The association between depression and quality of life in the elderly

Background

Depression is the most common cause of emotional disorder in older adults causing functional impairment and leading to lower quality of life (QOL). The aim of the study was to investigate the prevalence of depression, measure the perceived QOL and evaluate the impact of depression on life quality of older people in the community.

Methods

We conducted a cross-sectional study in older people, enrolled in open day care centers and other healthcare facilities. To all participants the Greek validated version of the Geriatric Depression Scale (GDS-15) was applied to screen for depressive symptoms and the EQ-5D-5L scale to estimate their self-reported health status.

Results

A total of 634 seniors participated in the study, 53% were females, mean age 78 years. 45.6% of the participants showed moderate to severe depression. Those who suffered from at least two chronic diseases (75.6%) were more likely to develop moderate or severe depressive symptoms compared to those with only one (19.3%) or none (2.2%) chronic disease. Increased risk of depression was observed in people with Parkinson’s disease (56.5%), mental illness (47.1%), respiratory disease (40%) and stroke (35.1%). Regarding the EQ-5D-5L scale, 72% reported slight to extreme anxiety or depression, 68.2% slight to extreme pain or discomfort, 59.8% slight to extreme problems in performing usual activities, 59.8% in mobility and 40.1% in self-care, respectively. Significant differences were found between people with or without depression. Specifically, participants who reported slight to severe problems in all five domains of the EQ-5D-5L, showed higher levels of depression in the GDS-15.

Conclusions

Our results revealed that elderly with depressive symptoms have a lower quality of life. Given the mutual relationship between chronic diseases, lower life quality and depression, assessment of depressive symptoms are needed in elderly population, mainly in people with multiple chronic diseases.

Key messages

• Depression can be a predictor of poorer quality of life in older population.

Influence of IGF-I and cell density on MDR1 expression in the T-lymphoblastoid cell line CCRF-CEM

The debate about a direct or indirect effect of GH and IGF-I on the recurrence of malignancy, especially in the case of rhGH therapy in patients with leukemia, is still going on. Recent studies suggested that IGF-I plays a role in drug resistance during anticancer therapy. This resistance to diverse cytotoxic drugs, named multidrug-resistance (MDR), is mainly due to high levels of P-glycoprotein (P-gp). The gene encoding this membrane-associated transporter protein was named MDR1, and increased levels of P-gp are linked to enhanced MDR1 mRNA expression. Our aim was to investigate a possible effect of rhIGF-I on MDR1 gene expression in vitro. We cultured the T-lymphoblastoid cell line CCRF-CEM with different rhIGF-I concentrations (0, 5, 20 and 50 ng/ml) in serum-free medium for 3 days. CCRF-CEM cells are drug-sensitive and express MDR1 at low levels. MDR1 mRNA expression was measured by semiquantitative RT-PCR using a competitive assay with a heterologous DNA construct. In addition, GAPDH mRNA was amplified as an internal control for RNA integrity. P-gp activity was determined by a flow cytometric assay measuring rhodamine 123 accumulation. Furthermore, cell proliferation was monitored in all experiments. Our data do not support an effect of rhIGF-I on MDR1 mRNA expression, P-gp activity or cell proliferation in the CCRF-CEM cell line. MDR1 mRNA levels were inversely correlated to cell density with high significance (p < 0.0001). In conclusion, multidrug resistance linked to P-gp is not induced by IGF-I in CCRF-CEM cells. At high density, CCRF-CEM cells downregulate MDR1 gene expression. Our experimental model provides a very useful tool for monitoring the influence of growth factors on multidrug resistance in vitro.