Comparison of the levels of depression and anxiety in elderly aortic stenosis patients treated with surgical or transcatheter aortic valve replacement

Effect of physical activity interventions on physical and mental health of the elderly: a systematic review and meta-analysis

OBJECTIVE

This meta-analysis aimed to systematically assess whether physical activity (PA) can improve physical health(PH) and mental health(MH) in elderly.

METHOD

To conduct this meta-analysis, four databases were searched from the start to October 24, 2024 (Web of Science and PubMed in English, CNKI and Wanfang Data Knowledge Service Platform in Chinese). Eligibility criteria included (1) study populations aged ≥ 60 years of normal elderly, with no gender restrictions; (2) the experimental group included PA interventions; (3) the control group consisted of non-PA interventions or usual activities; (4) assessment results from health evaluation tools and psychological scales; (5) the research design was a controlled experimental study. The Cochrane bias risk tool was used to assess the quality of evidence for each study. Among 4,151 potential related articles, 9 met the criteria for inclusion in this review.

RESULTS

The PA intervention shows a high degree of statistical heterogeneity in the overall results for the PH of the elderly (I²=93.8%, p < 0.01). The effect size of the PA intervention on the PH of the elderly is 0.86 (95% CI: 0.08, 1.64), which is statistically significant. Subgroup analysis showed that in intervention frequency, the heterogeneity for interventions less than three times per week is low (I² = 25.6%); in intervention duration, interventions lasting less than 30 min is relatively high, the direction of the study results is quite consistent. The overall effect size is 2.32 (CI: 1.45, 3.20), indicating statistical significance; in overall intervention duration, the overall effect size for interventions lasting less than 12 weeks is (CI: 0.08, 1.59), while the effect sizes for the other two subgroups include 0, indicating non-significant results. The overall results for the MH of the elderly also exhibit a high degree of statistical heterogeneity (I²=95.3%, p < 0.01). The effect size of the PA intervention on the MH of the elderly is -0.22 (95% CI: -1.46, 1.03), which is not statistically significant. Subgroup analysis also showed no statistically significant differences. The PH and MH of the elderly may potentially improve through PA interventions, although further research is needed to clarify whether these benefits hold clinical significance beyond statistical significance.

CONCLUSION

PA interventions with a frequency of less than 3 times per week, each session lasting less than 30 min, and a total duration not exceeding 12 weeks may be more effective in improving the PH of the elderly. This study did not identify the optimal dosage for improving the MH of the elderly. These findings highlight the potential benefits of PA for PH in the elderly but underscore the need for more rigorous studies to determine optimal intervention parameters and to explore the clinical significance of PA for both PH and MH.

Using the Hospital Anxiety and Depression Scale in Patients 80 Years-Old and Older: A Systematic Review

AIMS

To identify and report results from studies of anxiety and depression, as measured by The Hospital Anxiety and Depression Scale (HADS) in patients ≥ 80 years admitted to hospital settings, and to inform nurses, researchers and educators in nursing about these findings.

DESIGN

Systematic review.

DATA SOURCES

MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane, Epistemonikos, Scopus and Web of Science Core Collection of studies published until October 2023.

METHODS

A search strategy was developed with a university librarian. Four independent reviewers screened titles and abstracts based on predefined inclusion criteria. Data were systematically extracted, descriptively analysed, and Critical Appraisal Skills Programme checklists were used to assess studies.

RESULTS

Out of 7076 identified studies, three met the eligibility criteria. Data from 420 participants aged ≥ 80 years were analysed, revealing anxiety prevalence rates between 6% and 18% and mean scores below 4. Depression prevalence rates ranged from 7% to 17%, with a mean score below 4. Most patients with depression were not previously recognised as being depressed.

CONCLUSIONS

Few publications reported on anxiety and/or depression in hospitalised patients aged ≥ 80 years using HADS. A gap in the knowledge base has been identified.

IMPLICATIONS

Anxiety and depression are mental health conditions that can lead to adverse events and strongly affect aging. Increased understanding of the role that these conditions have on hospitalised patients ≥ 80 years is important for nurses when in contact with this patient group.

IMPACT

There is a need for more studies to generate evidence regarding anxiety and depression in an increasingly common and challenging hospital population by building upon evidence that is based on validated instruments such as the Hospital Anxiety and Depression Scale.

REPORTING METHOD

The PRISMA guideline was followed, and the review registered in PROSPERO (Registration number CRD 42022380943).

PATIENT CONTRIBUTION

No patient or public contribution.

TRIAL REGISTRATION

CRD 42022380943.

Symptoms of Anxiety and Depression in Patients Who Underwent Transcatheter Aortic Valve Implantation: The SAD-TAVI Study

Symptoms of anxiety and/or depression (SAD) commonly co-exist in severe aortic stenosis. In patients who underwent transcatheter aortic valve implantation (TAVI), these symptoms are associated with increased morbidity and mortality. Despite this, mental health remains under-researched in the TAVI literature. Drawing from the largest registry in Australia, we aimed to characterize the prevalence of SAD in TAVI patients. We also aimed to identify patient phenotypes at the highest risk of these symptoms, examine how they evolve after TAVI, and establish factors predictive of improvement and regression in mental health. A total of 1,279 patients who underwent TAVI between 2018 and 2023 included in a multi-center Australian registry were analyzed. The median age was 82 years (interquartile range 77 to 87), 41% were females, and the median Society of Thoracic Surgeons score was 3.9 (2.3 to 5.9). In addition, 353 patients (28%) reported moderate or worse SAD at baseline. Of this group, 260 (74%) had complete resolution in symptoms within 30 days. Body mass index <25 kg/m2 (adjusted odds ratio [aOR] 3.4, p <0.001), vascular site complications (aOR 3.4, p = 0.029), and nonhome discharge (aOR 2.4, p = 0.036) independently predicted the persistence of SAD. Only 72 patients (8%) developed new-onset SAD at 30 days after TAVI. Nonhome discharge (aOR 2.12, p = 0.025) and a composite cardiovascular end point, including stroke, acute myocardial infarction, and heart failure readmission (aOR 2.55, p = 0.028), were independent predictors of new-onset SAD. In conclusion, SAD are common but under-recognized in aortic stenosis. TAVI is highly effective at improving these symptoms, and regular screening for mental health should be considered in the management of all TAVI patients.

Short-Term Outcomes and Multidimensional Factors Associated With Preoperative Sedentary Behavior Among Chinese Older Adults With Gastric Cancer: An Observational Study

PURPOSE

The current study aimed to examine the short-term outcomes and multidimensional factors associated with preoperative sedentary behavior among Chinese older adults with gastric cancer.

METHOD

An observational study was conducted among older adults with gastric cancer in a tertiary hospital in Jiangsu, China. A total of 393 participants were enrolled by convenience sampling. Sedentary behavior was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Logistic regression was applied to explore the relationship between preoperative sedentary behavior and short-term outcomes. Univariate and multivariate analyses were used to determine the factors associated with participants' sedentary behavior.

RESULTS

Preoperative sedentary behavior was related to multiple outcomes, including total complications, prolonged length of stay, and increased hospitalization costs. Two or more comorbidities and depression were risk factors for sedentary behavior. High-density lipoprotein; female sex; and high school, middle school, and primary school and below educational levels were protective factors for sedentary behavior.

CONCLUSION

Health care professionals need to simultaneously concentrate on multidimensional aspects linked to sedentary behavior to successfully administer behavioral interventions for enhancing older adults' overall prognosis. [Journal of Gerontological Nursing, 51(1), 32-41.].

Mental health and transcatheter aortic valve replacement: A scoping systematic review

OBJECTIVE

To systematically review the literature on mental health symptoms before and after transcatheter aortic valve replacement (TAVR) and describe reported clinical associations with these symptoms.

METHODS

Using the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines, we reviewed studies involving pre- or post-TAVR mental health assessments or psychiatric diagnoses.

RESULTS

Eighteen studies were included. Before TAVR, clinically significant depression and anxiety prevalence is 15-30% and 25-30%, respectively, with only a third of these meeting diagnostic thresholds. These symptoms generally improve over the year post-TAVR. Depression is associated with functional impairment, multimorbidity, and lower physical activity; few associations have been described in relation to anxiety. Inconsistent evidence finds depression associated with post-TAVR mortality. One notable study found persistent depression independently predictive of 12-month mortality, and another found depression and cognition to have additive value in predicting mortality risk.

CONCLUSIONS

Mental health symptoms occur in a significant proportion of the TAVR population. Although symptoms tend to improve, the associations with depression, particularly persistent depression, call for further investigation to examine their associated outcomes. Research is also needed to understand the relationships between mental health conditions and cognition in TAVR-related outcomes.

[Anxiety-depressive disorders in patients before and in the long terms after aortic replacement]

OBJECTIVE

To study the structure and dynamics of anxiety-depressive disorders in patients with dissection/aneurysm of the ascending aorta and aortic arch before and in the long term after surgical treatment and to identify factors associated with disturbances in psycho-emotional status.

MATERIAL AND METHODS

We examined 124 patients with dissection/aneurysm of the ascending aorta and arch before and in the long-term period after aortic replacement, assessing anxiety and depression using the Generalized Anxiety Disorder (GAD-7) and Beck Depression Questionnaires. Multivariate regression analysis was used to identify factors associated with clinically significant anxiety and depressive disorders.

RESULTS

Average scores on the GAD and the depression scale before surgery decreased from 6.5 (4.0-9.0) and 12.0 (8.0-16.0) to 3.0 (2.0-5.0) and 6.0 (3.0-10.0) (p<0.05) respectively, in the long-term postoperative period. There was no significant decrease in the proportion of patients with clinically significant levels of GAD and depression (p>0.05). Before surgery, clinically significant anxiety and depressive disorders are associated with older age, chronic cerebrovascular insufficiency (CCI) and atrial fibrillation (AF) in the hospital period. After surgery, clinically significant GAD was associated with older age, CCI, and a history of stroke. Depressive disorders were associated with older age and a history of stroke.

CONCLUSION

In all patients with aortic disease, GAD and depression of varying severity are recorded; clinically significant GAD and depression are recorded in 19.2 and 23.2% of cases. In the long-term postoperative period, there is no significant decrease in the proportion of patients with clinically significant levels of GAD and depression, which amounted to 10.1 and 13.1%. Clinically significant anxiety and depressive disorders before and after surgery are associated with older age and the history of cerebrovascular disorders. In addition, the baseline clinically significant anxiety and depressive disorders showed an association with the subsequent development of AF in the early postoperative period.

Anxiety and depression in patients aged 80 years and older following aortic valve therapy. A six-month follow-up study

BACKGROUND

Little is known about mental health following advanced cardiac procedures in the oldest patients.

AIMS

To study changes in anxiety and depression from baseline to one- and six-month follow-up in older patients following transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR).

METHODS

Prospective cohort study of patients ≥ 80 years undergoing elective TAVI or SAVR in a tertiary university hospital. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale. Differences between TAVI/SAVR were analyzed using Welch's t test or chi-squared. Changes over time and group differences were established with longitudinal models using generalized least squares.

RESULTS

In 143 patients (83.5 ± 2.7 years), 46% (n = 65) received TAVI. Anxiety was identified in 11% of TAVI patients at baseline. One- and six-months later, percentages were 8% and 9%. In SAVR patients, 18% had baseline scores indicating anxiety. One and six-months later, percentages were 11% and 9%. Depression was identified in 15% of TAVI patients. One- and six-months later, percentages were 11% and 17%. At baseline, 11% of SAVR patients had scores indicating depression. One- and six-months after SAVR, percentages were 15% and 12%. Longitudinal analyses showed reductions (P < 0.001) in anxiety from baseline to one-month, and stable scores between one- and six-months for both treatment groups. There was no change over time for depression among treatment groups (P = 0.21).

DISCUSSION AND CONCLUSIONS

SAVR or TAVI in patients ≥ 80 years was associated with anxiety reduction between baseline and follow-up. For depression, there was no evidence of change over time in either treatment group.

Study on anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy

BACKGROUND

Patients with malignant tumors are more likely to have psychological problems due to their worries about their life expectancy. To understand the psychological status of elderly patients with malignant liver tumor undergoing hepatectomy better, the study was designed to investigate the current situation of anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy and to analyze its related factors.

METHODS

A total of 126 elderly patients with malignant liver tumor undergoing hepatectomy were selected as the research objects. The anxiety and depression of all subjects were evaluated by HADS (Hosptial Anxiety and Depression Scale). The correlation factors affecting the psychological state of elderly patients with malignant liver tumor undergoing hepatectomy were analyzed by linear regression method.

RESULTS

The HADS-A score of elderly patients with malignant liver tumor undergoing hepatectomy was 8.79 ± 2.56, among which 37 patients were asymptomatic, 60 patients with suspicious symptoms, and 29 patients with definite symptoms. The HADS-D score was 8.40 ± 2.97, among which 61 patients were asymptomatic, 39 patients with suspicious symptoms, and 26 patients with definite symptoms. Multivariate analysis using linear regression method showed that FRAIL score, residence, and complication were significantly associated with anxiety and depression of elderly patients with malignant liver tumor undergoing hepatectomy.

CONCLUSIONS

Anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy were obvious. FRAIL score, regional differences, and the complication were the risk factors for anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy. Improving frailty, reducing regional differences, and preventing complications is beneficial to alleviate the adverse mood of elderly patients with malignant liver tumor undergoing hepatectomy.

Quality of Life and Depressive Symptoms in Transcatheter Aortic Valve Implementation Patients-A Cross-Sectional Study

Quality of life is an important factor influencing mood. In any group of elderly people undergoing valve implementation or surgical aortic valve replacement, one in three will have depressive symptoms. The aims of this study were as follows: 1. to evaluate the impact of health-related quality of life on depressive symptoms in elderly patients undergoing TAVI, and 2. to analyze beliefs about TAVI. Methods: A total of 131 elderly people (mean age: 82.1 ± 6.1 years) scheduled to receive TAVI completed the Geriatric Depression Scale, EQ-5D-3L, and Mini Mental State Examination. A total of 43 patients completed the questionnaires after the treatment. The narrative interview analyses were performed based on 20 randomly selected patients after TAVI. Results: The mean level of general depression before TAVI was 4.19 ± 2.83, and after it was 3.12 ± 2.52 (p = 0.02), and the frequency decreased from 20% to 3%. An increase in the level of activity and number of interests and a decrease in life satisfaction were identified. The higher the general quality of life was, the lower the levels of depressiveness before and after TAVI were (r = 0.26 vs. r = 0.48; p < 0.05). Conclusions: Patients differed in their depressive symptoms, as well as their intensity and frequency, before and after TAVI. These results underscore the importance of screening for depression at baseline and reassessing changes in depressiveness during follow-up.