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Subthreshold Depressive Symptoms have a Negative Impact on Cognitive Functioning in Middle-Aged and Older Males  [PDF]
Erlend J. Brevik,Rune A. Eikeland,Astri J. Lundervold
Frontiers in Psychology , 2013, DOI: 10.3389/fpsyg.2013.00309
Abstract: Introduction: Cognitive aging is associated with a decline on measures of fluid intelligence (gF), whereas crystallized intelligence (gC) tends to remain stable. In the present study we asked if depressive symptoms might contribute to explain the decline on gF in a sample of healthy middle-aged and older adults.
Social participation reduces depressive symptoms among older adults: An 18-year longitudinal analysis in Taiwan
Chi Chiao, Li-Jen Weng, Amanda L Botticello
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-292
Abstract: Data are from a nationally representative sample of 1,388 adults aged 60-64 first surveyed in 1989 and followed over an 18-year time period for a total of six waves. Individual involvement in social activities was categorized into continuous participation, ceased participation before age 70, initiating participation in older adulthood, never participated, and dropped out before age 70. Two domains of depressive symptoms--negative affect and lack of positive affect--were measured using a 10-item version of the Center for Epidemiologic Studies-Depression Scale.Analyses using growth curve modeling showed that continuously participating or initiating participation in social activities later life is significantly associated with fewer depressive symptoms among older Taiwanese adults, even after controlling for the confounding effects of aging, individual demographic differences, and health status.These findings suggest that maintaining or initiating social participation in later life benefits the mental health of older adults. Facilitating social activities among older adults is a promising direction for programs intended to promote mental health and successful aging among older adults in Taiwan.Depression is one of the most common chronic mental health conditions among older adults in Chinese communities [1,2]. Symptoms of depression experienced in later life have serious implications for the health and functioning of older persons as emotional distress is consistently associated with higher levels of cognitive [3,4] and functional impairment [5,6], and the increased risk of physical illnesses such as heart disease and stroke. Depressive symptoms also place older adults at the increased risk for suicide [7-10], which can devastate families and communities.Growing evidence suggests that involvement in social activities improves the mental health of older adults. Research has demonstrated that socially active older adults have better health outcomes than their inactive co
Depressive symptoms and psychosocial stress at work among older employees in three continents
Johannes Siegrist, Thorsten Lunau, Morten Wahrendorf, Nico Dragano
Globalization and Health , 2012, DOI: 10.1186/1744-8603-8-27
Abstract: Cross-sectional and longitudinal multivariate regression analyses of data from 4 cohort studies with elder workers (2004 and 2006) testing associations of psychosocial stress at work (‘effort-reward imbalance’; ‘low control’) with depressive symptoms.Cross-sectional analyses from 17 countries with 14.236 participants reveal elevated odds ratios of depressive symptoms among people experiencing high work stress compared to those with low or no work stress. Adjusted odds ratios vary from 1.64 (95% CI 1.02-2.63) in Japan to 1.97 (95% CI 1.75-2.23) in Europe and 2.28 (95% CI 1.59-3.28) in the USA. Odds ratios from additional longitudinal analyses (in 13 countries) controlling for baseline depression are smaller, but remain in part significant.Findings indicate that psychosocial stress at work might be a relevant risk factor for depressive symptoms among older employees across countries and continents. This observation may call for global policy efforts to improve quality of work in view of a rapidly aging workforce, in particular in times of economic globalization.On a global scale, depression is one of the leading causes of premature mortality and disability-adjusted life years [1]. Despite uncertainty about the scope of a potentially increased incidence in recent years [2] depression makes a significant contribution to the global burden of disease and associated costs, in particular in rapidly aging populations [3-5]. On a different level, work stress is now considered a growing threat to the health of employed people, especially so in association with aggravated competition, work intensification and job insecurity resulting from rapid spread of free market principles in a globalized economy [6]. Whether there is an association between work stress and depression has been explored in a number of epidemiological studies (for reviews see [7-10]. Although results are not fully consistent significantly increased odds ratios of incident depression were documented in a majori
Concurrent Validity of the Cognitive Assessment of Minnesota in Older Adults with and without Depressive Symptoms  [PDF]
Leilani Feliciano,Jonathan C. Baker,Sarah L. Anderson,Linda A. LeBlanc,David M. Orchanian
Journal of Aging Research , 2011, DOI: 10.4061/2011/853624
Abstract: Cognitive impairment represents a common mental health problem in community-dwelling and institutionalized older adults, and the prevalence increases with age. Multidisciplinary teams are often asked to assess cognitive and functional impairment in this population. The Cognitive Assessment of Minnesota was created by occupational therapists for this purpose and is frequently used, but has not been extensively validated. This study examined the performance of the CAM and compared it to the MMSE with 113 outpatient clinic patients over the age of 60. Subgroups were established based on scores on a depression inventory to determine if the presence of depressed mood altered the relationship between the measures. Both measures demonstrated good internal consistency. The overall correlation between the two measures was high, statistically significant and remained high regardless of depression status. We offer recommendations about the utility of each measure in screening cognitive functioning for older adults. 1. Introduction Cognitive impairment represents a common mental health problem in community dwelling and institutionalized older adults, and the prevalence increases with age [1]. Several measures have been developed to assess cognitive functioning in this population with some measures having a greater emphasis on memory and language functioning in analog conditions and others focusing more on functional adaptive skill use. Occupational therapists often work within multi-disciplinary settings and are frequently asked to assess the functional and cognitive status of their patients. The Cognitive Assessment of Minnesota (CAM) [2] was created for this purpose. The CAM is a standardized assessment of cognitive functioning developed by occupational therapists. The advantage of using a measure like the CAM is that it covers a greater range of cognitive impairment compared to most cognitive screens, making it potentially more useful as a screening measure. In addition to providing a global measure of cognition, the CAM also assesses practical skill domains. For example, the CAM allows for assessments of working memory and simple mathematical ability (e.g., can the person make change) that would allow for specific recommendations (e.g., providing assistance to the affected person in managing finances). The CAM also allows for hierarchical grading of cognitive skills, which may be useful in monitoring change over time. Thus, the CAM may be a promising measure to be used in geriatric settings. Although the CAM is frequently used internationally by OTs in practice
Potentially inappropriate medication use: the Beers' Criteria used among older adults with depressive symptoms  [PDF]
Lee D,Martini N,Moyes S,Hayman K
Journal of Primary Health Care , 2013,
Abstract: INTRODUCTION: The ageing population means prescribing for chronic illnesses in older people is expected to rise. Comorbidities and compromised organ function may complicate prescribing and increase medication-related risks. Comorbid depression in older people is highly prevalent and complicates medication prescribing decisions. AIM: To determine the prevalence of potentially inappropriate medication use in a community-dwelling population of older adults with depressive symptoms. METHODS: The medications of 191 community-dwelling older people selected because of depressive symptoms for a randomised trial were reviewed and assessed using the modified version of the Beers' Criteria. The association between inappropriate medication use and various population characteristics was assessed using Chi-square statistics and logistic regression analyses. RESULTS: The mean age was 81 (±4.3) years and 59% were women. The median number of medications used was 6 (range 1-21 medications). The most commonly prescribed potentially inappropriate medications were amitriptyline, dextropropoxyphene, quinine and benzodiazepines. Almost half (49%) of the participants were prescribed at least one potentially inappropriate medication; 29% were considered to suffer significant depressive symptoms (Geriatric Depression Scale ≥5) and no differences were found in the number of inappropriate medications used between those with and without significant depressive symptoms (Chi-square 0.005 p=0.54). DISCUSSION: Potentially inappropriate medication use, as per the modified Beers' Criteria, is very common among community-dwelling older people with depressive symptoms. However, the utility of the Beers' Criteria is lessened by lack of clinical correlation. Ongoing research to examine outcomes related to apparent inappropriate medication use is needed.
Poor Dissociation of Patient-Evaluated Apathy and Depressive Symptoms  [PDF]
Progress Njomboro,Shoumitro Deb
Current Gerontology and Geriatrics Research , 2012, DOI: 10.1155/2012/846075
Abstract: Apathy has traditionally been conceptualised as part of depression. The appropriateness of this conceptualisation has now been questioned, with the realization that apathy constitutes a distinct neuropsychiatric condition, with separate rehabilitation and patient-care implications to depression. Research on the relationship between apathy and depression has, however, produced mixed results. One reason for this inconsistency may lie behind who does the apathy evaluation. In this study we investigated whether the relationship between apathy and depression would differ when apathy was evaluated by the patients or an informant. A total of 49 brain damaged patients were assessed on self- and informant-rated Apathy Evaluation Scales. The relationship between the apathy scores and depressive symptoms was then investigated. Patient-rated, and not informant-rated apathy significantly correlated with depression. We discuss the implication of these results on the relationship between the two neuropsychiatric conditions and also in relation to the utility of patient self-evaluations in apathy. 1. Introduction The position of apathy as a distinct syndrome in both clinical practice and research is still uncertain and less clearly defined. Generally, apathy is conceptualised as constituting a significant loss of motivation [1]. For diagnostic purposes, this loss of motivation must be present for at least four weeks and should manifest in at least two of three dimensions of apathy involving reduced overt acts, cognitive activity, and affective responses related to goal directed behaviour [2]. The clinical importance of apathy is demonstrated through its association with reduced patient independence, social integration, rehabilitation success, and increased caregiver burden [3] and its high prevalence in patients suffering neurological change [4]. For instance, incidence of between 17–70% has been reported in Parkinson’s disease [5, 6], and incidence of between 46 and 71% has been reported in patients with traumatic brain injury [7, 8]. Similar high incidence rates have been reported in Alzheimer’s disease, frontotemporal dementia, progressive supranuclear palsy, and stroke [9–11]. See also [12] for a review. Much of the debate on apathy in the past decade has focused on its nosological position, particularly its relation to depressive symptoms [6, 13–16]. Traditionally, apathy has been viewed as a symptom of depression. Clinically, the two disorders are related in that they significantly overlap on symptom dimensions related to loss of interest, anhedonia, and reduced
Screening for depressive symptoms among older adults in Taiwan: Cutoff of a short form of the Center for Epidemiologic Studies Depression Scale  [PDF]
Ken-Fu Chang, Li-Jen Weng
Health (Health) , 2013, DOI: 10.4236/health.2013.53A078
Abstract:

Screening for elders at risk for depression is crucial for promoting mental health in later life. The present study investigates the cutoff score of a short form of the CES-D for screening of depressive symptoms in the elderly population of Taiwan. This particular short form of CES-D is repeatedly used in the Taiwan Longitudinal Study on Aging (TLSA), a national survey of representative older adults in Taiwan, and is therefore referred to as the TLSA form. Data collected from five waves of TLSA were analyzed in this study. Participant responses repeatedly measured in 1989 and 1993 were used to identify a cutoff for the TLSA form of the CES-D with sensitivity and specificity using the cutoff of 4 on the Boston form of the CES-D as the criterion. Longitudinal data from the years 1996, 1999, and 2003 were used to validate the proposed cutoff by comparing the prevalence rates for depressive symptoms among older Taiwanese estimated from the identified cutoff and reported in previous studies. The score of 10 on the TLSA form of the CES-D was suggested, yielding a specificity of 0.93 and a sensitivity of approximately 0.96. The estimated prevalence rates for depressive symptoms among Taiwanese elders based on the suggested cutoff were between 18.9% and 23.7%, which are similar to previously reported rates. The cutoff score of 10 on the TLSA form of the CES-D is therefore recommended for screening depressive symptoms among older adults in Taiwan.

Biomarkers and Depressive Symptoms in Older Women with and without Cognitive Impairment  [PDF]
James R. Hall, Leigh A. Johnson, Hoa T. Vo, Robert C. Barber, A. Scott Winter, Sid E. O’Bryant
Journal of Behavioral and Brain Science (JBBS) , 2012, DOI: 10.4236/jbbs.2012.22031
Abstract: A number of biological markers have been implicated in late life depression with inconsistent results. The present study examined the relationship between several serum based biomarkers and symptoms of depression in a sample of elderly women with AD or cognitively intact. Methods 171 females (58 with AD and 113 cognitively intact) were recruited from the Longitudinal Research Cohort of the Texas Alzheimer’s Research and Consortium (TARC). Stepwise regressions were conducted with GDS total and subscales and a panel of biomarkers (CRP, IL-10, IL-1α, TNF-α, ICAM-1, BDNF, and MIF). ApoE4 status was coded (carrier or non-carrier), and the results were analyzed by cognitive status (AD or controls). Results: None of the biomarkers significantly predicted total GDS score for AD cases, controls or sample as a whole. For the Controls, ICAM significantly predicted Dysphoria and level of Apathy. Among AD patients, MIF, ICAM, and CRP, were significantly associated with Apathy. MIF and ICAM were inversely associated with reported Apathy. CRP was positively associated with Apathy. CRP was also positively related to level of perceived Cognitive Impairment. Conclusions: The present study was one of the first to examine biomarkers related to depression symptoms in elderly women with AD and normal controls. For Controls ICAM alone predicted level of apathy. In the AD group, MIF, CRP, and ICAM were significantly associated with apathy. More research examining the relationship between biomarkers and depression is needed in older patients with and without cognitive impairment across genders.
The Association between Depressive Symptoms and Non-Psychiatric Hospitalisation in Older Adults  [PDF]
A. Matthew Prina, Dorly Deeg, Carol Brayne, Aartjan Beekman, Martijn Huisman
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0034821
Abstract: Background It is known that people who suffer from depression are more likely to have other physical illnesses, but the extent of the association between depression and non-psychiatric hospitalisation episodes has never been researched in great depth. We therefore aimed to investigate whether depressed middle-aged and older people were more likely to be hospitalised for causes other than mental illnesses, and whether the outcomes for this group of people were less favourable. Methods & Findings Hospital events from 1995 to 2006 were obtained from the Dutch National Medical Register and linked to participants of the Longitudinal Aging Study Amsterdam (LASA). Linkage was accomplished in 97% of the LASA sample by matching gender, year of birth and postal code. Depression was measured at each wave point of the LASA study using the Centre for Epidemiologic Studies Depression (CES-D). Hospital outcomes including admission, length of stay, readmission and death while in hospital were recorded at 6, 12 and 24 months intervals after each LASA interview. Generalised Estimating Equation models were also used to investigate potential confounders. After 12 months, 14% of depressed people were hospitalised compared to 10% of non-depressed individuals. There was a 2-fold increase in deaths while in hospital amongst the depressed (0.8% vs 0.4%), who also had longer total length of stay (2.6 days vs 1.4 days). Chronic illnesses and functional limitations had major attenuating effects, but depression was found to be an independent risk factor for length of stay after full adjustment (OR = 1.33, 95% CI: 1.22–1.46 after 12 months). Conclusions Depression in middle and old age is associated with non-psychiatric hospitalisation, longer length of stay and higher mortality in clinical settings. Targeting of this high-risk group could reduce the financial, medical and social burden related to hospital admission.
Exploring the feasibility of a community-based strength training program for older people with depressive symptoms and its impact on depressive symptoms
Jane Sims, Keith Hill, Sandra Davidson, Jane Gunn, Nancy Huang
BMC Geriatrics , 2006, DOI: 10.1186/1471-2318-6-18
Abstract: A randomised controlled trial was conducted. People aged ≥ 65 years with depressive symptoms were recruited via general practices. Following baseline assessment, subjects were randomly allocated to attend a local PRT program three times per week for 10 weeks or a brief advice control group. Follow-up assessment of depressive status, physical and psychological health, functional and quality of life status occurred post intervention and at six months.Three hundred and forty six people responded to the study invitation, of whom 22% had depressive symptoms (Geriatric Depression Scale, GDS-30 score ≥ 11). Thirty two people entered the trial. There were no significant group differences on the GDS at follow-up. At six months there was a trend for the PRT intervention group to have lower GDS scores than the comparison group, but this finding did not reach significance (p = 0.08). More of the PRT group (57%) had a reduction in depressive symptoms post program, compared to 44% of the control group. It was not possible to discern which specific components of the program influenced its impact, but in post hoc analyses, improvement in depressive status appeared to be associated with the number of exercise sessions completed (r = -0.8, p < 0.01).The UPLIFT pilot study confirmed that older people with depression can be successfully recruited to a community based PRT program. The program can be offered by existing community-based facilities, enabling its ongoing implementation for the potential benefit of other older people.Depressive illness results in considerable functional disability and decreased quality of life, particularly for older people. Prevalence of depression in older persons in the primary care setting ranges from 10 to 30% [1-3]. Whilst antidepressants may be effective, they can have significant side effects, such as increased risk of hip fracture [4]. Using physical activity as part of the management regimen may offset this side-effect of antidepressant medication.
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