Grief and loss in old age: Exploration of the association between grief and depression

Risk factors for depression, anxiety, and PTSS after loss: A systematic review and meta-analysis

BACKGROUND

Bereavement can lead to complicated grief reactions including clinically significant symptoms of depression, anxiety, and post-traumatic stress (PTSS) post-loss. Gaining insight into specific and shared risk factors for these complicated grief reactions can help identify individuals needing support.

METHODS

A comprehensive systematic review and meta-analysis of risk factors for post-loss depression, anxiety, and PTSS. PsycInfo, PubMed, Web of Science, and CINAHL were searched to identify risk factors for inclusion in the meta-analysis.

RESULTS

The systematic review included 144 studies. Most risk factors were of small magnitude. For depression, 21 risk factors were analyzed, with six analyses of adjusted risk factors reaching statistical significance. Pre-loss depression was the strongest risk factor (ESr = 0.25, 95 %CI [0.03,0.45]). Of nine analyzed risk factors for PTSS, four reached statistical significance, with the death of a close relative yielding the largest effect (ESr = 0.24, 95 %CI [0.01,0.44]). Only female gender significantly predicted anxiety (ESr = 0.21, 95 %CI [0.09,0.32]). Female gender, the death of a partner, and violent/unnatural losses were transdiagnostic risk factors.

CONCLUSIONS

An overview of risk factors for three complicated grief reactions, including their predictive strength, is presented. The results provide insights into transdiagnostic risk factors and can aid early identification of people at risk of complicated grief reactions.

Longitudinal Associations Between Friendship and Cognitive Function Among Older Chinese Adults: Will Gender Make a Difference?

This study aims to understand the influence of friendship ties on the cognitive function in older Chinese population aged 60+ and the moderating role of gender. Three waves of the Chinese Longitudinal Aging Social Survey (CLASS) (2014, 2016, and 2018) data were adopted (n = 2145). A latent class growth modelling (LCGM) was conducted to examine friendship trajectories from 2014 to 2018. Four friendship trajectories were identified: (1) stable and strong, (2) steady decline, (3) recovery after decline, and (4) decline after growth. After controlling the cognitive function at baseline, compared to the "stable and strong" group, the "steady decline" group reported significantly lower cognitive function in 2018 (B = -0.79, β = -0.27, 95% CI [-0.42, -0.11]). Recovering friendship ties after decline is associated with a higher increase in cognitive function among males than females. This study highlights the protective effects of friendship on later-life cognitive function.

Building Consensus on the Relevant Criteria to Screen for Depressive Symptoms Among Near-Centenarians and Centenarians: Modified e-Delphi Study

BACKGROUND

The number of centenarians worldwide is expected to increase dramatically, reaching 3.4 million by 2050 and >25 million by 2100. Despite these projections, depression remains a prevalent yet underdiagnosed and undertreated condition among this population that carries significant health risks.

OBJECTIVE

This study aimed to identify and achieve consensus on the most representative signs and symptoms of depression in near-centenarians and centenarians (aged ≥95 years) through an e-Delphi study with an international and interdisciplinary panel of experts. Ultimately, the outcomes of this study might help create a screening instrument that is specifically designed for this unique population.

METHODS

A modified e-Delphi study was carried out to achieve expert consensus on depressive symptoms in near-centenarians and centenarians. A panel of 28 international experts was recruited. Consensus was defined as 70% agreement on the relevance of each item. Data were collected through a web-based questionnaire over 3 rounds. Experts rated 104 items that were divided into 24 dimensions and 80 criteria to identify the most representative signs and symptoms of depression in this age group.

RESULTS

The panel consisted of experts from various countries, including physicians with experience in old age psychiatry or geriatrics as well as nurses and psychologists. The response rate remained consistent over the rounds (20/28, 71% to 21/28, 75%). In total, 4 new dimensions and 8 new criteria were proposed by the experts, and consensus was reached on 86% (24/28) of the dimensions and 80% (70/88) of the criteria. The most consensual potentially relevant dimensions were lack of hope (21/21, 100%), loss of interest (27/28, 96%), lack of reactivity to pleasant events (27/28, 96%), depressed mood (26/28, 93%), and previous episodes of depression or diagnosed depression (19/21, 90%). In addition, the most consensual potentially relevant criteria were despondency, gloom, and despair (25/25, 100%); depressed (27/27, 100%); lack of reactivity to pleasant events or circumstances (28/28, 100%); suicidal ideation (28/28, 100%); suicide attempt(s) (28/28, 100%); ruminations (27/28, 96%); recurrent thoughts of death or suicide (27/28, 96%); feelings of worthlessness (25/26, 96%); critical life events (20/21, 95%); anhedonia (20/21, 95%); loss of interest in activities (26/28, 93%); loss of pleasure in activities (26/28, 93%); and sadness (24/26, 92%). Moreover, when assessing depression in very old age, the duration, number, frequency, and severity of signs and symptoms should also be considered, as evidenced by the high expert agreement.

CONCLUSIONS

The classification of most elements as relevant highlights the importance of a multidimensional approach for optimal depression screening among individuals of very old age. This study offers a first step toward improving depression assessment in near-centenarians and centenarians. The development of a more adapted screening tool could improve early detection and intervention, enhancing the quality of mental health care for this population.

Perceived stress across population segments characterized by differing stressor profiles-A latent class analysis

OBJECTIVE

We aimed to 1) identify distinct segments within the general population characterized by various combinations of stressors (stressor profiles) and to 2) examine the socio-demographic composition of these segments and their associations with perceived stress levels.

METHODS

Segmentation was carried out by latent class analysis of nine self-reported stressors in a representative sample of Danish adults (N = 32,417) aged 16+ years. Perceived stress level was measured by the Perceived Stress Scale (PSS).

RESULTS

Seven classes were identified: Class 1 was labeled Low Stressor Burden (64% of the population) and the remaining six classes, which had different stressor combinations, were labeled: 2) Burdened by Financial, Work, and Housing Stressors (10%); 3) Burdened by Disease and Death among Close Relatives (9%); 4) Burdened by Poor Social Support and Strained Relationships (8%); 5) Burdened by Own Disease (6%); 6) Complex Stressor Burden Involving Financial, Work, and Housing Stressors (2%); and 7) Complex Stressor Burden Involving Own Disease and Disease and Death among Close Relatives (2%). Being female notably increased the likelihood of belonging to Classes 2, 3, 5, and 7. Higher age increased the likelihood of belonging to Class 3. Low educational attainment increased the likelihood of belonging to Classes 5 and 6. A significant difference was observed in perceived stress levels between the seven latent classes. Average PSS varied from 9.0 in Class 1 to 24.2 in Class 7 and 25.0 in Class 6.

CONCLUSION

Latent class analysis allowed us to identify seven population segments with various stressor combinations. Six of the segments had elevated perceived stress levels but differed in terms of socioeconomic composition and stressor combinations. These insights may inform a strategy aimed at improving mental health in the general population by targeting efforts to particular population segments, notably segments experiencing challenging life situations.

The Grief of Older Parents Over the Loss of a Child: A Scoping Review

Aging brings physical, psychological, and social changes, often accompanied by significant life events like the death of a loved one. One of the most devastating losses is the death of a child, which profoundly impacts older parents. This scoping review examines 47 studies on the effects of such grief, highlighting increased death anxiety, elevated mortality risk, psychological distress, and the role of social isolation in intensifying grief. Cultural factors, including stigma, further complicate the mourning process. The findings reveal that prolonged grief, social withdrawal, and declining health are common among bereaved older parents. These results underscore the urgent need for tailored interventions and support networks to mitigate the psychological and social consequences of this profound loss. Addressing this critical issue can improve the well-being of older parents, making it a vital area for further research and intervention.

Age Melancholy of Older Mizrahi Women Residing in Tel Aviv as a Social Loss: Exploring Intersections of Health and Social Support in an Ethnographic Study

Inspired by Freud's "Mourning and Melancholia" and expanding upon his notions within the social context, this article proposes an innovative concept called "age melancholy" to describe the multifaceted elements of social loss experienced by empty nest older adults. While most studies emphasize a psychological-individualist approach to this phenomenon, age melancholy frames older age as a process marked by a loss of social engagements. The findings are grounded in anthropological fieldwork conducted from 2010 to 2013 in a lower-income neighborhood of Tel Aviv. They are based on deductive comprehension of social melancholy, combined with inductive qualitative analyses of 29 meetings within a designated narrative group of older Mizrahi women-Jewish immigrants from Islamic countries. The results reveal that empty nest older adults perceive their loneliness, fragile health, and approaching death as interrelated aspects of social detachment, leading to melancholy. However, whereas their emotional experiences are tainted by age melancholy, it is temporal and contextual and may be mitigated through social support.

Feeling Connected to Nature Attenuates the Association between Complicated Grief and Mental Health

Complicated grief (CG) predicts decreased mental health over time. Furthermore, feeling connected to nature (CN) is positively associated with beneficial mental health outcomes, such as psychological wellbeing and perceived psychological resilience. Thus, we hypothesized that CN moderates the association between general grief or CG and negative mental health for bereaved people. Further, we hypothesized that one's physical exposure to nature-that is, estimated time spent in nature and greenness (i.e., vegetation) surrounding one's residential area-might moderate the association between general grief or CG and negative mental health for bereaved people. To test these hypotheses, we conducted a cross-sectional study. We sampled 153 participants who experienced the death of a close other by COVID-19 infection. Participants reported CG, general grief, anxiety symptoms, depression symptoms, CN, estimated time spent in nature, and residential area postal code via a single online survey. We estimated greenness surrounding participants' residential areas using their self-reported five-digit U.S. postal code. Cross-sectional analyses indicated that, as predicted, CN attenuated the association between CG and depression, trended toward moderating the association between CG and anxiety, and did not moderate the associations between general grief and depression or anxiety. Other variables related to the experience of nature-the estimated time an individual spends in nature and the greenness surrounding one's residential area-did not moderate the association between general grief or CG and depression or anxiety. We thus conclude that a sense of feeling connected to nature-not simply spending more time in nature or being surrounded by nature-may serve an important role in the mental health status of people experiencing complicated grief, perhaps because CN replenishes general belonging when someone significant has passed away.

Factors influencing the level of insight and treatment attitude: a cross-sectional study of 141 elderly patients of major depression in Guangzhou, China

Objective

To explore the insight, treatment attitude, and related influencing factors of hospitalized elderly patients suffering from major depression.

Methods

A total of 141 hospitalized elderly patients with depression were selected as the research objects. Insight was evaluated by the total score of the Insight and Treatment Attitude questionnaire (ITAQ). The data collected included sociodemographic characteristics, psychiatric symptoms, delirium status, social functioning, social support, suicide risk, and cognitive function.

Results

The sample included 74.5% of female patients, and the mean age was 67.53 (sd=7.19) years. The influencing factors of inpatients with depression included alcohol consumption, length of hospitalization, admission types, and the main caregivers (P<0.05). The various factors were further analyzed by linear regression, revealing that the insight and treatment attitude of elderly depressed hospitalized patients were mainly related to the Mini-Mental State Examination (MMSE) (β= 0.225, 95% CI 0.055-0.395, P=0.01), dependent on a caregiver (β=-5.810, 95% CI -8.086~-3.535, P<0.001), the type of admission (involuntary admission) (β=-3.365, 95% CI -5.448~-1.283, P=0.002), Functional Activities Questionnaire (FAQ) (β=-0.156, 95% CI -0.303~-0.010, P=0.037), and length of stay (≤28 days) (β=2.272, 95% CI 0.055~-4.489, P=0.045).

Conclusion

The level of insight was affected by cognitive function, involuntary admission, dependent on a caregiver, social function and length of stay. Future studies should focus on cognitive function recovery, observation of admission mode, and self-care ability in elderly patients with depression.

The impact of workload and job satisfaction on occupational stress - A comparison among newly qualified and experienced midwives

BACKGROUND

Midwives are potentially exposed to high levels of occupational stress. The level of stress may be related to the job demands and job resources, as well as midwife seniority. To date, few studies on the determinants of occupational stress have examined Polish midwives.

OBJECTIVE

This study aims to investigate the roles of workload, job satisfaction, and seniority in shaping the stress levels of midwives in Poland.

METHODS

A cross-sectional approach and structural equation modeling (SEM) were used to compare two groups: newly qualified midwives (NQMs; n = 79) and experienced midwives (n = 99). All data were collected between January and November 2018.

RESULTS

Analysis revealed that in both NQMs (β = 0.34, p = 0.006) and experienced midwives (β = 0.40, p < 0.001) workload was a positive predictor of occupational stress. In contrast, job satisfaction was found to be a negative predictor of stress in both groups (NQMs: β = -0.44, p < 0.001; experienced midwives: β = -0.57, p < 0.001). The study groups did not differ significantly in terms of the levels of workload, job satisfaction, and occupational stress.

CONCLUSION

Workload and job satisfaction are predictors of occupational stress in midwives. The results of this study indicate the important role of job satisfaction and workload in the shaping of occupational stress levels. Resource-rich and low-stress work environments can enhance the quality of health care provided by midwives.

Emotional geographies of loss in later life: An intimate account of rural older peoples' last move

Providing a rural example of the interconnection between aging, emotion, time and place, this paper explores the intimate experiences of loss as older adults move into long-term care settings. Drawing on findings from a qualitative case study of transitions in care in rural Canada, we demonstrate the spatial and temporal dimensions of the experiences of older adults and their carers. In so doing, we highlight the benefits of embracing emotional geographies of care as a new lens in transitions in care research and outline emergent questions for research, policy and practice that will enhance knowledge in the field.

Childhood maltreatment, subjective social status, and health disparities in bereavement

BACKGROUND

Spousal bereavement can lead to adverse health outcomes; however, not all widow(er)s experience the same degree of health problems. Thus, it is important to understand the contribution of disparities (e.g., childhood maltreatment and subjective social status) that may underlie adverse health outcomes that arise following bereavement.

METHODS

We collected data from 130 spousally bereaved individuals at 3-time points (3 months post-loss, 4 months post-loss, and 6 months post-loss). Using mixed models, we assessed the interaction of childhood maltreatment, subjective social status, and time to predict changes in proinflammatory cytokine production, depressive symptoms, grief symptoms.

RESULTS

We found a significant interaction between childhood maltreatment, subjective social status, and time predicting proinflammatory cytokine production (beta > -0.01, p = 0.048), depressive symptoms (beta = 0.008, p = .010), and grief symptoms (beta = 0.001 p = .001).

CONCLUSION

This study highlights the role of disparities related to childhood maltreatment and subjective social status on adverse health outcomes following spousal bereavement.