Depression predicts mortality in the young old, but not in the oldest old: results from the Berlin Aging Study

Assessment of depression and anxiety in young and old with a question-based computational language approach

Middle aged adults experience depression and anxiety differently than younger adults. Age may affect life circumstances, depending on accessibility of social connections, jobs, physical health, etc, as these factors influence the prevalence and symptomatology. Depression and anxiety are typically measured using rating scales; however, recent research suggests that such symptoms can be assessed by open-ended questions that are analysed by question-based computational language assessments (QCLA). Here, we study middle aged and younger adults' responses about their mental health using open-ended questions and rating scales about their mental health. We then analyse their responses with computational methods based on natural language processing (NLP). The results demonstrate that: (1) middle aged adults describe their mental health differently compared to younger adults; (2) where, for example, middle aged adults emphasise depression and loneliness whereas young adults list anxiety and financial concerns; (3) different semantic models are warranted for younger and middle aged adults; (4) compared to young participants, the middle aged participants described their mental health more accurately with words; (5) middle-aged adults have better mental health than younger adults as measured by semantic measures. In conclusion, NLP combined with machine learning methods may provide new opportunities to identify, model, and describe mental health in middle aged and younger adults and could possibly be applied to the older adults in future research. These semantic measures may provide ecological validity and aid the assessment of mental health.

Mood disorders increase mortality mainly through dementia: A community-based prospective cohort study

OBJECTIVE

The effects of mood disorders on mortality may be mediated by their effects on the risk of dementia, and interventions to reduce the occurrence of dementia may reduce their overall mortality. This study aimed to investigate the direct effects of depressive and bipolar disorders on the 6-year risk of mortality and also their indirect effects on mortality due to their effect on the risk of dementia.

METHODS

A total of 5101 Koreans were selected from a community-based prospective cohort study, and 6-year risks of mortality and dementia in participants with depressive and bipolar disorders were estimated by Cox proportional hazard analysis. The direct and indirect effects of depressive and bipolar disorders on the risk of mortality were estimated using structural equation modeling.

RESULTS

The depressive and bipolar disorder groups showed 51% and 85% higher 6-year mortality, and 82% and 127% higher risk of dementia, respectively, compared to euthymic controls. The effects of depressive and bipolar disorders on mortality were mainly mediated by their effects on the risk of dementia in a structural equation model. The direct effects of each mood disorder on mortality were not significant.

CONCLUSION

Both depressive and bipolar disorders increased the risks of mortality and dementia, and the effects of mood disorders on mortality were mainly mediated through dementia. As dementia occurs later in life than mood disorders, measures to prevent it may effectively reduce mortality in individuals with a history of mood disorders, as well as being more feasible than attempting to control other causes of death.

Social Resources as Compensatory Cognitive Reserve? Interactions of Social Resources With Education in Predicting Late-Life Cognition

OBJECTIVE

Access to social relationships has been linked with better cognitive performance. We examined whether social resources interact with education to predict cognitive outcomes, which could indicate that social resources fulfill a compensatory role in promoting cognitive reserve.

METHOD

We applied multilevel growth models to 6-wave, 13-year longitudinal data from the Berlin Aging Study (aged 70-103 years at first occasion; M = 84.9 years, 50% women) and have taken into account key individual difference factors, including sociodemographic variables, medically diagnosed comorbidities, and depressive symptoms. To account for possible reverse causality, analyses were conducted on a subset of the BASE participants without dementia (n = 368), and in follow-up analyses with the full sample (n = 516) using wave-specific longitudinal assessments of probable dementia status as a covariate.

RESULTS

Larger networks were associated with better performance on tests of perceptual speed and verbal fluency, but did not interact with education, providing little support for a compensatory reserve hypothesis. An interaction of education with emotional loneliness emerged in the prediction of perceptual speed, suggesting that the educational divide in speed was minimal among people who reported lower levels of loneliness.

DISCUSSION

We discuss our results in the context of differential implications of social resources for cognition and consider possible mechanisms underlying our findings.

Morbidity and mortality in very old individuals with subsyndromal depression: an 8-year prospective study

OBJECTIVES

Both morbidity and mortality are elevated for individuals with subsyndromal depression (SSD) compared to non-depression (ND) in those of younger ages, but scientific studies are scarce for very old individuals. The aim of this study was therefore to compare the morbidity and mortality in very old individuals with SSD and ND.

DESIGN AND SETTING

An 8-year prospective population-based study was undertaken on 85-year-old individuals in Sweden.

MEASUREMENTS

Data were collected from postal questionnaires and clinical assessments at baseline, after 1, 5, and 8 years. Depressive symptoms were measured with Geriatric Depression Scale and the results were classified into ND, SSD, and syndromal depression. Mortality was investigated using multivariable cox regressions, and variables of morbidity were investigated using linear mixed models.

RESULTS

Compared to ND, in people with SSD, mortality was elevated in the univariate regression, but this association vanished when controlling for relevant covariates. Morbidity was elevated with regard to basic activities of daily living (ADLs), instrumental ADLs, loneliness, self-perceived health, and depressive symptoms for individuals with SSD compared to ND, whereas cognitive speed, executive functions, and global cognitive function were not significantly impaired when adjusting for covariates.

CONCLUSIONS

SSD among very old individuals is longitudinally associated with elevated morbidity but not mortality, when controlling for relevant covariates. Considering the high prevalence of SSD and the demographic development of increasing numbers of very old people, the findings highlight the need to develop clinical and societal strategies to prevent SSD and associated negative outcomes.

Predictive Accuracy of Frailty Tools for Adverse Outcomes in a Cohort of Adults 80 Years and Older: A Decision Curve Analysis

OBJECTIVES

To compare the predictive performance of 3 frailty identification tools for mortality, hospitalization, and functional decline in adults aged ≥80 years using risk reclassification statistics and decision curve analysis.

DESIGN

Population-based, prospective cohort.

SETTING

BELFRAIL study, Belgium.

PARTICIPANTS

560 community-dwelling adults aged ≥80 years.

MEASUREMENTS

Frailty by Cardiovascular Health Study (CHS) phenotype, Longitudinal Aging Study Amsterdam (LASA) markers, and Groeningen Frailty Indicator (GFI); mortality until 5.1 ± 0.25 years from baseline and hospitalization until 3.0 ± 0.25 years; and functional status assessed by activities of daily living at baseline and after 1.7 ± 0.21 years.

RESULTS

Frailty prevalence was 7.3% by CHS phenotype, 21.6% by LASA markers, and 22% by GFI. Participants determined to be frail by each tool had a significantly higher risk for all-cause mortality and first hospitalization. For functional decline, only frail by GFI had a higher adjusted odds ratio. Harrell 's C-statistic for mortality and hospitalization and area under receiver operating characteristic curve for functional decline were similar for all tools and <0.70. Reclassification statistics showed improvement only by LASA markers for hospitalization and mortality. In decision curve analysis, all tools had higher net benefit than the 2 default strategies of "treat all" and "treat none" for mortality risk ≥20%, hospitalization risk ≥35%, and functional decline probability ≥10%, but their curves overlapped across all relevant risk thresholds for these outcomes.

CONCLUSIONS AND IMPLICATIONS

In a cohort of adults aged ≥80 years, 3 frailty tools based on different conceptualizations and assessment sources had comparable but unsatisfactory discrimination for predicting mortality, hospitalization, and functional decline. All showed clinical utility for predicting these outcomes over relevant risk thresholds, but none was significantly superior. Future research on frailty tools should include a focus on the specific group of adults aged ≥80 years, and the predictive accuracy for adverse outcomes of different tools needs a comprehensive assessment that includes decision curve analysis.

Adolescent socioeconomic status and depressive symptoms in later life: Evidence from structural equation models

BACKGROUND

The complex association between socioeconomic status (SES) and depressive symptoms is not entirely understood and the existing literature does not address the relationship between early-life SES and later-life depression from a life-course perspective, incorporating mediating events.

METHODS

Using data from the Wisconsin Longitudinal Study, we employed structural equation modeling to examine how SES measured at age 18 affects depressive symptoms at age 54 directly and through mediating variables college graduation, marriage, and household income level at age 36.

RESULTS

The total effect of adolescent SES on later-life depressive symptoms is largely mediated through college graduation. Our final model was driven by the effects of women. The variables contributing most to depressive symptoms in women were the direct effect of being raised in a home with a low SES and the indirect effect of low adolescent SES mediated through non-completion of college.

LIMITATIONS

Cohort was exclusively comprised of white, high school graduates born in 1939 (± 2 years). In our analysis we assume that missing values are missing at random (MAR); however, attrition both from death (excluded from our population) and from non-response could be associated with depression, i.e. missing not at random (MNAR).

CONCLUSIONS

This study demonstrates the impact of completion of college, particularly among women, and supports the social mobility hypothesis to explain the relationship between adolescent socioeconomic circumstances and late-life health.

Effect of pulsed magnetic stimulation on quality of life of female patients with stress urinary incontinence: an IDEAL-D stage 2b study

INTRODUCTION AND HYPOTHESIS

We evaluated the effects of pulsed magnetic stimulation (PMS) on overall and different aspects of quality of life (QoL) in female patients with stress urinary incontinence (SUI).

METHODS

This study involved 120 female SUI subjects aged ≥21 years old randomized to either active or sham PMS. Treatment involved two PMS sessions per week for 2 months (16 sessions). After 2 months, subjects could opt for 16 additional sessions regardless of initial randomization. The primary response criterion was a 7-point reduction in the total score of the International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol) questionnaire. Follow-ups were conducted at months 1, 2, 5, 8, and 14.

RESULTS

At 2 months, 35 out of 60 (58%) subjects in the active arm and 21 out of 60 (21%) in the sham arm were treatment responders (≥7-point reduction) (p = 0.006). There was a significant difference in changes in the mean ± SE ICIQ-LUTSqol total score between the active and sham arms (M_diff = -8.74 ± 1.25 vs -4.10 ± 1.08, p = 0.006). At 1-year post-treatment, regardless of number of PMS sessions (16 or 32 sessions), subjects who received active PMS (63 out of 94, 67%) were more likely to be treatment responders compared with subjects who did not receive any active PMS (3 out of 12, 25%; p < 0.001). The impact of PMS treatment was the greatest on the "physical activities" domain.

CONCLUSIONS

PMS resulted in significant short- and long-term improvements in overall and various physical, social, and psychological aspects of QoL.

Increased mortality among people with anxiety disorders: total population study

BACKGROUND

Anxiety disorders and depression are the most common mental disorders worldwide and have a striking impact on global disease burden. Although depression has consistently been found to increase mortality; the role of anxiety disorders in predicting mortality risk is unclear.

AIMS

To assess mortality risk in people with anxiety disorders.

METHOD

We used nationwide Danish register data to conduct a prospective cohort study with over 30 million person-years of follow-up.

RESULTS

In total, 1066 (2.1%) people with anxiety disorders died during an average follow-up of 9.7 years. The risk of death by natural and unnatural causes was significantly higher among individuals with anxiety disorders (natural mortality rate ratio (MRR) = 1.39, 95% CI 1.28-1.51; unnatural MRR = 2.46, 95% CI 2.20-2.73) compared with the general population. Of those who died from unnatural causes, 16.5% had comorbid diagnoses of depression (MRR = 11.72, 95% CI 10.11-13.51).

CONCLUSIONS

Anxiety disorders significantly increased mortality risk. Comorbidity of anxiety disorders and depression played an important part in the increased mortality.

Impact of loneliness and depression on mortality: results from the Longitudinal Ageing Study Amsterdam

BACKGROUND

Loneliness is highly prevalent among older people, has serious health consequences and is an important predictor of mortality. Loneliness and depression may unfavourably interact with each other over time but data on this topic are scarce.

AIMS

To determine whether loneliness is associated with excess mortality after 19 years of follow-up and whether the joint effect with depression confers further excess mortality.

METHOD

Different aspects of loneliness were measured with the De Jong Gierveld scale and depression with the Centre for Epidemiologic Studies Depression Scale in a cohort of 2878 people aged 55-85 with 19 years of follow-up. Excess mortality hypotheses were tested with Kaplan-Meier and Cox proportional hazard analyses controlling for potential confounders.

RESULTS

At follow-up loneliness and depression were associated with excess mortality in older men and women in bivariate analysis but not in multivariate analysis. In multivariate analysis, severe depression was associated with excess mortality in men who were lonely but not in women.

CONCLUSIONS

Loneliness and depression are important predictors of early death in older adults. Severe depression has a strong association with excess mortality in older men who were lonely, indicating a lethal combination in this group.

The association between blood lead level and clinical mental disorders in fifty thousand lead-exposed male workers

BACKGROUND

While there has been research into the relationship between blood lead (BPb) level and mental disorders, there have been few investigations that use clinically diagnosed mental disorders in the adult population with a retrospective cohort study design. Hence, our study investigated the association between BPb level and risk of clinically diagnosed mental disorders.

METHODS

The data of male workers exposed to lead (Pb; n=54,788) were collected from annual Pb associated medical check-ups from 2000 to 2004 in Korea. The workers' hospital admission histories due to mental disorders (International Classification of Diseases, 10th revision, F00-F99) were used to identify clinically diagnosed mental disorders. After merging the data, the hazard ratio (HR) with a 95% confidence interval (95% CI) was calculated by survival analysis using the Cox proportional hazards model according to the quartile level of BPb (1st quartile<4.10 μg/dl, 2nd quartile<6.04 μg/dl, 3rd quartile<10.00 μg/dl, and 4th quartile≥10 μg/dl).

RESULTS

In a total of 54,788 workers, there were 223 admission cases of mental disorders (F00-F99) during the follow-up period. The HR (95% CI) of total mental and behavioral disorders (F00-F99) was 1.63 (1.12-2.39) in the 4th quartile group compared to the HR of the 1st quartile group after adjusting for age. The HR (95% CI) of the 4th quartile group was 2.59 (1.15-5.82) for mood (affective) disorders (F30-F39).

LIMITATION

The hospital admission data, not outpatient data, were used for current study while almost affective disorder treated at outpatient clinic level.

CONCLUSION

Our study highlighted that Pb exposure can cause clinical mental disorders that require hospital admission in adult male workers. Our relatively large sample size strengthens the evidence of the association between BPb level and risk of clinically diagnosed mental disorders.

High morale is associated with increased survival in the very old

BACKGROUND

high morale is defined as future-oriented optimism. Previous research suggests that a high morale independently predicts increased survival among old people, though very old people have not been specifically studied.

OBJECTIVE

to investigate whether high morale is associated with increased survival among very old people.

SUBJECTS

the Umeå 85+/GErontological Regional DAtabase-study (GERDA) recruited participants aged 85 years and older in northern Sweden and western Finland during 2000-02 and 2005-07, of whom 646 were included in this study.

METHODS

demographic, functional- and health-related data were collected in this population-based study through structured interviews and assessments carried out during home visits and from reviews of medical records. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale.

RESULTS

the 5-year survival rate was 31.9% for participants with low morale, 39.4% for moderate and 55.6% for those with high morale. In an unadjusted Cox model, the relative risk (RR) of mortality was higher among participants with low morale (RR = 1.86, P < 0.001) and moderate morale (RR = 1.59, P < 0.001) compared with participants with high morale. Similar results were found after adjustment for age and gender. In a Cox model adjusted for several demographic, health- and function-related confounders, including age and gender, mortality was higher among participants with low morale (RR = 1.36, P = 0.032) than those with high morale. There was a similar but non-significant pattern towards increased mortality in participants with moderate morale (RR = 1.21, P value = 0.136).

CONCLUSION

high morale is independently associated with increased survival among very old people.

Effects of an Evidence-Based Falls Risk-Reduction Program on Physical Activity and Falls Efficacy among Oldest-Old Adults

Purpose of the study

The current study was designed to examine changes in falls efficacy and physical activities among oldest-old and young-old participants in a falls risk-reduction program called a matter of balance/volunteer lay leader model.

Design and methods

An oldest-old group (aged 85 years and older; n = 260) and a young-old group (aged between 65 and 84 years old; n = 1,139) in Texas with both baseline and post-intervention measures were included. Changes in Falls Efficacy Scale scores and weekly physical activity levels were examined from baseline to post-intervention. Repeated measures analysis of covariance were employed to assess program effects on falls efficacy.

Results

Results showed significant changes in falls efficacy from baseline to post-intervention, as well as a significant interaction effect between time (baseline and post-intervention) and physical activity on falls efficacy.

Implications

Findings from this study imply the effectiveness of evidence-based programs for increasing falls efficacy in oldest-old participants. Future implications for enhancing physical activities and reducing fear of falling for oldest-old adults are discussed.

Explanatory factors for the increased mortality of stroke patients with depression

OBJECTIVE

To identify explanatory factors for the association between depression and increased mortality up to 5 years after stroke.

METHODS

In this cohort study, data from the South London Stroke Register (1998-2013) were used. Patients (n = 3,722) were assessed at stroke onset. Baseline data included sociodemographics and stroke severity. Follow-up at 3 months included assessment for depression with the Hospital Anxiety and Depression Scale (scores ≥7 = depression). Associations between depression at 3 months and mortality within 5 years of stroke were estimated with Cox regression models adjusted for age, sex, ethnicity, and stroke severity, and subsequently adjusted for possible explanatory factors for the association. These factors, introduced into the model individually, included comorbidities at baseline, smoking and alcohol use, compliance with medication, treatment with selective serotonin reuptake inhibitors (SSRIs), social support, and activities of daily living at 3 months.

RESULTS

A total of 1,354 survivors were assessed at 3 months: 435 (32.1%) had depression and 331 (24.4%) died within 5 years. Survivors with depression had a greater risk of mortality (hazard ratio [HR] 1.41 [95% confidence interval (CI) 1.13-1.77]; p = 0.002). The association between depression and mortality was strongest in patients younger than 65 years. Adjustment for comorbidities, smoking and alcohol use, SSRI use, social support, and compliance with medication did not change these associations. SSRIs started after stroke were associated with higher mortality, independently of depression at 3 months (HR 1.72 [95% CI 1.34-2.20]; p < 0.001).

CONCLUSION

Depression after stroke is associated with higher mortality, particularly among younger patients. Stroke survivors taking SSRIs have an increased mortality. The association between depression and mortality is not explained by other individual medical factors.

Effect of successful aging on mortality in older individuals: The PALA study

The definition of successful aging and identification of predictors have been extensively reviewed, less attention however, has been given to the role of this condition on mortality.

Cognition and psychopathology in nonagenarians and centenarians living in geriatric nursing homes in Switzerland: a focus on anosognosia

BACKGROUND

The number of nonagenarians and centenarians is rising dramatically, and many of them live in nursing homes. Very little is known about psychiatric symptoms and cognitive abilities other than memory in this population. This exploratory study focuses on anosognosia and its relationship with common psychiatric and cognitive symptoms.

METHODS

Fifty-eight subjects aged 90 years or older were recruited from geriatric nursing homes and divided into five groups according to Mini-Mental State Examination scores. Assessment included the five-word test, executive clock-drawing task, lexical and categorical fluencies, Anosognosia Questionnaire-Dementia, Neuropsychiatric Inventory, and Charlson Comorbidity Index.

RESULTS

Subjects had moderate cognitive impairment, with mean ± SD Mini-Mental State Examination being 15.41 ± 7.04. Anosognosia increased with cognitive impairment and was associated with all cognitive domains, as well as with apathy and agitation. Subjects with mild global cognitive decline seemed less anosognosic than subjects with the least or no impairment. Neither anosognosia nor psychopathological features were related to physical conditions.

CONCLUSIONS

Anosognosia in oldest-old nursing home residents was mostly mild. It was associated with both cognitive and psychopathological changes, but whether anosognosia is causal to the observed psychopathological features requires further investigation.

Normal Aging or Depression? A Qualitative Study on the Differences Between Subsyndromal Depression and Depression in Very Old People

PURPOSE OF THE STUDY

The aim of this study was to make a qualitative comparison of experiences of being in very old people with subsyndromal depression (SSD), in relation to the experiences of very old people with syndromal depression or nondepression. Through investigation and deeper understanding of the interface between depressive disease and normal aging, clinicians might give more accurate prevention or treatment to those very old persons who need such help.

DESIGN AND METHODS

Semistructured qualitative interviews were conducted for 27 individuals of 87-88 years of age, who were categorized in the 3 strata of nondepressive, SSD, and syndromal depression. Transcripts were analyzed using qualitative content analysis within each stratum and later with a comparison between the strata.

RESULTS

The content analysis resulted in 4 themes in people with SSD, as defined by a self-report depression screening instrument, giving a comprehensive picture of SSD in very old people, and also showed qualitative differences between the SSD, syndromal depression, and nondepressive groups. A main finding was that SSD differs qualitatively from syndromal depression but not clearly from nondepression.

IMPLICATIONS

The results might indicate that SSD in very old people is not related to pathology but to normal aging, even though the condition correlates with negative health parameters. Overlooking certain psychosocial aspects of living in the very old may pose a risk of both underdiagnosis and overdiagnosis in the spectrum of depressive disorders.

Animal-assisted therapy and agitation and depression in nursing home residents with dementia: a matched case-control trial

OBJECTIVES

To investigate the efficacy of animal-assisted therapy (AAT) on symptoms of agitation/aggression and depression in nursing home residents with dementia in a randomized controlled trial. Previous studies have indicated that AAT has beneficial effects on neuropsychiatric symptoms in various psychiatric disorders but few studies have investigated the efficacy of AAT in patients suffering from dementia.

METHODS

Of 65 nursing home residents with dementia (mean [standard deviation] age: 81.8 [9.2] years; mean Mini-Mental State Examination score: 7.1 [0.7]), 27 matched pairs (N = 54) were randomly assigned to either treatment as usual or treatment as usual combined with AAT, administered over 10 weekly sessions. Blinded raters assessed cognitive impairment with the Mini-Mental State Examination, presence of agitation/aggression with the Cohen-Mansfield Agitation Inventory, and depression with the Dementia Mood Assessment Scale at baseline and during a period of 4 weeks after AAT intervention.

RESULTS

In the control group, symptoms of agitation/aggression and depression significantly increased over 10 weeks; in the intervention group, patients receiving combined treatment displayed constant frequency and severity of symptoms of agitation/aggression (F1,48 = 6.43; p <0.05) and depression (F1,48 = 26.54; p <0.001). Symptom amelioration did not occur in either group.

CONCLUSIONS

AAT is a promising option for the treatment of agitation/aggression and depression in patients with dementia. Our results suggest that AAT may delay progression of neuropsychiatric symptoms in demented nursing home residents. Further research is needed to determine its long-time effects.

Validation of the Whooley questions and the Beck Depression Inventory in older adults

OBJECTIVE

To analyse the psychometric properties of the Whooley questions and the 21-item Beck Depression Inventory (BDI-21) in older adults with depression and chronic health problems.

DESIGN

A population-based study.

SETTING

Community.

SUBJECTS

474 adults, aged 72-73 years, living in the city of Oulu, Finland.

MAIN OUTCOME MEASURES

The screening parameters of the Whooley questions and the BDI-21 for detecting major depression.

RESULTS

The prevalence of major depression according to the DSM-IV was 5.3% (single or recurrent episode) obtained by the Mini Neuropsychiatric Interview (MINI). The BDI-21 was best able to identify a current episode of major depression with a cut-off point of 11. The sensitivity and specificity of this cut-off point were 88.0% (95% confidence interval (95% CI) 68.8-97.5) and 81.7% (95% CI 77.8-85.2), respectively. The area under the receiver operating characteristics (ROC) curve was 0.89 (95% CI 0.83-0.96). The two Whooley screening questions had a sensitivity of 62.5% (95% CI 40.6-81.2) and either screening question plus the help question had a sensitivity of 66.7% (44.7-84.4).

CONCLUSIONS

The Beck Depression Inventory is a valid instrument for the diagnosis of depression in older adults. As a screening measure, the optimal cut-off score should be 11 or higher. Our results indicate that the sensitivity of the Whooley questions is not high enough to be used as a screening scale among the elderly.

Oldest Old Long-Term Care Recipients

The purpose of this study was to examine socio-demographic and health characteristics of the oldest old receiving services from three types of long-term care (LTC) providers. About 45% of nursing home residents in 2004 and 22% of home health care patients and 38% of discharged hospice care patients in 2007 were 85 years and older. The oldest old across the three LTC settings were predominantly White and women. More than two thirds of oldest old nursing home residents, home health care patients, and discharged hospice care patients needed assistance in performing three or more activities of daily living (ADLs) and were bladder incontinent. Hypertension and heart disease were the two most common chronic health conditions that the oldest old LTC recipients had across the care settings. Results provide a baseline that can be used to make comparisons with other new and emerging LTC providers like residential care and home care.

Association between the prevalence of depression and age in a large representative German sample of people aged 53 to 80 years

OBJECTIVE

The aim of the study was to determine the association between the prevalence of clinically significant depression and age in a large representative sample of elderly German people.

METHODS

In the second follow-up (2005-2007) of the ESTHER cohort study, the 15-item geriatric depression scale (GDS-15) as well as a sociodemographic and clinical questionnaire were administered to a representative sample of 8270 people of ages 53 to 80 years. The prevalence of clinically significant depression was estimated using a GDS cut-off score of 5/6. Prevalence rates were estimated for the different age categories. Association between depression and age was analyzed using logistic regression, adjusted for gender, co-morbid medical disorders, education, marital status, physical activity, smoking, self-perceived cognitive impairment, and anti-depressive medication.

RESULTS

Of the participants, 7878 (95.3%) completed more than twelve GDS items and were included in the study. The prevalence of clinically significant depression was 16.0% (95%CI = [15.2; 16.6]). The function of depression prevalence dependent on age group showed a U-shaped pattern (53-59: 21.0%, CI = [18.9; 23.3]; 60-64: 17.7%, CI = [15.7; 19.7]; 65-69: 12.6%, CI = [11.2; 14.0]; 70-74: 14.4%, CI = [12.6; 16.0]; 75-80: 17.1%, CI = [14.9; 19.4]). Adjusted odds ratios showed that the chances of being depressive decrease with the age category but remain relatively stable for people aged 65 and over.

CONCLUSIONS

The prevalence of depression in the elderly seems to be associated with the age category. Adjusted odds ratios showed that people aged 60 and older had lower chances of being depressive than people aged 53 to 59 years.

The combination of depressive symptoms and smoking shorten life expectancy among the aged

BACKGROUND

Depression is a potential risk factor for mortality among the aged and it is also associated with other chronic diseases and unhealthy lifestyles that may also affect mortality. The purpose of this study was to investigate the association between depressive symptoms and mortality, controlling for health, nutritional status, and life-style factors.

METHODS

A cohort of elderly people (N = 167) was followed-up for ten years. Information on socio-demographic characteristics, medical history, smoking, and alcohol consumption was collected. The primary outcome was all-cause mortality; the secondary outcome was cancer-specific mortality. The Geriatric Depression Scale (GDS-15) was used to assess depression. Using a multivariable Cox proportional hazards regression, we examined the association between depressive symptoms and mortality.

RESULTS

Elderly people with depression (scoring above the depression cut-off of 7) had a 53% increased risk of mortality (relative risk (RR) 1.53; 95%CI: 1.05-2.24) compared to non-depressed subjects. The combination of depressive symptoms with smoking was associated with a particularly higher risk of mortality (RR: 2.61; 95%CI: 1.28-5.31), after controlling for potential confounders.

CONCLUSIONS

Depressive symptoms are associated with a significantly increased risk of all-cause mortality. The combination of depressive symptoms and smoking shorten life expectancy among the aged.

The contribution of depression to mortality among elderly with self-reported hypertension: analysis using a national representative longitudinal survey

OBJECTIVE

Previous research has suggested that hypertension and depression are two of the important causes of mortality among the elderly. This study aims to test the contribution of depression to mortality among elderly with self-reported hypertension.

METHODS

This research used data from the Survey of Health and Living Status of the Middle Age and Elderly (SHLS) conducted by the Bureau of Health Promotion, Department of Health in Taiwan. The 1989, 1996, 1999, 2003, and 2007 waves were used. In total, 3736 respondents aged 60 or above were analyzed. Participants were grouped by status of hypertension and depression. The contribution of depression to mortality among elderly with self-reported hypertension was estimated using Cox proportional hazard model. Analyses were separated into younger elderly individuals (<70 years) and older elderly individuals (≥ 70 years).

RESULTS

In the full model, the hazard ratios for mortality for the groups of not hypertensive/depressed, hypertensive/not depressed, and hypertensive/depressed were 1.12 [95% confidence interval (CI) 0.98-1.28], 1.32 (95% CI 1.19-1.46), and 1.54 (95% CI 1.29-1.83), respectively, compared with the reference group of not hypertensive/not depressed. The pattern remained the similar after separating the participants into the two age groups. However, much higher hazard ratios were observed for the older cohort.

CONCLUSION

Depression contributes significantly to the hypertension-mortality relationship for the elderly. For the elderly, hypertension should be tackled along with depression in order to reduce the mortality associated with hypertension.

Prevalence of health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites

BACKGROUND

The oldest old represent a unique group of older adults. This group is rapidly growing worldwide and yet there are gaps in the knowledge related to their health condition. Ethnic differences in disease prevalence and mortality must be understood to better care for the oldest old.

OBJECTIVE

To compare prevalence of common health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites.

METHODS

This study included 568 community-dwelling Mexican Americans (MA) aged 85 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly 2004-2005 and 933 non-Hispanic whites (NHW) of the same age from the Health and Retirement Study 2004. Measures included sociodemographic variables, self-reported medical conditions, activities of daily living (ADLs), and instrumental activities of daily living. Logistic regression analysis was used to examine 2-year mortality in both populations.

RESULTS

Heart attack was significantly more prevalent in oldest old NHW compared with MA, regardless of gender. Conversely, diabetes was significantly more prevalent among MA men and women compared with their NHW counterparts. Compared with NHW men, MA men had significantly higher prevalence of cognitive impairment and hypertension. Additionally, prevalence of hip fracture was significantly higher for MA women compared with NHW women. Significant differences in ADL disability were observed only between both groups of women, whereas significant differences in instrumental activities of daily living disability were observed only between men. MA men and women had higher prevalence of obesity compared with NHW. Predictors of 2-year mortality for both ethnic groups included older age, male gender, and ADL disability. Cognitive impairment was a mortality predictor only for NHW. Similarly, lung disease was a predictor only for MA.

CONCLUSION

Health-related conditions that affect the oldest old vary by gender and ethnicity and entail careful evaluation and monitoring in the clinical setting. Better care requires inclusion of such differences as part of the comprehensive evaluation of the oldest old adults.

A comorbid anxiety disorder does not result in an excess risk of death among patients with a depressive disorder

BACKGROUND

Several studies have demonstrated increased mortality associated with depression and with anxiety. Mortality due to comorbidity of two mental disorders may be even more increased. Therefore, we investigated the mortality among patients with depression, with anxiety and with both diagnoses.

METHODS

By linking the longitudinal Psychiatric Case Register Middle-Netherlands, which contains all patients of psychiatric services in the Utrecht region, to the death register of Statistics Netherlands, hazard ratio's of death were estimated overall and for different categories of death causes separately.

RESULTS

We found an increased risk of death among patients with an anxiety disorder (N=6919): HR=1.45 (95%CI: 1.25-1.69), and among patients with a depression (N=14,778): HR=1.83, (95%CI: 1.72-1.95), compared to controls (N=103,824). The hazard ratios among both disorders combined (N=4260) were similar to those with only a depression: HR=1.91, (95% CI: 1.64-2.23). Among patients with a depression, mortality across all important disease-related categories of death causes (neoplasms, cardiovascular, respiratory, and other diseases) and due to suicide was increased, without an excess mortality in case of comorbid anxiety.

LIMITATIONS

The presented data are restricted to broad categories of patients in specialist services. No data on behavioral or intermediate factors were available.

CONCLUSIONS

Although anxiety is associated with an increased risk of death, the presence of anxiety as comorbid disorder does not give an additional increase in the risk of death among patients with a depressive disorder. The increased mortality among patients with depression is not restricted to suicide and cardiovascular diseases, but associated with a broad range of death causes.

Risk of coronary heart disease events over 15 years among older adults with depressive symptoms

OBJECTIVES

To determine whether depression status is associated with an increased risk of coronary heart disease (CHD) events, defined as CHD death or nonfatal acute myocardial infarction (MI).

DESIGN

Prospective cohort study.

SETTING

An urban primary care practice.

PARTICIPANTS

Two thousand seven hundred twenty-eight adults (71.4% women, 65.5% black), age 60 years and older, who were screened for depression between 1991 and 1993.

MEASUREMENTS

Depressive symptom severity at baseline was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Data regarding baseline demographic and clinical variables, as well as laboratory evidence of acute MI, were obtained from an electronic medical record system. All-cause mortality and CHD death were determined from the National Death Index through 2006.

RESULTS

A total of 423 (15.5%) participants reported elevated symptoms of depression (CES-D score ≥16). During the 13 to 16 years of follow-up, 1,646 (60.3%) individuals died from any cause, and 727 (26.6%) died from CHD or suffered an acute MI. Cox proportional hazards models revealed that individuals with elevated depressive symptoms were more likely to experience a CHD event, even after adjustment for demographics and comorbid health conditions (relative risk = 1.46, 95% confidence interval: 1.20-1.77). Depression status was also a significant predictor of all-cause mortality in adjusted models.

CONCLUSIONS

We report the longest prospective study to date to examine depression status as an independent risk factor for CHD among a cohort of older adults including large numbers of women and underrepresented minorities. The present findings underscore the need to consider depression as a common and modifiable risk factor for CHD events among older adults.

Income and the midlife peak in common mental disorder prevalence

BACKGROUND

The prevalence of psychological distress and common mental disorders has been shown to peak in midlife but analyses have ignored the association of poor material circumstances with prevalence. This study aimed to test the hypothesis that the midlife prevalence peak occurs only in lower-income households.

METHOD

Pooled data were used from the annual Health Survey for England, a nationally representative cross-sectional study, on community-dwelling individuals aged ≥ 16 years from years 1997 to 2006 (n=100 457). 12-item General Health Questionnaire scores, reported mental illness diagnoses and receipt of relevant medication were assessed in relation to household income and age. Analyses were separated by gender and adjusted for age, ethnicity, smoking, social class, education and co-morbidities.

RESULTS

Prevalence of psychological distress, diagnoses and treatments rose with age until early middle age and declined subsequently. In analyses conducted separately by income categories, this pattern was marked in low-income groups but absent in high-income groups. Income-related inequalities in the prevalence of psychological distress were greatest in midlife; for example, in men aged 45-54 years the odds ratio of receiving psychiatric medication in the lowest income group compared with the highest was 7.50 [95% confidence interval (CI) 4.24-13.27] and in women aged 45-54 years the odds ratio of reporting mental illness was 10.25 (95% CI 6.16-17.05).

CONCLUSIONS

An increased prevalence of psychological distress, common mental disorder diagnoses and treatment in midlife is not a universal phenomenon but is found only in those in low-income households. This implies the phenomenon is not inevitable but is potentially manageable or preventable.

Long-term deficiency of circulating and hippocampal insulin-like growth factor I induces depressive behavior in adult mice: a potential model of geriatric depression

Numerous studies support the hypothesis that deficiency of insulin-like growth factor I (IGF-1) in adults contributes to depression, but direct evidence is limited. Many psychological and pro-cognitive effects have been attributed to IGF-1, but appropriate animal models of adult-onset IGF-1 deficiency are lacking. In this study, we use a viral-mediated Cre-loxP system to knockout the Igf1 gene in either the liver, neurons of the CA1 region of the hippocampus, or both. Knockout of liver Igf1 reduced serum IGF-1 levels by 40% and hippocampal IGF-1 levels by 26%. Knockout of Igf1 in CA1 reduced hippocampal IGF-1 levels by 13%. The most severe reduction in hippocampal IGF-1 occurred in the group with knockouts in both liver and CA1 (36% reduction), and was associated with a 3.5-fold increase in immobility in the forced swim test. Reduction of either circulating or hippocampal IGF-1 levels did not alter anxiety measured in an open field and elevated plus maze, nor locomotion in the open field. Furthermore, local compensation for deficiencies in circulating IGF-1 did not occur in the hippocampus, nor were serum levels of IGF-1 upregulated in response to the moderate decline of hippocampal IGF-1 caused by the knockouts in CA1. We conclude that adult-onset IGF-1 deficiency alone is sufficient to induce a depressive phenotype in mice. Furthermore, our results suggest that individuals with low brain levels of IGF-1 are at increased risk for depression and these behavioral effects are not ameliorated by increased local IGF-1 production or transport. Our study supports the hypothesis that the natural IGF-1 decline in aging humans may contribute to geriatric depression.

Leukocyte telomere length in major depression: correlations with chronicity, inflammation and oxidative stress--preliminary findings

BACKGROUND

Depression is associated with an unusually high rate of aging-related illnesses and early mortality. One aspect of "accelerated aging" in depression may be shortened leukocyte telomeres. When telomeres critically shorten, as often occurs with repeated mitoses or in response to oxidation and inflammation, cells may die. Indeed, leukocyte telomere shortening predicts early mortality and medical illnesses in non-depressed populations. We sought to determine if leukocyte telomeres are shortened in Major Depressive Disorder (MDD), whether this is a function of lifetime depression exposure and whether this is related to putative mediators, oxidation and inflammation.

METHODOLOGY

Leukocyte telomere length was compared between 18 unmedicated MDD subjects and 17 controls and was correlated with lifetime depression chronicity and peripheral markers of oxidation (F2-isoprostane/Vitamin C ratio) and inflammation (IL-6). Analyses were controlled for age and sex.

PRINCIPAL FINDINGS

The depressed group, as a whole, did not differ from the controls in telomere length. However, telomere length was significantly inversely correlated with lifetime depression exposure, even after controlling for age (p<0.05). Average telomere length in the depressed subjects who were above the median of lifetime depression exposure (≥9.2 years' cumulative duration) was 281 base pairs shorter than that in controls (p<0.05), corresponding to approximately seven years of "accelerated cell aging." Telomere length was inversely correlated with oxidative stress in the depressed subjects (p<0.01) and in the controls (p<0.05) and with inflammation in the depressed subjects (p<0.05).

CONCLUSIONS

These preliminary data indicate that accelerated aging at the level of leukocyte telomeres is proportional to lifetime exposure to MDD. This might be related to cumulative exposure to oxidative stress and inflammation in MDD. This suggest that telomere shortening does not antedate depression and is not an intrinsic feature. Rather, telomere shortening may progress in proportion to lifetime depression exposure.

The role of physical and psychological variables in predicting the outcome of hospitalization in very old adults

The aim of this study was to examine predictors of functional outcome in hospitalized geriatric patients with a focus on psychological variables, as these have been somewhat neglected in this population. A prospective study was conducted in aged-care wards in Melbourne, Australia. Consecutively admitted patients (n = 100, mean age 82 years) completed measures of health status, anxiety, depression, self-efficacy, personality and coping. Two months later data were collected with respect to three outcomes, namely overall functioning, ability to carry out activities of daily living as measured by the Barthel Index (BI), and quality of life (QoL), as measured by the assessment of quality of life (AQoL) instrument. Syndromal depression was highly prevalent (28%) and syndromal anxiety was less common (5% prevalence), but neither was predictive of functional outcome. The strongest predictor of outcome was physical health status on admission to hospital. The results suggest that in physically unwell, very old populations, physical health factors may be stronger predictors of functioning than psychological variables. The findings also highlight some difficulties in the use of psychological measures in old-old populations, and the need for more research that recognizes the oldest old as a distinct group.

Predicting survival and morbidity-free survival to very old age

As life expectancy continually increases, it is imperative to identify determinants of survival to the extreme end of the lifespan and more importantly to identify factors that increase the chance of survival free of major morbidities. As such, the current study assessed 45 common disease factors as predictors of survival and morbidity-free survival to age 85 years. Within the Rotterdam Study, a population-based cohort, we evaluated morbidity-free participants who were able to attain age 85 within the study duration (n = 2,008). Risk factors were assessed at baseline (1990-1993), and mortality and morbidities were then collected continuously until mortality or the occurrence of their 85th birthday (average time of 7.9 years). Risk factors included demographic and lifestyle variables, health and morbidity indicators and physiological makers. Major morbidities examined included dementia, cancer, cerebrovascular accident, heart failure and myocardial infarction. Logistic regression analyses demonstrated that many of the variables were independently predictive for survival and for morbidity-free ageing to 85 years. These included being female, absence of left ventricular abnormalities, stable body weight, unimpaired instrumental activities of daily living, lower C-RP levels and higher levels of femoral neck bone mineral density and albumin. Relative to non-survival, predictors were stronger for morbidity-free survival than for total survival or survival with morbidity. This suggests that lifespan and healthy survival to older age can be relatively well predicted. Understanding predictors of a long and healthy lifespan is vital for developing primary and secondary preventions to help improve the quality of life of older adults and for reducing the financial burden of the rapidly escalating ageing population.

Predictors of preventable nursing home hospitalizations: the role of mental disorders and dementia

OBJECTIVES

Nursing home (NH) hospitalizations place an enormous economic burden on an already overtaxed American healthcare system. Hospitalizations for "ambulatory care-sensitive" (ACS) conditions are considered preventable, as these are physical health conditions that can potentially be treated safely in a NH. The authors examined risk factors, including mental disorders and dementia, for hospitalization of Medicaid-enrolled NH residents with ACS conditions during fiscal year 2003-2006.

METHODS

The authors merged Medicaid claims and enrollment data and Online Survey Certification and Reporting information for 72,251 Medicaid-enrolled NH residents in 647 NHs in Florida. The authors identified at least one ACS hospitalization in 8,382 residents for a total of 10,091 hospital admissions (18.5% of all hospitalizations). The authors used Cox proportional hazard regression to assess time to the first ACS hospitalization.

RESULTS

In a fully adjusted model, younger age, non-white race, dementia, and serious mental disorder were associated with greater risk of ACS hospitalization. In addition, residents with a diagnosed mental disorder and no dementia incurred relatively high expenditures for ACS hospitalizations. Among facility characteristics, participants from for-profit facilities, facilities that were not a member of a chain, had more Medicaid recipients, and fewer than 120 beds had greater risk of ACS hospitalizations.

CONCLUSIONS

Attention to the identified predictors of hospitalization for ACS conditions, which are potentially preventable, could reduce the risk and cost of these hospitalizations among Medicaid-enrolled NH residents. The need to reduce unnecessary hospitalization will become only more urgent as the population ages and healthcare expenses continue to escalate.

Association of depressed mood and mortality in older adults with and without cognitive impairment in a prospective naturalistic study

OBJECTIVE

The authors examined predictors of mortality in individuals age 50 or older with or without cognitive impairment in a 12-year prospective naturalistic study of subcortical ischemic vascular disease focusing on symptoms of depressed mood, apathy, anhedonia, or anergia.

METHOD

A total of 498 participants were recruited from the community and from memory clinics into a multicenter longitudinal study of subcortical ischemic vascular disease. For baseline cognitive status, 36% of participants were assessed as cognitively intact, 31% as cognitively impaired, and 33% as demented. All participants underwent a research protocol MRI, and 41% were classified as having subcortical lacunes. Depressed mood, anhedonia, anergia, and apathy were assessed at baseline using a structured behavioral assessment. Cox regression models were used to investigate the associations between neuropsychiatric symptoms and mortality, controlling for age, gender, race, education level, cognitive status, presence of vascular lacunes, and vascular risk factors.

RESULTS

Of 498 participants, 175 (35%) died over the follow-up period, with a median survival time of 5.6 years. In the multivariate analyses, cognitive impairment, age, male gender, depressed mood, and the presence of lacunes predicted higher mortality. Participants with both lacunes and depressed mood had the shortest survival among all cognitive groups. The mortality hazard ratio for participants with depressed mood was 2.2 (95% CI=1.5-3.2) after adjustment for cognitive status, age, gender, education level, race, lacunes, and all vascular conditions.

CONCLUSIONS

These findings suggest the importance of detecting depressed mood in individuals with cerebrovascular disease and of developing more aggressive treatment and preventive interventions for this vulnerable population.

Interleukin-1beta serum levels is increased in antidepressant-free elderly depressed patients

OBJECTIVE

To assess the serum levels of interleukin 1beta (IL-1beta) in elderly depressed patients in comparison with nondepressed healthy elderly subjects.

DESIGN

Cross-sectional study.

SETTING

Tertiary memory clinic.

PARTICIPANTS

Twenty-three antidepressant-free elderly depressed patients and 44 nondepressed healthy elderly comparison group were enrolled to this study.

MEASUREMENT

Serum IL-1beta levels were determined with highly sensitive colorimetric sandwich enzyme-linked immunosorbent assay. Severity of the depressive episode was determined by scores on the Hamilton Depression Scale-21 item and cognitive performance by the scores on the Cambridge Cognition Examination, Mini Mental State Examination clock drawing test, and verbal fluency.

RESULTS

IL-1beta serum levels were increased in elderly patients versus nondepressed elderly (t = 2.21, df = 65, p = 0.04). After categorizing elderly depressed subjects into late onset (LOD) versus early onset (EOD), patients with EOD had the highest IL-1beta levels, when compared with nondepressed elderly patients and patients with LOD in analysis of variance (F = 4.9, df = 2, 64, p <0.01).

CONCLUSIONS

Late-life depression is associated with higher IL-1beta levels suggesting that increased proinflammatory state may play a role in the physiopathology of depression in the elderly. The authors further show that this might be more prominent in those patients with EOD geriatric depression.

A multiplicity of approaches to characterize geriatric depression and its outcomes

PURPOSE OF REVIEW

Research in geriatric depression has always had a multidisciplinary bent, particularly in methods used to characterize depression. Understanding diagnosis, psychiatric comorbidities, and course continues to be a goal of clinical researchers. Those interested in cognitive neuroscience and basic neuroscience have more recently trained their sights on late-life depression. This review identifies recent progress in the characterization of geriatric depression using a variety of methodologies.

RECENT FINDINGS

Depression in the elderly remains underdetected and underdiagnosed, particularly in nonmental health settings. Studies of the impact of psychiatric comorbidities and of the negative outcomes of depression in older adults demonstrate that geriatric depression is a serious medical condition that not only affects mood but can also lead to functional and cognitive decline. Advances in neuroimaging technology have demonstrated structural and functional changes in the brains of older depressed patients. With the advent of brain banks in neuropsychiatry, we are now seeing postmortem neuroanatomical studies that seek to extend findings from clinical practice and from neuroimaging research.

SUMMARY

Clinicians should become more aware of advances in detection of depression, the effect of psychiatric comorbidities, the poor mood and cognitive outcomes associated with late-life depression and should keep abreast of recent neuroimaging and neuroanatomical findings.

Do depressive symptoms predict mortality in older people?

CONTEXT

Depressive symptoms are common in older persons, and may predict mortality.

OBJECTIVES

To determine: (1) If depressive symptoms predict mortality; (2) If there is a gradient in this effect; and (3) Which depressive factors predict mortality.

POPULATION

In 1991-1992, 1751 community-dwelling older persons, sampled from a population-based registry, were interviewed.

MEASURES

The Center for Epidemiologic Studies - Depression (CES-D), age, gender, the Modified Mini-Mental State Examination, self-rated health, and functional status.

OUTCOME MEASURE

Time to death.

ANALYSIS

Those scoring 16+ on the CES-D were considered depressed. To determine if a gradient was present, the CES-D was treated as a continuous variable. Four depressive factors from the CES-D (depressed affect, positive affect, somatic, and interpersonal) were analyzed. Cox regression models were constructed.

RESULTS

The mortality in those with depressive symptoms was higher in those without depressive symptoms (Hazard Ratio of 1.71, p < 0.001, Log rank test). In multivariable models, this association was no longer significant after accounting for self-rated health and functional status. There was a gradient in risk of mortality across the range of the CES-D. Somatic factors, depressed affect, and positive affect were all associated with mortality in bivariate analyses, but not in multivariable models adjusting for functional status. Interpersonal factors were not associated with mortality.

CONCLUSIONS

Depressive symptoms predict mortality in older persons.