Association between indicators of disability burden and subsequent depression among older persons

Longitudinal Association of Conversion Patterns of Functional Disability With Risk of Depressive Symptoms in Older Chinese Adults

BACKGROUND

Functional disability has been identified as a risk factor for depressive symptoms (DS). However, most studies have measured functional disability at only one time point, and functional disability is dynamic and changeable over the life course, and can vary between individuals. Therefore, we aimed to examine the longitudinal association between conversion patterns of functional disability and the risk of DS.

METHODS

Based on the China Health and Retirement Longitudinal Study (CHARLS) participants in 2013, we retrospectively assessed their functional disability from 2011 to 2013 through activities of daily living ability (ADLs) and instrumental activities of daily living ability (IADLs), which were categorized as ten conversion patterns. A total of 2057 participants who met the inclusion criteria were included in the final analysis and were followed from 2013 to 2018 to determine the incidence of DS, measured by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Cox proportional hazards regression models were applied to estimate association between conversion patterns of functional disability and the risk of DS.

RESULTS

Over the 61 months follow-up period, 508 incident DS cases were identified. Three conversion patterns of functional disability were more likely to develop DS than those with never both ADLs and IADLs disabilities: relieved both ADLs and IADLs disabilities (adjusted HR = 2.01, 95% CI = 1.21-3.32), persistent only IADLs disability (adjusted HR = 1.81, 95% CI = 1.04-3.12), and persistent both ADLs and IADLs disabilities (adjusted HR = 4.75, 95% CI = 2.19-10.31).

CONCLUSIONS

Older adults with persistent both ADLs and IADLs disabilities may be at a greater risk of DS. Meanwhile, those with relief should not be ignored for functional disability. Attention should be paid to psychological monitoring of older adults with a history of or current functional disability.

Uncovering unseen ties: a network analysis explores activities of daily living limitations and depression among Chinese older adults

Background

Chinese older adults frequently encounter limitations in activities of daily living (ADL) and experience depression. Prior research has not deeply explored the interconnectedness of these factors through network analysis.

Methods

The study utilized data from 2,137 older adults aged 65 and older, sourced from the 2018 China Health and Retirement Longitudinal Study (CHARLS). The ADL scale and CESD-10 were employed to assess ability to perform ADL and depression, respectively. We conducted network modeling and bridge expected influence (BEI) evaluations to investigate the relationships between these ADL and depression.

Results

Our network analysis revealed robust connections between ADL and depressive symptoms. Specifically, somatic symptoms emerged as significant predictors of depression risk with the highest BEI of 0.21, whereas positive symptoms exhibited a protective effect with the highest BEI of 0.13. Notably, toileting with the highest BEI of 0.04 among the ADL was identified as a pivotal node linking ADL to depression.

Conclusion

This study illuminated the complex interplay between ADL and depression in Chinese older adults, with toileting serving as a crucial connecting point. Our findings offer valuable insights that can inform efforts to enhance mental health and improve the quality of life for this population.

Association between hygiene environment, care needs, and depression among Chinese older adults: A cohort analysis from the CHARLS

Limited research has explored the link between functional dependency, care needs, and depression among older adults. This study aims to explore the association between dependency levels and depression among Chinese older adults, as well as examine the relationship between hygiene environment and these two factors. Data were obtained from the CHARLS 2011-2018. A total of 4871 individuals aged 60 years and older were included. Generalized estimating equations were employed for the analysis. A conceptual framework was established to longitudinally illustrate the pathway from hygiene environment to dependency levels to depression. Findings indicated higher dependency levels and poorer hygiene environments were associated with an increased risk of depression, with dependency serving as a mediator between hygiene environment and depression. Policymakers should prioritize improvements in rural sanitation and long-term care policies, healthcare providers should enhance depression screening and caregiver training, and clinicians should provide personalized interventions to better address mental health challenges.

Longitudinal association between handgrip strength and depressive symptoms in middle-aged and older Chinese adults: mediating role of functional limitation

Background

The relationship between handgrip strength (HGS) at baseline and subsequent depressive symptoms among middle-aged and older Chinese adults remains highly uncertain. This research endeavored to investigate the effect of functional limitation on the association between these two variables.

Methods

A total of 5,684 participants aged ≥45 years from the China Longitudinal Study of Health and Retirement (CHARLS) were enrolled, using data from the 2015 and 2018 waves. Functional limitation was evaluated based on participants' self-reported basic activities of daily living (BADL) and instrumental activities of daily living (IADL). Logistic regression models were utilized to analyze the relationship between HGS and subsequent depressive symptoms, and bootstrap analysis was performed to explore the potential mediating role of functional limitation.

Results

After adjusting for confounders, an inverse correlation was detected between HGS and functional limitation (B = -0.885, p < 0.001), a positive correlation was found between functional limitation and subsequent depressive symptoms (B = 1.054, p < 0.001). The mediated effect size of HGS on depressive symptoms through functional limitation was a*b = -0.933 (BCa 95% CI: -1.224, -0.642). Functional limitation had a significant impact on 18.9% of the overall association.

Conclusion

Among the Chinese middle-aged and senior population, functional limitation accounted for 18.9% of the connection between HGS and depressive symptoms. Interventions targeting the enhancement of muscle strength should be regarded as crucial elements for maintaining physical function and preventing depressive symptoms.

Racial-ethnic differences in the associations between functional disabilities and subsequent depression among community-dwelling midlife and older adults in the US

BACKGROUND

The intersection of race/ethnicity with disability is a critical dimension of mental health outcomes in later ages that remains under-investigated.

OBJECTIVE

We examined the role of race-ethnicity in moderating the associations between functional disabilities and subsequent depression among Americans 51 and older and stratified into the two age-groups of midlife (51-64) and older adults (≥65).

METHODS

Using a nationally representative sample of community-dwelling Americans (≥51; n = 7475) in the 2016-2018 Health and Retirement Study, we conducted bivariate and multivariable regression analyses. Racial-ethnic groups included non-Hispanic (NH) Black, Hispanic, and NH White and a binary (0/1) outcome defined subsequent depression in 2018. The total number of difficulties on the Nagi, Lawton, and Katz disability scales represented baseline (2016) functional disabilities with a secondary four-level (no/mild/severe with assistance/severe without assistance) disability indicator incorporated to examine the role of assistance with daily living.

RESULTS

Across age-groups, subsequent depression was significantly more prevalent among NH Whites with functional disabilities compared to counterparts reporting no disabilities. Compared to NH Black and Hispanic counterparts, midlife NH Whites were three times more likely to report subsequent depression with each unit increase in the functional disability score, after adjusting for covariates. However, we observed no such racial-ethnic differences among older adults. Among the 51+ severe with no assistance group, adjusted odds of subsequent depression among NH Whites was 2.5 times higher than minority counterparts.

CONCLUSION

Health programs and environmental adaptations supporting functional care needs in later ages could be beneficial for improving mental health of adults with disabilities.

Association between functional disability and mental health among Chinese older adults: Examining the moderating effects of social participation and physical exercise

BACKGROUND

Functional disability significantly burdens healthcare services, negatively affecting older adults' social interaction and quality of life. This study aims to identify the association between functional disability and mental health, and examine the moderating effects of social participation and physical exercise on the association.

METHODS

The data were drawn from 2018 wave of Chinese Longitudinal Healthy Longevity Survey, and ordinary least squares regression model was exploited to explore the association between functional disability and mental health.

RESULTS

Activity of daily living (ADL) disability negatively predicted mini-mental state examination (MMSE) score. Furthermore, social participation and physical exercise moderated the association between ADL disability and MMSE score.

CONCLUSION

The results highlight the importance of social participation and physical exercise for the older adults with ADL disability.

A Visualization Tool to Study Dyadic Caregiving Health Profiles

OBJECTIVES

Guided by a life course perspective and fundamental cause theory, this study aims to visualize co-trajectories of health between partners and examine how changes in one spouse's cognitive status can cohesively impact the health of the other spouse along three dimensions (functional, mental, and cognitive).

METHODS

Drawing longitudinal data from the Health and Retirement Study 2000-2016 (N = 3582), we measure women's health profiles by functional limitation (physical health), depression (mental health), and cognitive function (cognitive health). We use multivariate linear mixed models to summarize these paths in the same visual representation.

RESULTS

The approach provides a visualization tool that depicts data and model in the same spatial representation allowing assessment of model fit and comparison. This study advances the traditional life course studies by representing underlying processes as a multidimensional time vector of health outcomes.

DISCUSSION

The described approach provides a blueprint for studying complex health profiles or trajectories.

Psychosocial Well-Being Differences Between the Young Old, Old-Old, and Oldest Old: A Global Comparison

OBJECTIVES

We investigate global differences in psychosocial well-being between older adult age groups.

METHODS

Using multinomial logistic regression, we analyzed 2018 data (n = 93,663) from 9 countries/regions in the Health and Retirement Study international family of studies to compare age group differences in depression, loneliness, and happiness.

RESULTS

Compared to the young old, the old-old reported more depression in Southern Europe, while the oldest old had higher risk in India and Southern Europe but lower risk in the United States. The old-old reported less loneliness in the United States but more in Southern Europe, while the oldest old had greater risk in Southern Europe. The old-old reported less happiness in Korea, while the oldest old had lower reports in Korea but higher reports in the United States.

DISCUSSION

The psychosocial well-being of the oldest old is exceptionally good in the United States but exceptionally poor in Southern Europe.

Disparities in overall survival by varying duration of disability in activities of daily living in older people: A population-based cohort from Chinese Longitudinal Healthy Longevity Survey (CLHLS)

OBJECTIVES

To investigate the association between duration of disability in activity of daily living (ADL) and overall survival in older individuals.

DESIGN

A prospective cohort study.

SETTING

Community-based data from Chinese Longitudinal Healthy Longevity Survey.

PARTICIPANTS

In total, 13,560 participants without ADL disability and 2772 participants with ADL disability at baseline were included.

MEASUREMENTS

ADL disability was assessed using Katz index scale, which included six essential ADLs: dressing, bathing, transferring, toileting, continence, and eating. Dependence of each item was scored on a scale of 1, the maximum total score was 6. At baseline, duration of ADL disability was defined as the maximum duration among the six items. The study outcome was overall survival. Accelerated failure time models were constructed to investigate the association between duration of ADL disability and overall survival. Subgroup analyses by sex, age, and multimorbidites, as well as sensitive analyses were conducted.

RESULTS

During 81,868.7 person-years follow-up, 11,092 deaths were recorded. Overall, ADL disability was associated with lower overall survival compared to non-ADL disability. With duration of ADL disability extending, the overall survival strikingly dropped in the first 12 months, reaching its lowest point with adjusted time ratio (TR) at 0.66 (95%CI: 0.61-0.72, p < 0.001), then moderately grew until the 60th month, finally stayed constant thereafter. Participants with ADL scores of 1-3 had higher survival compared to those with scores of 4-6, and both groups followed a similar trend of varied survival to the whole cohort. Moreover, subgroup analyses and sensitivity analyses showed the robustness of these findings.

CONCLUSIONS

Our findings first address a golden time window for the older individuals with ADL disability. More attention should be given to them, especially in the first 12 months since diagnosis, to reduce mortality and extend the lifespan.

Association between activities of daily living and depressive symptoms among older adults in China: evidence from the CHARLS

Objective

The limitation of activities of daily living (ADL) affects the mental health of older adults. We distinguished activities of daily living into basic activities of daily living (BADL) and instrumental activities of daily living (IADL) and aimed to explore the relationship between the two limitations and depressive symptoms among Chinese older adults by using nationally representative cross-sectional data.

Methods

Data from the China Health and Retirement Longitudinal Study (CHARLS, wave 4) were used, and 9,789 older adults aged 60 years and above were screened. The 10-item Center for Epidemiologic Studies Depression (CES-D-10) scale was used to measure the depressive symptoms of older adults, and a 12-item scale for ADL was used to estimate functional limitations. Generalized linear mixed-effect models were employed to examine the relationship between BADL/IADL and depressive symptoms among older adults.

Results

The prevalence of high-risk depression among older adults was 43.5%, and the rates of limitation in BADL and IADL were 19.02 and 25.29%, respectively. The prevalence of high-risk depression significantly differed among subgroups of smoking, drinking, chronic diseases, duration of sleep, having social activities or not, and the type of medical insurance. Older adults with limited BADL or IADL were at a higher risk of depression than those without limitations of BADL or IADL; BADL (OR-adjusted = 2.71; 95% CI: 2.40-3.06) and IADL (OR-adjusted = 2.68; 95% CI: 2.41-2.98) had various influences on the risk of depression in older adults.

Conclusion

ADL was a related factor in the risk of depression among older adults in China. BADL and IADL had different effects on the risk of depression, suggesting that older adults with physical function limitations might be more likely to suffer from depression.

The mediating effects of social support and depressive symptoms on activities of daily living and social frailty in older patients with chronic heart failure

OBJECTIVES

To investigate the level of social frailty (SF) in older patients with chronic heart failure (CHF) and examine the mediating role of social support and depressive symptoms between activities of daily living and SF.

METHODS

Using a convenience sampling method, 205 older patients with CHF were recruited from China between November 2021 and May 2022. Activities of daily living, social support, depressive symptoms, and SF were assessed using a self-administered questionnaire. Data were analyzed using structural equation modeling.

RESULTS

The final model obtained a good fit. Activities of daily living in older patients with CHF were directly related to SF. The multiple mediation analysis revealed that the relationship between activities of daily living and SF was mediated by social support (effect: -0.010, 95% CI [-0.021, -0.003]) and depressive symptoms (effect: -0.011, 95% CI [-0.019, -0.005) separately, and serially (effect: -0.007, 95% CI [-0.012, -0.003).

CONCLUSIONS

Social support and depressive symptoms are multiple mediating variables in the relationship between activities of daily living and SF. Activities of daily living can improve patients' SF through social support and depressive symptoms.

Long-term functional ability trajectories and mental health among older people before and after the COVID-19 pandemic onset in Chile

OBJECTIVES

Despite the advances in understanding the complex association between functional abilities and mental health in old age, studies have overlooked two important aspects. First, traditionally, research has employed cross-sectional designs, measuring limitations at a single time point. Second, most gerontological studies on this field have been conducted before the COVID-19 pandemic onset. This study aims to explore the association between diverse long-term functional ability trajectories across late adulthood and old age, and older people's mental health in Chile, before and after the COVID-19 pandemic onset.

METHODS

We use data from the population-representative and longitudinal 'Chilean Social Protection Survey', sequence analysis to reconstruct functional ability trajectory types from 2004 to 2018, and bivariate and multivariate analyses to measure their association with depressive symptoms in early 2020 (N = 891) and late 2020 (N = 672). We analyzed four age groups defined by their age at baseline (2004): people aged 46-50, 51-55, 56-60, and 61-65.

RESULTS

Our findings indicate that erratic or equivocal patterns of functional limitations across time (with people transiting back and forth between low and high levels of limitations) show the worst mental health outcomes, both before and after the pandemic onset. Prevalence of people with depression increased after the COVID-19 onset in most groups, being particularly high among those with previous equivocal functional ability trajectories.

CONCLUSIONS

The relationship between functional ability trajectories and mental health calls for a new paradigm, moving away from age as the main policy guide, and highlighting the need to adopt strategies to improve population-level functional status as an efficient policy to address the challenges of population aging.

Association between functional disability and long-term trajectories of depressive symptoms: Evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

Prior research has suggested that functional disability was associated with increased risk of incident depressive symptoms in the elderly. However, little is known about the potential role of functional disability on the long-term trajectories of depressive symptoms among middle-aged and older Chinese adults.

METHODS

Data were drawn from the China Health and Retirement Longitudinal Study. A total of 8415 participants with up to four measurements of depressive symptoms assessed by the Center for Epidemiologic Studies Depression Scale (CESD) were included. Functional disability was evaluated by activities of daily living (ADLs) and instrumental ADLs (IADLs) at baseline. We identified the trajectories of depressive symptoms over 7-year follow-up using group-based trajectory modelling, and examined the association between functional disability and depressive symptom trajectories using multinomial logistic regression.

RESULTS

We identified four trajectories of depressive symptoms throughout the follow-up, characterized by maintaining a low CES-D score (low symptoms); maintaining a moderate CES-D score (moderate symptoms); increasing progressively and reaching a high CES-D score at the end of follow-up (increasing symptom); and increasing quickly and maintaining a high CES-D score (high symptoms). We found that participants with severe functional disability were at increased likelihood of being in the moderate (odds ratio [OR] = 2.27, 95% confidence interval [CI] 1.68-3.07), increasing (OR = 2.31, 95% CI 1.49-3.59), and high (OR = 4.74, 95% CI 3.07-7.31) depressive symptom trajectories.

LIMITATIONS

Depressive symptoms and functional disability were evaluated based on self-reported scales.

CONCLUSIONS

Our findings suggest that functional disability was associated with unfavorable depressive symptom trajectories among middle-aged and older Chinese adults.

Participating in Different Activities and Their Association with Mental Health Problems in the Working Disabled Population in Korea

Background: There are a large number of people suffering from disabilities and this number is rapidly rising. People with disabilities experience various hardships and are more vulnerable to mental health problems. Participating in different types of activities (e.g., leisure, social, etc.) has been shown to ameliorate people’s mental health problems such as stress and depression. The aim of this study was to assess the effects of leisure and social activities on the mental well-being of the working disabled population in Korea. Methods: A total of 1521 disabled people aged between 15 and 64 were included in the study. The degree of participation in leisure (i.e., weekends or weekdays) and social activities, as well as stress and depressive symptoms, were measured using single-item questions. The association between participation in different activities (i.e., leisure and social) and mental health (i.e., stress and depression) was analyzed using a generalized estimating equation (GEE) model. Results: In the fully adjusted model, participation in leisure activities was associated with the level of stress, and less leisure participation was significantly associated with higher odds of stress. For example, in the “2 or fewer hours” group (odds ratio [OR] = 1.461, 95% confidence interval [CI] = 1.193–1.789) with the “5 h or more” group used as the reference for weekdays and the “5–9 h” group (OR = 1.223, 95% CI = 1.007–1.486) with the “10 h or more” group used as the reference for weekends. In terms of participation in social activities, increased participation was associated with lower levels of depression. For example, in the “Very much” group (OR = 0.314, 95% CI = 0.156–0.633) compared to the “Not at all” group. Conclusions: Participation in different activities was associated with better mental health outcomes in the working disabled population in Korea.

Prevalence and factors associated with comorbid depressive symptoms among people with low back pain in China: A cross-sectional study

BACKGROUND

Low back pain is a common medical condition among the general population that is associated with many adverse health effects when comorbid with depressive symptoms. However, little is known about depressive symptoms in the population with low back pain in China. Our study evaluated the prevalence of depressive symptoms and analyzed the factors associated with this condition in the Chinese population with low back pain.

METHODS

We conducted a cross-sectional analysis of data from the 2018 China Health and Retirement Longitudinal Study. We collected low back pain information for each participant and identified depressive symptoms using the brief version of the Center for Epidemiologic Studies Depression Scale. A wide range of sociodemographic and health-related characteristics of the subjects were extracted. We measured the prevalence of depressive symptoms comorbid with low back pain and analyzed the associated factors by multiple logistic regression.

RESULTS

A total of 5,779 respondents aged 45 and over with low back pain formed the sample, 41.8% of whom reported depressive symptoms. Multiple logistic regression analysis indicated greater vulnerability to depressive symptoms among females (OR = 1.41, 95% CI, 1.16-1.73), relatively younger persons (60-74 years: OR = 0.72, 95% CI, 0.63-0.83; ≥ 75 years: OR = 0.62, 95% CI, 0.49-0.79, reference: 45-59 years), those from the central and western regions (central: OR = 1.39, 95% CI, 1.18-1.64; western: OR = 1.56, 95% CI, 1.33-1.83), participants with extremely short sleep duration (OR = 2.74, 95% CI, 2.33-3.23), those with poor self-perceived health status (OR = 2.91, 95% CI, 2.34-3.63,), multisite pain (OR = 1.54, 95% CI, 1.20-1.98) and disability in activities of daily living (Basic: OR = 1.70, 95% CI, 1.47-1.98; Instrumental: OR = 1.95, 95% CI, 1.70-2.24).

CONCLUSION

Depressive symptoms were highly prevalent in the Chinese population ≥ 45 years with low back pain. More attention should be paid to the individuals at high-risk confirmed by this study to facilitate early identification and intervention against depressive symptoms.

Association between Ambient Fine Particulate Matter and Physical Functioning in Middle-aged and Older Chinese Adults: A Nationwide Longitudinal Study

BACKGROUND

Exposure to air pollution is associated with several chronic diseases and subclinical processes that could subsequently contribute to physical disability. However, whether and to what extent air pollution exposure is associated with objective measures of physical functioning remains understudied.

METHODS

We used longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) and included 10,823 participants who were surveyed at least twice. Annual average exposure to fine particulate matter (PM2.5) was assessed using a state-of-the-art estimator. Physical functioning was assessed with four objective tests covering hand-grip strength, balance, repeated chair stands, and gait speed. Mixed-effects models with participants as a random term were used to estimate associations with multiple adjustments.

RESULTS

We found a significant and robust association between exposure to increased PM2.5 and the reduction in hand-grip strength and balance ability. Each 10-μg/m 3 increase in annual averaged concentrations of PM2.5 was associated with a 220-g (95% confidence interval [CI]: 127, 312 g) reduction in hand-grip strength per 60 kg of body weight and a 5% risk (95% CI: 2, 7) of reduced balance ability. The estimated effect of each 10-μg/m 3 increase in PM2.5 on hand-grip strength and balance ability was equivalent to the effect of aging [1.12 (95% CI: 0.76, 1.48) and 0.98 (95% CI: 0.50, 1.50) years, respectively].

CONCLUSIONS

PM2.5 may be differentially associated with various dimensions of physical functioning. Improving air quality can prevent physical disability.

The relationship between depressive symptoms and activity of daily living disability among the elderly: results from the China Health and Retirement Longitudinal Study (CHARLS)

OBJECTIVE

The acceleration of population aging has brought an unprecedented impact on China's health system. This study is designed to examine the association between depressive symptoms and activity of daily living disability among the elderly in China.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS). The 10-item Center for Epidemiologic Studies-Depression (CES-D) scale was used to access depressive symptoms, and physical function was assessed by the Activity of Daily Living (ADL) scale. Multivariate logistic regression was used to assess the association between depressive symptoms and ADL among the elderly.

RESULTS

Based on a sample of 5863 elderly people over 60 years old, our results showed that 1999 elderly people are with depressive symptoms, accounting for 34.1%. The mean score of ADL among the elderly with depressive symptoms (20.65 ± 7.14) was much higher than that in those without depressive symptoms (17.40 ± 4.87). After controlling potential confounders, multivariate logistic regression showed that ADL and its specific domains including personal care, transfer, medical care, household, and managing money were associated with depressive symptoms.

CONCLUSION

This cross-sectional study provides evidence of the association between depressive symptoms and ADL disability among the Chinese elderly. As a result, prevention or reduction of ADL disability may have a positive effect on the medical care of the elderly with depressive symptoms.

The reciprocal relationship between depression and disability in low-income homebound older adults following tele-depression treatment

OBJECTIVES

Research has shown ample evidence for reciprocity between depression and disability. We examined whether decreases in disability among low-income, homebound older adults who received brief depression treatments were mediated by improvement in depressive symptoms and vice versa and whether the mediation effects varied by treatment modality.

METHODS

In a 3-arm randomized clinical trial, 277 low-income homebound individuals aged 50+ participated in behavioral activation tele-delivered by bachelor's-level lay counselors (Tele-BA), problem-solving therapy tele-delivered by licensed clinicians (Tele-PST), or telephone support calls (attention control). Depressive symptoms were assessed with the 24-item Hamilton Rating Scale for Depression and disability with the 12-item World Health Organization Disability Schedule 2.0. Along with mediation models, mediation was assessed controlling for autoregressive and contemporaneous effects.

RESULTS

Mediation models showed evidence of postintervention disability and depression mediating each other in separate mediation models. In the cross-lagged model, in which autoregressive and contemporaneous effects were included, only the depression-to-disability path exhibited mediation. There was no evidence of difference between Tele-BA and Tele-PST. Although the temporal precedence of treatment conditions on the outcomes is apparent, we could not establish a temporal precedence between disability and depression as these two measures exhibited parallel improvement.

CONCLUSIONS

Brief depression treatments for low-income homebound older adults were effective in reducing both depression and disability among these disabled older adults. The importance of this study lies in the comparable effects of Tele-BA and Tele-PST. Lay-counselor model is a promising alternative to clinician-delivered psychotherapy for growing numbers of homebound older adults.

Depression symptoms and quality of life in patients receiving renal replacement therapy in Jordan: A cross-sectional study

Patients with chronic illnesses, such as those with chronic kidney disease (CKD) that are undergoing renal replacement therapy (RRT), face significant psychological changes. This descriptive cross-sectional research was carried out to investigate the factors that influence depressive symptoms and quality of life (QoL) in patients with end-stage renal disease. Data were collected from 70 participants undergoing RRT using a self-reported questionnaire that included sociodemographic information, depressive symptoms, disease status, and QoL. The Beck Depression Inventory-II (BDI-II) screening scale was used to measure depressive symptoms and the SF-36 (Medical Outcome Survey-Short Form 36) was used to assess QoL. Participants in the study rated their depressive symptoms as 'minimum (44.3%), 'mild' (20%), 'moderate' (21.4%), and 'severe (14.3%). Furthermore, a shorter duration of dialysis and comorbid conditions were significantly associated with the development of depressive symptoms. Patients on RRT for a longer period of time had lower physical activity scores than patients on dialysis for a shorter period of time. Male participants have a higher mental QoL than female participants, suggesting that the mental aspect of renal disease is less impaired than the physical aspect. The findings of this study are expected to increase awareness of RRT therapy targets and enhance patient outcomes.

The Longitudinal Associations between Physical Health and Mental Health among Older Adults

OBJECTIVES

This study examines the lead-lag relationship between physical and mental health among older adults.

METHOD

Data are collected from 16,417 older adults aged 50 years and older participating in the biannual Health and Retirement Study (HRS). Participants were assessed on up to 11 measurement points over a 21-year period from 1994 to 2014. Physical health was measured as a composite of chronic diseases, functional limitations, and difficulties in basic and instrumental activities of daily living. Mental health was measured with the modified CES-D. Bivariate latent change score models (BLCSM) were estimated.

RESULTS

Both physical and mental health declined in the observed years, with slower declining rates over time. A reciprocal relationship emerged, with the prior level of physical health acting as the leading indicator of subsequent change in mental health, and the prior mental health state acting as the leading indicator of subsequent changes in physical health. Additionally, the influence of physical health on mental health changes was larger than the corresponding effect of mental health on subsequent physical health.

CONCLUSION

This study demonstrates the reciprocal relationship between physical and mental health in later adulthood and highlights the need to pay attention to the mental health of older people with physical health problems.

Multimorbidity and Mental Health: The Role of Gender among Disease-Causing Poverty, Rural, Aged Households in China

(1) Background: The association between multimorbidity and mental health is well established. However, the role of gender in different populations remains unclear. Currently, China is facing an increased prevalence of multimorbidity, especially in its disease-causing poverty population. The present study explores the gender-based differences in the relationship between multimorbidity and mental health using data from the rural, disease-causing poverty, older-age population in Shandong province, China, as a case study. (2) Methods: The data were obtained from the survey on the health and welfare of disease-causing poverty households in rural Shandong province. We identified 936 rural participants who were over 60 years old from disease-causing poverty households. The mental health status was measured using the Kessler Psychological Distress Scale (K10) instrument. Using a multivariable linear regression model, including the interaction of gender and multimorbidity, gender differences in the association between multimorbidity and mental health were explored. (3) Results: Multimorbidity was a serious health problem in rural, disease-causing poverty, older-age households, with the prevalence of multimorbidity estimated as 40% for women and 35.4% for men. There was a strong association between multimorbidity and mental health, which was moderated by gender. Women had higher K10 scores than men, and the mean K10 score was highest in women with three or more chronic diseases. Compared with men, women with multimorbidity had a higher risk of mental health problems. (4) Conclusions: The prevalence of multimorbidity in older-age rural disease-causing poverty subpopulations is a severe public health problem in China. The association between multimorbidity and mental health differed by gender, where multimorbid women suffered an increased mental health risk compared with men. Gender differences should be addressed when delivering effective physical and mental healthcare support to disease-causing poverty, older-age, rural households.

Late-Life Depressive Symptoms Are Associated With Functional Impairment Cross-sectionally and Over Time: Results of the AgeMooDe Study

OBJECTIVES

This study examines the relationship between late-life depressive symptoms, cognitive and functional impairment in a cohort of very old community-based participants.

METHODS

A sample of 1,226 primary care patients was assessed at baseline (Mage = 80.6 years). Statistical analyses were conducted using baseline and 12-month follow-up data.

RESULTS

At baseline, depressed participants showed minor cognitive deficits compared with nondepressed participants, whereas functional deficits were pronounced. Depressive symptoms and global cognition were not associated longitudinally. In contrast, follow-up functional impairment was predicted by baseline level and increase of depressive symptoms between baseline and follow-up. Reversely, follow-up depressive symptoms were predicted by functional decline between baseline and follow-up, whereas baseline functional status was not predictive.

DISCUSSION

Depressive symptoms and global cognitive function were not associated longitudinally, but level and increase of depressive symptoms over time predicted functional impairment after 1 year. Interventions to reduce depressive symptoms, or to encourage coping strategies might be promising to reduce functional impairment. Elevated follow-up depressive symptoms were only predicted by functional decline, supposedly emphasizing that incident functional impairment might be associated with an acute increase of depressive symptoms. Psychological adjustment processes were not examined, but might be targeted in future.

Major depressive disorder and impaired health-related quality of life among US older adults

OBJECTIVES

To examine the association of current and past major depressive disorder (MDD) and measures of health-related quality of life (HRQOL) in a nationally representative sample of older adults.

METHODS

Cross-sectional analysis of the 2012 to 2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III (NESARC-III) was used. NESARC-III is a nationally representative health interview survey on substance use and mental health in the US, and we limited our sample to survey respondents aged 65 or older (n = 5806 unweighted). Using DSM-5 criteria, we identified older adults with current MDD, past MDD (ie, prior but not current MDD), and no history of MDD. Using standardized algorithms, we also constructed HRQOL measures: mental component summary (MCS), physical component summary (PCS), and quality-adjusted life years (QALYs). We performed multivariable-adjusted linear regression analyzes to assess the associations of MDD types with HRQOL measures while adjusting for socio-demographics and clinical co-morbidities.

RESULTS

Overall, 14.4% of the older adults, representative of 6.0 million nationwide, met criteria for lifetime MDD. About 2.2 million older adults (5.4%) had current MDD and 3.7 million older adults (9.0%) had past MDD. Older adults with current or past MDD had a moderate difference in HRQOL measures compared with never depressed (Cohen's d measures ranging from -1.02 to -0.07). When controlling for other covariates, MCS and QALYs measures were lowest in the current MDD group.

CONCLUSION

Current MDD is associated with significantly lower HRQOL than never MDD, while adults with past MDD had minor (often insignificant) residual impairment in HRQOL.

Frailty and depression: Reciprocal influences or common causes?

BACKGROUND

Previous research demonstrated substantial associations between frailty and depression in late life, but it remains unclear whether this relationship is best explained by reciprocal influences of these variables or by common causes. This study investigated the interdependencies between frailty and depression across time by examining cross-lagged effects within individuals, while accounting for variability in baseline levels and long-term development between individuals.

METHODS

We modeled longitudinal data from six panel waves gathered in the Survey of Health, Ageing and Retirement in Europe, covering a time period of up to 14 years. The total sample size was N = 58,152 individuals aged 50 years or older. Frailty was based on a deficit accumulation frailty index and depressive symptoms were measured with the EURO-D scale. We used a latent curve model with structured residuals for statistical analysis.

RESULTS

The results did not demonstrate relevant cross-lagged effects of frailty and depression at the within-person level. However, within-person increases in frailty were accompanied by within-person increases in depression at the same point in time. At the between-person level, it showed that individuals with higher levels and steeper trajectories in frailty also tend to show higher levels and steeper trajectories in depression.

CONCLUSION

These findings question the notion that frailty and depression reciprocally influence each other over the course of time, but rather indicate that frailty and depression might be both affected by common causes, in both the short and the long term.

Vocal pattern detection of depression among older adults

Depression is a serious problem for many older adults but is too often undetected by the person, family or providers. Although vocal patterns have been successfully used to detect and predict depression in adults aged 18 to 65 years, no studies to date have included older adults. The study purpose was to determine whether vocal patterns associated with clinical depression in younger people also signify depression in older adults. An observational, repeated measures design was used to enroll 46 volunteer older adults who completed a semi-structured interview composed the 9-item Patient Health Questionnaire or PHQ-9 depression scale and selected speech measures. Recorded interviews were analysed by machine learning algorithms to evaluate whether vocal patterns may predict presence of depression in older adults. In this study, using the PHQ-9 and a supervised machine learning algorithm accurately predicted high and low depression scores between 86% and 92% of the time. Change in raw PHQ-9 scores between interview cycles was predicted within 1.17 points. These results provide strong and promising evidence that vocal patterns can be used effectively to detect clinical depression in adults who are 65 years and older.

Association of the cumulative burden of late-life anxiety and depressive symptoms with functional impairment

OBJECTIVES

This study investigates the association of the cumulative burden of anxiety-only, depression-only, and comorbid anxiety and depression symptoms with (a) incident self-care or household activities impairment among those with no baseline self-care or household activities impairment, respectively, or (b) change in status of self-care or household activities impairment among those with baseline impairment.

METHODS

This study consists of participants (N = 4619) from the National Health and Aging Trends Study, a longitudinal study that examines a nationally representative sample of US adults aged 65 years and older. Outcomes included incident or change in self-care or household activity impairment. Primary independent variables were yearly counts of screening positive for clinically significant symptoms for anxiety-only, depression-only, or co-occurring anxiety and depression. Multivariable logistic regression models examined incident impairment and change in impairment status.

RESULTS

Yearly counts of anxiety-only symptoms were associated with incident impairment in self-care and household activities and less improvement in self-care functioning. Yearly counts of depression-only symptoms were associated with incident impairment in self-care and household activities. Yearly counts of co-occurring symptoms of anxiety and depression were associated with incident impairment in self-care and household activities, less improvement in self-care activities, and worsening impairment in household activities.

CONCLUSIONS

This study finds that the cumulative burden of co-occurring anxiety and depression symptoms is associated with incident impairment in functioning, persistent self-care impairment, and deterioration in household activity impairment. These findings emphasize the importance of managing late-life anxiety and depressive symptoms, which are treatable, frequently co-occur, and contribute to disability.

Disability type, depression, and antidepressants use among older adults in the United States

Objectives: The study aimed to estimate the prevalence of depression and antidepressant use among older adults with different types of disability.Methods: The study sample consisted of 32,193 adults 50 years and older who participated in the Adult Functioning and Disability supplement of the National Health Interview Survey from 2010-2014. Logistic regression was used to estimate depressive symptoms and self-reported antidepressant use by disability type.Results: One in ten participants reported feeling depressed daily or weekly, and less than half of them reported using antidepressants. Adults with a disability in cognition (odds ratio [OR] = 5.55), mobility (OR = 1.92), vision (OR = 1.91), hearing (OR = 1.88), and self-care (OR = 1.66) were more likely to often feel depressed. Antidepressant use was higher among those with cognition and self-care disability compared with no disabilities. A dose-response association existed between the number of disabilities and depression (AOR = 2.3) and antidepressant use (AOR = 1.39).Conclusions: Various forms of disability are strongly associated with depression in older adults. Antidepressants may be underutilized among older adults with certain impairments, including vision, hearing, and mobility. Future research needs should elucidate the mechanisms linking different disabilities to depression and aim to develop treatments tailored to the needs of older adults with disabilities.

Physical injury and depression in six low- and middle-income countries: A nationally representative study

BACKGROUND

Studies on the association between physical injury and depression in low- and middle-income countries (LMICs) are scarce. Therefore, our goal was to analyze the association between physical injury and depression using nationally representative data from six LMICs.

METHODS

Cross-sectional data from the Study on Global Ageing and Adult Health (SAGE) survey (2007-2010) were analyzed (N = 42,489). Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Any injury in our analysis referred to having experienced traffic injury or other injury in the past 12 months. Multivariable logistic regression analysis and meta-analyses were used to assess associations.

RESULTS

Overall, the prevalence of depression was higher among those who had any injury compared to those without injuries (9.0% vs. 3.7%). Compared to having no injury, any injury without disability was associated with a 1.72 (95%CI=1.18-2.50) times higher odds for depression, while the odds for injury with disability was much higher (OR =3.81; 95%CI=2.16-6.73). The pooled estimate (OR) for the association between any injury and depression based on a meta-analysis using country-wise estimates was 3.28 (95%CI = 1.71-6.31) and a moderate level of between-country heterogeneity was observed (I² = 63.1%).

LIMITATIONS

Causality or temporal associations cannot be established due to the cross-sectional nature of the study.

CONCLUSIONS

Personalized mental health care to victims of physical injury may reduce risk for depression. Treating disability as the result of injuries may also be effective in the prevention of depressive disorders.

Association between activities of daily living disability and depression symptoms of middle-aged and older Chinese adults and their spouses: A community based study

BACKGROUND

Little is known about the impact of activities of daily living (ADL) disability on personal and spouse depression symptoms among Chinese.

METHODS

We used data from the baseline and 2013 follow-up surveys of the China Health and Retirement Longitudinal Study, a nationally representative survey in 17,708 adults aged 45 years and older, to evaluate cross-sectional and prospective association between ADL disability and depression symptoms of subjects and their spouses. The derived basic ADL scale (BADL) and the Center for Epidemiologic Studies Depression Scale short form were utilized to assess ADL disability and depressive symptoms, respectively. Logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI), adjusting for depression risk factors and taking into account the complex survey design and response rate.

RESULTS

There were 15,890 subjects included in the study. Prevalence of baseline depression symptoms was 29.5% (95%CI 27.9-31.1%), 58.0% (95%CI 54.5-61.4%) and 73.6% (95%CI 70.4-76.8%) in subjects with BADL scores of 0, 1 and ≥2, respectively, and 27.0% (95%CI 25.3-28.7%), 34.2% (95%CI 30.0-38.4%) and 43.8% (95%CI 39.1-48.5%) in subjects without ADL disability while having spouses with BADL scores of 0, 1 and ≥2, respectively. Prospectively, BADL score ≥2 was associated with higher risk of depression symptoms of subjects (OR 1.63, 95% CI 1.03-2.57) and their spouses (OR 1.50, 95% CI 1.01-2.22).

LIMITATIONS

Bias might be introduced because of observational study design, and findings may not be generalizable to younger population.

CONCLUSIONS

ADL disability might have potential to increase risk of depression symptoms of middle-aged and older Chinese adults and their spouses.

Racial/Ethnic Contrasts in the Relationships between Physical Disability, Perceived Discrimination, and Depressive Symptoms

INTRODUCTION

The systematic deprivation of equal access to valued opportunities has greatly harmed the disadvantaged. Discrimination, whether it is based on gender, race, sexual orientation, or physical health exacts a high toll. This is especially true with respect to the role of race and equality in the USA today. This paper attempts to evaluate the significance of perceived discrimination among a multiethnic sample of physically disabled and non-disabled study participants.

METHODS

We employ survey data from a community-based multiethnic sample of study participants to assess whether physical disability increases perceptions of discrimination across racial/ethnic groups. Additionally, we assess whether physical disability impacts the relationship between discrimination and depressive symptoms and whether this relationship is consistent across race/ethnicity.

RESULTS

Descriptive and multivariate analyses indicate that disabled whites and Hispanics report higher levels of discrimination than their non-disabled counterparts. However, this pattern was not observed among black respondents who report high levels of discrimination regardless of their disability status. OLS models indicate that among Hispanics, physical disability moderates the relationship between discrimination and depressive symptoms. Among black and white study participants, physical disability does not moderate this relationship.

CONCLUSION

Taken together, the results demonstrate the continuing significance of race as a source of discrimination and a health risk.

Disability in prison activities of daily living and likelihood of depression and suicidal ideation in older prisoners

OBJECTIVE

The study objective was to determine if disability in activities of daily living specific to prison, prison activities of daily living (PADLs), is associated with depression and severity of suicidal ideation (SI) in older prisoners, a rapidly growing population at high risk of suicide.

METHODS

Cross-sectional design using data from a study of prisoners age ≥50 years (N = 167). Depression was operationalized as a score of ≥15 on the 9-item Physician Health Questionnaire (PHQ-9). SI severity was assessed using the Geriatric Suicide Ideation Scale (GSIS). Participants were considered to have PADL disability if they reported any of the following as "very difficult" or "cannot do:" dropping to the floor for alarms, climbing on/off the top bunk, hearing orders, walking while wearing handcuffs, standing in line for medications, and walking to chow. Associations were examined with bivariate tests and with multivariable logistic and linear regression models, and the interaction term gender × PADL disability was tested.

RESULTS

PADL disability was associated with depression and SI severity. There was no main effect of gender on either depression or SI, yet the association between PADL disability and depression was considerably stronger in male than in female older prisoners.

CONCLUSIONS

Identifying older prisoners who have difficulty performing PADLs may help distinguish prisoners who may also be likely to be depressed or experience more severe SI. Furthermore, the association between PADL disability and depression may be particularly salient in older male prisoners. Longitudinal studies are needed as causal inferences are limited by the cross-sectional design. Copyright © 2016 John Wiley & Sons, Ltd.

The longitudinal relationship between mental health disorders and chronic disease for older adults: a population-based study

OBJECTIVE

Although mental health disorders in older adults are common, their relationship with chronic disease and the influence of chronic disease on the development of mental health disorders over time is not well understood. This longitudinal study investigated the change in status of mental health disorders and chronic disease, as well as their interrelationships, over time.

METHODS

Participants included community-dwelling older adults living in Taiwan, aged 65 years or older, who completed six waves of survey interviews. Mental health disorders were scored using the Short Psychiatric Evaluation Schedule, and chronic disease(s) status was recorded during consecutive biennial data collection waves. The autoregressive latent trajectory model and parallel latent growth curve model were used for data analysis.

RESULTS

The study findings suggest that in older people pre-existing mental health disorders and/or chronic disease(s) will predispose them to developing significantly more mental health disorders and/or chronic diseases respectively. The study findings also suggest that pre-existing mental health disorders can significantly contribute to the development of chronic disease over time, and that pre-existing chronic disease(s) significantly can contribute to the development of mental health disorders over time, indicating a reciprocal interrelationship.

CONCLUSIONS

Our study findings suggest that it in addition to monitoring and treating chronic disease(s) in older people, it is also important to monitor and treat their mental health disorders. Doing so will result in overall better health outcomes and will facilitate a better quality of life as they age. Copyright © 2016 John Wiley & Sons, Ltd.

Disentangling the complex relation of disability and depressive symptoms in old age - findings of a multicenter prospective cohort study in Germany

BACKGROUND

Most of the previous studies attempted to disentangle the relationship between disability and depressive symptoms were limited to observation periods of only few years. Moreover, evidence is missing regarding the complex co-occurrence of disability and depressive symptoms in old age in Germany. In order to close the research gap, we aimed at disentangling the complex co-occurrence of disability and depressive symptoms in old age in Germany over a longer time frame.

METHODS

Based on data from a representative survey of the German general population aged 75 years and older, the course of disability as well as depressive symptoms was observed every 1.5 years over six waves. While disability was quantified by the Lawton and Brody Instrumental Activities of Daily Living scale, the Geriatric Depression Scale was used to measure depressive symptoms. Taking into account the complex co-occurrence of depressive symptoms and disability, a panel vector autoregressive model was used. By taking the first differences, unobserved heterogeneity was taken into account.

RESULTS

In the total sample and in both sexes, we revealed a robust positive association between an initial change in depressive symptoms and subsequent changes in disability. No robust association between an initial change in disability and a subsequent change in depressive symptoms was detected.

CONCLUSION

Our findings highlight the importance of changes in depressive symptoms for future changes in disability in old age.

Incidence, risk, and associated factors of depression in adults with physical and sensory disabilities: A nationwide population-based study

BACKGROUND

Physical disability has been associated with the risk of depression. We examined the incidence, risk, and associated factors of depression in Taiwanese adults with physical/sensory disabilities.

METHODS

Two national databases were used to retrospectively analyze 749,491 ≥20-year-old Taiwanese with physical/sensory disabilities in 2002-2008. The incidence of depression was analyzed by univariate Poisson regression. Risk factors of depression were followed up through 2014 and examined with a Cox proportional hazards model.

RESULTS

Among the study subjects, the incidence of depression was 6.29 per 1000 person-years, with 1.83 per 1000 person-years corresponding to major depression. The subjects' depression risk was affected by disability type, disability severity, gender, age, education, marital status, aboriginal status, monthly salary, residence urbanization level, and Charlson comorbidity index (CCI). Subjects with rare diseases, mild disability, female gender, age 35-44 years, a high school education level, divorced/widowed status, non-aboriginal status, a NT$22,801-28,800 monthly salary, a highly urbanized residence area, or a CCI≥3 were at higher risk for depression.

CONCLUSIONS AND IMPLICATIONS

Adults with physical/sensory disabilities have a 3.7-fold higher incidence of depression than the general population. Social services departments and family members should take extra measures toward preventing and treating depression in this subpopulation.

One size fits all? Applying theoretical predictions about age and emotional experience to people with functional disabilities

The current study examined whether commonly observed age differences in affective experience among community samples of healthy adults would generalize to a group of adults who live with significant functional disability. Age differences in daily affect and affective reactivity to daily stressors among a sample of participants with spinal cord injury (SCI) were compared with a noninjured sample. Results revealed that patterns of affective experience varied by sample. Among noninjured adults, older age was associated with lower levels of daily negative affect, higher levels of daily positive affect, and less negative affective reactivity in response to daily stressors. In contrast, among the sample with SCI, no age differences emerged. Findings, which support the model of Strength and Vulnerability Integration, underscore the importance of taking life context into account when predicting age differences in affective well-being.

The association between higher social support and lower depressive symptoms among aging services clients is attenuated at higher levels of functional impairment

OBJECTIVE

Adults seeking services from the Aging Services Provider Network (ASPN) are at risk for depression. ASPN clients also have high prevalence of both functional impairments and social morbidities. Study of the relationships between these factors may inform the development of interventions for depression in this service setting.

METHODS

We interviewed 373 older adults accessing ASPN services and assessed depression symptom severity, functional impairment (instrumental activities of daily living and activities of daily living), and social support.

RESULTS

Lower social support and greater functional impairment were associated with greater depressive symptoms. At a high level of functional impairment, the inverse associations between indices of social support and depressive symptoms were attenuated.

CONCLUSIONS

Results suggest that older adults with more severe functional impairment may benefit somewhat less from increased social support with respect to depression symptom severity.

Disability, caregiver's dependency and patterns of access to rehabilitation care: results from a national representative study in Peru

PURPOSE

To determine the prevalence of disability in Peru, explore dependency on caregiver's assistance and assess access to rehabilitation care.

METHOD

Data from Disability National Survey (ENEDIS), including urban and rural areas, were analyzed. Disability was defined as a permanent limitation on movement, vision, communication, hearing, learning/remembering or social relationships. Dependency was defined as the self-reported need for a caregiver to help with daily activities; and access to rehabilitation care was defined as the self-report of any therapy for disabilities. Estimates and projections were calculated using sample strata, primary sampling units and population weights, and prevalence ratios (PRs) and 95%CI were reported.

RESULTS

From 798,308 people screened, 37,524 (5.1%; 95%CI 4.9--5.2%) had at least one disability. A total of 37,117 were included in further analysis, mean age 57.8 (SD ± 24.1) years, 52.1% women. Dependency was self-reported by 14,980 (40.5%; 95%CI: 39.2-41.9%) individuals with disabilities. A family member, usually female, was identified as a caregiver in 94.3% (95%CI: 93.3-95.3%) of dependent participants. Only 2881 (10.7%; 95%CI: 9.7-11.9%) of people with disabilities reported access to rehabilitation care. Major inequality patterns of disability burden versus access to rehabilitation care were observed by age and education level. Older age groups had higher disability burden yet lower chances of access to rehabilitation care. Conversely, the higher the education level, the lesser the overall disability burden but also the higher chances of reporting receiving care. Private healthcare insurance doubled the probability of having access to rehabilitation compared with those without insurance.

CONCLUSIONS

Approximately 1.6 million Peruvians have at least one disability, and 40% of them require assistance with daily activities. Informal caregiving, likely female and relative-provided, is highly common. Rehabilitation care access is low and inequitable. Our results signal a major need to implement strategies to guarantee the highest standard of health care for people with disabilities.

IMPLICATIONS FOR REHABILITATION

Major inequality patterns in terms of burden of disability versus access to rehabilitation care were observed: those groups who concentrate more disability reported receiving less rehabilitation care. Caregiving is mostly informal and provided by a direct relative, mainly a woman, who resigned to their usual activities in order to help care for the person with disability. As a result, there is a need to develop appropriate support and training for caregivers. Access to care services in Peru is low and inequitable, but especially for people with disabilities: they experience greater barriers when accessing healthcare services even in the case of having health insurance.

Association of depression with sexual and daily activities: a community study of octogenarian men

OBJECTIVE

To determine the association between clinically significant depressive symptoms, routine function, and sexual interest and practice in a community-derived sample of octogenarian men.

METHODS

Cross-sectional study of 1,649 community-dwelling men aged 80 years or over with no history of terminal illnesses or neurodegenerative diseases. Men with Patient Health Questionnaire (PHQ-9) scores greater than or equal to 10 were deemed to be clinically depressed. Scores between 5 and 9 were considered indicative of subthreshold depression. We used standard procedures to collect self-reported sociodemographic, lifestyle, and clinical data, as well as basic and instrumental activities of daily living, and a structured questionnaire to ask men about their 12-month interest in sex, frequency, past experiences, and current sexual problems.

RESULTS

121 men (7.3%) had clinically significant depression and 239 (14.5%) had subthreshold depression. Depressive symptoms were associated with difficulties in basic and instrumental activities of daily living, but not with sexual practice. Decreased interest in sex and anxiety before sex were associated with subthreshold depression. Clinically significant depressive symptoms were independently and positively associated with past history of diabetes (odds ratio [OR]: 2.1, 95% confidence interval [CI]: 1.1-4.0), depression (OR: 9.0; 95% CI: 4.6-17.3), impaired ability to groom (OR: 3.7, 95% CI: 1.2-11.0), carry out heavy housework duties (OR: 2.4, 95% CI: 1.1-5.1), manage finances (OR: 2.5, 95% CI: 1.1-5.7), or engage in leisure activities (OR: 4.1, 95% CI: 2.0-8.2).

CONCLUSIONS

Ability to function effectively at home, financial autonomy, and leisure are associated with clinically significant depression in octogenarian men. Maintaining daily function and autonomy may be a suitable target for interventions that aim to reduce the prevalence and incidence of depression in older age.

Disability transitions in the oldest old in the general population. The Leiden 85-plus study

Transitions between disability states in older people occur frequently. This study investigated predictors of disability transitions in the oldest old and was performed in the Leiden 85-plus study, a population-based prospective cohort study among 597 participants aged 85 years. At baseline (age 85 years), data on sociodemographic characteristics and chronic diseases were obtained. Disabilities in basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were measured annually for 5 years with the Groningen Activities Restriction Scale (GARS). Mortality data were obtained. A statistical multi-state model was used to assess the risks of transitions between no disabilities, IADL disability, BADL disability, and death. At baseline, 299 participants (50.0 %) were disabled in IADL only, and 155 participants (26.0 %) were disabled in both BADL and IADL. During 5-year follow-up, 374 participants (62.6 %) made >1 transition between disability states, mostly deterioration in disability. Males had a lower risk of deterioration [hazard ratio (HR), 0.75 (95 % CI, 0.58-0.96)] compared to females. No gender differences were observed for improvement [HR, 0.64 (95 % CI, 0.37-1.11)]. Participants with depressive symptoms were less likely to improve [HR, 0.50 (95 % CI, 0.28-0.87)]. Participants with depressive symptoms [HR, 1.46 (95 % CI, 1.12-1.91)], >1 chronic disease [HR, 1.60 (95 % CI, 1.27-2.01)], and with cognitive impairment [HR, 1.60 (95 % CI, 1.20-2.13)] had the highest risk of deteriorating. Disability is a dynamic process in the oldest old. Deterioration is more common than improvement. Older men are less likely to deteriorate than women. The presence of depressive symptoms, chronic disease, and cognitive impairment predicts deterioration.

Depression in the elderly with visual impairment and its association with quality of life

Background

Visual impairment is more prevalent in the elderly and depression is common in this population. Although many studies have investigated depression or quality of life (QOL) in older adults with visual impairment, few have looked at the association between these two concepts for this population. The aim of this systematized review was to describe the association between depression and QOL in older adults with visual impairment.

Methods

A search was done using multiple electronic databases for studies addressing the relationship between QOL and depression in elders with visual impairment. The concept of QOL was divided into two different approaches, ie, QOL as achievement and QOL as subjective well-being. Comparison of QOL scores between participants with and without depression (Cohen’s d) and correlations between depression and QOL (Pearson’s r) were examined.

Results

Thirteen studies reported in 18 articles were included in the review. Nearly all of the studies revealed that better QOL was moderately to strongly correlated with less severe depressive symptoms (r = 0.22–0.68 for QOL as achievement; r = 0.68 and 0.72 for QOL as subjective well-being). Effect sizes for the QOL differences between the groups with and without depression ranged from small to large (d = 0.17 to 0.95 for QOL as achievement; no data for QOL as subjective well-being).

Conclusion

Additional studies are necessary to pinpoint further the determinants and mediators of this relationship. Considering the high prevalence rate of depression in this community and its disabling effects on QOL, interventions to prevent and treat depression are essential. More efforts are needed in clinical settings to train health care practitioners to identify depressed elders with visual impairment and provide appropriate treatment.

Prevalence and correlates of disability in a late middle-aged population of women

OBJECTIVE

This study estimates the prevalence of disability among late middle-aged women and identifies important correlates of disability among this population.

METHOD

Disability was assessed among 376 participants of the Michigan Study of Women's Health Across the Nation cohort at the 2011 follow-up using the World Health Organization Disability Assessment Schedule. Demographic and health measures were related to disability status using logistic regression models (none or mild vs. moderate, severe, or extreme disability).

RESULTS

Nearly 25% of women reported moderate to extreme global disability. African American race/ethnicity, economic strain, peripheral neuropathy, and depressive symptomatology were associated with global disability. Obesity, knee osteoarthritis, and hypertension were only associated with disability for the mobility domain (getting around).

DISCUSSION

The prevalence of disability is relatively high among this population of late middle-aged women. Efforts to prevent or forestall disability should be extended to include middle-aged populations as they may be most amenable to intervention.