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Prevalence and predictors of depression in populations of elderly: A review
Abstract
To offer an update on prevalence and predictors of old age depression in populations of elderly Caucasians.
The databases MEDLINE and Psychinfo were searched and relevant literature from 1993 onwards was reviewed.
The prevalence of major depression ranges from 0.9% to 9.4% in private households, from 14% to 42% in institutional living, and from 1% to 16% among elderly living in private households or in institutions; and clinically relevant depressive symptom 'cases' in similar settings vary between 7.2% and 49%. The main predictors of depressive disorders and depressive symptom cases are: female gender, somatic illness, cognitive impairment, functional impairment, lack or loss of close social contacts, and a history of depression.
Depression is frequent in populations of elderly. Methodological differences between the studies hinder consistent conclusions about geographical and cross-cultural variations in prevalence and predictors of depression. Improved comparability will provide a basis for consistent conclusions.
... However, information on the occurrence and risk factors for depressive symptoms in the oldest age groups is rare, since longitudinal studies require elaborate processing. In systematic reviews of the international literature on risk factors for depression in old age, only a few studies in the oldest age groups were reported (7)(8)(9). A current systematic summary of Maier et al. (4) reported only five studies including individuals from the middle-old age to the oldest-old age [75+: [10][11][12][13][14], and only one study conducted in a sample of oldest-old individuals [85+: 15]. ...
... However, it was also pointed out that further research is needed, especially using a model-driven approach (33). Revising former reviews on risk factors for incident depressive symptoms (7)(8)(9), subjective cognitive decline has been shown as the first in the AgeCoDe/AgeQualiDe study (4,12). In our study, we found subjective cognitive decline as a risk factor for incident depressive symptoms in the two younger age groups (75-79, 80-84 years), but not for the oldest age group. ...
... The marital status of being single or divorced was only a significant risk factor in the age group 80 to 84 years, but not in the younger and oldest age group. Previous reviews showed rather heterogeneous or insignificant results for marital status (4,9) that support our findings of significance only for the age group 80 to 84 years. Sociodemographic information of our sample shows an increasing number of individuals being single or divorced, as well as widowed, and a decreasing number of married individuals across the considered age range, and also an increasing number of individuals living alone. ...
Purpose
The present study aimed to investigate age-group-specific incidence rates and risk factors for depressive symptoms in the highest age groups.
Methods
Data were derived from a prospective multicenter cohort study conducted in primary care – the AgeCoDe/AgeQualiDe study. In total, 2,436 patients 75 years and older were followed from baseline to ninth follow-up. To assess depressive symptoms, the short version of the Geriatric Depression Scale (GDS-15, cutoff score 6) was used. Age-specific competing risk regressions were performed to analyze risk factors for incident depressive symptoms in different age groups (75 to 79, 80 to 84, 85+ years), taking into account the accumulated mortality.
Results
The age-specific incidence rate of depression was 33 (95% CI 29-38), 46 (95% CI 40-52) and 63 (95% CI 45-87) per 1,000 person years for the initial age groups 75 to 79, 80 to 84 and 85+ years, respectively. In competing risk regression models, female sex, mobility as well as vision impairment, and subjective cognitive decline (SCD) were found to be risk factors for incident depression for age group 75 to 79, female sex, single/separated marital status, mobility as well as hearing impairment, and SCD for age group 80 to 84, and mobility impairment for age group 85+.
Conclusion
Depressive symptoms in latest life are common and the incidence increases with increasing age. Modifiable and differing risk factors across the highest age groups open up the possibility of specifically tailored prevention concepts.
... Living without a partner and social isolation have previously been found to be associated with depression in elderly people. 25 The present study found that being single is a significant risk factor for depression in patients with HFrEF. Nonetheless, a study by Shimizu, et al. (2014) did not find the same relation to be significant. ...
... It has been found to lower the quality of life and the survival rate. 25 Adelberg, et al. (2016) have shown that all-cause mortality increases in heart failure patients with ejection fraction <35% 3 , and depressed patients were at risk for significant worsening of their HF symptoms, physical and social function, decline in health status and quality of life. 31 Accordingly, studies have suggested that treatment of depression can decrease morbidity and mortality in patients of HF. 27 Therefore, comprehensive treatment strategies should be taken to deal with depression in patients of chronic heart failure with low ejection fraction to decrease morbidity and improve quality of life among them. ...
Background: Clinically significant depression is estimated to occur in a significant portion of chronic heart failure (CHF) patients and increases sharply with increase in heart failure severity. However, the frequency and predictors of depression in this group of patients are underreported. This study was designed to assess frequency & predictors of depression in patients of chronic heart failure with reduced ejection fraction (HFrEF). Methods: This cross-sectional analytical study was performed in the department of Cardiology, Dhaka Medical College Hospital, Dhaka, during the period from October’2018 to Septemeber’2019. One hundred and fifty-two CHF patients with reduced ejection fraction (<40%) either admitted in the department of Cardiology or attended Cardiology OPD, Dhaka Medical College Hospital (DMCH), Dhaka who fulfilled the selection criteria were included into the study. A translated and validated Patient Health Questionnaire (PHQ-9) in Bengali was used to assess depression level in CHF patients in this study. Informed written consent was taken from each patient. Approval for the study was taken from Ethical Review Committee (ERC) of Dhaka Medical College before commencement of the study. After compiling data from all participants, statistical analyses were performed using the Statistical Package for Social Science (SPSS), version 22.0 for windows. Results: Mean age of the patients was 58.68±9.40 years, ranging from 36 to 75 years. Male predominance was noted (72% vs 28%). Overall, frequency of depression was 56%. Among the depressed patients (n=85), majority (40%) had minimal depression while 27%, 19% and 14% had mild, moderate and severe depression. respectively. Among the different risk factors, DM and sedentary lifestyle were significantly associated with depression (p<0.05). Age >65 years, sedentary lifestyle, and H/O past MI were independently associated with depression among chronic HErEF patients. Widowed patients, diabetes, hospital readmission in last 2 months before study inclusion and NYHA class III/IV were also significantly associated with depression among patients with chronic HFrEF (p<0.05). Conclusion: More than half of the patients with chronic HFrEF had concurrent depression of varied severity. Proper care of depression along with HF may improve the survival and quality of life of these patients. Bangladesh Heart Journal 2024; 39(2): 74–84
... A person's aging process can be exacerbated or precipitated by a variety of obstacles, such as deteriorating physical health, losing autonomy, a lack of social interaction, and life-changing events. Given its links to greater rates of illness and death, worse quality of life, and increased functional impairment, the burden of depression among the elderly is especially worrisome [1,2]. ...
... Globally, the depression prevalence among the elderly population varies widely, with estimates ranging from 4.7% to 16% in community-dwelling older adults [1,2]. However, because of the cumulative impact of socioeconomic status, suffering, inadequate access to healthcare services, an increased level of stress and adversity, and living in slum communities or financially disadvantaged areas, some subgroups of the elderly population may be more susceptible to depression. ...
Background: An often-occurring and severely disabling mental illness that mostly affects older people living in urban slums is depression. Developing successful therapies requires an understanding of the complex interactions between the different factors that contribute to depression in this susceptible population.
Objectives: This study aimed to find the prevalence of depression and identify the factors associated with depression in the geriatric population aged ≥60 years in the study area during the study period in Gujarat, India.
Methods: This study was carried out among 450 participants aged ≥60 years. Face-to-face interviews and standardized assessment tools, including the Geriatric Depression Scale (GDS) for depression and the Mini-Cog test for cognitive impairment, were used to collect data on depression levels, sociodemographic characteristics, behavioral factors, medical conditions, life events, and psychiatric history. Statistical analyses, including chi-squared tests, were performed to assess the associations.
Results: Significant associations were found between various factors and depression levels, which were lower education (11.11% severe depression among non-literate vs. 2.11% among literate, p<0.001) and widowhood (11.56% severe depression among widowed vs. 4.53% among married, p<0.001), which were linked to higher depression severity. Behavioral risk factors like short sleep duration (<6 hours at night: 21.71% severe depression, p<0.001), tobacco snuffing (16.24% severe depression, p<0.001), and lack of physical activity (28.71% severe depression, p<0.001) were strongly associated with increased depression. Medical conditions such as hypertension (10.36% severe depression, p<0.001) and stressful life events like family conflicts (16.67% severe depression, p<0.001) exhibited strong associations. A personal history of depression (38.82% severe depression, p<0.001) was a potent predictor.
Conclusions: The study highlights the multifaceted nature of depression in the geriatric population of the study area, underscoring the necessity of all-encompassing measures to tackle the recognized possible risk factors. The results provide valuable insights for developing targeted prevention strategies, healthcare policies, and support systems to enhance the mental well-being of this vulnerable population.
... 1,5,7,11,13) indicated depression when answered negatively. Score 0f (0-4) are considered normal; (5-8) indicated mild depression; (9-11) indicated moderate depression; and (12)(13)(14)(15) indicated severe depression (10) . The questions meant to answer both Yes or No; and scored based on (1, 0) respectively. ...
... This result is agreed with Cole et al., which indicate that women experiencing depression about twice as often as men. The life time risk of depression in women is about 20%-26% compared to about 8% -12% for men (13,14) . ...
Objective: The study aims to assess depression in elderly and find out the relationship of depression with their demographic characteristics. Methodology: A descriptive design study was carried out for elderly persons who attendant to the Public Clinics in Baghdad City during 1st July 2010 to 1st June 2011. A purposive [non probability] sample of [50] persons was selected from the public clinics in Baghdad City. The data was collected through the constructed questionnaire and filling by interview. The data were analyzed by using descriptive statistical approach [frequency and percentage] and inferential data analysis approach [chi- square]. Results: The finding of the study was indicated that the large number of the elderly suffered from mild level of depression and it was a significant association between the depressed level and some variables. Recommendation: The study is recommended that do more researches because of they need to recognize and understand all aspects of elderly people with depression and mentally ill for help those people and get treatment.
... In older people, less characteristic symptoms of depression do often appear; compared to younger age groups, low mood and sadness are less prevalent [9,10], whereas somatic symptoms, painful conditions, and physical disability, along with anxiety and cognitive impairment are much more prevalent [8]. As a result of this uncharacteristic symptomatology, depression is less frequently diagnosed and treated among older adults [4,5,8,[12][13][14]. In addition, many community-dwelling older adults who meet the diagnostic criteria for depression do not seek health care for their symptoms; less than half have contact with the health service, and barely 10% receive effective treatment [12]. ...
... Possibly, the lack of treatment for clinically relevant symptoms of depression and anxiety represents an alarming concern to the healthcare system and society; health politics highlights the need for health promotion interventions to keep older people in their own homes as long as possible. Undetected issues of depression and anxiety may cause reduced mental and physical functionality and increased risk of dementia and other diseases [1,[3][4][5], all of which trigger a need for professional health care. ...
Objectives
The Hospital Anxiety and Depression Scale (HADS) is commonly used to measure anxiety and depression, but the number of studies validating psychometric properties in older adults are limited. To our knowledge, no previous studies have utilized confirmative factor analyses in community-dwelling older adults, regardless of health conditions. Thus, this study aimed to examine the psychometric properties of HADS in older adults 70 + living at home in a large Norwegian city.
Methods
In total, 1190 inhabitants ≥ 70 (range 70 – 96) years completed the HADS inventory in the population-based Trøndelag Health Study (HUNT), termed “HUNT4 70 + ” in Trondheim, Norway. Confirmatory factor analyses were performed to test the dimensionality, reliability, and construct validity.
Results
The original two-factor-solution (Model-1) revealed only partly a good fit to the present data; however, including a cross-loading for item 6D (“I feel cheerful”) along with a correlated error term between item 2D (“I still enjoy the things I used to enjoy”) and 12D (“I look forward with enjoyment to things”) improved the fit substantially. Good to acceptable measurement reliability was demonstrated, and the construct validity was acceptable.
Conclusions
The HADS involves some items that are not reliable and valid indicators for the depression construct in this population, especially item 6 is problematic. To improve the reliability and validity of the Norwegian version of HADS, we recommend that essential aspects of depression in older adults should be included.
... While the disorder affects people of all ages, its prevalence can vary greatly depending on the population studied. For instance, among older adults, the prevalence of depression ranges from 1% to 49% and is influenced by factors such as physical health and social isolation [6]. In the United States, depression rates among young people have shown a significant rise in recent years, increasing from 3.1% in 2016 to 4.0% in 2020-an approximately 30% increase over a five-year period. ...
This study investigates the combined effects of environmental pollutants (lead, cadmium, total mercury) and behavioral factors (alcohol consumption, smoking) on depressive symptoms in women. Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 cycle, specifically exposure levels of heavy metals in blood samples, were used in this study. The analysis of these data included the application of descriptive statistics, linear regression, and Bayesian Kernel Machine Regression (BKMR) to explore associations between environmental exposures, behavioral factors, and depression. The PHQ-9, a well-validated tool that assesses nine items for depressive symptoms, was used to evaluate depression severity over the prior two weeks on a 0-3 scale, with total scores ranging from 0 to 27. Exposure levels of heavy metals were measured in blood samples. BKMR was used to estimate the exposure-response relationship, while posterior inclusion probability (PIP) in BKMR was used to quantify the likelihood that a given exposure was included in the model, reflecting its relative importance in explaining the outcome (depression) within the context of other predictors in the mixture. A descriptive analysis showed mean total levels of lead, cadmium, and total mercury at 1.21 µg/dL, 1.47 µg/L, and 0.80 µg/L, respectively, with a mean PHQ-9 score of 5.94, which corresponds to mild depressive symptoms based on the PHQ-9 scoring. Linear regression indicated positive associations between depression and lead as well as cadmium, while total mercury had a negative association. Alcohol and smoking were also positively associated with depression. These findings were not significant, but limitations in linear regression prompted a BKMR analysis. BKMR posterior inclusion probability (PIP) analysis revealed alcohol and cadmium as significant contributors to depressive symptoms, with cadmium (PIP = 0.447) and alcohol (PIP = 0.565) showing notable effects. Univariate and bivariate analyses revealed lead and total mercury's strong relationship with depression, with cadmium showing a complex pattern in the bivariate analysis. A cumulative exposure analysis of all metals and behavioral factors concurrently demonstrated that higher quantile levels of combined exposures were associated with an increased risk of depression. Finally, a single variable-effects analysis in BKMR revealed lead, cadmium, and alcohol had a stronger impact on depression. Overall, the study findings suggest that from exposure to lead, cadmium, mercury, alcohol, and smoking, cadmium and alcohol consumption emerge as key contributors to depressive symptoms. These results highlight the need to address both environmental and lifestyle choices in efforts to mitigate depression.
... There are sex and gender differences in risk factors for AD. For instance, depression (a psychosocial risk factor of dementia 1 ) is more prevalent in women than men 22 . There are also sex and gender differences in the progression of cognitive decline and AD, with women having faster deterioration than men 23 . ...
Emerging evidence suggests that repetitive negative thinking (RNT; i.e., worry and ruminative brooding) is associated with biomarkers of Alzheimer’s disease. Given that women have a greater risk of many neurodegenerative diseases, this study investigated whether worry and brooding are associated with general neurodegeneration and whether associations differ by sex. Exploratory analyses examined whether allostatic load, a marker of chronic stress, mediates any observed relationships. Baseline data from 134 cognitively healthy older adults in the Age-Well clinical trial were utilised. Worry and brooding were assessed using questionnaires. Plasma neurofilament light chain (NfL), a biomarker of neurodegeneration, was quantified using a Meso Scale Discovery assay. We found a positive interaction between brooding and sex on NfL, with higher brooding associated with greater NfL levels in women. No associations were observed between worry/ruminative brooding and allostatic load. These results offer preliminary support that RNT is associated with worse brain health, specifically in women.
... Again, the association between sociodemographic indicators and psychological distress showed some tendencies, although they are not replicated in other studies. The work of Cole and Dendukuri [105], Djernes [106], and Vink et al. [10] illustrates the variability found in studies of the associations between psychological distress and a variety of sociodemographic factors in older adults. A study of 236,503 older adults in Australia found that the overall prevalence of psychological distress was lower at older ages, whereas there was a gradual increase in the proportion of high or very high scores from both men and women aged 80 years or older, [22]. ...
This study examines the differential weight of a wide range of factors—sociodemographic factors, indicators of autonomy, social support, coping styles, vulnerability to emotional contagion, and empathy—in the presence of two profiles of psychological distress and in their absence. This cross-sectional study included 170 older adults. As assessed by the Hospital Anxiety and Depression Scale (HADS), 65.9% of the individuals in the sample had a clinical or subthreshold level of anxiety and depression (score > 1). Based on the HADS’s clinical cutoff scores for the anxiety and depression subscales, three profiles were created for the no distress, anxiety, and anxious depression groups. The profiles did not differ on demographic indicators except for sex. Vulnerability to emotional contagion, satisfaction with the social network and coping styles emerged as factors weighing the likelihood of being in either of the psychological distress groups relative to individuals with no distress. After controlling for adversity and psychotropic treatment, vulnerability to emotional contagion had the strongest relationship with both psychological distress profiles. Future research, such as a prospective longitudinal study, may provide an opportunity to explain the direction of the relationship between psychological distress and the factors studied, particularly vulnerability to emotional contagion.
... limited access and opportunities), and motivations (e.g. less interest) to engage in arts activities (14)(15)(16). Furthermore, engagement is lower among groups that are disproportionately more likely to experience poorer mental health (17,18), including those from racial/ethnic minority backgrounds, with fewer educational qualifications, of lower socioeconomic status, and living in more deprived areas (19)(20)(21)(22). ...
Increasing evidence links arts engagement with mental health, but the directionality of the link remains unclear. Applying a novel approach to causal inference, we used non-recursive instrumental variable models to analyse two waves of data from the United Kingdom Household Longitudinal Study (N = 17,927). Our findings reveal bidirectional causal relationships between arts engagement (arts participation, cultural attendance, heritage visits) and mental health (GHQ-12 mental distress, SF-12 MCS mental well-being). After adjusting for Time 1 measures and identified confounders, cultural attendance and heritage visits were reciprocally associated with mental distress and mental well-being, while arts participation was only reciprocally associated with mental well-being. The bidirectional effects between arts engagement and mental health are modest but clearly demonstrated not just from mental health to arts but also from arts to mental health. Our findings indicate that previous evidence of an association between arts engagement and mental health is due to bidirectional causal effects. Interventions that boost arts participation, cultural attendance and heritage visits may help break the negative feedback loop and enhance mental health.
... Finally, we examined the association between depressive symptoms and social activity classes using multiple linear regression. In our analysis, we controlled for covariates known to influence depressive symptoms in older adults, as identified in previous reviews [44][45][46][47][48]. The LCA and multinomial logistic regression were conducted using Mplus 8.8 (Muthén & Muthén) [43] and subsequent analyses were performed using IBM SPSS Statistics for Windows version 26.0 (IBM Corp., Armonk, NY, USA). ...
Background
With the trend of digitalization, social activities among the older population are becoming more diverse as they increasingly adopt technology-based alternatives. To gain a comprehensive understanding of social activities, this study aimed to identify the patterns of digital and in-person social activities among community-dwelling older adults in South Korea, examine the associated factors, and explore the difference in depressive symptoms by the identified latent social activity patterns.
Methods
Data were extracted from a nationwide survey conducted with 1,016 community-dwelling older adults (mean age 68.0 ± 6.5 years, 47.8% male). The main variables assessed were digital social activities (eight items), in-person social activities (six items), and depressive symptoms (20 items). Data were analyzed using latent class analysis, multinomial logistic regression, and multiple linear regression.
Results
We identified four distinct social activity patterns: “minimal in both digital and in-person” (22.0%), “moderate in both digital and in-person” (46.7%), “moderate in digital & very high in in-person” (14.5%), and “high in both digital and in-person” (16.8%). Younger age, living in multi-generational households, and higher digital literacy were associated with a higher likelihood of being in the “moderate in both digital and in-person” than the “minimal in both digital and in-person” group. Younger age, male, living in multi-generational households, residing in metropolitan areas, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the “moderate in digital & very high in in-person” than the “minimal in both digital and in-person” group. Younger age, living in multi-generational households, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the “high in both digital and in-person” than the “minimal in both digital and in-person” group. Depressive symptoms were significantly higher in the group with minimal engagement in both digital and in-person activities, compared to other three groups.
Conclusions
This study highlights distinct patterns of social activities among Korean community-dwelling older adults. Since older adults with minimal social activity engagement can be more vulnerable to depressive symptoms, interventions that address modifiable attributes, such as supporting digital literacy and facilitating physical activity of older adults, could serve as potential strategies to enhance their social activity engagement and, consequently, their mental well-being.
... Examining the factors contributing to depression in the geriatric population enables the implementation of strategic management measures by addressing them. Known risk factors associated with depression among the geriatric population include being female, having physical and cognitive impairments, lacking social connections, genetic predisposition, specific personality traits, and a history of depression [22,23]. Certain Malaysia-based studies have also regularly identified comparable risk factors among the geriatric population. ...
Background
Although significant and disabling consequences are presented due to geriatric population-related depression, an insufficient comprehension of various biological, psychological, and social factors affecting this issue has been observed. Notably, these factors can contribute to geriatric population-related depression with low social support. This study aimed to identify factors associated with depression among the community-dwelling geriatric population with low social support in Malaysia.
Methods
This study used secondary data from a population-based health survey in Malaysia, namely the National Health Morbidity Survey (NHMS) 2018: Elderly Health. The analysis included 926 community-dwelling geriatric population aged 60 and above with low social support. The primary data collection was from August to October 2018, using face-to-face interviews. This paper reported the analysis of depression as the dependent variable, while various biological, psychological and social factors, guided by established biopsychosocial models, were the independent variables. Multiple logistic regression was applied to identify the factors. Analysis was performed using the complex sampling module in the IBM SPSS version 29.
Results
The weighted prevalence of depression among the community-dwelling geriatric population aged 60 and above with low social support was 22.5% (95% CI: 17.3–28.7). This was significantly higher than depression among the general geriatric Malaysian population. The factors associated with depression were being single, as compared to those married (aOR 2.010, 95% CI: 1.063–3.803, p: 0.031), having dementia, as opposed to the absence of the disease (aOR 3.717, 95% CI: 1.544–8.888, p: 0.003), and having a visual disability, as compared to regular visions (aOR 3.462, 95% CI: 1.504–7.972, p: 0.004). The analysis also revealed that a one-unit increase in control in life and self-realisation scores were associated with a 32.6% (aOR: 0.674, 95% CI: 0.599–0.759, p < 0.001) and 24.7% (aOR: 0.753, 95% CI: 0.671–0.846, p < 0.001) decrease in the likelihood of developing depression, respectively.
Conclusion
This study suggested that conducting depression screenings for the geriatric population with low social support could potentially prevent or improve the management of depression. The outcome could be achieved by considering the identified risk factors while implementing social activities, which enhanced control and self-fulfilment.
... [9] Lack or loss of close contact and reduced socialization have been proven to be one of the major predictors of the prevalence of depressive mental disorders in the elderly population. [10] And it has been found that self-isolation per se does not necessarily lead to the onset of depression but that perceiving COVID-19 symptomatology (e.g. dry cough, fever) and being exposed to news reporting about the pandemic does. ...
A BSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has significantly altered the lives and lifestyles of several older populations in the United Kingdom. It was important to note how it has affected their physical, mental, and social health and well-being during the first wave of the Covid-19 pandemic. To study the impact of the Covid-19 pandemic and the imposed restrictions on the day-to-day lives of the elderly population in the United Kingdom. A review of the published literature on the first wave of the Covid-19 pandemic and its consequences on the older population in the United Kingdom is done. Search engines used for medical databases were Pubmed, Google Scholar, and Internet Explorer. It was found that physical as well as mental well-being was affected in the elderly citizens of the United Kingdom. Mental health studies noted an obvious increase in anxiety and depressive symptoms. Social isolation and reduced access to healthcare services had a deteriorating impact on their social health. Covid-19-related lockdown and pandemic-associated physical, mental, and social well-being effects have been evident in the elderly population in the United Kingdom. The reasons identified for such findings are lack of physical activity, poor social interactions, social isolation, the perceived threat of a pandemic, and poor access to healthcare facilities.
... In Canada, a comprehensive set of 117 criteria has been established to benchmark quality of care, of which only 25 out of 117 (21.4%) criteria have been implemented in all provinces as of December 2022 [7]. Mental health is similarly worse in long-term care [8][9][10][11]. A study in Canada found that, among 50,000 seniors in long-termcare homes, 44% were either diagnosed with or had symptoms of depression [12]. Aging in place allows older adults to remain in their own home as they age while receiving physical, cognitive, social, or mental health support that can aid in the completion of activities of daily living (ADLs), such as eating, dressing, cooking, or housework [13][14][15][16]. ...
As Canada’s population of older adults rises, the need for aging-in-place solutions is
growing due to the declining quality of long-term-care homes and long wait times. While the current
standards include questionnaire-based assessments for monitoring activities of daily living (ADLs),
there is an urgent need for advanced indoor localization technologies that ensure privacy. This study
explores the use of Ultra-Wideband (UWB) technology for activity recognition in a mock condo in
the Glenrose Rehabilitation Hospital. UWB systems with built-in Inertial Measurement Unit (IMU)
sensors were tested, using anchors set up across the condo and a tag worn by patients. We tested
various UWB setups, changed the number of anchors, and varied the tag placement (on the wrist or
chest). Wrist-worn tags consistently outperformed chest-worn tags, and the nine-anchor configuration
yielded the highest accuracy. Machine learning models were developed to classify activities based on
UWB and IMU data. Models that included positional data significantly outperformed those that did
not. The Random Forest model with a 4 s data window achieved an accuracy of 94%, compared to
79.2% when positional data were excluded. These findings demonstrate that incorporating positional
data with IMU sensors is a promising method for effective remote patient monitoring.
... Different factors, including genetic predisposition, chronic diseases and disabilities, pain, frustration with limitations in activities of daily living (ADL), personality traits (dependent, anxious, or avoidant), unfavorable life events (separation, divorce, bereavement, poverty, social isolation), and inadequate social support, can raise an individual's risk of developing depression in their later years (Akbaş et al., 2020;Djernes, 2006;Hayward et al., 2012;Roberts et al., 1997;Velázquez-Brizuela et al., 2014;Yaka et al., 2014). Many studies have shown a relationship between depression and a number of socioeconomic factors, including older age, a lack of education, and manual labor (Park et al., 2015). ...
Objectives: Depression is one of the main causes of disability worldwide and makes a major contribution to the global disease burden, especially in developing countries. It is also one of the most prevalent psychiatric disorders in the older people and a significant risk factor for both disability and death. Despite the fact that little research has been done on it among those who live in sub-Saharan Africa, especially Ethiopia, the aim of this study was to fill the above-mentioned gap among older people. Method: A community-based cross-sectional study was conducted from April to June 2023. A total of 607 older people were included using the multistage sampling technique. An interview-administered questionnaire was used to assess depression using the Geriatric Depression Scale item 15 with a cutoff ≥5. For statistical analysis, the binary logistic regression model was employed. Results: The mean age of the study participants was 72.45 (SD ±9.08) years. The prevalence of depression was found to be 45%. Age 80 years and above, 70-79 years, widowed, retired, known chronic disease, and poor social support were associated factors with depression. Conclusion: Compared to other studies conducted in different regions of Ethiopia, the prevalence of depression in this study was found to be high, at 45%. The results of this study may be taken as providing health professionals, health policymakers, and other pertinent stakeholders' early warning signs and guidance on how to take efficient control measures and conduct periodic monitoring among older people.
... More specifically, late onset depression has been more frequently associated to cognitive deterioration rather than early onset depression, late onset depression being more severe and mostly affecting cognition in terms of memory, verbal fluency, visuospatial abilities reaction times, and executive functioning [21,22]. A third view holds that cognitive performance decline and depression symptoms share common risk factors, which may explain the increase in prevalence of both conditions in older people and the reason of why they are frequently comorbid [23][24][25]. ...
Human aging is a physiological, progressive, heterogeneous global process that causes a decline of all body systems, functions, and organs. Throughout this process, cognitive function suffers an incremental decline with broad interindividual variability.
The first objective of this study was to examine the differences in the performance on the MoCA test (v. 7.3) per gender and the relationship between the performance and the variables age, years of schooling, and depressive symptoms .The second objective was to identify factors that may influence the global performance on the MoCA test (v. 7.3) and of the domains orientation, language, memory, attention/calculation, visuospatial and executive function, abstraction, and identification.
A cross-sectional study was carried out in which five hundred seventy-three (573) cognitively healthy adults ≥ 50 years old were included in the study. A sociodemographic questionnaire, the GDS-15 questionnaire to assess depression symptoms and the Spanish version of the MoCA Test (v 7.3) were administered. The evaluations were carried out between the months of January and June 2022. Differences in the MoCA test performance per gender was assessed with Student’s t-test for independent samples. The bivariate Pearson correlation was applied to examine the relationship between total scoring of the MoCA test performance and the variables age, years of schooling, and depressive symptoms. Different linear multiple regression analyses were performed to determine variables that could influence the MoCA test performance.
We found gender-related MoCA Test performance differences. An association between age, years of schooling, and severity of depressive symptoms was observed. Age, years of schooling, and severity of depressive symptoms influence the MoCA Test performance, while gender does not.
... As in the present study women reported more depressive symptoms than men, and widows tended to exhibit more symptoms than women living with spouse. Similar results were reported in a study among western population (Djernes, 2006). ...
... As in the present study women reported more depressive symptoms than men, and widows tended to exhibit more symptoms than women living with spouse. Similar results were reported in a study among western population (Djernes, 2006). ...
... There are sex and gender differences in risk factors for AD. For instance, depression (a psychosocial risk factor of dementia 1 ) is more prevalent in women than men 20 . There are also sex and gender differences in progression of cognitive decline and AD with women having faster deterioration than men 21 . ...
Emerging evidence suggests that Repetitive Negative Thinking (RNT; i.e., worry and ruminative brooding) is associated with biomarkers of Alzheimer’s disease. However, it is neither known whether RNT may be a marker of neurodegenerative disease more generally, nor the mechanism through which RNT may act. Given that women have greater risk of many neurodegenerative diseases, this study aimed to investigate (I) the relationships between worry and ruminative brooding and a blood-based biological correlate of neurodegeneration, neurofilament light chain (NfL), (II) whether this relationship differs by sex, and (III) the extent to which allostatic load, a marker of chronic stress, may mediate this relationship. Cross-sectional baseline data from 134 cognitively healthy older adults (61.2% women) enrolled in the Age-Well clinical trial were utilised. Worry and brooding were assessed by the Penn State Worry Questionnaire and the Rumination Response Scale brooding subscale, respectively. Plasma NfL levels were quantified using a Meso Scale Discovery assay. A composite measure of allostatic load was calculated using 18 biomarkers spanning five sub-categories (anthropometric, cardiovascular and respiratory, metabolic, immune, neuroendocrine). Associations were examined using linear regressions adjusted for demographic characteristics. We found a positive interaction between brooding and ex on NfL, with higher brooding associated with greater NfL levels in women. No associations were observed with worry or allostatic load. These results offer preliminary support that RNT is associated with worse brain health, specifically in women. Further research is needed to elucidate the underlying mechanisms that explains the association between RNT and markers of dementia risk in women.
... Many older adults may not seek help because they attribute depressive symptoms to normal aging or other physical ailments. According to previous epidemiology studies, the frequency of Late-Life Depression (LLD) varies between 0.9% to 9.4% in private households and 14% to 42% in institutions [1]. ...
Evidence suggests that depressive symptomatology is a consequence of network dysfunction rather than lesion pathology. We studied whole-brain functional connectivity using a Minimum Spanning Tree as a graph-theoretical approach. Furthermore, we examined functional connectivity in the Default Mode Network, the Frontolimbic Network (FLN), the Salience Network, and the Cognitive Control Network. All 183 elderly subjects underwent a comprehensive neuropsychological evaluation and a 3 Tesla brain MRI scan. To assess the potential presence of depressive symptoms, the 13-item version of the Beck Depression Inventory (BDI) or the Geriatric Depression Scale (GDS) was utilized. Participants were assigned into three groups based on their cognitive status: amnestic mild cognitive impairment (MCI), non-amnestic MCI, and healthy controls. Regarding affective symptoms, subjects were categorized into depressed and non-depressed groups. An increased mean eccentricity and network diameter were found in patients with depressive symptoms relative to non-depressed ones, and both measures showed correlations with depressive symptom severity. In patients with depressive symptoms, a functional hypoconnectivity was detected between the Anterior Cingulate Cortex (ACC) and the right amygdala in the FLN, which impairment correlated with depressive symptom severity. While no structural difference was found in subjects with depressive symptoms, the volume of the hippocampus and the thickness of the precuneus and the entorhinal cortex were decreased in subjects with MCI, especially in amnestic MCI. The increase in eccentricity and diameter indicates a more path-like functional network configuration that may lead to an impaired functional integration in depression, a possible cause of depressive symptomatology in the elderly.
... Previous studies [10] have shown that the prevalence of depression among these residents ranges from 31.3 to 94.2%, compared with 6-23.3% in community-dwelling adults. Depressive symptoms are associated with a decline in cognitive function, social isolation, and worsening physical health [11,12]. Depression in older adults can manifest as loss of appetite, weight loss, sleep disturbances, and reduced activity, further exacerbating their health conditions [12][13][14]. ...
Background
Many older adults residing in long-term care often face issues like poor sleep, reduced vitality, and depression. Non-pharmacological approaches, specifically Binaural Beat Music (BBM) and Rhythmic Photic Stimulation (RPS), may alleviate these symptoms, yet their efficacy in this demographic has not been extensively explored.
Aims
This study investigated the effects of combined BBM and RPS interventions on sleep quality, vitality, and depression among older residents with depressive symptoms in long-term care facilities.
Methods
Using a quasi-experimental design, a total of 88 older adults with depressive symptoms from Taiwanese daytime care centers were divided into the BBM with RPS, and Sham groups (44 each). They underwent 20-minute daily sessions of their assigned treatment for two weeks. The BBM with RPS group listened to 10 Hz binaural beat music with 10 Hz photic stimulation glasses, and the Sham group received non-stimulating music and glasses.
Results
After the intervention, participants in the BBM with RPS groups showed significant improvements in vitality and depressive mood, with a notable increase in sympathetic nervous system activity. Conversely, the Sham group exhibited significant deterioration in vitality and mental health, with a significant increase in parasympathetic activity. Additionally, compared with the Sham group, the BBM and RPS groups showed significant improvements in vitality, mental health, and depression, with a significant increase in sympathetic nervous activity.
Conclusion
The two-week intervention suggests that the combination of BBM and RPS, as a non-invasive intervention, can potentially improve vitality, mental health, and depressive mood among older adults in long-term care institutions.
... However, studies on frail older adults have indicated a high frequency of depression and anxiety. For example, 35% of hospitalized older patients and 12.4%-42% of institutionalized older adults have been reported to exhibit depressive symptoms [9,10,22,23]. Furthermore, it has been reported that in the last few years of life, when frailty rapidly progresses, life satisfaction and happiness show a terminal decline while negative emotions increase in older adults [7,[24][25][26][27][28]. ...
Background
At present, there are no consistent findings regarding the association between physical health loss and mental health in older adults. Some studies have shown that physical health loss is a risk factor for worsening of mental health. Other studies revealed that declining physical health does not worsen mental health. This study aimed to clarify whether the relationship between physical health loss and emotional distress varies with age in older inpatients post receiving acute care.
Methods
Data for this study were collected from 590 hospitalized patients aged ≥ 65 years immediately after their transfer from an acute care ward to a community-based integrated care ward. Emotional distress, post-acute care physical function, and cognitive function were assessed using established questionnaires and observations, whereas preadmission physical function was assessed by the family members of the patients. After conducting a one-way analysis of variance (ANOVA) and correlation analysis by age group for the main variables, a hierarchical multiple regression analysis was conducted with emotional distress as the dependent variable, physical function as the independent variable, age as the moderator variable, and cognitive and preadmission physical function as control variables.
Results
The mean GDS-15 score was found to be 6.7 ± 3.8. Emotional distress showed a significant negative correlation with physical function in younger age groups (65-79 and 80-84 years); however, no such association was found in older age groups (85-89, and ≥ 90 years). Age moderated the association between physical function and emotional distress. Poor physical function was associated with higher emotional distress in the younger patients; however, no such association was observed in the older patients.
Conclusions
Age has a moderating effect on the relationship between physical health loss and increased emotional distress in older inpatients after acute care. It was suggested that even with the same degree of physical health loss, mental damage differed depending on age, with older patients experiencing less damage.
... Other cohort studies have found that late-life depression may even indicate the prodromal stage of AD [130,131]. Importantly, depression due to persistent feelings of loneliness and health anxiety are commonly reported in elderly populations [132]. Altogether, while more work is needed to understand how mental stress exactly impairs OL functions, the well-recognized effect of PE on improving depressive symptoms [133,134] can contribute to mitigating mental stress-associated WM damage, which could later cause AD. ...
... The prevalence of depression in our study was higher than that in a previous study conducted in Saudi Arabia, which was 12% [7]. The prevalence rates in previous studies may vary due to differences in diagnostic criteria and methods [15]. In addition, it is well known that the prevalence of late-life depression is underdiagnosed for several reasons, including the fact that depressive disorders manifest differently in geriatric populations, as well as the fact that depressive symptoms are often regarded as an inevitable part of aging [16]. ...
Objective: There is currently limited evidence about the prevalence of depression among elderly people residing in Makkah, Saudi Arabia. This study aims to report the magnitude of depression among the older population in Makkah, Saudi Arabia, and the related risk factors.
Methods: An online cross-sectional pilot survey was carried out in Makkah City, Saudi Arabia. Data were collected using an online self-administered questionnaire.
Results: The study questionnaire was completed by 191 older people. The participants' ages varied from 60 to 88 years. 55.5% were women, 47.9% were married, and 21.5% were divorced/widowed. 46.6% had hypertension, 42.4% had diabetes, 17.3% had hypothyroidism, 7.9% had cardiovascular diseases (CVDs), and 6.3% reported psychiatric problems. 44.5% of the subjects had no depression, 23.5% had mild, 15.2% had moderate, and 16.8% had severe depression. The sample included 32% who had been classified as having major depression. Elderly participants with insomnia, cognitive diseases, and chronic diseases showed a high risk for experiencing severe depression (OR=2.74; 95% CI: 1.42-5.28),(OR=2.63; 95% CI: 1.29-5.40), and (OR=2.62; 95% CI: 1.11-6.14) respectively.
Conclusion: Depression was common among the elderly population in Makkah, particularly among those with a documented history of insomnia, cognitive diseases, and chronic diseases. Depression screening and treatment for old people in medical settings is recommended.
... Previous research has indicated that several signi cant factors are associated with the onset and persistence of depression in older adults, including being female, having a low educational level, experiencing spousal loss, cognitive decline, physical illness, and functional impairment [10]. Currently, the relationship between disability in elderly individuals and depression is still the subject of ongoing investigations, and interventions for depression among disabled older adults are considered essential for healthcare services. ...
Background
Given the accelerated aging population in China, the number of disabled elderly individuals is increasing, depression has been a common mental disorder among older adults. This study aims to establish an effective model for predicting depression risks among disabled elderly individuals.
Methods
The data for this study was obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS). In this study, disability was defined as a functional impairment in at least one activity of daily living (ADL) or instrumental activity of daily living (IADL). Depressive symptoms were assessed by using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D10). We employed SPSS 27.0 to select independent risk factor variables associated with depression among disabled elderly individuals. Subsequently, a predictive model for depression in this population was constructed using R 4.3.0. The model's discrimination, calibration, and clinical net benefits were assessed using receiver operating characteristic (ROC) curves, calibration plots, and decision curves.
Results
In this study, a total of 3,107 elderly individuals aged ≥ 60 years with disabilities were included. Poor self-rated health, pain, absence of caregivers, cognitive impairment, and shorter sleep duration were identified as independent risk factors for depression in disabled elderly individuals. The XGBoost model demonstrated better predictive performance in the training set, while the logistic regression model showed better predictive performance in the validation set, with AUC of 0.76 and 0.73, respectively. The calibration curve and Brier score (Brier: 0.20) indicated a good model fit. Moreover, decision curve analysis confirmed the clinical utility of the model.
Conclusions
The predictive model exhibits outstanding predictive efficacy, greatly assisting healthcare professionals and family members in evaluating depression risks among disabled elderly individuals. Consequently, it enables the early identification of elderly individuals at high risks for depression.
... Glavni su prediktori depresije: ženski spol, somatska bolest, kognitivno oštećenje, funkcionalno oštećenje, nedostatak ili gubitak bliskih društvenih kontakata itd. 28,29 Dobivenu razliku u depresivnosti nakon operacije s obzirom na razinu obrazovanja moguće je objasniti razlikom u dobi te je očito najstarija populacija pacijenata ona kojoj bi trebalo obratiti najviše pozornosti u edukaciji i informiranju na temu depresije. U praksi bi trebalo više vremena provesti razgovarajući s njima te vidjeti što ih zabrinjava, imaju li odgovarajuću podršku i pomoć kod kuće te kako bi im se najbolje moglo pomoći tijekom njihova boravka u bolnici. ...
Ugradnja totalne endoproteze kuka (TEP) jedna je od najčešćih operacija u ortopedskoj kirurgiji. Riječ je o složenom operacijskom zahvatu koji zahtijeva dugotrajan oporavak. Neugodne emocije mogu usporiti oporavak i otežati prilagodbu pacijenata te je važno znati u kojoj su mjeri neugodna emocionalna stanja poput depresije, anksioznosti i stresa prisutna kod pacijenata. Stoga je cilj ovoga istraživanja bio utvrditi učestalost pojave anksioznosti, depresije i stresa kod pacijenata prije i nakon ugradnje totalne endoproteze kuka. Zanimalo nas je i kakav je odnos promatranih emocionalnih stanja s nekim sociodemografskim obilježjima. Primijenjen je upitnik koji uključuje osnovne sociodemografske podatke ispitanika te Skala depresije, anksioznosti i stresa (DASS-S). Uzorak od 50 ispitanika obaju spolova bio je prigodnog tipa, prosječne dobi 69 godina. Istraživanje je provedeno dvokratno za vrijeme boravka pacijenata u bolnici, dan prije operacije i drugi dan nakon operacije kuka. Prije operacije emocionalno stanje pacijenata bilo je vrlo neugodno, osobito stres. Nakon operacije došlo je do izrazitog, statistički značajnog smanjenja svih triju neugodnih emocija, što ukazuje na poboljšanje emocionalnog stanja pacijenata nakon operacije u odnosu na stanje prije. Osobe koje imaju samo osnovnoškolsko obrazovanje značajno su starije od ostalih te imaju značajno izrazitiju depresivnost nakon operacije. Korelacije su pokazale da s povećanjem dobi pacijenata, raste i anksioznost, i to u obje točke mjerenja, te je i razina depresivnog raspoloženja izrazitija. Po spolu, bračnom statusu, kao ni po tome imaju li ispitanici djece nije dobivena statistički značajna razlika.
... In recent years, the Epidemiological Research Center Depression Scale (CES-D) has been reported to have high detection rates in countries such as Italy (37%) and Spain (49%), which has prompted us to study psychiatric disorders in European countries (10). Early studies have found a strong association between depression and suicidal ideation (11,12), with approximately 58% of patients with major depressive episodes reporting suicidal thoughts (13), which suggests that the serious risk posed by psychiatric disorders to an individual's health cannot be ignored. ...
Objectives
Adverse childhood experiences (ACEs) and anxiety-depression co-morbidity are attracting widespread attention. Previous studies have shown the relationship between individual psychiatric disorders and ACEs. This study will analyze the correlation between anxiety-depression co-morbidity and different levels of ACEs.
Methods
Seven categories of ACE and four classifications of psychiatric disorders were defined in a sample of 126,064 participants identified by the UK Biobank from 2006–2022, and correlations were investigated using logistic regression models. Then, to explore nonlinear relationships, restricted spline models were developed to examine differences in sex and age across cohorts (n = 126,064 for the full cohort and n = 121,934 for the European cohort). Finally, the impact of the category of ACEs on psychiatric disorders was examined.
Results
After controlling for confounders, ACEs scores showed dose-dependent relationships with depression, anxiety, anxiety-depression co-morbidity, and at least one (any of the first three outcomes) in all models. ACEs with different scores were significantly positively correlated with the four psychiatric disorders classifications, with the highest odds of anxiety-depression co-morbidity (odds ratio [OR] = 4.87, 95% confidence intervals [CI]: 4.37 ~ 5.43), p = 6.08 × 10⁻¹⁷⁸. In the restricted cubic spline models, the risk was relatively flat for females at ACEs = 0–1 and males at ACEs = 0–2/3 (except in males, where ACEs were associated with a lower risk of anxiety, all other psychiatric disorders had an increased risk of morbidity after risk smoothing). In addition, the risk of having anxiety, depression, anxiety-depression co-morbidity, and at least one of these disorders varies with each category of ACEs.
Conclusion
The prevalence of anxiety-depression comorbidity was highest across ACE scores after controlling for confounding factors and had a significant effect on each category of ACEs.
... Like all physical diseases, mental health issues are also closely associated with demography. Mental health issues are found to be prevalent among the older population and are often associated with physical co-morbidities and malnourishment [11,12]. This makes an imperative domain of research to aid in policy formulation and build age-related preparedness in a country like India which has a rapidly growing elderly population. ...
As India’s elderly population grows rapidly, there is a demand for robust policy tools for geriatric health management. This study focuses on unveiling the impact of financial stress and insecurity in diverse economic sectors on adult malnutrition in India. Further, we explore the connections of adult malnourishment with mental and physical health outcomes. Analysis has been done using data of 59,764 respondents aged 45 years and above from the Longitudinal Ageing Study in India (LASI- Wave I) (2017-19). A modified Malnutrition Universal Screening Tool (MUST) has been used to assess the risk of adult malnutrition. It categorizes malnutrition into Low Risk, High Risk Group 1 (HRG1-undernourished), and High Risk Group 2 (HRG2-over-nourished). Approximately 26% of adults were classified in HRG1, characterized by low body mass index, recent hospital admissions, and affiliation with food-insecure households. Around 25% adults belonged to HRG2 characterized by high body mass index and waist-to-hip ratio. The relative risk ratios from the multinomial logit generalized structural equation model indicate that the risk of being in HRG1 was 20–40% higher among respondents not presently working or receiving pension benefits, as well as those involved in agricultural work. The risk of being in HRG2 doubles if the respondent was diagnosed with some chronic disease during the last 12 months. A higher composite cognition score reduces the risk of being in HRG1 by 4%, while it increases the risk of being in HRG2 by 3%. Additionally, experiencing episodic depression raises the risk of being in HRG1 by 10%. Financial insecurity, particularly in the informal and agricultural sectors, coupled with poor mental health, hinders positive nutritional outcomes. Extending universal pro-poor policies to fortify food security in resource poor households and integrating mental health variables in nutrition policies can be beneficial to address adult malnourishment in India.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12877-023-04532-7.
... According to various studies, the prevalence of major depression in the elderly population is estimated to be between 1-4%, while the rate of those affected by anxiety disorders is approximately 17% (2,3). Psychotic disorders commonly seen in adults are also common in the elderly population. ...
Introduction: Various reports have documented the psychological issues that affect the elderly. According to estimates, approximately 20% of the geriatric population experiences at least one psychological symptom or disorder. The aim of this study is to establish the frequency of psychological symptoms in the elderly populati on in İstanbul, Turkey. Methods: This cross-sectional study was conducted with 350 participants aged 65 and over, between 01.02.2019 and 19.07.2019. The psychiatric symptoms of the participants were evaluated with the Symptom Check List-90 Revised (SCL-90-R) test. Results: Psychological symptoms are present in 32.9% of the elderly population. The prevalence of depressive symptoms is 32.9% and the rate of obsessions is 26.6%. Somatization is present in 13.4% of cases, while interpersonal sensitivity is observed in 8.9% of cases. The paranoid symptom rate is 10.6%. While 6.9% of the participants have possible anger disorder symptoms, the rate of participants with anxiety symptoms is 6.6%. The rate of participants with probable phobic symptoms is 5.4%, and the rate of those with psychotic symptoms is 4.0%. Conclusion: Psychiatric problems encountered in old age negatively affect the quality of life. Because the most common psychological symptoms were depression, obsession, and somatization, family physicians should conduct screenings for possible mental problems in elderly individuals registered with them, regardless of the reason.
This research examined the mental health challenges of older adults during the COVID-19 pandemic in Nigeria using interpretive phenomenology. The consequences of these challenges on the quality of life of older people were also explored. The coping ability of older adults differs from younger adults during crisis which can cause severe hardship and psychological trauma, that affect the mental health of older adults. Five female and 8 male older adults were purposively selected for interview using an in-depth interview guide containing 10 open-ended questions. Data from the study were analysed using thematic analysis. The findings of the study revealed that fear of death, grief, depression, and social isolation are the major challenges of older adults which affected their mental well-being and relationship with family and friends. Older adult’s quality of life could be improved with timely and effective interventions. The Nigeria Centre for Disease Control (NCDC) and health care professionals should increase awareness and respond to challenges of older people during health crises. Education on safety measures is recommended to reduce the impact of crisis on mental health of older adults. A health policy framework would improve the quality of life of older adults in Nigeria and enable them to contribute their quota to the development of the society.
Depression in elderly is a growing and a major public health problem in both the developing countries and developed world. It is
anticipated to touch second place of DALYs (Disability Adjusted Life Years) by 2020 and single leading cause by 2030 (World
Federation for Mental Health, 2012). It is also interesting to note that elderly populations above 55 years with depression have
four times higher death rate than those without depression (WHO Report, 2001). Elderly living in Pakistan experience significant
level of physical, social and psychological health problems, leading to increased burden of chronic diseases, disabilities, and
psychiatric illnesses. In Pakistan, depression is the most common psychiatric disorder among elderly population that cannot be
neglected (Bhamani, Karim& Khan, 2013). The magnitude of the problem is much greater than what is being reported. In United
States, the rate of prevalence of depression is high as 40% where as in Pakistan it is as high as 66% among elderly (Javed&
Mustafa, 2013).
This paper will provide an in depth analysis on the major determinants of depression among elderly in Pakistani context. These
determinants are the root cause of the issue among elderly and it includes genetic/biological factors, physical factors, and
economic factors, sociocultural and political/organizational factors. Timely identification of these determinants and prospective
workup and recommendations will be a rationale attempt towards improvement of physical and psychological wellbeing of
geriatric population.
Purpose of the Review
This narrative review examines the efficacy, mechanisms and safety of mind-body medicine (MBM) in the treatment of depression. We reviewed the potential effects of various MBM interventions such as yoga, tai chi, qigong, mindfulness-based interventions and nutrition on clinical and subthreshold depressive symptoms.
Recent Findings
Current studies indicate a growing interest in the use of MBM for psychiatric disorders, including depression. MBM interventions demonstrate efficacy in reducing depressive symptoms with fewer adverse effects and costs compared to pharmacological treatments.
Summary
MBM has significant potential to improve mental health outcomes for depression. These interventions encourage self-care and stress management through behavioural, exercise, relaxation and nutritional approaches. While existing data are promising, further, more rigorous studies are required to confirm long-term effectiveness and to determine the role of MBM in comprehensive depression treatment strategies.
Introduction:The neighborhood is a regular living and activity space for the elderly. It is important to identify neighborhood environmental factors that can alleviate depression in the elderly to improve their health. However, existing literature does not consider the complex interdependencies among key neighborhood environmental factors.
Method:This study employs the Qualitative Comparative Analysis (QCA) method to explore how the configuration of neighborhood environmental conditions can help alleviate depressive symptoms in the elderly. The data is derived from the 2020 China Family Panel Study (CFPS) survey.
Results: The results show that three different neighborhood environment configurations can help reduce depressive symptoms in older Chinese individuals. The first configuration requires a combination of neighborhood safety, good neighborhood relations, and neighborhood assistance. The second configuration involves amalgamating optimal community facilities, high-quality neighborhood relations, and neighborhood assistance. The third configuration encompasses sound community facilities, favorable housing surroundings, a secure communal atmosphere, and advanced neighborhood assistance. Furthermore, we identify neighborhood assistance as a core condition for alleviating depressive symptoms and find that the combined effects of neighborhood safety and housing surroundings on alleviating depressive symptoms are comparable to the effect of neighborhood relationships.
Discussion:These research results deepen the current understanding of neighborhood environment configurations to alleviate depressive symptoms in older adults, offer important implications for theory and practice, and set new directions for the construction of age-friendly neighborhoods.
Dizziness is a common complaint among older adults and one of the most important risks for falls. Objectives. This study aimed to report falls, physical capacity, and self-rated health in men and women with and without dizziness in a population-based sample of 70-year-olds, and to investigate which factors may be associated with falls and dizziness. Methods. A cross-sectional population-based sample from 1203 70-yearolds (644 women, 559 men, response rate 72%) was surveyed regarding dizziness, falls, physical capacity, medications, and self-rated health. Physical capacity level was assessed using the six-minute walk test, chair stand test, and tandem standing test with eyes opened and closed. Results. Dizziness was more commonly reported among women than among men (p < 0.0001) and associated with decreased self-rated health and physical levels among both men and women. Dizzy women tended to fall more often, performed worse in fitness measurements (chair stand, tandem standing), exercised less frequently, and went for walks less often than non-dizzy women. The number of medications and dizziness were identified as having significant associations with falls. Conclusions. To experience dizziness already at the age of 70 affects health and physical levels in both men and women, and dizzy women tended to fall more often than non-dizzy women. We suggest that dizziness among older adults should be carefully evaluated regarding medications, physical function, and treatable causes, and when needed, postural training and vestibular rehabilitation should be initiated to avoid future falls and improve quality of life.
I disturbi ansioso-depressivi nel paziente anziano e con comorbilità: l’approccio corretto, gli errori da evitareC. Mazzoccoli, S. Digregorio, G. Nicoletti Il trattamento dell’ipertensione arteriosa nel paziente con comorbilità. Focus sul ruolo di componente organica e componente funzionaleA. Belfiore, D. Germinario, B. Margilio, E. Mastandrea La dispepsia: un caleidoscopio di percorsi e terapie, dal disturbo organico al disturbo funzionaleM.M. Marcellini, A. Tani, G. Ballardini Il paziente diabetico con ansia e depressione: riflessi sull’aderenza terapeuticaT.M. Attardo Sintomi ansioso-depressivi e carenza di vitamina D: quali conseguenze?G. Mantovani, M. Meschi
The critical role of sleep in maintaining physical and mental health is well-documented, with functions ranging from cellular restoration to cognitive processing. However, sleep patterns and architecture evolve with age, often deteriorating in quality and duration, contributing to a higher incidence of sleep disorders among the elderly. This decline is characterized by increased sleep fragmentation and decreased total sleep time potentially exacerbating age-related cognitive decline and increasing the risk for neurodegenerative diseases. Emerging research also highlights the profound impact of sleep on the quality of life (QoL) in older adults. Good sleep is positively associated with better overall health, particularly affecting domains such as physical well-being, psychological health, and social functioning. Conversely, poor sleep quality is linked with negative health outcomes, including an elevated risk of falls, cognitive impairment, and mood disorders. Interventions targeting sleep disturbances in the elderly, such as cognitive-behavioral therapy for insomnia, have been shown to be efficacious without the adverse effects common to conventional pharmacological treatments. Additionally, the use of melatonin and bright light therapy aligns with the need for non-invasive, chronobiological strategies to improve circadian regulation. These approaches underscore the necessity of treating poor sleep and sleep disorders not as inevitable consequences of ageing but as modifiable and essential factors for enhancing late-life QoL. The application of the Selection, Optimization, and Compensation (SOC) model further supports individualized strategies to maintain healthy sleep by adapting to the changing needs and capacities associated with ageing.
About one in three cases of depressive disorders in the geriatric population have their onset in late life; many more cases are recurrences of depressive disorders which began earlier in life. This chapter reviews the diagnosis and treatment of depressive disorders in late life to facilitate their differentiation from other conditions and recommend non-pharmacological treatment and age-adjusted pharmacological interventions.
Both early-onset and late-onset categories may be unreported or missed. Late-life depressive disorders have been under-recognized and inadequately treated in primary care, especially among Hispanic and African American men in the United States (Hasin et al. JAMA Psychiatry 75:336–46, 2018)).
Many factors may account for missed depressive disorders among aging individuals. The geriatric patient may present with more somatic complaints, greater social isolation, and reduced access to medical care (especially for underserved minority populations) and be hesitant to report depressive symptoms. The impact of psychosocial stressors on the patient may not be fully appreciated nor is clinical time often adequate to explore them. The number of systemic medical comorbidities increases with age and correlates with the increased prevalence of depressive disorders as patients age. Teasing out depressive symptoms among somatic complaints in the elderly patient is a challenge. Complex medication regimens, in the context of pharmacodynamic and pharmacokinetic effects of aging, can contribute to an increased risk of adverse effects, which can also contribute to depressive symptoms.
___________________________________________________________________ The level of the emotional health of teacher has been noticed to be on the high side and this affects their performances. This study investigated the effects of emotionally focused therapy on the management of emotional health problems of teachers in Ilorin metropolis. The research design used was quasi-experimental. An experimental design of 2 by 2 factorial matrix which adopts pre-test and post-test treatment was employed in this study. All secondary school teachers in Ilorin metropolis constituted the population for the study while selected secondary school teachers experiencing emotional health problems were the target population for this study. 30 secondary school teachers experiencing mental health problems were sampled for this study. An Emotional Health Problems Scale (EHPS) designed by Warwick-Edinburgh was adopted for this study. Analysis of Covariance (ANCOVA) was the major statistical tool that was employed to test seven hypotheses generated at 0.05 level of significance. The result of the findings revealed that emotional-focused therapy is effective in managing the emotional health problems of teachers in Ilorin metropolis. There were no significant main effects of age or gender on the emotional health of secondary school teachers in Ilorin metropolis. It was also revealed that there were no significant interactive effects of age or gender on the emotional health of secondary school teachers in Ilorin metropolis but significant interactive effects were found on treatment, age and gender on the emotional health of secondary school teachers in Ilorin metropolis. It was recommended that mental health professionals should consider EFT as a valuable therapeutic option for teachers experiencing emotional difficulties. Therapists should consider these demographic factors when implementing EFT and be prepared to adapt their approach accordingly.
Background
Global research hotspots and future research trends in the neurobiological mechanisms of late-life depression (LLD) as well as its diagnosis and treatment are not yet clear.
Objectives
This study profiled the current state of global research on LLD and predicted future research trends in the field.
Methods
Literature with the subject term LLD was retrieved from the Web of Science Core Collection, and CiteSpace software was used to perform econometric and co-occurrence analyses. The results were visualized using CiteSpace, VOSviewer, and other software packages.
Results
In total, 10,570 publications were included in the analysis. Publications on LLD have shown an increasing trend since 2004. The United States and the University of California had the highest number of publications, followed consecutively by China and England, making these countries and institutions the most influential in the field. Reynolds, Charles F. was the author with the most publications. The International Journal of Geriatric Psychiatry was the journal with the most articles and citations. According to the co-occurrence analysis and keyword/citation burst analysis, cognitive impairment, brain network dysfunction, vascular disease, and treatment of LLD were research hotspots.
Conclusion
Late-life depression has attracted increasing attention from researchers, with the number of publications increasing annually. However, many questions remain unaddressed in this field, such as the relationship between LLD and cognitive impairment and dementia, or the impact of vascular factors and brain network dysfunction on LLD. Additionally, the treatment of patients with LLD is currently a clinical challenge. The results of this study will help researchers find suitable research partners and journals, as well as predict future hotspots.
As the population ages, the prevalence of dysphagia among older adults is a growing concern. Age-related declines in physiological function, coupled with neurological disorders and structural changes in the pharynx associated with aging, can result in weakened tongue propulsion, a prolonged reaction time of the submental muscles, delayed closure of the laryngeal vestibule, and delayed opening of the upper esophageal sphincter (UES), increasing the risk of dysphagia. Dysphagia impacts the physical health of the elderly, leading to serious complications such as dehydration, aspiration pneumonia, malnutrition, and even life-threatening conditions, and it also detrimentally affects their psychological and social well-being. There is a significant correlation between frailty, sarcopenia, and dysphagia in the elderly population. Therefore, older adults should be screened for dysphagia to identify both frailty and sarcopenia. A reasonable diagnostic approach for dysphagia involves screening, clinical assessment, and instrumental diagnosis. In terms of treatment, multidisciplinary collaboration, rehabilitation training, and the utilization of new technologies are essential. Future research will continue to concentrate on these areas to enhance the diagnosis and treatment of dysphagia, with the ultimate aim of enhancing the quality of life of the elderly population.
Objectives
The association between socioeconomic status (SES) and the onset of depressive symptoms has attracted considerable attention. However, few studies have simultaneously examined the association of multiple SES indicators, including “assets,” with the onset of depressive symptoms. Therefore, this study examined the association of four SES indicators in old age (‘years of education’ ‘equivalent income,’ ‘equivalent assets,’ and ‘the longest‐held job’) with new‐onset depressive symptoms in a large Japanese dataset.
Methods
This longitudinal study used panel data of cognitively and physically independent older adults from the Japan Gerontological Evaluation Study (JAGES) conducted in 2013 and 2016. Multivariate logistic regression analysis was conducted to examine the association of each SES indicator with new‐onset depressive symptoms, and odds ratios and 95% confidence intervals (CIs) were calculated.
Results
We analyzed the data of 40,257 older adults, with a mean age (± standard deviation) of 72.9 (±5.5) years. In the follow‐up survey, 4292 older adults had new‐onset depression symptoms (10.7%). 39.3% had 10–12 years of education. 36.9% had an equivalent income of up to JPY 1.99 million. 24.4% had equivalent assets of JPY 4–17.99 million. Most had a clerical job for the long time. Furthermore, fewer years of education (males: OR = 1.42, 95% CI = 1.22–1.64, p ‐value <0.001/females: 1.26, [1.09–1.47], p = 0.002), lower income (males: 1.64, [1.34–2.01], p < 0.001/females: 1.82, [1.49–2.22], p < 0.001), and fewer assets (males: 1.40, [1.16–1.68], p < 0.001/females: 1.21, [1.02–1.42], p = 0.025) resulted in higher odds of having new‐onset depressive symptoms, even when other SES indicators were entered simultaneously.
Conclusions
All four SES indicators have an independent association with the development of new‐onset depressive symptoms among older adults, reflecting different aspects of SES. The association between the “longest‐held job” and new‐onset depressive symptoms can be largely explained by other SES indicators. A multifaceted and lifetime approach is required to prevent the onset of depressive symptoms in old age.
This study examines how physical activity affects critical health outcomes among older people in India, focusing on functional limitations and depressive symptoms. The sample consists of 4,214 individuals aged 60 or above. The study uses binary logistic regression and Wooldridge residual analysis. The results indicate that 49.5 percent and 42.3 percent of the sample have functional limitations and depressive symptoms respectively. The study finds that physical activity is negatively related to functional limitations and positively related to depression. Furthermore, physical activity influences depressive symptoms both directly and indirectly. Additionally, functional limitations escalate the likelihood of depressive symptoms among older people. Older males with functional limitations are more prone to depressive symptoms than older females. Conversely, older females without functional limitations are more likely to have depressive symptoms than older males. Therefore, the study advocates such interventions which address multiple levels and aspects, such as how people think and feel about physical activity, and what their surroundings are like in order to help people who face challenges of being physically active.
Purpose
Perceptions of ageing towards the self and towards others can positively and negatively impact an older adult’s mental wellbeing. This paper aims to consolidate literature examining the relationship between perceptions of ageing and depression in older adults to inform both practice and policy for older adult mental health services.
Design/methodology/approach
Quantitative research articles examining perceptions of ageing and depression in older adults were identified through searches on three electronical databases, alongside forward and backwards citation searches. A total of 14 articles involving 31,211 participants were identified.
Findings
Greater negative attitudes towards ageing were associated with higher levels of depressive symptoms and greater positive attitudes towards ageing were associated with lower levels of depressive symptoms or higher levels of happiness. However, the causal direction of this relationship could not be determined. Studies demonstrated that perceptions of ageing also act as a moderator in the relationship between depression and health status, hopelessness and personality traits. Future research should attempt to examine the relationship between perceptions of ageing and depression in older adults to attempt to identify the causal direction of this relationship.
Originality/value
This is the only systematic review the authors are aware of consolidating literature which explores the relationship between older adults’ perceptions of ageing and depression. It is hoped that these findings will be able to inform both policy and practice to improve older adults’ care and support for depression.
Background
Selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk of upper gastrointestinal bleeding (UGIB) in older patients but little is known about the risk associated with individual SSRI drugs and doses.
Aims
To quantify the risk of UGIB in relation to individual SSRI use in older adults.
Methods
We conducted a nested case–control study within a cohort of 9565 patients aged ⩾65 years prescribed SSRIs from 2000 to 2013 using claims data of universal health insurance in Taiwan. Incident cases of UGIB during the follow-up period were identified and matched with three control subjects. Conditional logistic regression was used to estimate the odds ratio (OR) of UGIB associated with individual SSRI use and cumulative dose.
Results
UGIB risk increased with the increasing cumulative doses of SSRIs (adjusted OR: 1.28, 95% confidence interval (CI): 1.02–1.62 for the highest vs. the lowest tertile). Compared with users of other SSRIs, fluoxetine users were at an increased risk of UGIB (adjusted OR: 1.25, 95% CI: 1.03–1.50) with a dose–response manner, whereas paroxetine users had 29% decreased odds (95% CI: 0.56–0.91). The increased risk was only observed among current fluoxetine users.
Conclusions
Fluoxetine therapy was associated with an increased risk of UGIB in a dose–response manner among older adults.
Although older adults living alone are at a greater risk of solitary death, there is a dearth of literature in this area. Using the 2018 Seoul Elderly Survey, we investigated the extent to which older adults living alone in Seoul perceive the risk of solitary death and examined the association between the perceived risk of solitary death and depressive symptoms. Additionally, we explored the role of structural and functional support in that association as a buffering factor. Results showed that more than half of the older adults living alone in Seoul perceived that they could be victims of solitary death. The perceived risk of solitary death among older adults living alone was independently associated with depressive symptoms. Additionally, the structural aspect of social support moderated the impact of the perceived risk of solitary death on depressive symptoms. Interventions that enhance the structural aspect of social support should be primarily considered.
Objective:
The current study aimed to examine the relationship between depressive symptoms and quality of life among Jordanian community-dwelling older adults.
Methods:
A cross-sectional, descriptive correlational design was used. A convenience sample (N = 602) was selected to recruit the participants in the Amman governorate during the period from August to November 2021.
Results:
Findings demonstrated that the mean (SD) age of older adults was 67.5 (7.0) years and 51.5% of participants were females. Also, 54.1% of the participants experienced moderate to severe depressive symptoms with a total mean (SD) score was 8.57 on a scale of 0 to 15, while the mean (SD) for the quality of life scale was 12.12 (3.85) on a scale of 4 to 20. Significant differences existed in quality of life and depressive symptoms based on marital status (p < .001), educational level (p < .001), working status (p < .01), income (p < .001), and chronic disease (p < .01). Quality of life and its domains were negatively associated with depressive symptoms (B= - 0.596, p < .001). Also, marital status, working, educational level, income, and chronic disease were associated with depressive symptoms.
Conclusion:
Strategies to improve quality of life should be promoted to minimize depressive symptoms among older adults and consider significant demographic factors.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
Reexamined the prevalence of depressive symptoms among 1,724 rural, noninstitutionalized older adults (aged 59–99 yrs) and documented the need for mental health services as they relate to depression and potential barriers to receiving needed services. A telephone survey was conducted in North Dakota, with a random sample drawn from each of 8 human service districts. Instruments included the Geriatric Depression Scale and the CAGE. Results indicate that the prevalence of depression was relatively low. Controlling for potential alcohol abuse, cognitive impairment, and medical problems, the study found that 5% of older adults reported current depressive symptomatology. When using a cutoff score that is likely to correspond to a diagnosis of major depression, the study found a prevalence rate of 1.6%. Of those reporting significant levels of depression, only 27.6% were currently being treated for an emotional problem. The survey data suggested that cost, transportation, and concern about stigma are not major barriers to receiving needed mental health services. Rather, lack of awareness of available services and a lack of routine contact with mental health service providers are important factors that limit service utilization. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
We compared the screening accuracy of a short, five-item version of the Mental Health Inventory (MHI-5) with that of the 18-item MHI, the 30-item version of the General Health Questionnaire (GHQ-30), and a 28-item Somatic Symptom Inventory (SSI-28). Subjects were newly enrolled members of a health maintenance organization (HMO), and the criterion diagnoses were those found through use of the Diagnostic Interview Schedule (DIS) in a stratified sample of respondents to an initial, mailed GHQ. To compare questionnaires, we used receiver operating characteristic analysis, comparing areas under curves through the method of Hanley and McNeil. The MHI-5 was as good as the MHI-18 and the GHQ-30, and better than the SSI-28, for detecting most significant DIS disorders, including major depression, affective disorders generally, and anxiety disorders. Areas under curve for the MHI-5 ranged from 0.739 (for anxiety disorders) to 0.892 (for major depression). Single items from the MHI also performed well. In this population, short screening questionnaires, and even single items, may detect the majority of people with DIS disorders while incurring acceptably low false-positive rates. Perhaps such extremely short questionnaires could more commonly reach use in actual practice than the longer versions have so far, permitting earlier assessment and more appropriate treatment of psychiatrically troubled patients in primary care settings.
The Cornell Scale for Depression in Dementia is introduced. This is a 19-item clinician-administered instrument that uses information from interviews with both the patient and a nursing staff member, a method suitable for demented patients. The scale has high interrater reliability (kw = 0.67), internal consistency (coefficient alpha: 0.84), and sensitivity. Total Cornell Scale scores correlate (0.83) with depressive subtypes of various intensity classified according to Research Diagnostic Criteria.
Clinicians see many more nonagenarian patients now and there is a need for epidemiological data relating to this group. The aim of the present study was to investigate the prevalence of depressive symptoms and syndromes in this age group.
The DSM-IV and the ICD-10 criteria for depression were used and correlated with physical health, disability in daily life, gender, use of drugs, social circumstances and cognitive dysfunction. Data were derived from 329 persons aged 90 and over, registered in a parish of Stockholm, who had been extensively examined by physicians and nurses.
The prevalence of Major Depressive Episode as defined in DSM-IV was 7.9%; and of mild, moderate and severe Depressive Episode (combined); as defined in ICD-10 9.1%. No gender difference was found. Disability in daily life and the use of psychotropic drugs were found to correlate with depressive symptoms and syndromes.
Objective. To investigate the response of residential homes to four specific health problems of residents and the relationship between the quality of this response and the prevalence of depression.
Design and sample. Post hoc analysis of data collected for a cross‐sectional survey of homes chosen to represent ‘excellent’ and ‘standard’ care; resident sample sufficient to detect difference between 20% and 40% depression prevalence between two groups of homes (90% power, 5% significance). Three hundred and nine residents were assessed.
Setting. Seventeen residential homes in different areas of England.
Methods. Data were collected about aspects of the care provided, including quality rating of care plans. Standard instruments were used to collect resident data by direct and informant interviews, including assessments of dementia, depression, dependency, medication and specific health problems.
Results. Seventy‐nine per cent of the sample were suffering from dementia; 40% of 194 residents who could be assessed for depression were depressed. Of residents assessed by research nurses, 72% had problems with mobility, 67% with stability, 40% with hearing and 46% with vision. Quality of response to these problems was variable. In a combined assessment of care plan quality and key worker awareness, 7% of homes' responses to these four problems in residents were rated as good. Seventeen per cent of depressed residents were so identified by their key workers. Good interventions by key workers were associated with less depression in residents.
Discussion. The response of home staff and community health professionals to physical health needs in residential homes is variable and should be improved. This study suggests that improving this aspect of care provision might reduce depression and thus improve quality of life. Copyright © 2000 John Wiley & Sons, Ltd.
Synopsis
A standardized, semi-structured interview for examining and recording the mental state in elderly subjects is described. It allows the classification of patients by symptom profile and can demonstrate changes in that profile over time. It is believed that good reliability is demonstrated between psychiatric raters both for psychiatric diagnosis made on the basis of the schedule findings and for individual items. The Geriatric Mental State Schedule (GMS) consists mainly of items from the eighth edition of the PSE (Wing et al. 1967), together with additional items from the PSS (Spitzer et al. 1964), and extra sections dealing with disorientation and other cognitive abnormalities. Modifications have been introduced to facilitate interviewing elderly subjects.
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
Background:
Provocative international disparities reported in the prevalence rates of dementia and depression require further investigation. This is the first psychiatric study, to the best of our knowledge, about the prevalence of DSM-III-R dementing and depressive disorders and their relationships in a representative, stratified community sample of the elderly in both a Spanishspeaking country and southern Europe.Methods:
A two-stage screening was completed in 1080 elderly. Sampling with replacement was done, and the cumulative response rate was 88%. In phase 1, lay interviewers administered the Spanish versions of the Mini-Mental State examination and the Geriatric Mental State Schedule—Automated Geriatric Examination for Computer Assisted Taxonomy package. In phase 2, research psychiatrists administered the same instruments and the History and Aetiology Schedule to all the probable cases and a similar number of randomly selected, probably normal subjects.Results:
An estimated 5.5% of the elderly were considered to have a dementing disorder, the most prevalent types being primary degenerative dementia, Alzheimer's type (4.3%), and multi-infarct dementia (0.6%). Depressive disorders were found in 4.8% of the elderly. Psychiatric morbidity, specifically depression, was associated with lower educational levels. "Case levels" of depression were documented in 25.4% of the demented cases and case levels of "organic" disturbance were seen in 18.2% of cases of major depression.Conclusions:
Among the elderly, the prevalence of Alzheimer's disease and multi-infarct dementia, as opposed to depression, increases steeply with age. The overlap found between dementia and depression may have nosological implications. There could be an effect of lower education levels on psychiatric morbidity, particularly on depression.
• A new interview schedule allows lay interviewers or clinicians to make psychiatric diagnoses according to DSM-III criteria, Feighner criteria, and Research Diagnostic Criteria. It is being used in a set of epidemiological studies sponsored by the National Institute of Mental Health Center for Epidemiological Studies. Its accuracy has been evaluated in a test-retest design comparing independent administrations by psychiatrists and lay interviewers to 216 subjects (inpatients, outpatients, ex-patients, and nonpatients).
Zusammenfassung
Aufgrund der Zunahme der allgemeinen Lebenserwartung steigt die Zahl Hochbetagter (70–84 Jahre) und v. a. der Hchstbetagten
(85 Jahre und lter). Ungeklrt ist, inwieweit es in diesen hohen Altersgruppen zu Vernderungen in der Hufigkeit oder im
Spektrum psychiatrischer Morbiditt kommt. Im Rahmen der Berliner Altersstudie (BASE) wurde eine nach Alter und Geschlecht
geschichtete reprsentative Stichprobe (n = 516) der 70- bis 100 jhrigen Westberliner Bevlkerung interdisziplinr psychologisch, soziologisch, internistisch sowie
psychiatrisch intensiv untersucht. Erfat wurden u. a. subjektive Beschwerden („Beschwerdenliste, BL“), beobachtbare psychopathologische
Symptomatik („Brief Psychiatric Rating Scale, BPRS“) und psychiatrische Diagnosen nach DSM-III-R (auf der Basis des „Geriatric
Mental State Interviews (GMS-A)“). Auf der Selbstbeurteilungsskala BL gaben 10 % ausgeprgte bzw. 32 % zumindest deutliche
subjektive Beschwerden an. Bei syndromaler psychiatrischer Befundung waren unter Zugrundelegung der BPRS 17 % deutlich oder
75 % zumindest leicht psychopathologisch auffllig. Diagnostisch fanden sich nach DSM-III-R bei 4,2 % schwer ausgeprgte bzw.
bei insgesamt 23,5 % psychische Strungen; nach dem klinischen Urteil der untersuchenden Psychiater lagen sogar bei 40,4 %
psychische Strungen mit Krankheitswert vor, berwiegend mit leichtem Ausprgungsgrad. Im Vordergrund des Erkrankungsspektrums
standen Strungen wie Insomnien (18,8 %) oder unspezifische depressive Strungen (17,8 %) sowie Demenzerkrankungen (13,8 %).
Die Demenzerkrankungen zeigen den bekannten Anstieg mit zunehmendem Alter. Fr die sonstige psychiatrische Morbiditt findet
sich kein Altersgang. Hchstbetagte unterscheiden sich somit in den hier untersuchten psychiatrischen Variablen bis auf die
hhere Demenzhufigkeit nicht von Hochbetagten.
An 8-year-long longitudinal study of elderly people in Botany (Sydney) has provided data on the prevalence, incidence and outcome of cognitive impairment and depression in this population. In 1985, a random sample of 146 persons aged 65 years or more, living in their own homes, were assessed using the Brief Assessment Schedule, depression ratings and cognitive tests. Follow-up interviews were conducted after 2, 4, 6 and 8 years. Data from separate hostel and nursing home studies were used when estimating prevalence rates. The estimated prevalence and annual incidence of definite dementia in Botany were, respectively, 14% (3.5% severe) and 2.5%. Among elderly people living at home the prevalence of definite dementia was 11%; 23% of our community sample suffered dementia during the 8 years. The prevalence and minimum annual incidence of depressive disorders were, respectively, 12.5% and 2.0%. Among those living at home the prevalence was 12.3%. Dementia was associated with a high mortality rate, but the apparently increased mortality of depressed subjects did not reach significance, probably because numbers were relatively small; a high proportion of the deceased had comorbid cognitive impairment. Some depressions eventually remitted.
Depression is a common disorder in the elderly. In population-based studies the rate of treatment is low. In spite of this most of the studies on the outcome of depression in the elderly are based on treated series. This study used data from a population of 1,101 very elderly persons. Of these, 7.2% (n=78) were diagnosed as having a major depression and 3.5% (n=39) as having a dysthymia at an initial examination. Both syndromes were over-represented in persons affected by dementia. Seventy-seven per cent of the depressed persons had consulted a physician recently and 17% were treated for depression. Three years later those who were depressed and had survived were re-examined. At the follow-up examination, 48.6% of the non-demented persons and 14.3% of the demented were depressed. In conclusion, the rate of treatment of depression in the very elderly is low and the course is chronic or relapsing in almost half of the cases.
Reviews the problems of the construction of depression scales, especially for the aged. Issues relevant to the diagnostic utility, reliability, and validity of the Center for Epidemiological Studies-Depression Scale (CES-D) are discussed. The psychometric properties of the CES-D in the general population are described, including the purposes for which it was originally developed, and the evidence about these properties when used with older adults are evaluated. Data indicate that the CES-D is a promising scale for use with older adults. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The aim of the study was to identify the prevalence of depressive symptoms (GDS score) and predictors of mood changes over a 12-month period in 56 nursing home residents (13 males and 43 females; mean age 81.1 ± 8.6). At baseline, 48.2% of the residents who scores above 11 on the MMSE had a GDS score > 15. GDS score was associated with pain, disabling diseases and self-evaluation of health, and independently with dissatisfaction with the nursing home environment, low level of nursing home social activities and younger age. Five depressed residents became non-depressed, eight non-depressed became depressed and 14 residents remained persistently depressed 12 months after baseline. After controlling for potential confounders, increasing GDS score was independently associated with decreasing basic activities of daily living, increasing number of clinical problems and younger age. Our data support the hypothesis that specific emotional adjustments can be found even in the apparently static environment of the nursing home.
Reliability studies for the Brief Assessment Schedule between raters trained in England, West Germany and Australia have been carried out, as this instrument is now being widely used for assessing psychiatric morbidity among elderly residents in care in several countries. Interrater reliability for the dementia and depression scales for raters from the different countries working in English was high. However, the interlingual (English-German) reliability for the dementia scale was less satisfactory.
Background
There is wide variation in the rates of behavioural and psychological symptoms of dementia (BPSD) reported in nursing homes.AimsThis study aimed to investigate: (1) the prevalence of BPSD in nursing home residents using the BEHAVE-AD; (2) the relationships of BPSD with (a) demographic, (b) dementia, (c) diurnal and (d) nursing home variables; and (3) the inter-relationships between different types of BPSD, as measured by subscales of the BEHAVE-AD.ResultsOver 90% of residents exhibited at least one behavioural disturbance. Specifically, there was evidence of psychosis in 60%, depressed mood in 42% and activity disturbances or aggression in 82% of residents. Younger, more functionally impaired residents with a chart diagnosis of psychosis had higher BPSD rates, as did those residing in larger nursing homes. Individual BPSD were significantly intercorrelated.ConclusionsBPSD are ubiquitous in nursing home residents. Behavioural disturbances are frequently associated with psychosis and/or depression. The findings suggest the need for psychogeriatric services to nursing homes and smaller facilities. Copyright © 2001 John Wiley & Sons, Ltd
Data are reported on a series of short-form (SF) screening scales of DSM-III-R psychiatric disorders developed from the World Health Organization's Composite International Diagnostic Interview (CIDI). A multi-step procedure was used to generate CIDI-SF screening scales for each of eight DSM disorders from the US National Comorbidity Survey (NCS). This procedure began with the subsample of respondents who endorsed the CIDI diagnostic stem question for a given disorder and then used a series of stepwise regression analyses to select a subset of screening questions to maximize reproduction of the full CIDI diagnosis. A small number of screening questions, between three and eight for each disorder, was found to account for the significant associations between symptom ratings and CIDI diagnoses. Summary scales made up of these symptom questions correctly classify between 77% and 100% of CIDI cases and between 94% and 99% of CIDI non-cases in the NCS depending on the diagnosis. Overall classification accuracy ranged from a low of 93% for major depressive episode to a high of over 99% for generalized anxiety disorder. Pilot testing in a nationally representative telephone survey found that the full set of CIDI-SF scales can be administered in an average of seven minutes compared to over an hour for the full CIDI. The results are quite encouraging in suggesting that diagnostic classifications made in the full CIDI can be reproduced with excellent accuracy with the CIDI-SF scales. Independent verification of this reproduction accuracy, however, is needed in a data set other than the one in which the CIDI-SF was developed. Copyright © 1998 Whurr Publishers Ltd.
To investigate the response of residential homes to four specific health problems of residents and the relationship between the quality of this response and the prevalence of depression.
Post hoc analysis of data collected for a cross-sectional survey of homes chosen to represent "excellent" and "standard" care; resident sample sufficient to detect difference between 20% and 40% depression prevalence between two groups of homes (90% power, 5% significance). Three hundred and nine residents were assessed.
Seventeen residential homes in different areas of England.
Data were collected about aspects of the care provided, including quality rating of care plans. Standard instruments were used to collect resident data by direct and informant interviews, including assessments of dementia, depression, dependency, medication and specific health problems.
Seventy-nine per cent of the sample were suffering from dementia; 40% of 194 residents who could be assessed for depression were depressed. Of residents assessed by research nurses, 72% had problems with mobility, 67% with stability, 40% with hearing and 46% with vision. Quality of response to these problems was variable. In a combined assessment of care plan quality and key worker awareness, 7% of homes' responses to these four problems in residents were rated as good. Seventeen per cent of depressed residents were so identified by their key workers. Good interventions by key workers were associated with less depression in residents.
The response of home staff and community health professionals to physical health needs in residential homes is variable and should be improved. This study suggests that improving this aspect of care provision might reduce depression and thus improve quality of life.
One-month prevalence of mental syndromes in demented and non-demented subjects was studied in a representative sample of 85-year-olds living in Gothenburg, Sweden (N = 494). All subjects were examined by a psychiatrist. Schizophreniform syndrome was significantly more common in subjects with Alzheimer's disease than in nondemented subjects (13% vs 1%, p < 0.001), and more common in severe dementia (p > 0.01). Depressive syndromes were significantly more common in subjects with mild dementia than in non-demented subjects (34% vs 20%, p > 0.05). Phobic syndrome was less common in demented than in non-demented subjects. It is hypothesized that the occurrence of mental syndromes in demented subjects may be related to structural and neurochemical brain changes.
In 1993, a survey was conducted in 46 of the 47 nursing homes in a health district of Sydney. Medication cards and notes of all residents (N = 2414) were studied. Subjects who were willing and able to answer questions were interviewed by research assistants (senior nurses). Using the Mini-Mental State Examination and Mental Status Questionnaire, about 80% were found to be cognitively impaired. Of 874 subjects assessed with the Geriatric Depression Scale (GDS), 30.4% scored in the clearly depressed range (14 or more) of whom 27.4% were taking antidepressants. From a subsample of 26 with GDS scores of 14+, the psychiatrist concluded that only one-third would fulfil DSM-III-R criteria for major depression, with or without dementia. The dosages of antidepressants used in these nursing homes were relatively low. Of residents taking a tricyclic or mianserin, 48% were taking less than 30 mg daily, even though in 72% of cases their doctors stated the primary reason they were having this medication was to treat or prevent recurrence of depression. Opinions and evidence concerning the efficacy of such low dosage are conflicting. There is a need for further research, including correlation of efficacy with blood levels of antidepressants.
Data for this analysis came from a cross-sectional study on dementia, depression, and disability conducted in Zurich and Geneva in 1995/96. The random sample stratified by age and gender consisted of 921 subjects aged 65 and more. Based on the Canberra Interview for the Elderly, depression was assessed by means of psychogeriatric assessment scales (PAS) according to DSM-III-R criteria. The number of depressive symptoms (NDS) and the prevalence rate of depression (PRD) were computed for the whole sample as well as according to age and gender. To evaluate the independent effects of age as well as gender with regard to the risk of being depressed, multivariate analyses were conducted. On average, 13% of females vs 8% of males reported having at least one depressive symptom. The PAS yielded 298 (41.8%) subjects without depressive symptoms, 341 (50.2%) with 1-3 symptoms, and 60 (8.0%) with four or more. The average NDS was 1.27 (95% CI 1.16-1.39). For females, NDS values statistically significantly higher than those for males were calculated (1.53, 95% CI 1.35-1.70 vs 1.05, 95% CI 0.90-1.20). The NDS increased significantly with age. Subjects with low education levels and being divorced or widowed had statistically significantly higher NDS values than highly educated, married, or single persons. There were strong positive associations between NDS, dementia, and activities of daily living. Multivariate regression analysis revealed gender - however, not age - as a strong risk factor for NDS. Overall PRD amounted to 8.0% (95% CI 5.7-10.2%). Females had statistically significantly higher PRD values than males (10.4%, 95% CI 7.0-13.9% vs 3.9, 95% CI 2.0-5.9%). The PRD increased substantially with age. After adjustment for other risk factors, multivariate logistic regression analysis confirmed the positive statistically significant association between age, gender, and depression.
This paper reports the prevalence of psychiatric morbidity in a cohort of elderly new admissions to nursing and residential homes. Three hundred and eight people aged over 65 were assessed within two weeks of admission to 30 nursing or residential homes in north-west England, using screening measures of cognitive impairment, depression and dependency. Population 'casemix' data were collected from homes. Almost two-thirds of the cohort, and 61% of those in residential, as opposed to nursing, homes showed clinically significant cognitive impairment. Just under 45% were identified as depression 'cases'. More respondents in the lower of two social class categories were found in both cognitively impaired and depressed groups. The high level of psychiatric morbidity in this new admission cohort raises questions about the availability of specialist expertise for this population, for both treatment and pre-admission assessment.
The elderly who suffer from chronic illness are at unusually high risk of depression and depressive symptoms. This study was conducted to describe the prevalence of depressive symptoms in a sample of chronically-ill elders and to examine the relationship between physical illness and depression, both as it is illuminated in a regression model and as it is understood by the respondents themselves. Interviews were conducted with a random sample of 100 clients in a community-based care program for low-income elderly at risk of nursing home placement. Over one-third of the sample (36%) reported significant depressive symptoms, as measured by the CES-D. Multiple regression analysis identified functional limitations, cognitive impairment and self-perception as significant correlates of depression in a model that explained 30 percent of the variance in CES-D scores.
The purpose of this study was to obtain information about the prevalence of depressive symptoms in a representative sample of elderly subjects aged 85 years and over. The study was carried out as a population-based interview study in the City of Vantaa in Finland. The Zung Depression Status Inventory (DSI) was used to evaluate various depressive symptoms in this study population. The DSI scores range from 20 to 80; the higher the score, the more severe the disturbance. In subjects interviewed (n = 467, 362 women, 105 men), the prevalence estimates of depression with cutoff scores used in earlier studies (40 and 48) were very low: 5.2% and 1.1%. Also, the mean DSI score (SD) was very low, 27.9 (6.4). The scores tended to decrease with age, although the differences were not statistically significant. The DSI means were 28.0 (6.1) for women and 27.3 (7.2) for men (p = .0349). Women had a greater risk of being classified as depressed on the DSI (odds ratio: 1.60, 95% confidence interval: 1.00-2.57, p = .049). Feelings of emptiness, personal devaluation, and depressive mood were the most common depressive symptoms. In conclusion, the present population-based study shows that subjective experience of depression is very rare in Finnish people aged 85+. Our results suggest that optimistic mood might give some protection against death.
Background: Previous estimates of the prevalence of geriatric depression have varied. There are few large population-based studies; most of these focused on individuals younger than 80 years. No US studies have been published since the advent of the newer antidepressant agents. Methods: In 1995 through 1996, as part of a large population study, we examined the current and lifetime prevalence of depressive disorders in 4559 nondemented individuals aged 65 to 100 years. This sample represented 90% of the elderly population of Cache County, Utah. Using a modified version of the Diagnostic Interview Schedule, we ascertained past and present DSM-IV major depression, dysthymia, and subclinical depressive disorders. Medication use was determined through a structured interview and a "medicine chest inventory." Results: Point prevalence of major depression was estimated at 4.4% in women and 2.7% in men (P=.003). Other depressive syndromes were surprisingly uncommon (combined point prevalence, 1.6%). Among subjects with current major depression, 35.7% were taking an antidepressant (mostly selective serotonin reuptake inhibitors) and 27.4% a sedative/hypnotic. The current prevalence of major depression did not change appreciably with age. Estimated lifetime prevalence of major depression was 20.4% in women and 9.6% in men (P<.001), decreasing with age. Conclusions: These estimates for prevalence of major depression are higher than those reported previously in North American studies. Treatment with antidepressants was more common than reported previously, but was still lacking in most individuals with major depression. The prevalence of subsyndromal depressive symptoms was low, possibly because of unusual characteristics of the population.
Synopsis
The Geriatric Mental State and a new computerized diagnostic system, AGECAT, are briefly described. A nomenclature for designating cases for epidemiological work is introduced. Concordance between AGECAT and psychiatrists' diagnoses for these studies, hospital and community based (total of 541 subjects), achieved overall kappa values of 0·84 for a psychiatric hospital sample and 0·74 for a community sample. The values for depression and organic illness specifically in these settings were psychiatric hospital 0·80/0·86, and community 0·80/0·88, respectively.
Limited information is available regarding the incidence, nature, and treatment of behavioral problems in Alzheimer's disease (AD). A chart review of 57 outpatients with a diagnosis of AD was conducted to examine these issues. Thirty-three (58%) patients had significant behavioral symptomatology (most commonly delusions, nonspecific agitation, and diurnal rhythm disturbances). Twenty-seven were treated with thioridazine (10-250 mg/day), 15 (55.6%) of whom were judged to have a positive response (mean maximum dose = 55 mg/day). Information regarding the characteristic phenomenology of the behavioral symptoms studied was used to design a clinical rating instrument for AD patients, the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), which should be useful in prospective studies of behavioral symptoms as well as in pharmacologic trials.
Synopsis
A survey was made of 274 non-institutionalized persons aged 70 and over living in Hobart. The prevalence of dementia and of depression was measured by interviewing subjects using a modified version of the Geriatric Mental State Schedule (GMS) (Copeland et al. 1976) and the Mini Mental State Examination (MMSE) (Folstein et al. 1975). Rates of morbidity were derived from different diagnostic procedures. These were: (1) diagnoses made by a psychiatrist (A.S.H.) directly from the interview schedules and audiotapes, and rated as mild, moderate or severe; (2) the criteria laid down in DSM-III, converted into algorithms describing 3 degrees of severity; and (3) the algorithms for pervasive dementia and depression proposed by Gurland et al. (1983), and from these authors' rational scales. In addition, the relation between scales for dementia and for depression and the diagnosed categories was examined. Some problems in applying these methods to aged persons in the community are discussed. It is concluded that more detailed specification of criteria is desirable if the comparative epidemiology of dementia and depression in old age is to advance.