 11 items of the Leisure Activity Scale and living arrangements as explanatory variables. Multivariate analyses were used to examine effects of leisure activity on living arrangements and mental health.

RESULTS

The proportion of people living alone was 22.9% (N = 72), and the mental health score was mean ± SD, 14.2 ± 7.2. Multiple regression analysis showed that subjective economic status (β = -0.177), instrumental activities of daily living (β = 0.167), living arrangements (β = -0.142) and leisure activity (β = 0.481) were associated with mental health. The interaction effect between living arrangements and leisure activity on mental health was significant (β = 0.112).

CONCLUSIONS

Our findings show that leisure activity moderates poor mental health in older adults living alone. Accordingly, interventions should encourage older adults living alone to engage in leisure activity to improve their mental health. Geriatr Gerontol Int 2021; 21: 421-425.

Clinical characteristics of late-life depression predicting mortality

OBJECTIVE

Depression has been associated with increased mortality rates, and modifying mechanisms have not yet been elucidated. We examined whether specific subtypes or characteristics of late-life depression predict mortality.

METHODS

A cohort study including 378 depressed older patients according to DSM-IV criteria and 132 never depressed comparisons. The predictive value of depression subtypes and characteristics on the six-year mortality rate, as well as their interaction with somatic disease burden and antidepressant drug use, were studied by Cox proportional hazard analysis adjusted for demographic and lifestyle characteristics.

RESULTS

Depressed persons had a higher mortality risk than non-depressed comparisons (HR = 2.95 [95% CI: 1.41-6.16], p = .004), which lost significance after adjustment for age, sex, education, smoking, alcohol, physical activity, number of prescribed medications and somatic comorbidity. Regarding depression subtypes and characteristics, only minor depression was associated with a higher mortality risk when adjusted for confounders (HR = 6.59 [95% CI: 1.79-24.2], p = .005).

CONCLUSIONS

Increased mortality rates of depressed older persons seem best explained by unhealthy lifestyle characteristics and multiple drug prescriptions. The high mortality rate in minor depression, independent of these factors, might point to another, yet unknown, pathway towards mortality for this depression subtype. An explanation might be that minor depression in later life reflects depressive symptoms due to underlying aging-related processes, such as inflammation-based sickness behavior, frailty, and mild cognitive impairment, which have all been associated with increased mortality.

Different levels of physical activity and depression symptoms among older adults from 18 countries: A population-based study from the Survey of Health, Ageing and Retirement in Europe (SHARE)

Objective: Analyse the relationship between different levels of physical activity (PA) and depression symptoms in a representative sample of European older adults. Methods: Data on PA, depression symptoms and sociodemographic variables from 64688 (28015 men) older adults participating in SHARE wave 6 was collected through a face-to-face interview. The EURO-D 12-item scale was administered for depression symptoms. Participants reported the frequency they engaged in moderate-intensity PA (MPA) and vigorous-intensity PA (VPA). Results: Men and women engaging in MPA and VPA once or more than once a week had less depression symptoms than those who engage less than once a week. MPA and VPA once or more than once a week were inversely associated with the depression symptoms score. Furthermore, engaging in MPA and VPA decreased the odds of depression (cut-off point of ≥4 depression symptoms) compared to engaging in PA less than once a week. Conclusions: Policies for promoting mental health should include PA for the prevention or treatment of depression symptoms. PA presents physical and psychological benefits and can be used as an overall health-promoting strategy, facing numerous problems at a time.

Leisure-time physical activity is negatively associated with depression symptoms independently of the socioeconomic status

Objective: There are few studies evaluating the relationship between depression symptoms (DS) and physical activity (PA) considering peoples' sociodemographic characteristics. This study aimed to analyse the relationship between DS and PA, stratified by sociodemographic characteristics of European adults. Methods: Participants were 29,285 adults (13,943 men, 47.6%; 15,342 women, 52.4%), aged 50.9 ± 17.4 (50.6 ± 17.3 men, 51.1 ± 17.5 women) from the European Social Survey round 7. DS was assessed with the Centre for Epidemiological Studies Depression Scale (CES-D8). Leisure-time PA (LTPA) was self-reported. The analysed sociodemographic characteristics were sex, age, living place, household members, marital status, income, and educational level. The relationship between DS and PA, stratified by sociodemographic variables, was examined by linear regression models. Results: Engaging in LTPA was negatively and linearly related to DS, independently of being men or women, being younger, middle or older adult, living in an urban or rural area, having children or not, being single or married, being wealthy or poor, employment status, and to having a lower or a higher education level. Age was the variable with both the least and the greatest effect of LTPA on DS. The least effect of LTPA on DS was observed in younger adults (β = -0.08, 95% CI: -0.11, -0.05) and the greatest effect in retired people (β = -0.33, 95% CI: -0.36, -0.29). Conclusion: Independently of sociodemographic characteristics, LTPA is associated with DS and can benefit everyone. Public health policies for promoting mental health should include PA promotion as an important strategy for the prevention or treatment of DS.

The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis

BACKGROUND

Late-life depression has become an important public health problem. Available evidence suggests that late-life depression is associated with all-cause and cardiovascular mortality among older adults living in the community, although the associations have not been comprehensively reviewed and quantified.AimTo estimate the pooled association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults.

METHOD

We conducted a systematic review and meta-analysis of prospective cohort studies that examine the associations of late-life depression with all-cause and cardiovascular mortality in community settings.

RESULTS

A total of 61 prospective cohort studies from 53 cohorts with 198 589 participants were included in the systematic review and meta-analysis. A total of 49 cohorts reported all-cause mortality and 15 cohorts reported cardiovascular mortality. Late-life depression was associated with increased risk of all-cause (risk ratio 1.34; 95% CI 1.27, 1.42) and cardiovascular mortality (risk ratio 1.31; 95% CI 1.20, 1.43). There was heterogeneity in results across studies and the magnitude of associations differed by age, gender, study location, follow-up duration and methods used to assess depression. The associations existed in different subgroups by age, gender, regions of studies, follow-up periods and assessment methods of late-life depression.

CONCLUSION

Late-life depression is associated with higher risk of both all-cause and cardiovascular mortality among community-dwelling elderly people. Future studies need to test the effectiveness of preventing depression among older adults as a way of reducing mortality in this population. Optimal treatment of late-life depression and its impact on mortality require further investigation.Declaration of interestNone.

Depression and cause-specific mortality in an ethnically diverse cohort from the UK: 8-year prospective study

BACKGROUND

Depression is associated with increased mortality, however, little is known about its variation by ethnicity.

METHODS

We conducted a cohort study of individuals with ICD-10 unipolar depression from secondary mental healthcare, from an ethnically diverse location in southeast London, followed for 8 years (2007-2014) linked to death certificates. Age- and sex- standardised mortality ratios (SMRs), with the population of England and Wales as a standard population were derived. Hazard ratios (HRs) for mortality were derived through multivariable regression procedures.

RESULTS

Data from 20 320 individuals contributing 91 635 person-years at risk with 2366 deaths were used for analyses. SMR for all-cause mortality in depression was 2.55(95% CI 2.45-2.65), with similar trends by ethnicity. Within the cohort with unipolar depression, adjusted HR (aHRs) for all-cause mortality in ethnic minority groups relative to the White British group were 0.62(95% CI 0.53-0.74) (Black Caribbean), 0.53(95% CI 0.39-0.72) (Black African) and 0.69(95% CI 0.52-0.90) (South Asian). Male sex and alcohol/substance misuse were associated with an increased all-cause mortality risk [aHR:1.94 (95% CI 1.68-2.24) and aHR:1.18 (95% CI 1.01-1.37) respectively], whereas comorbid anxiety was associated with a decreased risk [aHR: 0.72(95% CI 0.58-0.89)]. Similar associations were noted for natural-cause mortality. Alcohol/substance misuse and male sex were associated with a near-doubling in unnatural-cause mortality risk, whereas Black Caribbean individuals with depression had a reduced unnatural-cause mortality risk, relative to White British people with depression.

CONCLUSIONS

Although individuals with depression experience an increased mortality risk, marked heterogeneity exists by ethnicity. Research and practice should focus on addressing tractable causes underlying increased mortality in depression.

Hopelessness and Other Depressive Symptoms in Adults 70 Years and Older as Predictors of All-Cause Mortality Within 3 Months After Acute Hospitalization: The Hospital-ADL Study

OBJECTIVE

Depression among older adults predicts mortality after acute hospitalization. Depression is highly heterogeneous in its presentation of symptoms, whereas individual symptoms may differ in predictive value. This study aimed to investigate the prevalence of individual cognitive-affective depressive symptoms during acute hospitalization and investigate the predictive value of both overall and individual cognitive-affective depressive symptoms for mortality between admission up to 3-month postdischarge among older patients.

METHODS

A prospective multicenter cohort study enrolled 401 acutely hospitalized patients 70 years and older (Hospitalization-Associated Disability and impact on daily Life Study). The predictive value of depressive symptoms, assessed using the Geriatric Depression Scale 15, during acute hospitalization on mortality was analyzed with multiple logistic regression.

RESULTS

The analytic sample included 398 patients (M (SD) = 79.6 (6.6) years; 51% men). Results showed that 9.3% of participants died within 3 months, with symptoms of apathy being most frequently reported. The depression total score during hospitalization was associated with increased mortality risk (admission: odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.2-1.3; discharge: OR = 1.2, 95% CI = 1.2-1.4). Stepwise multiple logistic regression analyses yielded the finding that feelings of hopelessness during acute hospitalization were a strong unique predictor of mortality (admission: OR = 3.6, 95% CI = 1.8-7.4; discharge: OR = 5.7, 95% CI = 2.5-13.1). These associations were robust to adjustment for demographic factors, somatic symptoms, and medical comorbidities.

CONCLUSIONS

Symptoms of apathy were most frequently reported in response to acute hospitalization. However, feelings of hopelessness about their situation were the strongest cognitive-affective predictor of mortality. These results imply that this item is important in identifying patients who are in the last phase of their lives and for whom palliative care may be important.

Positive Mental Attitude Associated with Lower 35-Year Mortality: The Leisure World Cohort Study

Background

Although emerging research has suggested that "positive psychological well-being" is associated with better health outcomes, studies of long-term health and mortality in the elderly are limited. This study assessed the relationship of mental attitude and mortality in older adults followed up for 35 years.

Methods

In the 1980s, the Leisure World Cohort Study recruited residents of a California retirement community to a prospective cohort study of health promotion and disease prevention. Participants completed a postal survey including seven positively worded items from the Zung self-rating depression scale. Age-adjusted and multivariable-adjusted (for lifestyle behaviors and disease conditions) hazard ratios (HRs) for death were calculated using Cox regression for 8682 women and 4992 men (median age at entry, 74 years). During follow-up (1981-2016), 13,405 participants died (median age at death, 88 years).

Results

In both women and men, HRs for death were significantly related to mental attitude with increasing risk with decreasing positive responses for total attitude and the seven individual items. The multivariable-adjusted HR (95% CI) for death for individuals in the lowest vs. highest quarter of total attitude was 1.24 (1.16, 1.32) for women and 1.30 (1.19, 1.41) for men. Some attenuation in the observed associations occurred after adjustment for potential confounders and after elimination of the first five years of follow-up.

Conclusions

Our study suggests that persons with negative attitude have an increased risk of death even after many years of follow-up. Research into strategies to improve mental outlook may help improve the quantity as well as the quality of life.

Understanding the relationship between cognition and death: a within cohort examination of cognitive measures and mortality

Despite several studies demonstrating an independent and inverse association between cognition and mortality, the nature of this association still remains unclear. To examine the association of cognition and mortality after accounting for sociodemographic, health and lifestyle factors and to explore both test and population characteristics influencing this relationship. In a population based cohort of 8585 men and women aged 48-92 years, who had cognitive assessments in 2006-2011 and were followed up till 2016 for mortality, we examined the relationship between individual cognitive tests as well as a global cognition score to compare their ability in predicting mortality and whether these differed by population characteristics. Risk of death was estimated using Cox proportional hazard regression models including sociodemographic, lifestyle and health variables, and self-reported comorbidities, as covariates in the models. Poor cognitive performance (bottom quartile of combined cognition score) was associated with higher risk of mortality, Hazard Ratio = 1.32 (95% Confidence Interval 1.09, 1.60); individual cognitive tests varied in their mortality associations and also performed differently in middle-age and older age groups. Poor cognitive performance is independently associated with higher mortality. This association is observed for global cognition and for specific cognitive abilities. Associations vary depending on the cognitive test (and domain) as well as population characteristics, namely age and education.

Sedentary behaviors, physical activity, and changes in depression and psychological distress symptoms in older adults

BACKGROUND

Television (TV) viewing and computer use have been associated with higher risk of depression, but studies specifically assessing the impact of these and other types of sedentary behaviors (SBs) on the mental health of older adults are scarce and their results are inconclusive. Similarly, the association between specific types of recreational physical activity (rPA) and mental health in older adults is poorly understood.

METHODS

In 2012, information on SBs, rPA, and other health behaviors was collected with validated questionnaires from community-dwelling older adults participating in the Seniors-ENRICA cohort. In 2012 and 2015, symptoms of depression and mental distress were assessed using the GDS-10 and the General Health Questionnaire-12 (GHQ-12), respectively.

RESULTS

Time spent watching TV was prospectively associated with higher (worse) GDS-10 scores in women (β [95% confidence interval (CI)] comparing the second and third tertiles of TV viewing to the first: 0.21 [-0.04 to 0.46] and 0.37 [0.13-0.62], respectively; P-trend: < 0.01), but not in men (-0.11 [-0.35 to 0.13] and -0.18 [-0.44 to 0.08]; P-trend: 0.16). Women, but not men, who spent more time in other SBs, including reading, using the computer and commuting, showed a lower number of depressive symptoms (-0.19 [-0.44 to 0.06] and -0.34 [-0.60 to -0.08]; P-trend: 0.01) and lower (better) GHQ-12 scores (-0.33 [-0.67 to -0.00] and -0.35 [-0.69 to -0.00]; P-trend: 0.05) at follow-up. Both in men and women, higher levels of rPA, such as walking, practicing sports, and do-it-yourself activities, were associated with lower GDS-10 scores (-0.07 [-0.25 to 0.11] and -0.19 [-0.36 to -0.01]; P-trend: 0.04) and with lower GHQ-12 scores (-0.02 [-0.26 to 0.22] and -0.23 [-0.47 to -0.00]; P-trend: 0.06).

CONCLUSIONS

Older women who spent more time watching TV and less time in other SBs showed a higher number of depressive symptoms. Data suggest that increasing rPA may improve mental health in older adults, particularly among women.

Differences in the prevalence of depression in older Spanish Romany and non-Romany people and associated factors

AIM

Depression among older adults has serious implications, especially because suicide rates are higher in this group than in younger adults. Research has identified biological and social risk factors. However, studies addressing cultural and psychosocial factors associated with specific ethnic groups, such as Spanish Romani, are lacking. The objective of the present study was to establish the differential prevalence of depression among Romany and non-Romany people older than 55 years of age. It also aimed to explore how cultural, sociodemographic, and psychosocial factors predispose individuals to depression.

METHODS

A total of 181 people were interviewed. The sample consisted of 95 self-adscribed Romany individuals and 86 non-Romany individuals over the age of 55; the latter group served as the control group. We performed bifactorial univariate anova, epidemiological analysis using Epi Info software, and analysis of correlations between Geriatric Depression Scale scores and the different factors analyzed.

RESULTS

Significant differences in Geriatric Depression Scale score related to ethnicity and sex were found. Probable depression or depression in Romany men was four times higher than in non-Romany men. In Romany women, the risk was more than twice as high as in non-Romany women. Among the factors analyzed, income level, activity at home, and perception of being valued by family members showed significant differences between the groups.

CONCLUSIONS

In short, we can state that Romany people develop symptoms of depression to a greater extent than non-Romany people, and although Romany women have a higher risk of depression, the differential effect of ethnicity is greater among Romany men. Income level, activity at home, and perception of being valued by family members are unambiguously related to ethnicity.

Sudden cardiac death and antipsychotics. Part 1: Risk factors and mechanisms

Mortality from causes other than suicide is higher than expected in schizophrenia. Cardiovascular causes are most common, accounting for the majority of the 5% of sudden and unexpected deaths. Most cases have no clear explanation on post-mortem examination (‘sudden unexplained deaths’) and are thought to result from fatal arrhythmias. Prospective studies show that people with prolongation of the QT interval beyond 500 ms are at increased risk of serious arrhythmias such as ventricular tachycardia and torsade de pointes. In about 1 in 10 cases, the torsade is fatal. Most antipsychotics prolong the QTc interval in overdose but some prolong it even at therapeutic doses. Droperidol, sertindole and ziprasidone extend the QT interval by an average of 15–35 ms; quetiapine, haloperidol and olanzapine by 5 ms, to 15 ms. There is only an approximate relationship between QT prolongation and risk of sudden death, and the risk related to antipsychotics is thought to increase in people with pre-existing cardiac disease, those taking multiple QT-acting drugs and those taking antipsychotics at high dose for long periods. There is little evidence of an association with route of administration. More data are required to clarify to what extent people with mental health difficulties who die suddenly have pre-existing cardiac disease.

The interaction between stress and positive affect in predicting mortality

OBJECTIVE

Positive affect is associated with longevity; according to the stress-buffering hypothesis, this is because positive affect reduces the health harming effects of psychological stress. If this mechanism plays a role, then the association between positive affect and mortality risk should be most apparent among individuals who report higher stress. Here, we test this hypothesis.

METHODS

The sample consisted of 8542 participants aged 32-86 from the National Health and Nutrition Examination Survey (NHANES I) Epidemiological Follow-up Study (NHEFS). We used Cox's proportional hazards regression to test for the main effects of and the interaction between positive affect and perceived stress in predicting mortality risk over a 10year follow up period.

RESULTS

Greater positive affect was associated with lower mortality risk. We found a significant interaction between positive affect and perceived stress such that the association between positive affect and mortality risk was stronger in people reporting higher stress. In the fully adjusted model, a standard deviation increase in positive affect was associated with a 16% (HR=0.84; 95% CI=0.75, 0.95) reduction in mortality risk among participants who reported high levels of stress. The association between positive affect and mortality risk was weaker and not significant among participants who reported low levels of stress (HR=0.98; 95% CI=0.89, 1.08).

CONCLUSION

Our results support the stress-buffering model and illustrate that the association between positive affect and reduced risk may be strongest under challenging circumstances.

The interaction between individualism and wellbeing in predicting mortality: Survey of Health Ageing and Retirement in Europe

The link between greater wellbeing and longevity is well documented. The aim of the current study was to test whether this association is consistent across individualistic and collectivistic cultures. The sample consisted of 13,596 participants from 11 European countries, each of which was assigned an individualism score according to Hofstede et al.'s (Cultures and organizations: software of the mind, McGraw Hill, New York, 2010) cultural dimension of individualism. We tested whether individualism moderated the cross-sectional association between wellbeing and self-rated health or the longitudinal association between wellbeing and mortality risk. Our analysis revealed a significant interaction between individualism and wellbeing such that the association between wellbeing and self-rated health or risk of mortality from cardiovascular disease was stronger in more individualistic countries. However, the interaction between wellbeing and individualism was not significant in analysis predicting all-cause mortality. Further prospective studies are needed to confirm our finding and to explore the factors responsible for this culturally dependent effect.

Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach

Background

Given the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early.

Methods

Our data come from waves 2–4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65–74 and women aged 60–69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood.

Results

Approximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant.

Conclusions

Potential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with.

Exploring the excess mortality due to depressive symptoms in a community-based sample: The role of Alzheimer's Disease

BACKGROUND

Depression has been associated with increased risk of death. However, there is lack of studies exploring such relationship in the context of dementia. Given the high prevalence of both depression and Alzheimer's Disease (AD), investigating their temporal association with mortality is of public health relevance.

METHODS

Longitudinal data from the WHICAP study were analyzed (1958 individuals aged ≥65 years). Depressive symptoms were assessed with the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Respondents were identified as having AD if they satisfied the criteria of the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Cox regressions analyses were performed to determine the association between depressive symptoms and risk of all-cause mortality using the overall sample, and by AD status.

RESULTS

Depressive symptoms were significantly associated with higher mortality risk after adjusting for all potential covariates in the overall sample (HR=1.22; 95% CI=1.02, 1.46) and in individuals with incident AD (HR=1.88; 95% CI=1.12, 3.18).

LIMITATIONS

The CES-D does not measure clinical depression but depressive symptomatology. Since those who were exposed to known risk factors for mortality are likely to die prematurely, our results may have been skewed to the individuals with longer survival.

CONCLUSIONS

Strategies focusing on prevention and early treatment of depression in the elderly may have a beneficial effect not only on patient quality of life and disability, but may also increase survival in the context of AD.

Comorbidity of Cognitive Impairment and Late-Life Depression Increase Mortality: Results From a Cohort of Community-Dwelling Elderly Individuals in Rural Greece

OBJECTIVE

To investigate the association of cognitive impairment (COGI) and depression with all-cause mortality and cardiovascular-specific mortality among community-dwelling elderly individuals in rural Greece.

METHODS

Cognition and depressive symptomatology of 676 Velestino town residents aged ≥60 years were assessed using Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Eight-year all-cause mortality and cardiovascular mortality were explored by multivariate Cox regression models controlling for major confounders.

RESULTS

Two hundred and one patients died during follow-up. Cognitive impairment (MMSE ≤ 23) was independently associated with all-cause mortality (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.13-2.18) and cardiovascular mortality (HR: 1.57, 95%CI: 1.03-2.41). Moderate to severe depression (GDS > 10) was significantly associated only with a 51% increase in all-cause mortality. A male-specific association was noted for moderate to severe depression, whereas the effect of COGI was limited to females. Noteworthy, COGI and depression comorbidity, rather than their sole presence, increased all-cause mortality and cardiovascular mortality by 66% and 72%, respectively. The mortality effect of COGI was augmented among patients with depression and of depression among patients with COGI.

CONCLUSION

COGI and depression, 2 entities often coexisting among elderly individuals, appear to increase all-cause mortality and cardiovascular mortality. Gender-specific modes may prevail but their comorbidity should be carefully assessed, as it seems to represent an independent index of increased frailty, which eventually shortens life expectancy.

Differential item functioning in the Cambridge Mental Disorders in the Elderly (CAMDEX) Depression Scale across middle age and late life

A long-standing and critical problem in the study of aging and depression is the comparability of measurement across age groups. While psychological measures of depression typically show increased incidence of symptoms with increasing age, rates of depression diagnosis do not show the same age trend. This analysis presents tests of differential item functioning on the depression section of the CAMDEX interview schedule, using factor analysis-derived affective and somatic subscales (McGue & Christensen, 1997). Results for the affective subscale show significant differences in item functioning in the majority of the affective items as a function of age (items "Happy Life," "Lonely," "Nervous" "Worthless," and "Future": χ6(2) = [30.193, 255.971] across items, all p < .0001). Analyses for the somatic subscale show differential item functioning is limited to a single item relating to coping (χ6(2) = 180.754, p < .0001). These results indicate that differences in depression symptoms across age groups are not entirely consistent with a unidimensional depression trait, and that the measurement structure of depression varies over the life span.

Degree of cognitive impairment and mortality: a 17-year follow-up in a community study

BACKGROUND

To test the hypothesis that cognitive impairment in older adults is associated with all-cause mortality risk and the risk increases when the degree of cognitive impairment augments; and then, if this association is confirmed, to report the population-attributable fraction (PAF) of mortality due to cognitive impairment.

METHOD

A representative random community sample of individuals aged over 55 was interviewed, and 4557 subjects remaining alive at the end of the first year of follow-up were included in the analysis. Instruments used in the assessment included the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS) and the Geriatric Mental State (GMS)-AGECAT. For the standardised degree of cognitive impairment Perneczky et al's MMSE criteria were applied. Mortality information was obtained from the official population registry. Multivariate Cox proportional hazard models were used to test the association between MMSE degrees of cognitive impairment and mortality risk. We also estimated the PAF of mortality due to specific MMSE stages.

RESULTS

Cognitive impairment was associated with mortality risk, the risk increasing in parallel with the degree of cognitive impairment (Hazard ratio, HR: 1.18 in the 'mild' degree of impairment; HR: 1.29 in the 'moderate' degree; and HR: 2.08 in the 'severe' degree). The PAF of mortality due to severe cognitive impairment was 3.49%.

CONCLUSIONS

A gradient of increased mortality-risk associated with severity of cognitive impairment was observed. The results support the claim that routine assessment of cognitive function in older adults should be considered in clinical practice.

Cognition and mortality in older people: the Sydney Memory and Ageing Study

BACKGROUND

Both cognitive ability and cognitive decline have been shown to predict mortality in older people. As dementia, a major form of cognitive decline, has an established association with shorter survival, it is unclear the extent to which cognitive ability and cognitive decline predict mortality in the absence of dementia.

OBJECTIVE

To determine whether cognitive ability and decline in cognitive ability predict mortality in older individuals without dementia.

DESIGN

The Sydney Memory and Ageing Study is an observational population-based cohort study. Participants completed detailed neuropsychological assessments and medical examinations to assess for risk factors such as depression, obesity, hypertension, diabetes, hypercholesterolaemia, smoking and physical activity. Participants were regularly assessed at 2-year intervals over 8 years.

SETTING

A community sample in Sydney, Australia.

SUBJECTS

One thousand and thirty-seven elderly people without dementia.

RESULTS

Overall, 236 (22.8%) participants died within 8 years. Both cognitive ability at baseline and decline in cognitive ability over 2 years predicted mortality. Decline in cognitive ability, but not baseline cognitive ability, was a significant predictor of mortality when depression and other medical risk factors were controlled for. These relationships also held when excluding incident cases of dementia.

CONCLUSIONS

The findings indicate that decline in cognition is a robust predictor of mortality in older people without dementia at a population level. This relationship is not accounted for by co-morbid depression or other established biomedical risk factors.

Severity of depressive symptoms as a predictor of mortality: the English longitudinal study of ageing

BACKGROUND

Major depressive disorder and subthreshold depression have been associated with premature mortality. We investigated the association between depressive symptoms and mortality across the full continuum of severity.

METHOD

We used Cox proportional hazards models to examine the association between depressive symptom severity, assessed using the eight-item Center for Epidemiological Studies Depression Scale (CES-D; range 0-8), and the risk of all-cause mortality over a 9-year follow-up, in 11 104 members of the English Longitudinal Study of Ageing.

RESULTS

During follow-up, one fifth of study members died (N = 2267). Depressive symptoms were associated with increased mortality across the full range of severity (p trend < 0.001). Relative to study members with no symptoms, an increased risk of mortality was found in people with depressive symptoms of a low [hazard ratio (HR) for a score of 2 was 1.59, 95% confidence interval (CI) 1.40-1.82], moderate (score of 4: HR 1.80, 95% CI 1.52-2.13) and high (score of 8: HR 2.27, 95% CI 1.69-3.04) severity, suggesting risk emerges at low levels but plateaus thereafter. A third of participants (36.4%, 95% CI 35.5-37.3) reported depressive symptoms associated with an increased mortality risk. Adjustment for physical activity, physical illnesses, and impairments in physical and cognitive functioning attenuated this association (p trend = 0.25).

CONCLUSIONS

Depressive symptoms are associated with an increased mortality risk even at low levels of symptom severity. This association is explained by physical activity, physical illnesses, and impairments in physical and cognitive functioning.

Does life satisfaction predict five-year mortality in community-living older adults?

OBJECTIVES

Depression and depressive symptoms predict death, but it is less clear if more general measures of life satisfaction (LS) predict death. Our objectives were to determine: (1) if LS predicts mortality over a five-year period in community-living older adults; and (2) which aspects of LS predict death.

METHOD

1751 adults over the age of 65 who were living in the community were sampled from a representative population sampling frame in 1991/1992 and followed five years later. Age, gender, and education were self-reported. An index of multimorbidity and the Older American Resource Survey measured health and functional status, and the Terrible-Delightful Scale assessed overall LS as well as satisfaction with: health, finances, family, friends, housing, recreation, self-esteem, religion, and transportation. Cox proportional hazards models examined the influence of LS on time to death.

RESULTS

417 participants died during the five-year study period. Overall LS and all aspects of LS except finances, religion, and self-esteem predicted death in unadjusted analyses. In fully adjusted analyses, LS with health, housing, and recreation predicted death. Other aspects of LS did not predict death after accounting for functional status and multimorbidity.

CONCLUSION

LS predicted death, but certain aspects of LS are more strongly associated with death. The effect of LS is complex and may be mediated or confounded by health and functional status. It is important to consider different domains of LS when considering the impact of this important emotional indicator on mortality among older adults.

Examination of the association between mental health, morbidity, and mortality in late life: findings from longitudinal community surveys

BACKGROUND

Physical health has been demonstrated to mediate the mental health and mortality risk association. The current study examines an alternative hypothesis that mental health mediates the effect of physical health on mortality risk.

METHODS

Participants (N = 14,019; women = 91%), including eventual decedents (n = 3,752), were aged 70 years and older, and drawn from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. Participants were observed on two to four occasions, over a 10-year period. Mediation analysis compared the converse mediation of physical and mental health on mortality risk.

RESULTS

For men, neither physical nor mental health was associated with mortality risk. For women, poor mental health reported only a small effect on mortality risk (Hazard Risk (HR) = 1.01; p < 0.001); more substantive was the risk of low physical health (HR = 1.04; p < 0.001). No mediation effects were observed.

CONCLUSIONS

Mental health effects on mortality were fully attenuated by physical health in men, and partially so in women. Neither mental nor physical health mediated the effect of each other on mortality risk for either gender. We conclude that physical health is a stronger predictor of mortality risk than mental health.

Interaction of depressive and anxiety symptoms on the mortality of patients with COPD: a preliminary study

BACKGROUND

Depressive and anxiety symptoms increase the risk of death in patients with Chronic Obstructive Pulmonary Disease (COPD), but the combined effects of the two factors are unknown.

PURPOSE

To assess the possible interactive effects of depressive and anxiety symptoms on the death of patients with COPD.

METHODS

Prospective data for 7787 Chinese patients with COPD was analyzed and the deaths were recorded. Depressive and anxiety symptoms were evaluated using the Hospital Anxiety and Depression Scale. A product of depressive and anxiety symptoms was added to the logistic regression model to evaluate the multiplicative interaction, and relative excess risk of interaction (RERI), attributable proportion (AP) of interaction, and synergy index (S) were applied to evaluate the additive interaction of the two factors. Bootstrap was used to calculate 95% confidence intervals (CIs) of RERI, AP and S. RERI > 0, AP > 0, or S > 1 indicated biological interaction.

RESULTS

After 4 years' follow-up, the cumulative mortality was 20.0%, and the percentages of deaths in patients with depressive and anxiety symptoms were 28.5% and 30.9%, respectively. When adjusting for variables such as age, sex, disease duration, marital status, income, education level, co-morbidity, smoke status, biomass smoke, 6MWD, MRC, BMI and FEV1. the RERI, AP, and S (with 95% CIs) resulted in depression and anxiety scores of 6.54 (1.23-13.79), 0.54 (0.18-0.83), and 2.64 (1.33-4.75) respectively.

CONCLUSION

Interaction effects were found between depressive and anxiety symptoms on the death of patients with COPD. Patients with both depressive and anxiety symptoms have an increased risk of death from COPD.

Elderly care recipients' perceptions of treatment helpfulness for depression and the relationship with help-seeking

Objective

This study aims to examine perceptions of the helpfulness of treatments/interventions for depression held by elderly care recipients, to examine whether these beliefs are related to help-seeking and whether the experience of depression affects beliefs about treatment seeking, and to identify the characteristics of help-seekers.

Method

One hundred eighteen aged care recipients were surveyed on their beliefs about the helpfulness of a variety of treatments/interventions for depression, on their actual help-seeking behaviors, and on their experience of depression (current and past).

Results

From the sample, 32.4% of the participants screened positive for depression on the Geriatric Depression Scale, and of these, 24.2% reported receiving treatment. Respondents believed the most helpful treatments for depression were increasing physical activity, counseling, and antidepressant medication. Help-seeking from both professional and informal sources appeared to be related to belief in the helpfulness of counseling and antidepressants; in addition, help-seeking from informal sources was also related to belief in the helpfulness of sleeping tablets and reading self-help books. In univariate analyses, lower levels of cognitive impairment and being in the two lower age tertiles predicted a greater likelihood of help-seeking from professional sources, and female sex and being in the lower two age tertiles predicted greater likelihood of help-seeking from informal sources. In multivariate analyses, only lower levels of cognitive impairment remained a significant predictor of help-seeking from professional sources, whereas both lower age and female sex continued to predict a greater likelihood of help-seeking from informal sources.

Conclusion

Beliefs in the helpfulness of certain treatments were related to the use of both professional and informal sources of help, indicating the possibility that campaigns or educational programs aimed at changing beliefs about treatments may be useful in older adults.

Cognitive impairment assessed at annual geriatric health examinations predicts mortality among the elderly

OBJECTIVE

To determine whether cognitive impairment assessed at annual geriatric health examinations is associated with increased mortality in the elderly.

METHOD

This cohort study was based on data obtained from the government-sponsored Annual Geriatric Health Examination Program for the elderly in Taipei City between 2006 and 2010. The study sample consisted of 77,541 community-dwelling Taipei citizens aged 65 years or older. The Short Portable Mental Status Questionnaire (SPMSQ) was selected to measure cognitive impairment. Mortality was ascertained by matching cohort IDs with national death files.

RESULTS

There was a dose-response relationship between cognitive impairment and mortality (increased one score of SPMSQ, Hazard ratio [HR]: 1.12, 95% confidence interval [CI]: 1.10-1.14). Relative to no cognitive impairment, the HRs were 1.67 (95% CI: 1.43-1.94), 2.26 (95% CI: 1.90-2.70), and 2.68 (95% CI: 2.25-3.19) for mild, moderate, and severe cognitive impairments, respectively. The causes of death associated with cognitive impairment were circulatory, respiratory, and other causes, but not death from cancer.

CONCLUSION

Cognitive impairment as measured by the SPMSQ is associated with an increased risk for mortality. Even mild cognitive impairment was associated with greater risk of mortality at a relatively short follow-up time.

Socioeconomic status and survival among older adults with dementia and depression

BACKGROUND

People from lower socioeconomic groups have a higher risk of mortality. The impact of low socioeconomic status on survival among older adults with dementia and depression remains unclear.

AIMS

To investigate the association between socioeconomic status and mortality in people with dementia and late-life depression in China.

METHOD

Using Geriatric Mental Status - Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) we interviewed 2978 people aged ⩾60 years in Anhui, China. We characterised baseline socioeconomic status and risk factors and diagnosed 223 people with dementia and 128 with depression. All-cause mortality was followed up over 5.6 years.

RESULTS

Individuals with dementia living in rural areas had a three times greater risk of mortality (multivariate adjusted hazard ratio (HR) = 2.96, 95% CI 1.45-6.04) than those in urban areas, and for those with depression the HR was 4.15 (95% CI 1.59-10.83). There were similar mortality rates when comparing people with dementia with low v. high levels of education, occupation and income, but individuals with depression with low v. high levels had non-significant increases in mortality of 11%, 50% and 55% respectively

CONCLUSIONS

Older adults with dementia and depression living in rural China had a significantly higher risk of mortality than urban counterparts. Interventions should be implemented in rural areas to tackle survival inequality in dementia and depression.

Is excess mortality higher in depressed men than in depressed women? A meta-analytic comparison

BACKGROUND

It is not well-established whether excess mortality associated with depression is higher in men than in women.

METHODS

We conducted a meta-analysis of prospective studies in which depression was measured at baseline, where mortality rates were reported at follow-up, and in which separate mortality rates for men and women were reported. We conducted systematic searches in bibliographical databases and calculated relative risks of excess mortality in men and women.

RESULTS

Thirteen studies were included. Among the people with depression, excess mortality in men was higher than in women (RR=1.97; 1.63-2.37). Compared with non-depressed participants, excess mortality was increased in depressed women (RR=1.55; 95% CI: 1.32-1.82), but not as much as in men (RR=2.04; 95% CI: 1.76-2.37), and the difference between excess mortality in men was significantly higher than in women (p<0.05).

CONCLUSIONS

Excess mortality related to depression is higher in men than in women. Although the exact mechanisms for this difference are not clear, it may point at differential or more intensified pathways leading from depression to increased mortality in depressed men compared to women.

Latent variables may be useful in pain's assessment

Background

Unobserved “latent” variables have the potential to minimize “measurement error” inherent to any single clinical assessment or categorical diagnosis.

Objectives

To demonstrate the potential utility of latent variable constructs in pain’s assessment.

Design

We created two latent variables representing depressive symptom-related pain (Pd) and its residual, “somatic” pain (Ps), from survey questions.

Setting

The Hispanic Established Population for Epidemiological Studies in the Elderly (H-EPESE) project, a longitudinal population-based cohort study.

Participants

Community dwelling elderly Mexican-Americans in five Southwestern U.S. states. The data were collected in the 7th HEPESE wave in 2010 (N = 1,078).

Measurements

Self-reported pain, Center for Epidemiological Studies Depression Scale (CES-D) scores, bedside cognitive performance measures, and informant-rated measures of basic and instrumental Activities of Daily Living.

Results

The model showed excellent fit [χ² = 20.37, DF = 12; p = 0.06; Comparative fit index (CFI) = 0.998; Root mean statistical error assessment (RMSEA) = 0.025]. Ps was most strongly indicated by self-reported pain-related physician visits (r = 0.48, p ≤0.001). Pd was most strongly indicated by self-reported pain-related sleep disturbances (r = 0.65, p <0.001). Both Pd and Ps were significantly independently associated with chronic pain (> one month), regional pain and pain summed across selected regions. Pd alone was significantly independently associated with self-rated health, life satisfaction, self-reported falls, Life-space, nursing home placement, the use of opiates, and a variety of sleep related disturbances. Ps was associated with the use of NSAIDS. Neither construct was associated with declaration of a resuscitation preference, mode of resuscitation preference declaration, or with opting for a “Do Not Resuscitate” (DNR) order.

Conclusion

This analysis illustrates the potential of latent variables to parse observed data into “unbiased” constructs with unique predictive profiles. The latent constructs, by definition, are devoid of measurement error that affects any subset of their indicators. Future studies could use such phenotypes as outcome measures in clinical pain management trials or associate them with potential biomarkers using powerful parametric statistical methods.

[Global self-rated health and mortality in older people]

OBJECTIVE

To explore the association between global self-rated health and mortality in older people.

METHODS

A systematic review was performed. The inclusion criteria were longitudinal studies that assessed self-rated health with a single general question and samples of community-dwelling persons aged 60 years or more. Electronic databases were searched and references were reviewed.

RESULTS

We selected 18 studies published between 1993 and 2011. Six out of seven studies that analyzed men and women found a higher risk of dying among persons who rated their health as poor; the most frequent covariables were age, gender, chronic diseases, and functional status. Half of the studies that analyzed only men or women found a significant association. The effect of self-reported health on mortality was observed among people younger than 75 years. Results were not dependent on the length of follow-up.

CONCLUSIONS

The results confirm previous findings suggesting that a negative self-rating of general health predicts mortality. The mechanisms through which this indicator may predict mortality among older people could differ in men and women and need to be elucidated. The role of depression should be investigated, considering that the effect of self-rated health on mortality was not present when depression was included.

The economic, public health, and caregiver burden of late-life depression

This article reviews the burden of late-life depression (LLD) from several perspectives, including costs of depression treatment and treatment of other comorbid psychiatric and medical conditions; the impact of LLD on job functioning, disability, and retirement; and how LLD influences others, such as family members and caregivers.

The relationship of mental and behavioral disorders to all-cause mortality in a 27-year follow-up of 4 epidemiologic catchment area samples

Subjects from the Epidemiologic Catchment Area Program, interviewed during 1979-1983, were linked to data in the National Death Index through 2007 to estimate the association of mental and behavioral disorders with death. There were more than 25 years of follow-up for 15,440 individuals, with 6,924 deaths amounting to 307,881 person-years of observation. Data were analyzed by using age as the time scale and parametric approaches to quantify the years of life lost due to disorders. Alcohol, drug use, and antisocial personality disorders were associated with increased risk of death, but there was no strong association with mood and anxiety disorders. Results of high- and low-quality matches with the National Death Index were similar. The 3 behavioral disorders were associated with 5-15 years of life lost, estimated along the life course via the generalized gamma model. Regression tree analyses showed that risk of death was associated with alcohol use disorders in nonblacks and with drug disorders in blacks. Phobia interacted with alcohol use disorders in nonblack women, and obsessive-compulsive disorder interacted with drug use disorders in black men. Both of these anxiety disorders were associated with lower risk of death early in life and higher risk of death later in life.

Gender differences in the trajectories of late-life depressive symptomology and probable depression in the years prior to death

BACKGROUND

Gender differences in depression are well established. Whether these differences persist into late life and in the years preceding death is less clear. There is a suggestion that there is no increased likelihood of depression in late life, but that there is an increase in depressive symptomology, particularly with proximity to death. We compared trajectories of probable depression and depressive symptomology between men and women over age and distance-to-death metrics to determine whether reports of depressive symptoms are more strongly related to age or mortality.

METHODS

Participants (N = 2,852) from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project had a mean age of 75 years (SD = 5.68 years) at baseline and were observed for up to 16 years prior to death. Multi-level regression models estimated change in depressive symptomology and probable depression over two time metrics, increasing age, and distance-to-death.

RESULTS

Increases in depressive symptomology were reported over increasing age and in the years approaching death. Only male participants reported increased probable depression in the years preceding death. Models that utilized distance-to-death metrics better represented changes in late-life depression, although any changes in depression appear to be accounted for by co-varying physical health status.

CONCLUSIONS

As death approaches, there are increases in the levels of depressive symptomology even after controlling for socio-demographic and health covariates. In line with increases in suicide rates in late life, male participants were at greater risk of reporting increases in depressive symptomology.

The relation between sex hormone levels, the androgen receptor CAGn-polymorphism and depression and mortality in older men in a community study

BACKGROUND

Sex hormones levels and the androgen receptor CAGn polymorphism have been shown to be involved in depressed mood in aging men. But the few prior studies found inconsistent results on the role of both factors.

METHODS

186 male participants aged ≥65 years from the community based Memory and Morbidity in Augsburg Elderly (MEMO) Study underwent a physical examination, and a medical interview including two scales (Center for Epidemiologic Studies Depression Scale (CES-D); Activities of Daily Living Scale (ADL). Testosterone, SHBG and LH levels were measured and the androgen receptor CAGn polymorphism was genotyped. χ(2), Mann-Whitney U-test, Pearson's correlations and multivariable linear and logistic regression were used in the analysis.

RESULTS

Higher depressive scores were significantly associated with higher SHBG-levels (beta coefficient 0.25, p<0.001). SHBG alone explained 8% of variance of the CES-D depression score. Mortality at 10 years follow-up was predicted by higher SHBG levels, higher ADL-scores, older age, current smoking and the depression score at baseline. This model explained 35% of the variance of mortality. The number of CAG repeats was neither related to depression scores nor to mortality.

CONCLUSIONS

We found positive associations between SHBG levels and old age male depression as well as mortality. Whether SHBG has a testosterone independent effect in this context should be investigated further.