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Broadening Options for Long-term Dialysis in the Elderly (BOLDE): Differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients

DOI:10.1093/ndt/gfq212
Authors:
Edwina Brown at Imperial College Healthcare NHS Trust
Edwina Brown
Lina Johansson
Lina Johansson
Lina Johansson
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Ken Farrington at Lister Hospital, East and North Hertfordshire NHS Trust, ListerStevenage, UK
Ken Farrington
  • Lister Hospital, East and North Hertfordshire NHS Trust, ListerStevenage, UK
Hugh Gallagher at National Health Service
Hugh Gallagher
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Health-related quality of life (QOL) is an important outcome for older people who are often on dialysis for life. Little is, however, known about differences in QOL on haemodialysis (HD) and peritoneal dialysis (PD) in older age groups. Randomising patients to either modality to assess outcomes is not feasible. In this cross-sectional, multi-centred study we conducted QOL assessments (Short Form-12 Mental and Physical Component Summary scales, Hospital Anxiety and Depression Scale and Illness Intrusiveness Ratings Scale) in 140 people (aged 65 years or older) on PD and HD. The groups were similar in age, gender, time on dialysis, ethnicity, Index of Deprivation (based on postcode), dialysis adequacy, cognitive function (Mini-Mental State Exam and Trail-Making Test B), nutritional status (Subjective Global Assessment) and social networks. There was a higher comorbidity score in the HD group. Regression analyses were undertaken to ascertain which variables significantly influence each QOL assessment. All were influenced by symptom count highlighting that the patient's perception of their symptoms is a critical determinant of their mental and physical well being. Modality was found to be an independent predictor of illness intrusion with greater intrusion felt in those on HD. Overall, in two closely matched demographic groups of older dialysis patients, QOL was similar, if not better, in those on PD. This study strongly supports offering PD to all suitable older people.
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Broadening Options for Long-term Dialysis in the Elderly (BOLDE): Differences in quality of life on peritoneal dialysis compared to haemodialysis for older patien
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... Indeed, PD has been associated with a better quality of life (54)(55)(56), better outcomes in the first 2-3 years and preservation of residual kidney function (50,52,(57)(58)(59), and lower costs than in-centre HD (51,60,61). It enables the patient to preserve a high degree of autonomy, to travel and have an active life. ...
... The conditions that act as a barrier to self-care PD can be overcome by assisted PD, where a trained staff or family member provides daily dialysis assistance in the patient's home or in nursing home (64,66). Assistance can thus improve accessibility of home dialysis and survival in elderly or frail patient (29,66,67), whose quality of life may benefit most from home care dialysis (55). ...
Home dialysis for the treatment of end stage chronic kidney disease
Thesis
  • Dec 2021
Peritoneal dialysis (PD) utilization has been declining over the past decades in Europe. Several reasons could explain this PD under-utilization, such as a low PD uptake and the persistence of an elevated rate of PD cessation. Strategic incentives to increase home dialysis, such as assisted PD programs, have been developed, however their impact remains under-described. In this work, we combined data of patients on PD from France and the UK, using statistical models including time-varying covariate, fractional polynomials and Cox regression with robust variance, to address some of the gaps in the current knowledge in PD under-utilization. With the present thesis, we have reported how the introduction of an assisted PD service positively influenced the uptake of PD and counterbalanced the decline in PD rates over time. In France, assisted PD currently relies on nurse assistance; which can be successfully promoted with economic incentives. Both PD cessation (due to either death or transfer to HD) and death linearly declined over time, and transfer to HD declined from 2011 mainly because of a significant decline in infection-related transfers. Finally, we have shown that time spent on HD before transfer to PD impacts patient survival but does not impact retransfer to HD. In lights of the results of this work, we believe that economic incentives promoting the reimbursement of assisted PD added with a shift in mentality and an increased commitment to PD could successfully increase PD rates and enable patients to have a free choice regarding their treatment modality.
... According to this model, patients on chronic PD would be considered underdialyzed. However, compared to HD patients, most PD patients do not have more uremic symptoms (27,28), worse quality of life or long-term survival (9-11), whether residual kidney function exists or not. When evaluating the preoperative state of dialysis patients, we should not only focus on the values of SCr and BUN on the laboratory test sheet but also on more comprehensive indicators such as anemia correction, volume status, cardiac function, mineral metabolism, nutrition status, and individual psychological status (29, 30). ...
Does temporary transfer to preoperative hemodialysis influence postoperative outcomes in patients on peritoneal dialysis? A retrospective cohort study
Article
Full-text available
  • Jan 2023
Background The associations between preoperative transfer to hemodialysis (HD) and postoperative outcomes in patients on chronic peritoneal dialysis (PD) remain unknown. We conducted this retrospective cohort study to investigate whether preoperative HD could influence surgical outcomes in PD patients undergoing major surgeries. Methods All chronic PD patients who underwent major surgeries from January 1, 2007, to December 31, 2020, at Peking University First Hospital were screened. Major surgery was defined as surgical procedures under general, lumbar or epidural anesthesia, with more than an overnight hospital stay. Patients under the age of 18, with a dialysis duration of less than 3 months, and those who underwent renal implantation surgeries and procedures exclusively aimed at placing or removing PD catheters were excluded. Patients involved were divided into either HD or PD group based on their preoperative dialysis status for further analysis. Results Of 105 PD patients enrolled, 65 continued PD, and 40 switched to HD preoperatively. Patients with preoperative HD were significantly more likely to develop postoperative hyperkalemia. The total complication rates were numerically higher in patients undergoing preoperative HD. After adjustment, the incidence of postoperative hyperkalemia or any other postoperative complication rates were similar between groups. There were no differences in long-term survival between the two groups. Conclusions It does not seem indispensable for PD patients to switch to temporary HD before major surgeries.
... Peritoneal dialysis (PD) can be used successfully in older people with ESKD 38 and results in similar HRQoL outcomes to in-centre HD. Among those able to perform autonomous PD, reported illness intrusiveness is lower than with in-centre HD 39 . Furthermore, assisted PD (asPD), whereby the PD technique is performed by a formal or informal caregiver, is associated with better treatment satisfaction among older people ...
A Review of Supportive Care for Older People with Advanced Chronic Kidney Disease
Article
Full-text available
  • Dec 2022
Supportive care (SC) is a multidimensional and person-centred approach to managing advanced CKD that engages the person and their caregivers in shared decision making from the outset. Rather than focussing on disease-specific therapies, SC is a collection of adjuvant interventions and adaptations to conventional treatments that can be used to improve the individual's quality of life. Recognising that frailty, multi-morbidity, and polypharmacy are more common among older people with advanced chronic kidney disease (CKD) and that people in this group tend to prioritise quality of life over survival as a goal of care, SC represents an important adjunct to disease-specific therapies in CKD management. This review provides an overview of SC in the older person with advanced CKD.
... Quality of life measures are considerably poorer in patients of all ages with impaired functional status on both haemodialysis (HD) and PD [6]. In relatively fit older patients who can manage PD themselves, the illness intrusiveness is lower on PD compared with matched patients on in-centre HD [7]. There are many advantages of dialysis at home using PD compared with in-centre HD for older patients as shown in Table 1. ...
Availability of assisted peritoneal dialysis in Europe: call for increased and equal access
Article
Full-text available
  • Jun 2022
Introduction Availability of assisted PD (asPD) increases access to dialysis at home, particularly for the increasing numbers of older and frail people with advanced kidney disease. Although asPD has been widely used in some European countries for many years, it remains unavailable or poorly utilised in others. A group of leading European nephrologists have therefore formed a group to drive increased availability of asPD in Europe and in their own countries. Methods Members of the group filled in a proforma with the following headings: personal experience, country experience, who are the assistants, funding of asPD, barriers to growth, what is needed to grow, and their top 3 priorities. Results Only 5 of the 13 countries surveyed provided publicly funded reimbursement for asPD. The use of asPD depends on overall attitudes to PD with all respondents mentioning need for nephrology team education and/or patient education and involvement in dialysis modality decision making. Conclusion and call to action Many people with advanced kidney disease would prefer to have their dialysis at home, yet if the frail patient chooses PD most healthcare systems cannot provide their choice. AsPD should be available in all countries in Europe and for all renal centres. The top priorities to make this happen are education of renal healthcare teams about the advantages of PD, education of and discussion with patients and their families as they approach the need for dialysis, and engagement with policy makers and healthcare providers to develop and support assistance for PD.
... Peritoneal dialysis (PD) is a vital kidney replacement therapy. It offers a number of potential advantages for elderly patients, including better cardiovascular stability due to slower, continuous ultrafiltration, no need for vascular access, fewer technical requirements, better autonomy and independence, and less disturbing for patient's daily life (3,4). ...
Microbiology and Outcome of Peritoneal Dialysis-Related Peritonitis in Elderly Patients: A Retrospective Study in China
Article
Full-text available
  • Apr 2022
Objective The number of elderly patients on peritoneal dialysis (PD) has rapidly increased in the past few decades. We sought to explore the microbiology and outcomes of peritonitis in elderly PD patients compared with younger PD patients. Methods We conducted a retrospective study to analyze the clinical characteristics, causative organism distribution, and outcome of all PD patients who developed peritonitis between September 1, 2014 and December 31, 2020, from Second Xiangya Hospital, Central South University, China. Patients who experienced peritonitis were separated into elderly and younger groups. The elderly was defined as ≥ 65 years old at the initiation of PD. Results Among 1,200 patients, 64(33.9%) in elderly ( n = 189) and 215 (21.3%) in younger ( n = 1,011) developed at least one episode of peritonitis. A total of 394 episodes of peritonitis occurred in 279 patients. Of these, 88 episodes occurred in 64 elderly patients, and 306 episodes occurred in 215 younger patients. Gram-positive bacteria were the main causative organisms in elderly and younger patients (43.2% and 38.0%, respectively). Staphylococcus and Escherichia coli were the most common gram-positive and gram-negative bacteria, respectively. Fungal peritonitis in elderly patients was higher compared with younger patients (χ2 = 6.55, P = 0.01). Moreover, Acinetobacter baumannii (χ ² =9.25, P = 0.002) and polymicrobial peritonitis (χ ² = 6.41, P = 0.01) in elderly patients were also significantly higher than that in younger patients. Additionally, elderly PD patients had higher peritonitis-related mortality than younger patients (χ ² = 12.521, P = 0.000), though there was no significant difference in catheter removal between the two groups. Kaplan-Meier analysis showed that cumulative survival was significantly lower in elderly patients than younger patients (log rank = 7.867, p = 0.005), but similar technical survival in both groups (log rank = 0.036, p = 0.849). Conclusions This retrospective study demonstrated that elderly PD patients were more likely to develop Acinetobacter baumannii, fungal and polymicrobial peritonitis than younger PD patients. In addition, peritonitis-related mortality was significantly higher in elderly patients, whereas peritonitis-related catheter removal was comparable between elderly and younger PD patients. Understanding microbiology and outcome in elderly patients will help to reduce the incidence of PD-associated peritonitis and improve the quality of life.
Impact of peritoneal dialysis modality on patient and PD survival: A systematic review
Article
  • Dec 2022
We conducted a systematic review and meta-analysis to determine the effect of the peritoneal dialysis (PD) modality, automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD), on all-cause mortality (ACM) and PD failure. Studies were identified in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure, Weipu and Wanfang databases from database inception until April 1, 2021. The inclusion and exclusion criteria were based on the Population, Intervention, Comparison, Outcome, and Study (PICOS) design. Adjusted hazard ratios (HRs) with 95% confidence intervals (CI) were used to pool outcome estimates. Seventeen studies (more than 230,000 patients) were included. Our meta-analysis showed that compared with CAPD, APD demonstrated a significantly lower ACM risk (HR 0.87 [95% CI 0.77–0.99], p = 0.04), especially in studies involving an as-treated analysis (HR 0.75 [95% CI, 0.63–0.90], p = 0.00), published in Asia (HR 0.76 [95% CI, 0.67–0.86], p < 0.001) or Europe (HR 0.81 [95% CI, 0.74–0.89], p < 0.00), or published after 2012 (HR 0.82 [95% CI, 0.68–0.99], p = 0.04). However, APD was as effective as CAPD for PD survival (HR, 0.87 [95% CI, 0.75 to 1.00], p = 0.05 or HR, 0.90 [95% CI, 0.60 to 1.35], p = 0.61). Our results demonstrate a significant survival benefit for APD and provide evidence for increasing the global use of APD, especially in developing nations, where APD use has been hampered by a lack of reimbursement for care.
Lebensqualität von geriatrischen Patienten*innen mit Peritonealdialyse: Peritonealdialyse für ältere Patienten*innen eine gute Option
Article
  • Oct 2022
ZUSAMMENFASSUNG Der vorliegende Beitrag befasst sich mit der Auswirkung der Peritonealdialyse bei geriatrischen Patienten*innen auf deren Lebensqualität. Studienergebnisse zeigen signifikante Unterschiede in Bezug auf die allgemeine Zufriedenheit der Patient*innen, den kognitiven Status und der sexuellen Funktion. Die Patient*innen erleiden weit weniger Symptome und weisen eine höhere Zufriedenheit mit der Behandlung auf. Weiterhin stellt die Peritonealdialyse für die Betroffenen eine weit weniger aggressive Behandlungsform dar. Die Art der jeweiligen Nierenersatztherapie sollte immer unter Berücksichtigung der Lebensqualität der Patient*innen gewählt werden.
Providing a PD Service
Chapter
  • Jan 2022
Peritoneal dialysis (PD) can be a superb renal replacement therapy, especially when used as the first renal replacement modality. Setting up, running, or expanding a home dialysis or PD services can be a daunting task. Successful units can grow and thrive only by proving success. This demands knowledge of the technique, careful patient selection and prescription, as well as monitoring of key metrics of success. A mandatory feature of successful programs is a dedicated, knowledgeable, and hardworking team, and building such a team is a key step in the provision of care. This chapter covers the practical aspects of setting up a service, how to maintain it, and what metrics to use to argue for more resources or to prove that you are delivering a quality service. It covers many comorbidities and how they affect PD as well as a discussion of pregnancy in PD. This chapter does not cover detailed prescription optimization, nor the treatment of peritonitis.KeywordsPeritoneal dialysisKey performance indicatorsHome dialysisService provisionCatheter place ment
Chronic Kidney Disease and the Aging Population: Addressing Unmet Needs
Chapter
  • Jan 2022
There is a large and growing geriatric population in patients with end-stage kidney disease (ESKD) requiring renal replacement therapy. Among incident ESKD patients, those older than age 75 years outnumber those aged 65–74 and have the highest incident growth rate. Contributing factors include increased prevalence of diabetes mellitus and hypertension, improved life expectancy, and increased willingness to initiate dialysis therapy in the older population. There are many geriatric considerations that must be taken into account when caring for older patients with ESKD. These include traditional geriatric syndromes (e.g., frailty, falls, cognitive impairment) along with renal specific considerations, such as renal replacement treatment modality and access considerations. Having an approach to these issues is essential to providing optimal, comprehensive care to older adults with renal disease.
A 12-Item Short-Form Health Survey
Article
Full-text available
Regression methods were used to select and score 12 items from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to reproduce the Physical Component Summary and Mental Component Summary scales in the general US population (n = 2,333). The resulting 12-item short-form (SF-12) achieved multiple R squares of 0.911 and 0.918 in predictions of the SF-36 Physical Component Summary and SF-36 Mental Component Summary scores, respectively. Scoring algorithms from the general population used to score 12-item versions of the two components (Physical Component Summary and Mental Component Summary) achieved R squares of 0.905 with the SF-36 Physical Component Summary and 0.938 with the SF-36 Mental Component Summary when cross-validated in the Medical Outcomes Study. Test-retest (2-week) correlations of 0.89 and 0.76 were observed for the 12-item Physical Component Summary and the 12-item Mental Component Summary, respectively, in the general US population (n = 232). Twenty cross-sectional and longitudinal tests of empirical validity previously published for the 36-item short-form scales and summary measures were replicated for the 12-item Physical Component Summary and the 12-item Mental Component Summary, including comparisons between patient groups known to differ or to change in terms of the presence and seriousness of physical and mental conditions, acute symptoms, age and aging, self-reported 1-year changes in health, and recovery from depression. In 14 validity tests involving physical criteria, relative validity estimates for the 12-item Physical Component Summary ranged from 0.43 to 0.93 (median = 0.67) in comparison with the best 36-item short-form scale. Relative validity estimates for the 12-item Mental Component Summary in 6 tests involving mental criteria ranged from 0.60 to 1.07 (median = 0.97) in relation to the best 36-item short-form scale. Average scores for the 2 summary measures, and those for most scales in the 8-scale profile based on the 12-item short-form, closely mirrored those for the 36-item short-form, although standard errors were nearly always larger for the 12-item short-form.
Choice of Treatment Improves Quality of Life
Article
Background: Quality of life (QOL) is an important measure of the success of medicine. Choice of treatment is an important variable influencing QOL. We studied QOL in patients undergoing treatment for end-stage renal failure. Until June 1993 our patients needing dialysis could freely choose continuous ambulatory peritoneal dialysis (CAPD); however, since that time most patients have been forced to undergo CAPD because the hemodialysis program is full.Methods: We compared QOL in patients accepted before or after June 1993. Forty-five patients undergoing CAPD were studied during the period of choice compared with 44 who had no choice. Quality of life was studied by Bradburn Affect Scale, Mental Health Scale, Campbell Life Satisfaction, Perceived Health, Karnofsky Scale, Activity Scale, Physical Symptoms Scale, and desire for treatment change.Results: The patients undergoing CAPD in the no-choice group had a lower score than the choice population in 4 of the 7 QOL scales. The Mental Health Scale mean score was 18.4 compared with 15.5, and the patients ranking highest on the Mental Health Scale decreased from 33% to 18%, while those ranking lowest increased 7-fold from 2% to 14% comparing choice with no-choice group. The Bradburn Affect Scale score was +0.7 in the choice group compared with -0.3 in the no-choice group. There were no differences in age, sex, race, or treatment that explained the difference. Influence of other time-related factors is unlikely as there were no similar lower scores with time in the QOL reported by patients in the in-center or assisted self-care hemodialysis or transplant groups.Conclusion: Once the freedom of choice of treatment is gone from the patients undergoing CAPD their psychological QOL deteriorates.Arch Intern Med. 1997;157:1352-1356
Symptoms reported by elderly patients with isolated systolic hypertension: baseline data from the SYST-EUR trial. Systolic Hypertension in Europe
Article
Objectives: to determine the symptomatic well-being of elderly persons with isolated systolic hypertension. Design and setting: well-being determined during the placebo run-in period prior to entry to the Systolic Hypertension in Europe (SYST-EUR) trial. Subjects: 641 people, 60 years or older with an average sitting blood pressure of 173/86 mmHg. Outcome measures: 33 symptomatic complaints determined by a standard interview. Results: the 437 women complained of 25% of the symptoms and the 204 men 21% (P < 0.001). A markedly higher prevalence was observed in women compared with men for: pain in the joints of the hands (35% of women complained of this against 22% of men); ‘racing heart’ (33% against 17%); dry eyes (16% against 6%); blurring of vision (35% against 23%); cramps in the legs (43% against 31%); and a sore throat (15% against 7%). Nocturia was the most frequent complaint (68% in both sexes). Eight symptoms increased with age and one (rash) tended to decline. With increasing systolic pressure women also reported more headaches, unsteadiness, blurring of vision, irregular heart beat and ‘racing heart’ but, of these, only headaches increased with diastolic pressure. These observations were made after adjusting for age, blood sugar and body mass index (BMI) and were not observed in men. Higher blood sugars were associated with mouth ulcers, ‘racing heart’, blurring of vision and cramps in the legs. A higher BMI was associated with six symptoms, and a lower age of leaving education with eight. In men, alcohol consumption was related to ‘racing heart’, and smoking to wheezing and having a dry cough. Conclusions: a high level of complaint was associated with female gender, increasing age, blood sugar and BMI and a low age of leaving education.
Physical symptoms and quality of life in patients on chronic dialysis: results of The Netherlands Cooperative Study on Adequacy of Dialysis (NECOSAD)
Article
BACKGROUND: So far, little attention has been paid to the value of dialysis adequacy for patients' quality of life (QL). Therefore we studied the impact of demographic, clinical, and dialysis characteristics on physical symptoms and perceived QL. METHODS: The study population consisted of 120 incident chronic haemodialysis (HD) and 106 peritoneal dialysis (PD) patients, starting dialysis treatment in 13 Dutch centres. Data were collected 3 months after the start of dialysis. Nine physical symptoms were assessed with a self-administered questionnaire. Patient's self-assessment of QL was measured with the 36-item MOS Short Form (SF-36). RESULTS: The most common symptoms in HD and PD were fatigue (respectively 82 and 87%) and itching (73 and 68%). In HD only a medium to high comorbidity--age risk index was associated with greater symptom burden. In PD also a lower percentage lean body mass, a lower rGFR, and past episodes of underhydration were associated with greater symptom burden. The explained variance by these variables was only 12% in HD and 21% in PD. However, greater symptom burden explained a substantial additional amount of impaired physical and mental QL on top of demographics and clinical status. Dialysis variables were associated neither with symptoms nor with QL. CONCLUSION: Symptom burden can be explained to a limited extent by demographic and clinical variables and not by dialysis characteristics. Addition of symptom burden to the other variables makes it possible to explain one-third of perceived QL. This underlines the importance of symptom reduction in order to improve patient's QL.
Population-Based Norms for the Mini-Mental State Examination by Age and Educational Level
Article
  • May 1993
Objective. —To report the distribution of Mini-Mental State Examination (MMSE) scores by age and educational level.Design. —National Institute of Mental Health Epidemiologic Catchment Area Program surveys conducted between 1980 and 1984.Setting. —Community populations in New Haven, Conn; Baltimore, Md; St Louis, Mo; Durham, NC; and Los Angeles, Calif.Participants. —A total of 18 056 adult participants selected by probability sampling within census tracts and households.Main Outcome Measures. —Summary scores for the MMSE are given in the form of mean, median, and percentile distributions specific for age and educational level.Results. —The MMSE scores were related to both age and educational level. There was an inverse relationship between MMSE scores and age, ranging from a median of 29 for those 18 to 24 years of age, to 25 for individuals 80 years of age and older. The median MMSE score was 29 for individuals with at least 9 years of schooling, 26 for those with 5 to 8 years of schooling, and 22 for those with 0 to 4 years of schooling.Conclusions. —Cognitive performance as measured by the MMSE varies within the population by age and education. The cause of this variation has yet to be determined. Mini-Mental State Examination scores should be used to identify current cognitive difficulties and not to make formal diagnoses. The results presented should prove to be useful to clinicians who wish to compare an individual patient's MMSE scores with a population reference group and to researchers making plans for new studies in which cognitive status is a variable of interest.(JAMA. 1993;269:2386-2391)
Performance of the SF36, SF12, and RAND36 Summary Scales in a Multiple Sclerosis Population
Article
Background. Multiple sclerosis (MS) patients accumulate both physical and mental health problems along with disease progression. Valid and sensitive outcome measures are important to measure disease effects and the effect of treatment. Objective. The objective of this study was to test the performance of the physical and mental summary scales of SF-36, SF-12, and RAND-36. Methods. The scales were evaluated by comparing the scores of a cohort of 194 MS patients with general population data and using the Expanded Disability Status Scale (EDSS) and the Incapacity Status Scale–mental as criterion variables for physical functioning and mental health. Results. All 3 physical summary scales were markedly reduced and correlated highly with the EDSS. The SF-36 mental summary score was only slightly reduced among MS patients (0.2 SD) compared with the general population, despite significantly reduced scores on all 4 health scales being most related to mental health and despite a high prevalence of mental health problems. This results from the poor physical functioning (mean scale score, 2.3 SD below the general population) and the orthogonal factor rotation used to derive independent measures of physical and mental health. Similar results were found for the SF-12. The nonorthogonal RAND-36 physical and mental summary scores were both markedly reduced. This is more compatible with the disease progression in MS and the results of the other measures of physical and mental health used in the study. Conclusions. The SF-36 and SF-12 mental health summary scales appear to overestimate mental health in people with MS.
The Hospital Anxiety And Depression Scale
Article
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Health status and risk for depression among the elderly: A meta-analysis of published literature
Article
the goal of this study was to determine the relationship between health status, including self-rated health status and chronic disease, and risk for depression among the elderly. Method: MEDLINE, EMBASE and The Cochrane Library Database were used to identify potential studies. The studies were classified into cross-sectional and longitudinal subsets. For each study, the numbers of the total participants, cases (for cross-sectional study) or incident cases (for longitudinal study) of depression in each health status group were extracted and entered into Review Manager 4.2. The quantitative meta-analysis of cross-sectional studies and that of longitudinal studies were performed, respectively. For prevalence and incidence rates of depression, odds risk and relative risk (RR) were calculated, respectively. the quantitative meta-analysis showed that, compared with the elderly without chronic disease, those with chronic disease had higher risk for depression (RR: 1.53, 95% confidence intervals (CI): 1.20-1.97). Compared with the elderly with good self-rated health, those with poor self-rated health had higher risk for depression (RR: 2.40, 95% CI: 1.94-2.97). despite the methodological limitations of this meta-analysis, both poor self-rated health status and the presence of chronic disease are risk factors for depression among the elderly. In the elderly, poor self-reported health status appears to be more strongly associated with depression than the presence of chronic disease.