[Dementia, depression and activity of daily living as risk factors for falls in elderly patients]

Association of depression with malnutrition, grip strength and impaired cognitive function among senior trauma patients

BACKGROUND

Depression is common among senior adults, yet understudied among trauma patients. The purpose of this study was to assess the prevalence of depressive symptoms among seniors hospitalized in acute trauma care, to compare patients with depressive symptoms vs. those without, and to evaluate whether depression symptoms affects discharge destination.

METHODS

This cross-sectional and prospective analysis was conducted among community-dwelling patients ≥70 years old, hospitalized at the Senior Trauma Center of the University Hospital Zurich, Switzerland. We used the Geriatric Depression Scale (GDS-15) to assess presence of depressive symptoms. Using a cutoff value of 5 points, we compared age- and gender-adjusted characteristics of patients with and without depressive symptoms. Multinomial logistic regression models were used to estimate the odds of returning home vs. not adjusting for age, gender, nutritional status, cognitive function and others.

RESULTS

Of the 273 seniors enrolled, 104 (38.1%) were men and the mean age was 79.4 (SD = 6.5) years. We identified 52 (19.0%) patients with depressive symptoms. These patients were more likely to be older (p = 0.04), at risk for malnutrition (p<0.0001), at least pre-frail (p = 0.005), and have decreased cognitive function (p = 0.001). They were also more than twice as likely to be discharged to acute geriatric care compared to home (OR = 2.28 (CI = 1.12-4.68)).

LIMITATIONS

Depressive symptoms were assessed during acute care without data before hospitalization.

CONCLUSIONS

Senior trauma patients with depressive symptoms during acute care were more likely to be at higher risk of malnutrition, have cognitive decline and are more likely to receive additional geriatric care.

The impact of dementia, depression and awareness on activities of daily living in a sample from a middle-income country

OBJECTIVE

Previous studies have indicated that dementia and depression have a considerable impact on the functional capacity of older adults, also influencing awareness about ability. The purpose of the current study was to investigate the impact of dementia, depression and awareness on activities of daily living (ADL) in a sample from a middle-income country.

METHODS

The current study explored impairments in basic, instrumental and advanced ADL using a factorial design comparing four groups: people with dementia and depression, people with dementia without depression, older adults with depression but no dementia and healthy older adults. For each type of ADL, self-report and informant report was contrasted in order to investigate the issue of lack of awareness in relation to ADL.

RESULTS

Results indicate that dementia is associated with impairments in all types of ADL. Advanced ADL were also reduced in depressed participants. In addition, in the case of instrumental and basic ADL, informant report indicated less preserved abilities than participant self-report, particularly in people with dementia.

CONCLUSIONS

The findings highlight the importance of developing interventions and compensatory strategies to prevent loss of ADL in dementia, also suggesting that early intervention in older adults with depression should focus on advanced ADL to prevent social isolation and withdrawal. Finally, the findings indicate that self-information about ADL may be compromised in dementia, so clinicians exploring disability should consider fully different aspects of ADL in this group. Copyright © 2017 John Wiley & Sons, Ltd.

Aging and the effects of emotion on cognition: Implications for psychological interventions for depression and anxiety

We review findings from laboratory research on age differences in the effects of emotion on cognition. Particular attention is given to sadness leading to mood congruent memory and to anxiety leading to selective attention bias to threat. While older adults in normal moods show the positivity effect as expected from socio-emotional selectivity theory, older adults whose mood has changed from baseline to sad or anxious show these mood-related cognitive biases. These mood-related biases are a foundational part of the theory underlying cognitive behavior therapy (CBT) and so these laboratory findings suggest ways that CBT may work differently with older adults. Pilot work suggests that the presence or absence of these effects may also predict responsiveness to treatment using CBT.

Do behavioral disturbances predict falls among nursing home residents?

BACKGROUND AND AIMS

The purpose of our study was to examine whether severity of dementia, behavioral and psychological symptoms and depression can predict falls among nursing home residents, such as demographic variables, activities of daily living, and use of psychotropic drugs, when potential confounders are controlled for.

METHODS

1147 nursing home residents were examined in this one-year follow-up study. All residents were examined with the Physical Self-Maintenance scale (Activities of Daily Living - ADL), Clinical Dementia Rating Scale (CDR), Neuropsychiatric Inventory (NPI) and Cornell Scale for Depression in Dementia. Demographic data, gender, education, physical health and use of medication were collected from medical records.

RESULTS

40% of participants had at least one fall during the one-year follow-up period. Bivariate survival analysis revealed that low level of education, severe dementia, severe behavioral and psychological symptoms, severe depression, greater functional impairment, age, worsening in physical health, and use of sedatives, significantly predict one or more falls. Multivariate Cox regression analyses showed that age, higher scores on NPI and CDR, use of sedatives and dependency in ADL were all, independently of each other, predictors of an increased risk of falling.

CONCLUSIONS

Having a high NPI score was identified as a significant and independent predictor of falls. Since falling is a common event which causes considerable morbidity and mortality in older people, these findings are important for healthcare and for the individuals concerned. To prevent falling in nursing homes, special attention must be paid to residents with severe dementia, to behavioral symptoms and use of sedatives.

Depression and public health: an overview

Depressive disorders are a significant public health issue. They are prevalent, disabling, often chronic illnesses, which cause a high economic burden for society, related to both direct and indirect costs. Depressive disorders also influence significantly the outcome of comorbid medical illnesses such as cardiac diseases, diabetes, and cancer. In primary care, underrecognition and undertreatment of depressive disorders are common, despite their relatively high prevalence, which accounts typically for more than 10% of patients. Primary care physicians should be aware of the common risk factors for depressive disorders such as gender, neuroticism, life events and adverse childhood experiences, and they should be familiar with associated features such as a positive psychiatric family history and prior depressive episodes. In primary care settings, depressive disorders should be considered with patients with multiple medical problems, unexplained physical symptoms, chronic pain or use of medical services that is more frequent than expected. Management of depressive disorders in primary care should include treatment with the newer antidepressant agents (given the fact they are typically well tolerated and safe) and focus on concomitant unhealthy behaviors as well as treatment adherence, which may both affect patient outcome. Programs aimed at improving patient follow-up and the coordination of the primary care intervention with that of specialists have been found to improve patient outcomes and to be cost effective.