The trajectories and correlation between physical limitation and depression in elderly residents of Beijing, 1992-2009

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.

Cognitive Function and Depressive Symptoms among Chinese Adults Aged 40 Years and Above: The Mediating Roles of IADL Disability and Life Satisfaction

The purpose of this study was to investigate the relationship between cognitive function and depressive symptoms among Chinese adults aged 40 years and above, as well as the series of multiple mediating effects of Instrument Activities of Daily Living disability and life satisfaction on this relationship. The data was obtained from the China Health and Retirement Longitudinal Study (CHARLS, 2013-2018), including 6466 adults aged 40 years and above. The mean age of the adults was 57.7 ± 8.5. The SPSS PROCESS macro program was conducted to examine the mediating effects. The results indicated that there was a significant association between cognitive function and depressive symptoms five years later (B = -0.1500, 95%CI: -0.1839, -0.1161), which could also be demonstrated through three mediation pathways: (1) the mediating pathway through IADL disability (B = -0.0247, 95%CI: -0.0332, -0.0171); (2) the mediating pathway through life satisfaction (B = 0.0046, 95%CI: 0.0000, 0.0094); and (3) the chain mediation pathway through IADL disability and life satisfaction (B = -0.0012, 95%CI: -0.0020, -0.0003). Both IADL disability and life satisfaction have been proven to be crucial mediators for the relationship between cognitive function and depressive symptoms five years later. It is necessary to improve individuals' cognitive function and reduce the negative impact of disability on them, which is important to enhance their life satisfaction and prevent depressive symptoms.

Perceived availability of home- and community-based services and self-reported depression among Chinese older adults: A cross-sectional study

Few studies have assessed the association between perceived availability of home- and community-based services (HCBSs) and self-reported depression among Chinese older adults, which the present study attempts to rectify. This cross-sectional study enrolled 11,941 participants aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey 2018 wave. The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) was used to evaluate depression, and perceived availability was measured for four categories of HCBSs: daily life assistance, medical care services, emotional support and social services, and other. These four categories and the number of services in each were used to represent the perceived availability of service provision. Binary logistic models were used to explore the relationship between perceived availability of HCBSs and depression in older adults. Perceived daily life assistance was found to be negatively associated with depression symptoms among Chinese older adults in both urban and rural areas [rural: OR (95%CI) = 0.66 (0.55-0.78), p < 0.001; urban: OR (95% CI) = 0.69(0.60-0.79), p < 0.001], while perceived levels of medical care services, emotional support and social services, and other were not associated with depression symptoms in rural or urban areas. Our primary finding was that providing daily life assistance at the community level may help to meet more older adults' daily needs, thus potentially decreasing the risk of depression.

Impact of intergenerational support and medical expenditures on depression: Evidence from rural older adults in China

Objective

Globally, depression has become a major health issue among older adults, who experience poor physical health and high medical expenditures. In Asian countries, older adults are greatly dependent on their children. This study assessed the impact of different types of intergenerational support and medical expenditures on depression among older adults in rural China.

Method

A three-phase balanced panel was constructed based on data from 1,838 rural older adults with comparable scores on the Center for Epidemiologic Studies Depression Scale (CES-D) from the China Family Panel Studies in 2012, 2016, and 2018. A fixed-effects model was used to analyze the impact of intergenerational support and medical expenditures on CES-D score and of intergenerational support on medical expenditures. The propensity score-matching model was used to test the regression results' robustness.

Results

The findings were as follows. First, different types of intergenerational support had a heterogeneous impact on depression among rural older adults. Emotional support had a significantly negative impact on CES-D score, although too much care-based support had a positive impact on CES-D score. Low-level economic support had no significant effect on CES-D score. Second, medical expenditures impacted depression; among these, non-inpatient medical expenditure had a significant and positive impact on CES-D score. Third, CES-D scores among rural older adults were associated with chronic diseases and per capita family income. Fourth, care-based support was associated with reduced non-inpatient medical expenditures, and the sub-sample regression results indicated that the impact was significant for older adults with no chronic diseases and those younger than 75 years.

Conclusion

Intergenerational emotional support and non-inpatient medical expenditures directly affected rural older adults' CES-D scores. The mediating role of medical expenditures between intergenerational support and CES-D score was not significant. Measures should be taken to encourage intergenerational emotional support and reduce the pressure on children's economic and care-based support. Further, the medical insurance reimbursement policy, as formal support, should be improved to alleviate depression among rural older adults when children's support is limited.

Depressive Symptoms and ADL/IADL Disabilities Among Older Adults from Low-Income Families in Dalian, Liaoning

Purpose

This study aimed to assess the prevalence of depressive symptoms and ADL/IADL disabilities and explore their correlation and associated factors for depressive symptoms among community-dwelling older adults from low-income families in Dalian, Liaoning Province, China.

Methods

This cross-sectional study included 522 participants aged 60 years and older from low-income families in Dalian. The 30-Item Geriatric Depression Scale was employed to measure depressive symptoms. The Katz ADL Scale and IADL Scale were used to evaluate the performance of activities necessary for independent life. SPSS 22.0 was employed to analyze the data. Logistic regression was used to estimate the relationship between depressive symptoms and ADL/IADL disabilities in five models.

Results

The prevalence of depressive symptoms among older people from low-income families in Dalian was 57.3%. A total of 19.0% had difficulties performing ADLs, and 40.2% had difficulties performing IADLs. Logistic regression analysis revealed that ADL/IADL disabilities were associated with depressive symptoms even after controlling for people’s sociodemographic characteristics, welfare, health conditions and informal care. The following factors were associated with depressive symptoms: education, self-reported health, number of chronic diseases, and emotional support from families.

Conclusion

Given that older people from low-income families in Dalian have a notable prevalence rate of depressive symptoms, and ADL/IADL disabilities were independently associated with these symptoms, it is crucial to give priority to this particular group in geriatric health services due to economic and health disparities.

Association between functional limitations and depression among community-dwelling older adults in Malaysia

AIM

This study aimed to assess the relationship between functional limitations and depression among community-dwelling older adults in Malaysia.

METHODS

Data from a nation-wide community-based cross-sectional study were analyzed. This study was conducted using a two-stage stratified random sampling design. In total, 3772 older adults aged ≥60 years responded to the survey. Depression was identified using a validated Malay version of the Geriatric Depression Scale (M-GDS-14), with those scored ≥6 categorized as having depression. Functional limitations were assessed using both Barthel's Activities of Daily Living (ADL) and Lawton's Instrumental Activities of Daily Living (IADL). The relationship was determined by multivariate logistic regression, adjusted for other variables.

RESULTS

The prevalence of depression was 11.5% (95% confidence interval [CI] 9.4, 13.4). Multiple logistic regression analysis found that older adults with limitations in ADL were 2.6 times more likely of having depression (adjusted odds ratio [aOR] 2.58, 95% CI 2.01, 3.32), while those with limitations in IADL the risk of having depression was almost doubled (aOR 1.68, 95% CI: 1.32, 2.14). Other significant factors were incontinence (aOR 3.33, 95% CI: 2.33, 4.74), chronic medical illness (aOR 1.44, 95% CI: 1.15, 1.81), current smoker (aOR 4.19, 95% CI: 1.69, 10.39), poor social support (aOR 4.30, 95% CI: 2.98, 6.20), do not have partner, ethnic minorities and low individual monthly income.

CONCLUSIONS

Older adults with functional limitation in both basic ADL and complex IADL are independently at higher risk of having depression. Geriatr Gerontol Int 2020; 20: 21-25.

Depression Over the Lifespan in a Population-Based Cohort of Women With Polycystic Ovary Syndrome: Longitudinal Analysis

OBJECTIVE

To (i) determine whether women with polycystic ovary syndrome (PCOS) from a population-based cohort experience elevated depression symptoms and (ii) characterize the trajectory of symptoms over the lifespan.

DESIGN

The association between PCOS and longitudinal depression scores was investigated among 1127 black and white women participating in Coronary Artery Risk Development in Young Adults study. PCOS was ascertained at baseline (ages 20 to 32) by U.S. National Institutes of Health (NIH) criteria, incorporating androgens and symptoms of oligomenorrhea and hirsutism. The Center for Epidemiologic Studies-Depression (CES-D) scale was repeated prospectively in 5-year intervals over 25 years. Mixed-effects models evaluated the association between depression scores and PCOS after adjustment for confounders and characterized the trajectory of scores. The impact of race was explored.

RESULTS

Eighty-three of 1127 (7.4%) participants met NIH PCOS criteria. Of these, 33 (40%) were black and 50 (60%) were white. CES-D scores were higher among women with PCOS [coefficient (coef) 2.51; 95% CI 1.49, 3.54; P < 0.01] across the lifespan. Scores decreased across the lifespan in women with and without PCOS (coef -0.1 point per year; P < 0.001). Black women experienced higher depression burden than white women (coef 1.80; 95% CI 1.20, 2.41; P < 0.001); however, an interaction was not detected between PCOS and race (P = 0.68).

CONCLUSIONS

Women with PCOS-NIH from a population-based cohort are at risk for higher depression scores across the lifespan. Depression scores decline over time in women with PCOS in a trajectory similar to that in women without PCOS. Racial differences in depression risk should be acknowledged clinically and further explored.

Heterogeneous Trajectories of Physical and Mental Health in Late Middle Age: Importance of Life-Course Socioeconomic Positions

Drawing on life course and cumulative disadvantage theory, this study examines heterogeneous trajectories of functional limitations and depressive symptoms among late middle-aged individuals. This study used prospective data from 6010 adults, 51 to 64 years old, collected over a 12-year-period from the Health and Retirement Study. Considering the empirical proposition that several physical and mental trajectories may exist, Latent Class Growth Modeling was used. Five heterogeneous patterns of joint trajectories (Relatively healthy, Moderately improving, Steadily deteriorating, Steeply deteriorating, and Persistently high comorbid) were identified. Early life adversity was related to an increasing risk of declines in physical and mental health. The Persistently high comorbid class was characterized by a concentration of disadvantages over the life course. The development of public health interventions could help reduce co-existing physical and mental health problems, especially during late middle-age.

Exploring Individual, Family, and Extrafamilial Factors Associated With Depression Among Elderly Residents of Care Settings

This study investigated simultaneously the associations among individual, family, and extrafamilial factors and depression among elderly residents of care settings in Taiwan. The data for this study were obtained from the Vulnerability and Social Exclusion among Different Groups of Disadvantaged Elderly in an Aging Society: Phenomena and Strategies (1/2) project, which was conducted in Taipei City and Taipei County in 2007. We applied multiple regression procedures to a sample of 327 residents of care settings (48.3% women) who were mild physical impairment or physically independent and cognitively clear for determining factors associated with depression and their cumulative effects. We discovered that 24.5% of the residents were depressed. Physical mobility, number of chronic diseases, and self-assessed health status were significantly associated factors in all models. In the final model, we determined that one third of extrafamilial factors were significantly associated with depression, after controlling for all other variables. In addition, we observed an overall trend of increased mean scores of depression with an increase in the number of risk factors. The results imply that interventions aimed at preventing depression in elderly persons living in care settings, particularly persons with multiple risk conditions such as impaired physical mobility and medical comorbidities, should be designed to include extrafamilial elements. Establishing strong connections between elderly care setting residents and the institutional and neighborhood environments can help prevent depression.

Influence of cognitive function on cerebrovascular disease among the elderly

OBJECTIVES

To determine the interrelationships between baseline Mini-Mental State Examination (MMSE) score and overall long-term risk of cerebrovascular disease (CBVD).

MATERIALS & METHODS

This was a prospective cohort study of subjects aged 55 years or more who were enrolled in the Beijing Longitudinal Study of Aging (BLSA) and had a baseline MMSE score available. Baseline MMSE score was divided into four categories: ≥28, 26-27, 23-25, and ≤22. Participants were followed for 23 years. Cox regression models were used to examine the association between MMSE score and CBVD.

RESULTS

A total of 2101 participants were included in this analysis, 335 (15.9%) with an MMSE score ≥28, 365 (17.4%) with a score of 26-27, 579 (27.6%) with a score of 23-25, and 822 (7.4%) with a score ≤22. There were 576 cases of CBVD. The overall risk of CBVD increased with decreasing MMSE score. The impact of MMSE score on the risk of CBVD was much stronger in women than in men. The hazard ratio for CBVD risk was 1.76 (95% confidence interval [CI], 1.29-2.39, P < 0.05) for subjects with an MMSE score ≤22, and 1.21 (95% CI, 0.91-1.61, P < 0.05) for those with an MMSE score of 23-25. Higher MMSE scores were less strongly associated with the risk of CBVD.

CONCLUSIONS

Elderly people with lower MMSE scores, especially women, are at higher long-term risk of CBVD.

Prediction of the 20-year incidence of diabetes in older Chinese: Application of the competing risk method in a longitudinal study

The competing risk method has become more acceptable for time-to-event data analysis because of its advantage over the standard Cox model in accounting for competing events in the risk set. This study aimed to construct a prediction model for diabetes using a subdistribution hazards model.We prospectively followed 1857 community residents who were aged ≥ 55 years, free of diabetes at baseline examination from August 1992 to December 2012. Diabetes was defined as a self-reported history of diabetes diagnosis, taking antidiabetic medicine, or having fasting plasma glucose (FPG) ≥ 7.0 mmol/L. A questionnaire was used to measure diabetes risk factors, including dietary habits, lifestyle, psychological factors, cognitive function, and physical condition. Gray test and a subdistribution hazards model were used to construct a prediction algorithm for 20-year risk of diabetes. Receiver operating characteristic (ROC) curves, bootstrap cross-validated Wolber concordance index (C-index) statistics, and calibration plots were used to assess model performance.During the 20-year follow-up period, 144 cases were documented for diabetes incidence with a median follow-up of 10.9 years (interquartile range: 8.0-15.3 years). The cumulative incidence function of 20-year diabetes incidence was 11.60% after adjusting for the competing risk of nondiabetes death. Gray test showed that body mass index, FPG, self-rated heath status, and physical activity were associated with the cumulative incidence function of diabetes after adjusting for age. Finally, 5 standard risk factors (poor self-rated health status [subdistribution hazard ratio (SHR) = 1.73, P = 0.005], less physical activity [SHR = 1.39, P = 0.047], 55-65 years old [SHR = 4.37, P < 0.001], overweight [SHR = 2.15, P < 0.001] or obesity [SHR = 1.96, P = 0.003], and impaired fasting glucose [IFG] [SHR = 1.99, P < 0.001]) were significantly associated with incident diabetes. Model performance was moderate to excellent, as indicated by its bootstrap cross-validated discrimination C-index (0.74, 95% CI: 0.70-0.79) and calibration plot.Poor self-rated health, physical inactivity, being 55 to 65 years of age, overweight/obesity, and IFG were significant predictors of incident diabetes. Early prevention with a goal of achieving optimal levels of all risk factors should become a key element of diabetes prevention.

Screening for Depression in the General Population with the Center for Epidemiologic Studies Depression (CES-D): A Systematic Review with Meta-Analysis

OBJECTIVE

We aimed to collect and meta-analyse the existing evidence regarding the performance of the Center for Epidemiologic Studies Depression (CES-D) for detecting depression in general population and primary care settings.

METHOD

Systematic literature search in PubMed and PsychINFO. Eligible studies were: a) validation studies of screening questionnaires with information on the accuracy of the CES-D; b) samples from general populations or primary care settings; c) standardized diagnostic interviews following standard classification systems used as gold standard; and d) English or Spanish language of publication. Pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratio were estimated for several cut-off points using bivariate mixed effects models for each threshold. The summary receiver operating characteristic curve was estimated with Rutter and Gatsonis mixed effects models; area under the curve was calculated. Quality of the studies was assessed with the QUADAS tool. Causes of heterogeneity were evaluated with the Rutter and Gatsonis mixed effects model including each covariate at a time.

RESULTS

28 studies (10,617 participants) met eligibility criteria. The median prevalence of Major Depression was 8.8% (IQ range from 3.8% to 12.6%). The overall area under the curve was 0.87. At the cut-off 16, sensitivity was 0.87 (95% CI: 0.82-0.92), specificity 0.70 (95% CI: 0.65-0.75), and DOR 16.2 (95% CI: 10.49-25.10). Better trade-offs between sensitivity and specificity were observed (Sensitivity = 0.83, Specificity = 0.78, diagnostic odds ratio = 16.64) for cut-off 20. None of the variables assessed as possible sources of heterogeneity was found to be statistically significant.

CONCLUSION

The CES-D has acceptable screening accuracy in the general population or primary care settings, but it should not be used as an isolated diagnostic measure of depression. Depending on the test objectives, the cut-off 20 may be more adequate than the value of 16, which is typically recommended.

Association of Baseline Sleep Quality With Trajectories of Depressive Symptoms in Patients Undergoing Interferon Treatment

OBJECTIVE

Some patients with hepatitis C starting interferon-α (IFN-α) therapy experience depression, although many patients do not develop depressive symptoms. We have found that poor sleep is associated with increased depressive symptoms on average. It is unknown whether this association holds generally or is driven by a specific, distinct subgroup. This investigation first determined whether patterns of change in depressive symptoms form clinically meaningful, distinct subgroups and then tested the extent to which sleep disturbances are associated with a less favorable depression trajectory.

METHOD

Group-based trajectory modeling was used on 124 patients with hepatitis C who started IFN-α therapy. The Pittsburgh Sleep Quality Index (PSQI) assessed pretreatment sleep, the Beck Depression Inventory minus the sleep question assessed depression over time, and the Structured Clinical Interview for DSM-IV provided categorical diagnoses.

RESULTS

Three distinct subgroups were found, where each subgroup shared similar patterns of depressive symptoms over time. The groups were characterized as "nondepressed," "slow increase," and "rapid increase." The nondepressed subgroup (44.4%) experienced low depressive symptoms with little change over time. In comparison, all rapid increasers (11.3%) were diagnosed as having a mood disorder by 12 weeks of treatment. The PSQI was strongly associated with group membership, where the odds of developing a rapid increase was elevated 39% for every unit-score increase in the PSQI compared with individuals who remained nondepressed (odds ratio = 1.39, 95% confidence interval = 1.07-1.80, adjusted for depression at baseline).

CONCLUSIONS

Only a distinct subpopulation of people is notably vulnerable to a developing a rapid increase in depression symptoms during IFN-α therapy. This group may be identifiable by their markedly poor sleep before IFN-α therapy.

Risk factors for cerebrovascular disease mortality among the elderly in Beijing: a competing risk analysis

Objective

To examine the associations of combined lifestyle factors and physical conditions with cerebrovascular diseases (CBVD) mortality, after accounting for competing risk events, including death from cardiovascular diseases, cancers and other diseases.

Methods

Data on 2010 subjects aged over 55 years were finally analyzed using competing risk models. All the subjects were interviewed by the Beijing Longitudinal Study of Aging (BLSA), in China, between 1 January 1992 and 30 August 2009.

Results

Elderly females were at a lower risk of death from CBVD than elderly males (HR = 0.639, 95% CI = 0.457–0.895). Increasing age (HR = 1.543, 95% CI = 1.013–2.349), poor self-rated health (HR = 1.652, 95% CI = 1.198–2.277), hypertension (HR = 2.201, 95% CI = 1.524–3.178) and overweight (HR = 1.473, 95% CI = 1.013–2.142) or obesity (HR = 1.711, 95% CI = 1.1754–2.490) was associated with higher CBVD mortality risk. Normal cognition function (HR = 0.650, 95% CI = 0.434–0.973) and living in urban (HR = 0.456, 95% CI = 0.286–0.727) was associated with lower CBVD mortality risk. Gray’s test also confirmed the cumulative incidence (CIF) of CBVD was lower in the ‘married’ group than those without spouse, and the mortality was lowest in the ‘nutrition sufficient’ group among the ‘frequent consumption of meat group’ and the ‘medial type group’ (P value<0.001).

Conclusions

CBVD mortality was associated with gender, age, blood pressure, residence, BMI, cognitive function, nutrition and the result of self-rated health assessment in the elderly in Beijing, China.

Physical capability and subsequent positive mental wellbeing in older people: findings from five HALCyon cohorts

Objective measures of physical capability are being used in a growing number of studies as biomarkers of healthy ageing. However, very little research has been done to assess the impact of physical capability on subsequent positive mental wellbeing, the maintenance of which is widely considered to be an essential component of healthy ageing. We aimed to test the associations of grip strength and walking, timed get up and go and chair rise speeds (assessed at ages 53 to 82 years) with positive mental wellbeing assessed using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) 5 to 10 years later. Data were drawn from five British cohorts participating in the Healthy Ageing across the Life Course research collaboration. Data from each study were analysed separately and then combined using random-effects meta-analyses. Higher levels of physical capability were consistently associated with higher subsequent levels of wellbeing; for example, a 1SD increase in grip strength was associated with an age and sex-adjusted mean difference in WEMWBS score of 0.81 (0.25, 1.37), equivalent to 10 % of a standard deviation (three studies, N = 3,096). When adjusted for body size, health status, living alone, socioeconomic position and neuroticism the associations remained albeit attenuated. The finding of these consistent modest associations across five studies, spanning early and later old age, highlights the importance of maintaining physical capability in later life and provides additional justification for using objective measures of physical capability as markers of healthy ageing.