Prevalence and risk factors for depression in non-demented primary care attenders aged 75 years and older

Depressive symptom trajectories in older breast cancer survivors: the Thinking and Living with Cancer Study

PURPOSE

To identify trajectories of depressive symptoms in older breast cancer survivors and demographic, psychosocial, physical health, and cancer-related predictors of these trajectories.

METHODS

Recently diagnosed nonmetastatic breast cancer survivors (n = 272), ages 60-98 years, were evaluated for depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D; scores ≥16 suggestive of clinically significant depressive symptoms). CES-D scores were analyzed in growth-mixture models to determine depression trajectories from baseline (post-surgery, pre-systemic therapy) through 3-year annual follow-up. Multivariable, multinomial logistic regression was used to identify baseline predictors of depression trajectories.

RESULTS

Survivors had three distinct trajectories: stable (84.6%), emerging depressive symptoms (10.3%), and recovery from high depressive symptoms at baseline that improved slowly over time (5.1%). Compared to stable survivors, those in the emerging (OR = 1.16; 95% CI = 1.08-1.23) or recovery (OR = 1.26; 95% CI = 1.15-1.38) groups reported greater baseline anxiety. Greater baseline deficit accumulation (frailty composite measure) was associated with emerging depressive symptoms (OR = 3.71; 95% CI = 1.90-7.26). Less social support at baseline (OR = 0.38; 95% CI = 0.15-0.99), but greater improvement in emotional (F = 4.13; p = 0.0006) and tangible (F = 2.86; p = 0.01) social support over time, was associated with recovery from depressive symptoms.

CONCLUSIONS

Fifteen percent of older breast cancer survivors experienced emerging or recovery depressive symptom trajectories. Baseline anxiety, deficit accumulation, and lower social support were associated with worse outcomes.

IMPLICATIONS FOR CANCER SURVIVORS

Our results emphasize the importance of depression screening throughout the course of cancer care to facilitate early intervention. Factors associated with depressive symptoms, including lower levels of social support proximal to diagnosis, could serve as intervention levers.

The mediating role of physical activity, morning wake-up time, and sleep-inducing medication use in the relationship between age and depression: a path analysis of a large kurdish cohort study in Iran

BACKGROUND

Depression is a common and debilitating psychiatric disorder worldwide. Recognizing the relationships between depression-related factors can play a significant role in depression management. However, no study has yet used path analysis to examine the mediating role of physical activity, morning wake-up time, and sleep-inducing medication in the relationship between age and depression.

METHODS

This path analysis study utilized data from the baseline phase of the Ravansar non-communicable disease cohort study. This study was conducted on people aged 35 to 65 years using sociodemographic, clinical, and the PERSIAN cohort's standard physical activity questionnaires. These analyses were done using SPSS (version 22) and MPLUS (version 8.3). Path analysis was applied to evaluate the direct, indirect, and total effects of age on depression.

RESULTS

The results indicated that increasing age was associated with an increase in depression through a decrease in physical activity and an increase in sleep-inducing medication use. In addition, an increase in age was significantly related to a reduced incidence of depression via an earlier morning wake-up time.

DISCUSSION

We found evidence for a mediational effect of age on depression, as the biopsychosocial model of mental illness implies. The findings of this study can add to the existing body of knowledge on depression management and help clarify the mechanisms of the effect of age on depression.

Biopsychosocial factors of depression among community-dwelling geriatric population with low perceived social support; a population-based study

BACKGROUND

Although significant and disabling consequences are presented due to geriatric population-related depression, an insufficient comprehension of various biological, psychological, and social factors affecting this issue has been observed. Notably, these factors can contribute to geriatric population-related depression with low social support. This study aimed to identify factors associated with depression among the community-dwelling geriatric population with low social support in Malaysia.

METHODS

This study used secondary data from a population-based health survey in Malaysia, namely the National Health Morbidity Survey (NHMS) 2018: Elderly Health. The analysis included 926 community-dwelling geriatric population aged 60 and above with low social support. The primary data collection was from August to October 2018, using face-to-face interviews. This paper reported the analysis of depression as the dependent variable, while various biological, psychological and social factors, guided by established biopsychosocial models, were the independent variables. Multiple logistic regression was applied to identify the factors. Analysis was performed using the complex sampling module in the IBM SPSS version 29.

RESULTS

The weighted prevalence of depression among the community-dwelling geriatric population aged 60 and above with low social support was 22.5% (95% CI: 17.3-28.7). This was significantly higher than depression among the general geriatric Malaysian population. The factors associated with depression were being single, as compared to those married (aOR 2.010, 95% CI: 1.063-3.803, p: 0.031), having dementia, as opposed to the absence of the disease (aOR 3.717, 95% CI: 1.544-8.888, p: 0.003), and having a visual disability, as compared to regular visions (aOR 3.462, 95% CI: 1.504-7.972, p: 0.004). The analysis also revealed that a one-unit increase in control in life and self-realisation scores were associated with a 32.6% (aOR: 0.674, 95% CI: 0.599-0.759, p < 0.001) and 24.7% (aOR: 0.753, 95% CI: 0.671-0.846, p < 0.001) decrease in the likelihood of developing depression, respectively.

CONCLUSION

This study suggested that conducting depression screenings for the geriatric population with low social support could potentially prevent or improve the management of depression. The outcome could be achieved by considering the identified risk factors while implementing social activities, which enhanced control and self-fulfilment.

Employment status and depressive symptoms in taiwanese older adults: an 11-year prospective cohort study

BACKGROUND

Taiwan became an aged society in March 2018, and it is expected to become a super-aged society by 2025. The trend of increasing proportions of older adults continuing to work is inevitable. However, few studies have been conducted to investigate the effects of employment on the mental health of older adults. Therefore, we longitudinally explored the relationship between employment status and depressive symptoms in Taiwanese older adults.

METHODS

The study included 5,131 individuals aged 50 and above, of which 55.6% were men, who had participated in the national-wide Taiwan Longitudinal Study of Aging in 1996, 1999, 2003, and 2007. Of them, 1,091 older adults had completed all four surveys. Depressive symptoms were assessed using the Center for Epidemiological Studies of Depression scale; the total score on this scale ranges from 0 to 30. Employment status was assessed during each survey wave. Logistic regression was performed using a cross-sectional design. The effects of unemployment on depressive symptoms were analyzed using a generalized estimating equation model with a repeated measures design.

RESULTS

In each survey wave, employed older adults exhibited better mental health than did unemployed ones. After adjustments for potential confounders, unemployment was found to exert a significant adverse effect on depressive symptoms. The repeated measures analysis revealed that employment protected against depressive symptoms, as noted in the subsequent surveys conducted after 3 to 4 years (aOR [95% CI] = 0.679 [0.465-0.989]).

CONCLUSION

Employment may reduce the risk of depressive symptoms in community-dwelling older adults in Taiwan.

Participation in Sports/Recreational Activities and the Occurrence of Psychological Distress in Mid-Aged Adults: Findings From the HABITAT Cohort Study

OBJECTIVES

The aim of this study was to investigate prospective associations between participation in sports/recreational activities and the occurrence of moderate-to-severe psychological distress over 2 years in a sample of mid-aged Australians.

METHODS

This prospective study used data from 6699 adults aged 40+ years, living in Brisbane in 2007, and surveyed in 2009, 2011 and 2013. Participants provided self-reported data on frequency of participation in each of 11 sports/recreational activities in past 12 months and completed the Kessler Psychological Distress 6-item Scale (K6). Generalized estimating equation (GEE) models with a 2-year lag were used to assess the associations of participation in sports/recreational activities in 2009 and 2011 with new cases of moderate-to-severe psychological distress (K6 score ≥ 5) in 2011 and 2013.

RESULTS

From 2009 to 2013, 22.4% of participants without moderate-to-severe psychological distress at baseline (N = 4943) developed this outcome in at least one survey. Overall, there were no clear patterns of association between frequency of participation in sports and recreational activities and occurrence of moderate-to-severe psychological distress. In unadjusted models, weekly participation in some activities (e.g., tennis, golf, and exercise classes) was associated with reduced odds of moderate-to-severe psychological distress over the next 2 years, but these associations were attenuated in most adjusted models with sociodemographic, lifestyle, and health covariates. Participation in home-based exercise and running/jogging were associated with higher odds of psychological distress.

CONCLUSION

Our findings do not provide strong evidence of beneficial associations of frequency of sport/recreational activities with psychological distress but show surprising negative associations of home-based exercise and running/jogging with occurrence of moderate-to-severe psychological distress over 2 years.

Investigating the association of anticholinergic burden with depression in older adults: a cross-sectional study

BACKGROUND

Although depression and anticholinergic drug use are common comorbidities that impair health status in later life, there are insufficient data on their relationship. This study aimed to investigate the relationship between depressive symptoms and anticholinergic use in older individuals.

METHODS

Community-dwelling older adults (≥65 years) admitted to the tertiary referral geriatric outpatient clinic were included. Participants were evaluated for depressive symptoms using the Geriatric Depression Scale (GDS) with a cut-off score of ≥6 for depression. Exposure to anticholinergic drugs was assessed using the anticholinergic cognitive burden (ACB) scale and three subgroups were created: ACB = 0, ACB = 1, and ACB ≥ 2. The relationship between these two parameters was assessed using multivariate logistic regression analysis considering other potential variables.

RESULTS

The study included 1232 participants (mean age 78.4 ± 7.2 years and 65.2% female) and the prevalence of depression was 24%. After adjusting for potential confounders, compared to ACB = 0, having ACB ≥ 2 was related to depression symptoms (odds ratio (OR): 1.56, 95% CI: 1.04-2.35, P = 0.034), whereas having ACB = 1 did not increase the risk (OR: 1.27, 95% CI: 0.88-1.83, P = 0.205).

CONCLUSION

Our findings indicate that special attention should be paid to drug therapy in preventing depression in older adults, as exposure to a high anticholinergic load is negatively associated with psychological status.

The health consequences of returning to work after retirement: Evidence from a Japanese longitudinal survey

Prolonged and active old age provides individuals with more chances to work again after full retirement. Returning to work is an increasingly common form of the retirement process and influences the sustainability of social security systems. Previous studies show a beneficial relationship between returning to work and health; however, little is known about the causal effect of returning to work on health. This study used data from men and women aged 50 and older (11,991 individuals) in the Longitudinal Survey of Middle-aged and Older Adults, conducted annually from 2005 to 2019 in Japan. The effects of three types of labor force transitions (continued work, full retirement, and return to work) on physical and mental health were examined. To obtain the causal effects, an instrumental variable approach was used by exploiting the Japanese pension reform and labor market settings as instruments. Compared with full retirement, returning to work showed significantly worse mental health but no significant difference in physical health. The negative effect of returning to work was pronounced among men, former nonmanual workers, and low-wealth individuals. Contrary to the findings in previous studies, insignificant or detrimental effects of returning to work were found in this study. The rigorous causal analysis adds new evidence to the literature. The findings provide important implications for labor and health policy in aging societies.

Relationship Between Cognitive Impairment and Depression Among Middle Aged and Older Adults in Primary Care

Objectives: To determine rates of previously undetected cognitive impairment among patients with depression in primary care. Methods: Patients ages 55 and older with no documented history of dementia or mild cognitive impairment were recruited from primary care practices in New York City, NY and Chicago, IL (n = 855). Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA) and depression with the Patient Health Questionnaire-8. Results: The mean age was 66.8 (8.0) years, 45.3% were male, 32.7% Black, and 29.2% Latinx. Cognitive impairment increased with severity of depression: 22.9% in persons with mild depression, 27.4% in moderate depression and 41.8% in severe depression (p = .0002). Severe depression was significantly associated with cognitive impairment in multivariable analysis (standardized β = -.11, SE = 0.33, p < .0001). Discussion: Depression was strongly associated with previously undetected cognitive impairment. Primary care clinicians should consider screening, or expand their screening, for both conditions.

Depression and Pseudodementia: Decoding the Intricate Bonds in an Italian Outpatient Setting

In spite of the uncertainties of its diagnostic framework, pseudodementia may be conceptualized as a condition characterized by depressive symptoms and cognitive impairment in the absence of dementia. Given the controversies on this topic, the aim of the present study was to assess neurological and cognitive dysfunctions in a sample of elderly depressed subjects, and the eventual relationship between cognitive impairment and depressive symptoms. Fifty-seven elderly depressed outpatients of both sexes were included in the study. A series of rating scales were used to assess diagnoses, depressive and cognitive impairment. Comparisons for continuous variables were performed with the independent-sample Student's t-test. Comparisons for categorical variables were conducted by the χ2 test (or Fisher's exact test when appropriate). The correlations between between socio-demographic characteristics and clinical features, as well as between cognitive impairment and depressive symptoms were explored by Pearson's correlation coefficient or Spearman's rank correlation. Our data showed the presence of a mild-moderate depression and of a mild cognitive impairment that was only partially related to the severity of depression. These dysfunctions became more evident when analyzing behavioral responses, besides cognitive functions. A high educational qualification seemed to protect against cognitive decline, but not against depression. Single individuals were more prone to cognitive disturbance but were similar to married subjects in terms of the severity of depressive symptoms. Previous depressive episodes had no impact on the severity of depression or cognitive functioning. Although data are needed to draw firm conclusions, our findings strengthen the notion that pseudodementia represents a borderline condition between depression and cognitive decline that should be rapidly identified and adequately treated.

Gut Microbiota in Anxiety and Depression: Unveiling the Relationships and Management Options

The gut microbiota is critical for maintaining human health and the immunological system. Several neuroscientific studies have shown the significance of microbiota in developing brain systems. The gut microbiota and the brain are interconnected in a bidirectional relationship, as research on the microbiome-gut-brain axis shows. Significant evidence links anxiety and depression disorders to the community of microbes that live in the gastrointestinal system. Modified diet, fish and omega-3 fatty acid intake, macro- and micro-nutrient intake, prebiotics, probiotics, synbiotics, postbiotics, fecal microbiota transplantation, and 5-HTP regulation may all be utilized to alter the gut microbiota as a treatment approach. There are few preclinical and clinical research studies on the effectiveness and reliability of various therapeutic approaches for depression and anxiety. This article highlights relevant research on the association of gut microbiota with depression and anxiety and the different therapeutic possibilities of gut microbiota modification.

Antidepressant Effects of a Multimodal Group Therapy Program for Mild Dementia: A Retrospective Evaluation of Clinical Routine Data

BACKGROUND

The multimodal CORDIAL treatment concept for mild dementia, combining cognitive rehabilitation, cognitive behavioral and humanistic psychology interventions, has proven its feasibility and demonstrated a reduction of depressive symptoms in individual dyadic/triadic settings.

OBJECTIVE

We investigate antidepressant effects of an adapted group-based CORDIAL program in clinical routine care.

METHODS

During 2013 and 2017, 51 outpatients with mild dementia (45% female, mean age 72.4 years, 67% Alzheimer's dementia, mean MMST 24.8) periodically received a modified CORDIAL group treatment as part of our regular outpatient care. Treatment comprised 10 bi-weekly sessions, partly involving caregivers. Systematic pre- and post-treatment assessments of clinical routine data were evaluated retrospectively (median time-interval of 6.6 months).

RESULTS

Depressive symptoms as measured by the Geriatric Depression Scale significantly decreased over time (p = 0.007, Cohen's d = 0.39), and irrespective of gender. Patients with longer disease duration before treatment start showed significantly higher initial levels of depressive symptoms (p = 0.044), followed by a reduction to a level of those with shorter disease duration (ns). Most secondary outcomes (cognitive symptoms, disease severity, quality of life, caregiver burden) remained unchanged (ns), while competence in activities of daily living declined from pre- to post-measurement (p = 0.033).

CONCLUSION

A group-based CORDIAL treatment is feasible in a clinical routine setting and demonstrated antidepressant effects comparable to those of the individual treatment design, further suggesting its implementation in regular care. Future trials might also investigate its potentially preventive effects by reducing depressive symptoms in pre-dementia stages, even at a subsyndromal level.

Social Network and Participation in Elderly Primary Care Patients in Germany and Associations with Depressive Symptoms-A Cross-Sectional Analysis from the AgeWell.de Study

This study aims to describe social network and social participation and to assess associations with depressive symptoms in older persons with increased risk for dementia in Germany. We conducted a cross-sectional observational study in primary care patients (aged 60−77) as part of a multicenter cluster-randomized controlled trial (AgeWell.de). We present descriptive and multivariate analyses for social networks (Lubben Social Network Scale and subscales) and social participation (item list of social activities) and analyze associations of these variables with depressive symptoms (Geriatric Depression Scale). Of 1030 included patients, 17.2% were at risk for social isolation (Lubben Social Network Scale < 12). Looking at the subscales, a reduced non-family network was found almost twice as often as a reduced family network. Patients with depressive symptoms had significantly smaller social networks than patients without depression (p < 0.001). They rather engaged in social activities of low involvement level or no weekly social activity at all (p < 0.001). The study shows associations of depressive symptoms with a decreased social network and less social participation in elderly participants. Sufficient non-family contacts and weekly social activities seem to play an important role in mental health and should be encouraged in elderly primary care patients.

Late-life depression and the family physician

Late-life depression (LLD) is a common disorder seen in clinical practice. Depression in this population group is often left undetected and untreated. The majority of elderly individuals who seek help present to the primary health care setting. The family physician is ideally placed to screen for symptoms of LLD, given that they often have longitudinal knowledge of the patient's history, premorbid personality, functioning and overall health status. An understanding of risk factors, differential diagnoses, appropriate opportunistic screening tools and decision-making around management plans can assist the family physician in the early detection and treatment of these patients. In doing so, this may lead to a decrease in mortality and morbidity and enhance the patient's quality of life.

Prevalence of unrecognized depression and associated factors among medical outpatient department attendees; a cross sectional study

OBJECTIVES

To determine the prevalence and associated factors of unrecognized depression among patients who visit non-psychiatric outpatient departments in the University of Gondar specialized teaching hospital. North West Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among Medical outpatient departments in the University of Gondar specialized referral hospital from March to April 2019. We collected data through face-to-face interviews. We recruited 314 participants for face-to-face interviews using the systematic random sampling technique. The patient health questionnaire (PHQ-9) was used to measure depression. Coded variables were entered into Epi Info version 7 and exported to SPSS version 20 for analysis. Descriptive statistics and multivariable logistic regression analysis were used. Adjusted odds ratios (AOR) with a 95% confidence interval were used to calculate significance.

RESULTS

A total of 314 participants were interviewed with a response rate of 100%. The prevalence of depression was 15.9% with (95% CI (12.1-20.1)). In the multivariate logistic regression revealed that, able to read and write (AOR = 0.24, 95% CI (0.67-0.84)), secondary education (AOR = 0.34, 95% CI (0.12-0.91)), education in college and university level (AOR = 0.32, 95% CI (0.13-0.78)), poor social support (AOR = 7.78, 95% CI (2.74-22.09)), current cigarette smokers(AOR = 12.65, 95% CI (1.79-89.14)) were associated with depression.

CONCLUSION

The prevalence of depression among outpatient attendees was high. We recommend an early depression screening be carried out by health professionals.

Prevalence and determinants of depression among old age: a systematic review and meta-analysis

BACKGROUND

Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. It is also one of the most common geriatric psychiatric disorders and a major risk factor for disability and mortality in elderly patients. Even though depression is a common mental health problem in the elderly population, it is undiagnosed in half of the cases. Several studies showed different and inconsistent prevalence rates in the world. Hence, this study aimed to fill the above gap by producing an average prevalence of depression and associated factors in old age.

OBJECTIVE

This study aims to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression and its determinants among old age.

METHOD

A comprehensive search of PubMed, Scopus, Web of sciences, Google Scholar, and Psych-info from database inception to January 2020. Moreover, the reference list of selected articles was looked at manually to have further eligible articles. The random-effects model was employed during the analysis. Stata-11 was used to determine the average prevalence of depression among old age. A sub-group analysis and sensitivity analysis were also run. A graphical inspection of the funnel plots and Egger's publication bias plot test were checked for the occurrence of publication bias.

RESULT

A search of the electronic and manual system resulted in 1263 articles. Nevertheless, after the huge screening, 42 relevant studies were identified, including, for this meta-analysis, n = 57,486 elderly populations. The average expected prevalence of depression among old age was 31.74% (95% CI 27.90, 35.59). In the sub-group analysis, the pooled prevalence was higher among developing countries; 40.78% than developed countries; 17.05%), studies utilized Geriatrics Depression Scale-30(GDS-30); 40.60% than studies that used GMS; 18.85%, study instrument, and studies having a lower sample size (40.12%) than studies with the higher sample; 20.19%.

CONCLUSION

A high prevalence rate of depression among the old population in the world was unraveled. This study can be considered as an early warning and advised health professionals, health policymakers, and other pertinent stakeholders to take effective control measures and periodic care for the elderly population.

Depression Screening for the Geriatric Population Visiting Primary Healthcare Centers in the Eastern Region of Saudi Arabia

Background Depression is considered one of the most common psychiatric disorders that affects more than 260 million people in all age groups worldwide. Yet, among the geriatric population, in which it can show nonspecific symptoms, depression can be easily underdiagnosed. The objectives of this study are to assess the prevalence of depression among the geriatric population in primary healthcare centers and to estimate the effects of different sociodemographic and medical factors. Methodology A total of 408 patients aged 60 years or older were approached in the primary healthcare centers of the eastern region of Saudi Arabia. Using the Patient Health Questionnaire-9, patients were either interviewed or filled the questionnaire by themselves. Questions about sociodemographic data and medical and medication histories were included in the questionnaire. Results Of the 408 participants, 173 (42.4%) reported depressive symptoms; 115 (28.2%) of the participants had mild depression, 50 (12.3%) had moderate depression, and 8 (2%) reported moderately severe depression. Correlates of depression included elderly patients aged 75 years or more, of whom 78.9% showed depression compared to 39.3% of those who were 60-65 years old (P = 0.001). Furthermore, the female elderly showed higher rates of depression compared to males (52.8% vs. 35.7%; P = 0.001). A reported 81.1% of the elderly were diagnosed with chronic diseases; approximately half of them were depressed, while only 32.9% of the elderly free of diseases were depressed (P = 0.001). Conclusions The prevalence of depression is high among the elderly in the eastern province of Saudi Arabia, especially in those who complain of chronic diseases, older patients, and females. Screening for depression must be employed early to manage depressive symptoms and prevent further complications.

Different Sides of Depression in the Elderly: An In-depth View on the Role of Aβ Peptides

BACKGROUND

Late-onset depression (LOD) is the most common neuropsychiatric disorder associated with Alzheimer's disease (AD), often associated with structural and functional brain changes, neuropsychological impairments and negative family history for affective disorders. LOD could be a risk factor or a prodromal phase of AD; this has led to the investigation of the link between depression and amyloid-β (Aβ) peptides by measuring Aβ levels in plasma, cerebrospinal fluid (CSF) and brains of elderly depressed subjects.

OBJECTIVE

Clarify the complex relationship between depression, Aβ peptides and AD.

METHOD

We evaluated all articles published up to 2019 in PubMed in which Aβ was measured in serum (or plasma), CSF or brain in elderly with Major Depressive Disorder or depressive symptoms evaluated with standard scales.

RESULTS

Low plasma Aβ42 levels are strongly associated with depression severity. Plasma Aβ40 levels are higher in younger depressed, drug-resistant and those with more severe symptoms. CSF Aβ42 levels are lower in depressed than controls. PET-detected global and region-specific increases in Aβ deposition are sometimes associated with LOD, cognitive impairment, anxiety but not with Cardiovascular Diseases (CVDs)/CVD risk factors. Elderly depressed with CVDs/CVD risk factors have more frequently high plasma Aβ40 levels and drug-resistance; those without these co-morbidities have low plasma Aβ42 levels and a greater cognitive impairment.

CONCLUSION

Two specific Aβ profiles emerge in elderly depressed. One is associated with Aβ42 reductions in plasma and CSF, possibly reflecting increased brain amyloid deposition and prodromal AD. The other one is characterized by high plasma Aβ40 levels, cerebrovascular disease and clinically associated with increased AD risk.

Life satisfaction and depressive symptoms of mentally active older adults in Poland: a cross-sectional study

Background

For older adults, life satisfaction and depressive symptoms are related to quality of life. In this group of society, life satisfaction is particularly associated with the emotional area. The notion of life satisfaction is related to many factors, such as personality traits, moods and various life events, and poses challenges in various aspects of everyday life. Given that mental health is one of the determinants of the quality of life of older adults, it is reasonable to conduct research among this growing group of the population. The aim of this study was to assess life satisfaction and depressive symptoms in mentally active older adults in Poland.

Methods

The study covered 125 attendees at the University of Healthy Senior (UHS) and 125 auditing students at the University of Psychogeriatric Prophylaxis (UPP), organised by the Faculty of Health Sciences at the Medical University of Bialystok, of whom 78.3% were female and 21.7% male. The study was conducted using four standardised scales: the Satisfaction with Life Scale (SWLS), Beck Depression Inventory, Geriatric Depression Scale (GDS), and Hospital Anxiety and Depression Scale (HADS).

Results

Seniors who participated in the study were satisfied with their lives; the average SWLS score was 23 points. Men rated their level of satisfaction higher than women: the median score on the SWLS was 26 points for men and 23 points for women. Life satisfaction and mental disorders did not differ on the basis of sex, age, or education (the type of place of education attended). As the level of depression increased, life satisfaction decreased. Statistically significant correlations of average strength were found between the point values of the four measures of depression under consideration and were evenly distributed from 0.57 to 0.69.

Conclusions

The high level of life satisfaction and a low level of mental disorders should be maintained in this population, and additional educational activities should be organised among seniors on a large scale. There were no differences in the distribution of psychometric measure scores among the three compared age groups of respondents in this study. Each of the questionnaires used measured of different aspects of depressive conditions, and it is worth using them in parallel rather than interchangeably.

Association of Alcohol and Tobacco Consumption with Depression Severity in the Oldest Old. Results from the Age Different Old Age Cohort Platform

This study aimed to examine the association of alcohol and tobacco use with severity of depression in older age. Analyses were performed on a pooled data set (n = 3724) from two German old-age cohort studies (LEILA 75+, 6 follow-ups and AgeCoDe/AgeQualiDe, 9 follow-ups). Depressive symptoms were assessed via two screening scales for depression (CES-D and GDS-15) which were harmonized for pooled analysis. A mixed-effects linear regression model for the total sample and additional stratified models for men and women were used. Smoking at baseline was significantly associated with a higher level of depression severity (β = 0.142, 95% CI: 0.051–0.233, p = 0.002), whereas drinking was significantly associated with a decreased level of depression (β = −0.069, 95% CI: −0.119–−0.021, p = 0.005). Concurrent substance use at baseline increased longitudinal depression severity (β = 0.193, 95% CI: 0.011–0.375, p = 0.037). Analyses stratified by gender showed a significant inverse association between drinking and depressive symptoms in men (β = −0.138, 95% CI: −0.231–−0.045, p = 0.004), but not in women (β = −0.060, 95% CI: −0.120–0.001, p = 0.052). Given the burden of major depression, it is important that health care providers, especially primary care physicians, assess and monitor lifestyle factors, even at older ages.

Effects of riverbank erosion on mental health of the affected people in Bangladesh

Background

In Bangladesh, riverbank erosion is a major problem that regularly displaces millions of people and affects their mental health every year.

Objectives

The primary objective is to explore the effects of riverbank erosion on mental health problems such as depression, anxiety, and stress in Bangladesh.

Methods

We conducted a household survey from August 2019 to November 2019 on randomly selected adult respondents from Rajbari District located along the Ganges River and Tangail District located along the Brahmaputra River. The respondents were divided into two groups: exposed and non-exposed to riverbank erosion. All participants were asked to complete self-reported questionnaires on the Depression, Anxiety and Stress Scale-21, and other socio-demographic, economic and riverbanks erosion-related factors. We performed Chi-squared test and multiple logistic regression analysis to explore the significant risk factors (P<0.05) of mental illness (depression, anxiety and stress).

Results

We surveyed 611 households, of whom 410 were from Rajbari and 201 were from Tangail. Among 611 respondents, 509 (83.31%) were exposed by riverbank erosion whereas 102 (16.69%) were non-exposed. The prevalence of depression, anxiety and stress (DAS) was 38.30%, 76.60%, 32.41%, respectively, and they were significantly higher among the exposed group than the non-exposed group (depression: 45.19% versus 3.92%, P<0.001; anxiety: 82.71% versus 46.08%, P<0.001; stress: 38.11% versus 3.92%, P<0.001). The respondents exposed to river erosion were respectively 8.28, 2.26 and 5.09 times more likely to develop DAS disorder compared to their non-exposed counterparts (OR_D = 8.28, 95% CI = 2.75–24.89; OR_A = 2.26, 95% CI = 1.31–3.88; OR_S = 5.09, 95% CI = 1.64–15.76). Females and those who lost their houses and displaced, were more likely to have DAS disorder compared to their respective counterparts.

Conclusions

The exposed people were more likely to experience mental health problem and demand some social safety net programs with special focus on female and those who lost houses and displaced.

Depression, functional disability, and accessing health care among older Ghanaians and South Africans: a comparative study based on WHO study on global ageing and adult health (SAGE)

OBJECTIVES

The study explored the association and variabilities between mild depression, functional disability, and healthcare access among older Ghanaians and South Africans.

METHOD

The data used in this study was based on the Cross-sectional wave 1 (2007-2010) data from WHO's Study on Global Ageing and Adult Health (SAGE). Using multiple binary logistic regression, responses from a sample of 4558 Ghanaians and 3076 South Africans were analyzed to investigate hypothesized patterns.

RESULTS

The proportion of mild depression (MD) is 6.0 % and 7.53% for older Ghanaians and older South Africans, respectively. At 95% Confidence Interval, increased severity (mild and high levels) of functional disability are associated with increased odds of MD in Ghanaian and South African older adults. Apart from South African older adults, older Ghanaians in the study who do not receive healthcare when needed have increased odds of MD than those who do. Sociodemographic and socioeconomic factors are also associated with MD.

DISCUSSION

An untreated, persistent MD may lead to worse conditions with fatal outcomes. Since mental health care is lacking in both countries, this study may inform policies directed towards support for formal and informal long-term care, and healthcare access to reduce the risks of depression.

Risk factors and protective factors of depression in older people 65+. A systematic review

OBJECTIVES

Identifying risk factors of depression can provide a better understanding of the disorder in older people. However, to minimize bias due to the influence of confounders and to detect reverse influence, a focus on longitudinal studies using multivariate analysis is required.

DESIGN

A systematic literature search was conducted by searching the databases MEDLINE, Cochrane, PsycINFO and Web of Science for all relevant articles published from January 2000 to the end of March 2020. The following inclusion criteria were used: prospective design, nationally or regionally representative sample, published in English or German, analyzed risk factors for depression of individuals 65+ identified by multivariate analysis, and provided validity of diagnostic instrument. All results of multivariate analysis were reported and summarized.

RESULTS

Thirty articles were identified. Heterogeneous results were found for education, female gender, self-rated health, cognitive impairment and older age, although significant in several studies. Findings hinted at a protective quality of physical activity. In terms of physical health, chronic disease and difficulty initiating sleep homogeneously increased risk of depression. Mobility impairment resulted as a risk factor in three studies. IADL impairment and vision impairment were mostly identified as significant risk factors. Alcohol consumption and smoking behavior yielded heterogenous results. Psychosocial factors were assessed similarly in multiple studies and yielded heterogenous results.

LIMITATIONS

Research was limited to articles published in English or German. Length of follow up was not considered for the presentation of results. Adjustments for and inclusion of different variables in the studies may distort results.

CONCLUSION

Our findings demonstrate the necessity of refined, more comparable assessment tools for evaluating potential risk factors.

Associations between depressive symptoms and geriatric syndromes in community-dwelling older adults in Japan: A cross-sectional study

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Depressive symptoms are associated with frailty in community-dwelling older adults.

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AWGS’s new sarcopenia definition is not associated with depressive symptoms.

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Depressive symptoms may be associated with J-CHS-defined frailty.

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Among geriatric syndromes, only frailty may be associated with depressive symptoms.

It is estimated that 7.2% of community-dwelling older adults worldwide have major depression. Therefore, this study aimed to investigate the relationship between geriatric syndromes and depressive symptoms. Data were obtained from the Kaizuka Dementia Prevention Study 2018 and 2019, which was a community-based health check conducted in collaboration with the Osaka Kawasaki Rehabilitation University (Kaizuka City Office) and Cognitive Reserve Research Center in Osaka, Japan. The participants comprised 363 older adults (mean age 73.6 ± 6.6 years; women = 75.8%) who participated in a community-based health check. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). Depressive symptoms were defined as a GDS-15 score of ≥ 5. Furthermore, geriatric syndromes in participants—such as frailty, sarcopenia, and locomotive syndrome—were assessed. There was a 28.1% prevalence of depressive symptoms. In a logistic regression analysis with depressive symptoms as the dependent variable, both pre-frailty (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.09–3.01) and frailty (OR 5.45, 95% CI 2.23–13.31) were found to be significantly higher in the depressive group. There were no significant differences in sarcopenia and locomotive syndrome between the depressive groups. Our findings suggest that depressive symptoms are associated with frailty and pre-frailty in community-dwelling older adults in Japan. Physical frailty should be evaluated in depressed individuals and may contribute to the prioritization of clinical evaluation of geriatric syndromes.

Antepartum Depression and Associated Factors Among Pregnant Women Attending ANC Clinics in Gurage Zone Public Health Institutions, SNNPR, Ethiopia, 2019

BACKGROUND

Antepartum depression is a form of clinical depression that can be caused by the stress and worry that pregnancy can bring a more severe level. It can be triggered by an unplanned pregnancy, a history of substance abuse, and low economic status. Antepartum depression is critical and has an intergenerational impact on children in the developing world and it can have negative effects on fetal development. Therefore, this study aimed to assess its magnitude and associated factors among pregnant women attending antenatal clinics in Gurage zone public health institutions, SNNPR, Ethiopia, 2019.

METHODS

Intuition-based cross-sectional study was employed in Gurage zone public health institutions from February 14 to April 14/2019. A systematic random sampling technique was used. The data were collected and then entered into EpiData and processed by SPSS version 24.0 for analysis. P values <0.05 with 95% confidence level were used to declare statistical significance.

RESULTS

In this study, a total of 343 pregnant mothers were participated by making a response rate of 96%. The magnitude of antepartum depression among pregnant women was 27.6% (95% CI: 22.4-33.2). The multivariable analysis showed that respondents who had unplanned pregnancy [AOR=2.11 (95% CI: 1.05-4.44)], having complications during their previous labor and delivery [AOR=4.42 (95% CI: 2.06-9.48)], previous history of child hospitalization [AOR=3.34 (95% CI: 1.48-7.51)], and satisfaction in their marriage [AOR=3.9 (95% CI: 1.15-13.21)] were associated with antepartum depression.

CONCLUSION

In this study, about one in four women during pregnancy develop antepartum depression. Unplanned pregnancy, complications during labor and delivery of the last baby, women having a history of child hospitalization, and maternal satisfaction with marriage were statistically associated factors with APD. To prevent further consequences, all concerned bodies need to take action by making targeted intervention and early screening of all pregnant mothers for depression.

Prevalence and Correlates of Individuals Screening Positive for Depression and Anxiety on the PHQ-4 in the German General Population: Findings from the Nationally Representative German Socio-Economic Panel (GSOEP)

Our aim was to estimate the prevalence and correlates of probable depression and anxiety in the general adult population in Germany. Repeated cross-sectional data (i.e., cross-sectional data observed at different time points: year 2012 and year 2014) were derived from the innovation sample of the German Socio-Economic Panel, a population-based study of German households. The validated Patient Health Questionnaire (PHQ-4) was used to measure probable depression and anxiety. In the analytical sample, n equaled 2952 individuals. According to the PHQ-4 cut-off values, 10.4% of the individuals had probable depression and 9.8% of the individuals had probable anxiety. Regressions revealed that the likelihood of depression was positively associated with lower age (OR: 0.98 (95% CI: 0.98-0.99)), being unmarried (and living together with spouse) (OR: 0.75 (0.58-0.98)), worse self-rated health (OR: 1.99 (1.73-2.27)), and more chronic diseases (OR: 1.18 (1.07-1.31)). Furthermore, the likelihood of anxiety was positively associated with being female (OR: 1.36 (95% CI: 1.04-1.76)), lower age (OR: 0.98 (95% CI: 0.97-0.99)), low education (medium education, OR: 0.69 (0.50-0.95)), worse self-rated health (OR: 2.00 (1.74-2.30)), and more chronic diseases (OR: 1.15 (1.03-1.27)). The magnitude of depression and anxiety was highlighted. Clinicians should be aware of the factors associated with probable depression and anxiety.

Effects of bilateral transcranial direct current stimulation on working memory and global cognition in older patients with remitted major depression: A pilot randomized clinical trial

OBJECTIVES

To assess the effects of a 10-day course of bilateral anodal transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC) on working memory and global cognition in elderly participants with remitted major depressive disorder at 14 days (primary outcome) and 90 days (secondary outcome) post intervention.

DESIGN

Randomized double blind controlled trial (clinicaltrials.gov # NCT02212366).

SETTING

Community dwelling outpatient setting.

PARTICIPANTS

Sixty or older with previous single or recurrent episodes of major depression currently in full remission.

INTERVENTION

A 10 day course of active or sham bilateral DLPFC anodal tDCS.

MEASUREMENTS

(a) Working memory assessed by a computerized N back task, and (b) global cognition assessed by a standard paper and pencil neuropsychological test battery.

RESULTS

Thirty-three participants, (mean (SD) age = 66. 5 (5.7) year) were enrolled, out of which 18 (mean (SD) age = 66. 3 (5.8) year) were randomized to active tDCS and 15 (mean (SD) age = 66. 7 (5.8) years) to sham tDCS. All randomized participants except one from the sham group -completed the tDCS course. There were no differences between the groups on working memory performance or global cognition at 14 or 90 days post intervention. Both groups showed promising changes in working memory and global cognition over time.

CONCLUSIONS

tDCS was well tolerated in older patients with remitted MDD, however, as compared to the sham group, it did not improve working memory or global cognition. Future studies should investigate tDCS with alternative parameters to enhance cognition in this population.

Hospital adverse outcomes of the elderly in a tertiary referral hospital: A prospective cohort study of 9,586 admissions

OBJECTIVE

This study aimed to evaluate the hospital adverse outcomes (HAO) of admitted older adult patients in a large prospective cohort and investigate the demographic, economic, and health-related characteristics at risk of HAO in all older adult patients admitted in the general ward of a tertiary referral hospital.

MATERIALS AND METHODS

We recruited admission episodes of older adult patients aged over 65 years who were admitted at the general ward of Konkuk University Medical Center, which is a tertiary referral hospital, from September 2016 to October 2017. Out of 9,586 admission episodes, 8,263 were included. Modified from the Geriatric Screening for Care-10, six common geriatric health issues, namely, dysphagia, polypharmacy, fecal incontinence, functional mobility, depression, and dementia, were evaluated. Fall, hospital-acquired pressure ulcer (HPU), and mortality were checked daily by experienced nurses during the patients' hospital stay. A logistic regression model was used, and P < 0.05 was the threshold of significance.

RESULTS

The incidence rates of fall and HPU were 1.3 % and 4.0 %, respectively. The hospital mortality was 6.1 %. Older adult patients with dysphagia or dementia upon admission were significantly associated with an increased likelihood of falls. Furthermore, age, ER admission, low income, fecal incontinence, or functional immobility increased the HPU incidence. Meanwhile, age, male, ER admission, fecal incontinence, or functional immobility significantly increased the hospital mortality.

CONCLUSION

All demographic, economic, and health-related characteristics, except for polypharmacy and depression, affect the incidence of HAO. Intervention to vulnerable older adult patients with HAO risk could improve the treatment outcome.

Depression Severity, but Not Cognitive Impairment or Frailty, is Associated with Disability in Late-Life Depression

OBJECTIVES

Assess the relationship of cognitive impairment to disability, accounting for depression severity and frailty, among older adults with late-life depression (LLD).

METHODS

Data were analyzed from 78 community-dwelling older adults with LLD and without dementia (age M = 71.9; SD = 6.1). Cognitive functioning was assessed using a comprehensive neuropsychological battery. Depression severity was measured using the 17-item Hamilton Depression Rating Scale (HDRS; cutoff ≥15). Frailty was assessed using several motor tests. The World Health Organization Disability Assessment Schedule (WHO-DAS) measured disability status. A linear regression analysis was performed to identify relationships of cognition, frailty and depression severity with disability.

RESULTS

The average number of impaired cognitive tests was 2.0 (SD = 1.9), with 28.2% of participants showing no impaired scores. On average participants reported depression severity of 17.3 (SD = 3.6), and disability total score of 15.1 (SD = 6.9). The regression model accounted for 25.1% of the variance in disability, with only depression severity significantly predicting disability status. Burden of cognitive impairment and frailty were not predictive of disability in this sample.

CONCLUSIONS

In this sample, only depression severity was associated with increased disability.

CLINICAL IMPLICATIONS

These findings have implications for intervention in LLD, as depression severity may represent a more modifiable risk factor for disability.

Depressive symptoms and its associated factors among prisoners in Debre Berhan prison, Ethiopia

BACKGROUND

Depression is a common mental disorder among prisoners characterized by a mood change involving a feeling of sadness, lack of interest, or hopelessness that lasts for weeks, months, or even longer. Besides imprisonment, depression is the primary factor leading to suicidal attempts. However, little is known about the depressive status of prisoners in Ethiopia. Therefore, this study aimed at assessing the magnitude and associated factors of depressive symptoms among prisoners of Debre Berhan prison.

METHODS

We conducted an institution-based cross-sectional study. We collected data from 336 randomly selected prisoners using interviewer-administered Patient Health Questionnaire-9 (PHQ-9). We collected the data from May 3 to 28, 2015, and performed binary logistic regression to identify independent predictors of depressive disorder.

RESULT

Out of the total of 336 prisoners, 98% (n = 330) were males. Using PHQ-9 at the cut-off point of ≥5, we found the prevalence of depression to be 44% (n = 148). Being widowed (AOR = 6.30; CI: 1.09-36.67), having a college or university level educational status (AOR = 5.34; CI:1.59-17.94), having a history of suicide attempt (AOR = 2.76 CI: 1.04-7.31), having faced severe stressful life events (AOR = 2.57; CI: 1.41-4.67), being sentenced for 5 to 10 years (AOR = 2.51; CI:1.32-4.79), and having a history of chronic medical illness (AOR = 3.32 CI: 1.26-8.75) were found to be independently associated with depressive symptoms.

CONCLUSION

There is a high prevalence of depression among prisoners of Debre Berhan prison. Hence, designing strategies for early screening and treatment of depression at prisons is crucial.

An Evaluation of the Clinical and Economic Burden Among Older Adult Medicare-Covered Beneficiaries With Treatment-Resistant Depression

OBJECTIVE

To compare the clinical and economic burden of treatment-resistant depression (TRD) among older adult patients with major depressive disorder (MDD) to non-TRD MDD and non-MDD patients.

METHODS

Retrospective cohort study using 5% Medicare data (January 1, 2012-December 31, 2015) for MDD patients aged ≥65 years who were defined as TRD if they received ≥2 antidepressant treatments in the current episode. MDD patients not meeting TRD criteria were deemed non-TRD MDD; those without an MDD diagnosis were categorized as non-MDD. All were required to have continuous health plan enrollment for ≥6 months pre- and ≥12 months postindex date (index: first antidepressant claim/random [non-MDD]). Three cohorts were matched, and generalized linear and Cox proportional hazards models were used to compare medication use, healthcare resource utilization, costs, and risks of initial hospitalization and readmission ≤30 days postdischarge from initial hospitalization.

RESULTS

After matching, 178 patients from each cohort were analyzed. During 12 months of follow-up, TRD patients had higher use of different antidepressants and antipsychotics, higher inpatient and emergency room visits, longer inpatient stays, and higher total healthcare costs ($24,543 versus $16,059, $8,058) than non-TRD MDD and non-MDD cohorts, respectively (all p <0.05). Risk of initial hospitalization was higher in the TRD (hazard ratio [HR] = 3.60, 95% confidence interval [CI] = 2.08-6.23) and non-TRD MDD cohorts (HR = 1.82, 95% CI = 1.02-3.25) than the non-MDD cohort.

CONCLUSIONS

The burden of MDD among older adult Medicare beneficiaries is substantial, and even greater among those with TRD compared to non-TRD MDD, demonstrating the need for more effective treatments than those currently available.

Determinants of depressive symptoms among older people in Bangladesh

BACKGROUND

Depressive symptoms are common among older people which are associated with disability, morbidity and mortality. The aim of this study was to determine the associated risk factors for depressive symptoms among older people in Bangladesh.

METHODS

A cross-sectional survey was conducted among 400 people aged ≥65 years from the Meherpur district in Bangladesh. Depressive symptoms were measured by the 15-item Geriatric Depression Scale and categorized into: no depressive symptoms, mild, moderate and severe depressive symptoms. Information was also collected on socio-economic and demographic characteristics, health problems, feeling of loneliness, history of falls and concern about falling. Chi-square test of association and multinomial logistic regression was performed to reveal the determinants of depressive symptoms.

RESULTS

Just over half of the sample were female, aged 70+ years, and lived in rural areas. The prevalence of depressive symptoms was 55.5%, and 23.0% mild, 19.0% moderate, and 13.5% having severe levels of depressive symptoms. Older age, sex, residence, marital status, presence of co-morbidities, visual impairment, previous falls, loneliness, and fear of falling were the significant determinants for developing depressive symptoms.

LIMITATIONS

A convenience sampling method was used for data collection among older people from selected communities in a district of Bangladesh. The results do not represent the entire population of Bangladesh. Besides, it was a cross-sectional study, and causality cannot be determined.

CONCLUSION

Depressive symptoms among older people in Bangladesh is prevalent, and needs to be addressed. Public health programs and strategies are needed to reduce depressive symptoms among older adults in Bangladesh.

Lifestyle Aspects As A Predictor Of Pain Among Oldest-Old Primary Care Patients - A Longitudinal Cohort Study

Purpose

Dealing with the high prevalence of pain among the oldest-old (+75) is becoming a major health issue. Therefore, the aim of the study was to uncover health-related lifestyle behaviors (HLB) and age-related comorbidities which may predict, influence and prevent pain in old age.

Patients and methods

In this longitudinal cohort study, data were obtained initially from 3.327 individuals aged 75+ from over 138 general practitioners (GP) during structured clinical interviews in 2003. Nine follow-ups (FU) were assessed until 2017. Available data from 736 individuals scoring in FU3 and FU7 were included in this analysis. Data were assembled in an ambulatory setting at participant's homes. Associations were tested using a linear regression model (model 1) and ordered logistic regression model (model 2).

Results

Statistical analyses revealed increased likelihood to experience pain for participants with comorbidities such as peripheral arterial disease (PAD) (coef. 13.51, P>t = 0.00) or chronic back pain (CBP) (coef. 6.64, P>t = 0.003) or higher body mass index (BMI) (coef. 0.57, P>t = 0.015) and, female gender (coef. 6.00, SE 3.0, t = 2.02, P>t = 0.044). Participants with medium education and former smokers showed significantly lower pain rating (coef. -5.05, P>t = 0.026; coef. -5.27, P>t = 0.026). Suffering from chronic back pain (OR = 2.03), osteoarthritis (OR = 1.49) or depressive symptoms (OR = 1.10) raised the odds to experience impairments in daily living due to pain. Physical activity showed no significant results.

Conclusion

Chronic conditions such as PAD, or CBP, female gender and higher BMI may increase the risk of experiencing more pain while successful smoking cessation can lower pain ratings at old age. Early and consistent support through GPs should be given to older patients in order to prevent pain at old age.

Depressive Symptoms in Elderly Chinese Primary Care Patients: Prevalence and Sociodemographic and Clinical Correlates

OBJECTIVE

To estimate the prevalence of depressive symptoms (depression thereafter) and to identify the sociodemographic and clinical correlates of depression in a sample of elderly patients treated in the primary care setting in Wuhan, China.

BACKGROUND

Primary care is an opportune setting for the management of late-life depression in China, but there have been no representative studies on the clinical epidemiology of depression in elderly Chinese primary care patients.

METHODS

In total, 752 elderly patients (≥ 65 years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire. Depression was assessed with the 15-item Geriatric Depression Scale (GDS-15).

RESULTS

Of the elderly Chinese primary care patients, 30.6% had depression (GDS-15 ≥ 5). Correlates of depression were an education level of primary school or less (odds ratio [OR]: 1.94, 95% confidence interval [CI]: 1.36-2.77, P < .001), poor financial status (OR: 2.19, 95% CI: 1.16-4.15, P = .016), lack of an exercise habit (OR: 1.40, 95% CI: 1.06-1.74, P = .023), 2 or more chronic medical conditions (OR: 1.90, 95% CI: 1.34-2.69, P < .001), and loneliness (OR: 3.53, 95% CI: 2.46-5.08, P < .001).

CONCLUSIONS

Depression is prevalent among elderly Chinese primary care patients, indicating that elderly patients treated in primary care have a high level of need for mental health services in China. There is an urgent need to integrate mental health services into primary health care.

Identifying the Factors Related to Depressive Symptoms Amongst Community-Dwelling Older Adults with Mild Cognitive Impairment

High-level depressive symptoms have been reported in individuals with mild cognitive impairment (MCI), resulting in increased risk of progression to dementia. However, studies investigating the correlates of depressive symptoms among this population are scarce. This study aimed to investigate the significant socio-demographic, lifestyle-related and disease-related correlates of depressive symptoms among this cohort. Cross-sectional data were obtained from a sample of 154 Chinese community-dwelling older adults with MCI. MCI subjects were screened by the Montreal Cognitive Assessment. Depressive symptoms were measured by the Geriatric Depression Scale. Possible correlates of depressive symptoms in individuals with MCI were explored by multiple linear regressions. The prevalence of depressive symptoms among Chinese older adults with MCI was 31.8%. In multiple regression analysis, poor perceived positive social interaction, small social network, low level of physical activity, poor functional status, subjective memory complaint, and poor health perception were correlated with depressive symptoms. The findings highlight that depressive symptoms are sufficient to warrant evaluation and management in older adults with MCI. Addressing social isolation, assisting this vulnerable group in functional and physical activities, and cultivating a positive perception towards cognitive and physical health are highly prioritized treatment targets among individuals with MCI.

Personal, behavioral, and perceived environmental factors associated with late-life depression in older men and women

INTRODUCTION

Previous investigations on factors associated with depression were highly focused on personal characteristics and health behaviors; however, few studies used an ecological perspective on the issue, much less on sex differences. This study examined the factors associated with depression, including any sex differences.

METHODS

A total of 1025 Taiwanese adults older than 65 years were recruited. Their personal demographics, lifestyle behaviors, and perceived environmental factors were obtained through a telephone-based survey. The multiple factors associated with depression in older adults were examined using logistic regression analyses.

RESULTS

Fully logistic regression analyses revealed that poor self-rated health (odds ratio =2.54) was correlated with a greater likelihood of depression. Aside from poor self-rated health, being older, sufficient leisure time spent in walking, and perceptions of a safe environment were associated with lower risks of depression in older men, whereas having hypertension and excessive TV viewing were associated with higher risks of depression in older women.

CONCLUSION

Apart from self-rated health, sex differences in the associations of factors such as leisure-time walking, TV watching, and safe traffic environment with depression were observed among older adults. Strategies applied for geriatric depression prevention should take into consideration different sex group.

The Effectiveness of Horticultural Therapy on Older Adults: A Systematic Review

OBJECTIVES

Although the therapeutic effects of horticulture on older adults have been widely investigated, a recent and comprehensive synthesis of available evidence on outcomes is lacking. We systematically reviewed evidence for the therapeutic effects of horticulture on older adults.

DESIGN

A systematic search of PubMed, MEDLINE, Sage Journals, ProQuest, Science Direct, and CINAHL was conducted. Articles were selected if they were quantitative studies published in English from 2008 to 2018.

SETTING AND PARTICIPANTS

Articles were selected if they included participants aged 60 years and older and used horticulture as the main intervention.

MEASURES

Experimental studies were appraised using the Physiotherapy Evidence Database Scale.

RESULTS

The systematic search yielded 20 articles. Significant pre-post improvement was reported in quality of life, anxiety, depression, social relations, physical effects, and cognitive effects. However, between-group results were lacking or nonsignificant.

CONCLUSIONS AND IMPLICATIONS

There is evidence for benefits of horticulture among older adults, particularly in long-term care facilities. Nonetheless, as the robustness of evidence is lacking, more rigorous randomized controlled trials and between-group effects need to be investigated.

Depression: Prevalence and Associated Risk Factors in the United Arab Emirates

A Depression is a prevalent mental healthcare problem and a common cause of disability worldwide. The purpose of this study was to determine the prevalence and risk factors of depression in individuals living in the UAE. We used a systematic review approach, searching PubMed and Scopus electronic databases to collect studies conducted between 2007 and 2017 on the UAE population (both citizens and expatriates) relating to depression. After evaluating and screening relevant articles, a review of 14 articles was conducted. The prevalence of depression and study populations varied widely across studies with some including students and workers and others limited to those with diabetes. The most common contributing factors were female sex, financial difficulties/low socioeconomic status, stressful life events, lack of social support, serious or chronic illness (e.g., diabetes, obesity, epilepsy, multiple sclerosis), and a history of eating disorders. Vitamin D deficiency was also highlighted as a risk factor for seasonal depression. Even though previous evidence has promulgated the role of numerous causative factors, the epidemiological studies including risk factors such as personal or family history of depression, low academic performance, and the use of alcohol remain lacking. Further research is needed to identify effective strategies for treating and preventing depression in the future.

[Depression and coping strategies in the elderly with type 2 diabetes]

INTRODUCTION AND OBJECTIVES

Elderly patients with diabetes have been shown to have more diabetes-related complications, and they are more likely to develop somatic and psychiatric comorbidities including cognitive dysfunction and depression. Several studies have shown a close association between diabetes and depression. This comorbidity may lead to functional disability and quality of life deterioration. Thus, the elderly will face various constraints through the coping strategies. In this context, we conducted our study to assess the prevalence of depressive symptoms in elderly patients with diabetes as well as its associated factors, and to investigate their coping strategies.

METHODS

We conducted a cross-sectional, descriptive and analytic study among 50 elderly patients (age≥65 years) being followed for type 2 diabetes at the outpatient department for chronic diseases of the Regional Hospital of Aguereb, Sfax, Tunisia. We used the "Activity of Daily Living" to assess the dependence level, the "Geriatric Depression Scale" to screen for depressive symptoms, and the "Brief Coping with Problems Experienced" to investigate the coping strategies.

RESULTS

The mean age of patients was 73.3 years, with a sex-ratio (M/F) of 0.62. Smoking and alcohol consumption were reported respectively in 20% and 4% of participants. The mean duration of diabetes was 7.7 years. Diabetes complications were noted in 70% of participants. Somatic comorbidities were noted in 94% of cases (hypertension 84%; dyslipidemia 34%). Psychiatric histories were reported in 18% of patients who suffered from anxio-depressive symptoms. No patient among those with mental disorder histories benefited from any psychiatric management prior to the study. Three patients (6%) had previously presented suicidal ideations but none of them had attempted suicide. The mean "Activity of Daily Living" score was 4.9 points. Patients were autonomous in 28%, and dependent in 4% of cases. The mean "Geriatric Depression Scale" score was 9.8 points. According to this scale, the prevalence of depressive symptoms was 34%. They were correlated with: smoking (P=0.04), psychiatric histories (P=0.031), absence of leisure activity (P=0.035), "Activity of Daily Living" score (P=0.028), long duration of diabetes (P=0.04) and the presence of suicidal ideation (P=0.013). According to the « Brief Coping with Problems Experienced », the problem-focused coping strategies were the most frequently used (44%), followed by emotion-focused (38%) and passive strategies (18%). Participants with depressive symptoms are significantly more likely to adopt emotion-focused coping strategies (P=0.01).

CONCLUSION

Our study highlighted a high prevalence of depressive symptoms among elderly patients with diabetes. This relationship seems to be bi-directional and may increase somatic complications and alter the quality of life, and then darken the prognosis. Thus, besides pharmacological treatment, regular depression screening and psychological support are essential to ensure a better control of diabetes and to improve well-being.

Association between health behaviors and mood disorders among the elderly: a community-based cohort study

BACKGROUND

According to a WHO report, nearly 15% of adults aged 60 and over suffer from a mental disorder, constituting 6.6% of the total disability for this age group. Taipei City faces rapid transformation towards an aging society, with the proportion of elderly in the total population rising from 12% in 2008 to 16% in 2016. The aim of this study is to identify the prevalence of mental disorders among the elderly in Taipei City and to elucidate risk factors contributing to mental disorders.

METHODS

The elderly health examination database was obtained from the Department of Health, Taipei City government, from 2005 to 2012. A total of 86,061 people underwent publicly funded health examinations, with 348,067 visits. Each year, there are around 43,000 elderly persons in Taipei City using this service. We used a mental health questionnaire including five questions to estimated relative risks among potential risk factors with the generalized estimating equations (GEE) model to measure the mental health status of the elderly. Mood disorders were measured with the Brief Symptom Rating Scale (BSRS-5) questionnaire. Age, education level, gender, marital status, living alone, drinking milk, eating vegetables and fruits, long-term medication, smoking status, frequency of alcohol consumption, frequency of physical activity, BMI, and number of chronic diseases were included as covariates.

RESULTS

The results show that being male (odds ratio (OR) 0.57; 95% CI = 0.56, 0.59), higher education (OR 0.88; 95% CI = 0.82, 0.95), no long-term medication (OR 0.57; 95% CI = 0.56, 0.58), and exercising three or more times per week (OR 0.94; 95% CI = 0.91, 0.98) were all positively correlated with better emotional status. However, being divorced (OR = 1.22, 95% CI = 1.09, 1.36), not drinking milk (OR = 1.12, 95% CI = 1.09, 1.14), not eating enough vegetables and fruits every day (OR = 1.78, 95% CI = 1.73, 1.83), daily smoking (OR = 1.15, 95% CI = 1.01, 1.32), and having more chronic diseases (OR = 1.02, 95% CI = 1.01, 1.03) were all correlated with poor mental status among the elderly.

CONCLUSIONS

The findings of this research can both estimate the prevalence of mood disorders at the community level, and identify risk factors of mood disorders at the personal level.

Prevalence of depressive symptoms and associated factors among older adults treated at a referral center

Abstract The present study aimed to estimate the prevalence of depressive symptoms and associated factors among older adults treated at a referral center. A cross-sectional study was carried out with a sample of 360 older adults treated at a Referral Center for the Health of Older Adults in the north of Minas Gerais, Brazil. The following data were collected in 2017: demographic, socioeconomic, morbidity, hospital admission in the last year, frailty (Edmonton Frail Scale), functional capacity (Katz Index, Lawton and Brody Scale) and presence of depressive symptoms (Geriatric Depression Scale - GDS-15). Multiple analysis was performed through logistic regression. A prevalence of depressive symptoms was observed in 37.2% of the sample. The variables associated with depressive symptoms were: negative perception about one’s own health (OR=1.9, 95% CI 1.34-2.70); frailty (OR=1.94, 95% CI 1.41-2.66); having suffered falls (OR=1.24, 95% CI 1.01-1.61); having been hospitalized in the last year (OR=1.56, 95% CI, 1.11-2.27); (OR=2.56, 95% CI 1.38-4.77) and residing alone (OR=1.66, 95% CI 1.09-2.53). Thus, a high prevalence of depressive symptoms was identified among the older adults, evidencing the need for an effective and immediate approach by health professionals.

The role of meaning in life in community-dwelling older adults with depression and relationship to other risk factors

OBJECTIVES

The aims of this study were to examine the association of Meaning in Life (MiL) with sociodemographic and physical factors, and its association with depression in older people.

METHOD

A cross-sectional survey with a sample of N = 2104 older adults from communities of four European countries was conducted, using an age-appropriate interview for the diagnosis of depression and the Schedule for Meaning in Life Evaluation (SMiLE) questionnaire to assess MiL.

RESULTS

Overall, MiL was particularly low in old male participants, in older people from Ferrara (Italy), those with a lower religious affiliation, fewer social contacts, and poorer physical health. Furthermore, younger old age (65-69 compared to 80-84 year olds), female gender, being married, living in Geneva and poorer physical health were significantly associated with a higher risk for depression. In addition, lower MiL significantly increased the likelihood to suffer from depression in older people. An interaction effect of study center and MiL also emerged: with decreasing MiL the risk for depression significantly increases in Hamburg compared to the other study centers.

CONCLUSION

This study underlines the association of MiL and depression in old age. Integration of meaning-specific aspects in treatment for older adults with depression may be promising.

Depression symptoms as mediators of inequalities in self-reported health: the case of Southern European elderly

Background

Inequalities in the distribution of self-reported health (SRH) have been widely reported. Its higher expressivity among women, elderly and least educated groups has been partly attributed to differences in their health perceptions. However, this subjectivity may be masking the burden of mental illness in these groups. Thus, we sought to understand if depression symptoms mediate inequalities in SRH.

Methods

SHARE waves 4 and 6, pertaining to Spain, Italy and Portugal, were used (n2011 = 8517, n2015 = 11 046). Inequalities in SRH were calculated, comparing the risk amongst education level, gender and age groups, adjusting for chronic diseases, functional limitations and country fixed effects. We then tested depression symptoms as mediators.

Results

Depression symptoms were associated with poor SRH (odds ratio (OR)2011 = 1.379, OR2015 = 1.384, P < 0.001). Their inclusion reduced the magnitude of the association between SRH and education, annulled the statistical significance for age, and reversed the gender effect. As expected, chronic diseases and functional limitations remained significant predictors of poor SRH.

Conclusions

Depression symptoms, together with chronic diseases and functional limitations, explain the poorer SRH of the least educated, female and older groups in the Southern European population. Therefore, tackling inequalities in SRH must require focusing on mental health issues, which disproportionately affect the most vulnerable groups.

Sleep and mood changes in advanced age after blue-blocking (yellow) intra ocular lens (IOLs) implantation during cataract surgical treatment: a randomized controlled trial

OBJECTIVES

Both advanced age and depression are characterized by changes in sleep patterns. Light exposure is one of the main synchronizers of circadian cycles and influences sleep by inhibiting melatonin secretion, which is mostly sensitive to light of low wavelengths (blue). Blue-blocking (yellow) intraocular lenses (IOLs) have supplanted the usual UV-blocking (clear) IOLs during cataract surgery to prevent age-related macular degeneration, however, the impact of yellow IOLs on sleep and mood is unclear. The purpose of this study was to compare the effects of yellow and clear IOLs on sleep and mood in aged patients undergoing bilateral cataract surgery.

METHODS

A randomized controlled superiority study was conducted within three ophthalmic surgical wards in France. A total of 204 subjects (mean age 76.2 ± 7.5 years) were randomized into yellow or clear IOLs groups. Patients completed a sleep diary, the pictorial sleepiness scale and the Beck Depression Inventory (BDI) one week before and eight weeks after the last surgical procedure.

RESULTS

According to an Intent To Treat (ITT) analysis, no significant difference was found between yellow and clear IOLs groups regarding sleep time, sleep latency, total sleep duration, quality of sleep and BDI scores. The rate of patients whose BDI score increased at the cutoff score of ≥5 after surgery was significantly higher in the yellow IOL group (n = 11, 13.1%) compared with the clear IOL group (n = 4; 4.7%); p = 0.02.

CONCLUSIONS

Using yellow IOLs for cataract surgery doesn't significantly impact sleep but may induce mood changes in aging.

Risk factors of geriatric depression in rural China based on a generalized estimating equation

ABSTRACTBackground:The number of elderly individuals living in China is increasing rapidly. The aim of this study was to examine the potential risk factors of geriatric depression in rural areas.

METHODS

A repeated cross-sectional study was conducted between January 2015 and October 2016 in rural China. Nine hundred forty-five elderly individuals were included in both investigations. A generalized estimating equation (GEE) was used to examine the relationships between geriatric depression and socio-demographics, the number of chronic diseases, ADL (Activity of Daily Living) disability, cognitive impairment, and anxiety.

RESULTS

Among the participants, the majority was female (61.4%) and illiterate (81.5%) and had a general economic status (63.0%) and more than two kinds of chronic diseases (62.9%). The bivariate analysis indicated that geriatric depression was associated with social support, education level, economic status, ADL disability, anxiety disorders, and cognitive impairment at both survey time points. The GEE results showed that poor economic status (OR = 8.294, p < 0.001), the presence of more than two chronic diseases (OR = 1.681, p = 0.048), ADL disability (OR = 2.184, p < 0.001), cognitive impairment (OR = 1.921, p < 0.001), and anxiety (OR = 5.434, p < 0.001) were risk factors for geriatric depression in rural China; better social support (OR = 0.924, 95% CI = 0.899-0.949, p < 0.001) was found to be a protective factor.

CONCLUSIONS

Geriatric depression in rural China was associated with several socio-demographic, physical, and mental factors. Targeted interventions are essential to improve the psychological health of aged individuals in rural China.

Prevalence of pain and its associated factors among the oldest-olds in different care settings - results of the AgeQualiDe study

BACKGROUND

The prevalence of pain is very common in the oldest age group. Managing pain successfully is a key topic in primary care, especially within the ageing population. Different care settings might have an impact on the prevalence of pain and everyday life.

METHODS

Participants from the German longitudinal cohort study on Needs, Health Service Use, Costs and Health-related Quality of Life in a large Sample of Oldest-old Primary Care Patients (85+) (AgeQualiDe) were asked to rate their severity of pain as well as the impairment with daily activities. Besides gender, age, education, BMI and use of analgesics we focused on the current housing situation and on cognitive state. Associations of the dependent measures were tested using four ordinal logistic regression models. Model 1 and 4 consisted of the overall sample, model 2 and 3 were divided according to no cognitive impairment (NCI) and mild cognitive impairment (MCI).

RESULTS

Results show a decline in pain at very old age but nonetheless a high prevalence among the 85+ year olds. Sixty-three per cent of the participants report mild to severe pain and 69% of the participants mild to extreme impairment due to pain with daily activities. Use of analgesics, depression and living at home with care support are significantly associated with higher and male gender with lower pain ratings.

CONCLUSIONS

Sufficient pain management among the oldest age group is inevitable. Outpatient care settings are at risk of overlooking pain. Therefore focus should be set on pain management in these settings.

Index of vulnerability of elderly people in Medellín, Barranquilla, and Pasto

Introduction: Vulnerability can be defined as a lack of material and immaterial resources, which prevents the use of opportunities that may advance one’s self-interest. The presence of these welfare resources prevents reductions in the quality of life. Objective: The objective of this study was to build an index of vulnerability using characteristics of the physical, human, social and functional capital of adults in three cities of Colombia in the year 2016 and to determine the factors that contribute most to vulnerability. Materials and methods: We conducted a transversal study with primary information sources applying 1,514 surveys among people aged 60 years and over in Medellín, Barranquilla, and Pasto. For the construction of the vulnerability index, we used factor analysis with varimax rotation and the principal component method. Results: The conditions that lead to a person’s vulnerability were related mainly to human capital (quality of life, mental health and habits). The other types of capital that contributed to vulnerability were physical capital (occupation), social capital (accompaniment), and functional capital (functional independence). The highest vulnerability was registered among the residents of Pasto. The factors associated with vulnerability were the city of residence, the sex, the educational level and the role of the person in the home. Conclusion: In 58.55% of elderly people vulnerability was explained by the use of time, the functional independence and the subjective well-being. These findings contribute to the improvement of the quality of life, mainly those related to maintaining functional independence as long as possible, being occupied, improving mental health, and avoiding the risks of depression, anxiety, cognitive deterioration and deleterious habits.

Late-life depression: issues for the general practitioner

Late-life depression (LLD) is both a prevalent and life-threatening disorder, affecting up to 13.3% of the elderly population. LLD can be difficult to identify because patients mainly consult their general practitioner (GP) for somatic complaints. Moreover, patients may be hesitant to express the problem to their GP. Increased vigilance on the part of the GP can only benefit older people with depression. To recognize the risk of LLD, screening tools are provided in addition to treatment options for LLD. This review aims to provide the GP with guidance in recognizing and treating LLD. It tries to connect mainstream etiologies of LLD (e.g., vascular, inflammation, hypothalamo-pituitary-adrenal axis) with risk factors and current therapies. Therefore, we provide a basis to the GP for decision-making when choosing an appropriate therapy for LLD.

Cognitive Impairment and Structural Abnormalities in Late Life Depression with Olfactory Identification Impairment: an Alzheimer's Disease-Like Pattern

BACKGROUND

Late-life depression patients are at a high risk of developing Alzheimer's disease, and diminished olfactory identification is an indicator in early screening for Alzheimer's disease in the elderly. However, whether diminished olfactory identification is associated with risk of developing Alzheimer's disease in late-life depression patients remains unclear.

METHODS

One hundred and twenty-five late-life depression patients, 50 Alzheimer's disease patients, and 60 normal controls were continuously recruited. The participants underwent a clinical evaluation, olfactory test, neuropsychological assessment, and neuroimaging assessment.

RESULTS

The olfactory identification impairment in late-life depression patients was milder than that in Alzheimer's disease patients. Diminished olfactory identification was significantly correlated with worse cognitive performance (global function, memory language, executive function, and attention) and reduced grey matter volume (olfactory bulb and hippocampus) in the late-life depression patients. According to a multiple linear regression analysis, olfactory identification was significantly associated with the memory scores in late-life depression group (B=1.623, P<.001). The late-life depression with olfactory identification impairment group had worse cognitive performance (global, memory, language, and executive function) and more structural abnormalities in Alzheimer's disease-related regions than the late-life depression without olfactory identification impairment group, and global cognitive function and logical memory in the late-life depression without olfactory identification impairment group was intact. Reduced volume observed in many areas (hippocampus, precuneus, etc.) in the Alzheimer's disease group was also observed in late-life depression with olfactory identification impairment group but not in the late-life depression without olfactory identification impairment group.

CONCLUSION

The patterns of cognitive impairment and structural abnormalities in late-life depression with olfactory identification impairment patients were similar to those in Alzheimer's disease; olfactory identification may help identify late-life depression patients who are at a high risk of developing Alzheimer's disease.