Adverse life events among community-dwelling persons aged 65–70 years: gender differences in occurrence and perceived psychological consequences

Objectives  

To describe the occurrence of selected adverse life events in young-old men and women, as well as their perceived psychological consequences.     

The association between loneliness and health – a survey-based study among middle-aged and older adults in Denmark

ABSTRACT

Background: While the association between overall poor health and loneliness among older adults continues to be examined closely, less attention has been given to middle-aged adults. This paper examines the relationship between loneliness and health as measured by self-rated health, physical ability and multi-morbidity in a large sample of Danish adults between the ages of 52–92 years. Furthermore, it identifies vulnerable groups with regard to the year of birth and gender.

Method: We apply the survey-study method, using data collected by The Danish National Centre for Social Research in 2012. We analysed the association between loneliness and health in 9154 Danish adults through multi-variate regression analyses adjusting for the year of birth, gender, marital status, cohabitation status, employment status and home ownership.

Results: We found that loneliness was associated with increased risks of poor self-rated health (OR, 2.58; 95% Cl, 1.20–3.35), limited physical abilities (OR, 1.91; 95% Cl, 1.58–2.32) and multiple diagnoses (OR, 1.77; 95% Cl, 1.48–2.12). Lonely middle-aged adults (52–62 years of age) had an increased risk of having limited physical abilities.

Conclusion: Among middle-aged and older Danish adults, loneliness was strongly associated with poor self-rated health, limited physical ability and multi-morbidity.     

Does psychological distress vary between younger and older adults in health and disease?

ObjectiveThe effect of age on psychological distress remains controversial and it is unclear how a chronic medical illness influences this association. We aimed to compare the level of psychological distress between younger and older patients with chronic medical conditions attending hospital specialty clinics and to test whether a different pattern emerges when comparisons with individuals without long-term conditions are made.MethodsIn 519 individuals without chronic medical conditions and 949 patients with established severe chronic medical illnesses, we compared psychological distress (GHQ-28 and SCL-90R) between younger (< 65, N = 1040) and older (≥ 65, N = 428) participants after controlling for gender, marital status, education and primary diagnosis in multiple logistic regression models.ResultsAmong the healthy participants, a greater proportion of older individuals presented mild/moderate psychological distress (p = .026), predominantly depressive and somatization symptoms. Among the medical patients, both age groups presented elevated levels of psychological distress, but a greater proportion of younger patients had severe psychological distress (p = .016), predominantly depressive, anxiety and hostility symptoms. Younger patients reported similarly high levels of somatization symptoms compared to older patients. The odds of being assessed with severe psychological distress were significantly greater for younger individuals with physical illnesses, independently of gender, marital status, education and primary diagnosis.ConclusionsMedical patients from both age groups had significant psychological distress symptoms scores. Younger patients with chronic medical illnesses were more vulnerable to severe psychological distress, including symptoms of anxiety, depression, hostility and somatization. Therefore, clinicians should direct efforts to recognize these symptoms in order to prevent further functional impairment.     

How to manage gait and balance disorders among older adults aged 65 years and older with mild to moderate dementia in clinical practice?

Gait and balance disorders are frequent in demented older adults. Their management (i.e., diagnosis, assessment and treatment) is challenging in daily practice because of numerous evaluation tests available, difficulties to select the most adapted intervention, and the lack of knowledge of physicians and health professionals concerning adapted centers to refer their patients to those patients. Thus, a working group of experts was organized by the Gérontop?le of Pays de Loire, France, in December 2010 with the aim to provide clinical guidelines for the management of older adults aged 65 years and older with mild to moderate dementia with gait and balance disorders. These guidelines provide answers to the following questions: 1) Is there gait and/or balance disorders? 2) Which specific tests used? and 3) How to treat patients?     

Does physical activity moderate the association between depressive symptoms and disability in older adults?

OBJECTIVE: Depressive symptoms and disability are closely associated and known to have reciprocal relationships. This study examines whether physical activity moderates the association between depressive symptoms and disability in community-dwelling older adults. METHODS: Baseline and 1-year follow-up data of 645 persons aged 65 years or older from the Suwon Longitudinal Aging Study were analyzed. A 15-item Geriatric Depression Scale, Physical Functioning scale, and physical performance tests were used to assess the individual's depressive symptoms and functional disability. Physical activity was defined as the recommended level of exercise based on its frequency and intensity. Multiple regression analysis with generalized estimating equations was conducted to examine the physical activity's role as an effect modifier in the association between depressive symptoms and disability. RESULTS: Physical activity was a significant effect modifier in the 'depressive symptoms-disability' association, controlling for sociodemographic characteristics and health-related covariates. Moderate-intensity activity was as effective as vigorous activity in moderating the relationship. The moderating effect was notable among those displaying severe depressive symptoms and functional disability. Over time the strength of the association between depressive symptoms and disability tended to diminish for those engaging in physical activity. CONCLUSION: The association between depressive symptoms and disability is moderated by physical activity in older persons. The findings suggest that healthcare professionals need to promote moderate amount of physical activity as a potential intervention tool in attenuating the depression-disability connection in later life, especially among those with high levels of physical and mental impairments.     

Time trends in the incidence of diagnosed depression among people aged 5–25 years living in Finland 1995–2012

Abstract

Background: Knowledge of time trends for depression is important for disease prevention and healthcare planning. Only a few studies have addressed these questions regarding the incidence and cumulative incidence of diagnosed depression from childhood to early adulthood and findings have been inconclusive.

Aim: The aim of this national register-based Finnish study was to report the time trends of the age-specific and gender-specific incidence and cumulative incidence of diagnosed depression.

Methods: The study sample included all 1,245,502 singletons born in Finland between 1 January 1987 and 31 December 2007 and still living in Finland at the end of 2012. The participants were divided into three cohorts by birth year: 1987–1993, 1994–2000 and 2001–2007. Depression diagnoses (ICD-9: 2961; ICD-10: F32, F33) given in 1995–2012 were available and identified from the Care Register for Health Care.

Results: Ten percent of the females and five percent of the males were diagnosed with depression in specialized services by age 25 years. The cumulative incidence of depression by age 15 years rose from 1.8% (95% CI 1.8–1.9) to 2.9% (95% CI 2.8–3.0) in females and from 1.0% (95% CI 1.1–1.2) to 1.6% (95% CI 1.6–1.7) in males when the cohorts born 1987–1993 and 1994–2000 were compared.

Conclusions: A larger proportion of young people in Finland are diagnosed with depression in specialized services than before. This can be due to better identification, more positive attitudes to mental health problems and increased availability of the services.     

Relationship between sleep disturbances and multimorbidity among community-dwelling men and women aged 65–93 years: results from the KORA Age Study

Background/ObjectiveAlthough the association of disturbed sleep with specific chronic conditions is well known, the relationship between sleep disturbances and multiple diseases is less clear. Therefore, the objectives of this study were to examine the independent relationships of various sleep disturbances with 1) multimorbidity (≥2 chronic conditions) and 2) commonly co-occurring pairs of chronic conditions.MethodsAnalyses were based on data from 4127 individuals aged ≥65 years participating in the population-based cross-sectional Cooperative Health Research in the Region of Augsburg (KORA) Age Study conducted from 2008 to 2009 in Germany. Sex-specific odds ratios (OR) and 95% confidence intervals (CI) were calculated from sequential logistic regression models.ResultsNeither short nor long daily sleep duration was significantly associated with multimorbidity among men; a significant positive relationship was identified regarding short sleep duration among women (OR 2.16, 95% CI: 1.42–3.30). While insomnia and all unique symptoms of insomnia were connected to multimorbidity among women in the multivariable models, the relationship concerning trouble falling asleep no longer remained significant after adjustment for all covariables among men. Regarding commonly co-occurring pairs of conditions, the clearest associations were observed between insomnia and daytime tiredness with joint diseases/eye diseases in men and joint diseases/heart diseases in women.ConclusionsThere seems to be sex-specific particularities in the relationship between sleep disturbances and sleep duration with multimorbidity and commonly co-occurring pairs of chronic conditions in older adults from the general population.     

The association between preschool behavioural problems and internalizing difficulties at age 10–12 years

The aim was to study the association between preschool behavioural problems and emotional symptoms in 10- to 12-year-old children. The study was based on the Aarhus Birth cohort, Denmark, and included 1,336 children. Based on the parent-administered preschool behaviour questionnaire (PBQ), we identified three not mutually exclusive preschool behavioural categories: anxious–fearful (n = 146), hyperactive–distractible (n = 98), and hostile–aggressive (n = 170). Children without any known symptoms were considered well adjusted (n = 1,000). Borderline emotional (n = 105) and emotional difficulties (n = 136) were measured at age 10–12 years with the parent-administered strength and difficulties questionnaire (SDQ). Multinomial logistic regression analyses were used to adjust for potential confounding factors. We found that anxious–fearful behaviour and hostile–aggressive preschool behaviour were associated with twice the risk of school-age emotional difficulties. Comorbidity or confounding failed to explain these results. Hyperactive–distractible preschool behaviour was not associated with school-age emotional difficulties. Preschool anxious–fearful behaviour was associated with school-age emotional difficulties, suggesting internalizing symptom stability in some children from early childhood. Preschool hostile–aggressive behaviour was also associated with school-age emotional difficulties, which suggests transformation of one behavioural dimension into another through childhood, and the need to focus on both early internalizing difficulties and hostile–aggressive behaviour as risk factors for later internalizing difficulties.     

Prevalence and characteristics of significant social anxiety in children aged 8–13 years

Background  Social anxiety has been frequently studied in both population- and clinical-based adult and adolescent samples. Corresponding research in children is scarce and is dominated by clinical studies. The aim of the present population-based study was to examine the prevalence of significant social anxiety (SSA) in preadolescent children and compare their characteristics with those of children without SSA. The spectrum of social anxiety is explored by comparing children with different levels of social anxiety, as defined by 1–2 versus 3–5 social situations feared. Method  The sample consisted of 14,497 parents and their 3rd–7th grade children (8–13 years old) who participated in a health profile study, including questions covering DSM-IV criteria A–D for social anxiety disorder (SAD). Socio-demographic data, social and school functioning, somatic complaints, parent–child relationships, and use of health services were added to a logistic regression model to explore characteristics associated with children with, and without SSA. Associated emotional and behavioural problems were measured by the Strengths and Difficulties Questionnaire (SDQ) using parent and self-report. Results  Parents described 2.3% of all children as significantly socially anxious and 0.9% feared at least three social situations. The majority of children with SSA managed their everyday life well. However, compared with children without SSA, children with SSA struggled more often in different areas of life and showed a significantly higher prevalence of associated emotional and behavioural symptoms. Our findings also support the notion of social anxiety as a spectrum concept. Conclusions  Social anxiety problems start in childhood and can be impairing, even in non-clinical populations and in reasonably young age groups. Increased awareness of different aspects of social anxiety is needed to identify children who are at risk and to devise appropriate interventions to improve the immediate and long-term outcome.     

Age differences among older adults in the use of emotion regulation strategies. What happens among over 85s and centenarians?

Objective: Past research on emotion regulation strategies has concluded that older adults use more passive strategies than young adults. However, we found scarce research in this field focusing on the oldest old (i.e. those aged 85 and over). The aim of this study was to analyze whether or not differences exist in the way older adults aged 85 and over (centenarians included) use emotion regulation strategies, in comparison with younger age groups (65–74 and 75–84 years old).

Method: Participants were 257 older adults from Spain, all aged between 65 and 104. The sample was divided into four age groups: 65–74; 75–84; 85–94; and 95–104 years old. Participants completed the Strategy Questionnaire after reading each of the vignettes designed to elicit feelings of either sadness or anger. The questionnaire measures four types of regulation strategies: Passive, Express, Solve and Seek.

Results: The 85–94 age group and centenarians were found to use proactive (Express, Seek) and Solve strategies less in comparison with younger age groups when regulating sadness and anger. In contrast, an increased use of Passive strategies was observed in the regulation of both emotions in the 85–94 age group. Significant differences were also found between centenarians and younger age groups in the use of Passive strategies for sadness, although not for anger.

Conclusion: Age differences were observed in the use of emotion regulation strategies, with older age groups using proactive strategies less and passive strategies more.     

Gender difference in the association between adult attention deficit hyperactivity disorder symptoms and morningness–eveningness

We aimed to investigate the association between attention deficit hyperactivity disorder (ADHD) and morningness–eveningness in adulthood. Subjects without psychiatric comorbidity on the Structured Clinical Interview for DSM-IV Axis I Disorders (n = 344) completed the Morningness–Eveningness Questionnaire (MEQ) and the Adult Self-Report Scale for ADHD. MEQ showed an independent and negative association with ADHD symptoms (P < 0.0001). In male subjects, both inattention (P < 0.0001) and hyperactivity–impulsivity were associated with MEQ (P = 0.01). In female subjects, only inattention was associated with MEQ (P < 0.001). Our findings suggest that eveningness may be strongly associated with inattention of adult ADHD and that it may be associated with hyperactivity–impulsivity of adult ADHD in male subjects only.     

Association between sleep period time and dietary patterns in Brazilian schoolchildren aged 7–13 years

ObjectivesTo assess the association between sleep period time and dietary patterns (DPs) in Brazilian schoolchildren aged 7–13 years.MethodsSleep data of 1019 children were obtained from a questionnaire completed by parents/guardians. Food consumption, physical activity, and screen-based activity were assessed through the validated Web-CAAFE questionnaire. Latent profile analysis was used to identify dietary patterns. Associations between sleep period time and dietary patterns were analyzed by multinomial logistic regression, and the average marginal effect of sleep period time on the probability of adherence to dietary patterns was determined.ResultsOverall, 11.4% of children had inadequate sleep period time (<9 h per day). Three mutually exclusive dietary patterns were identified: “Monotonous” characterized by high consumption of pasta, instant pasta, sweets, and hamburgers/hot dog/pizza/salty snacks; “Traditional” characterized by high consumption of rice, vegetables, green leaves, beans, manioc flour, maize/potatoes, and meats; and “Dairy, bread, green leaves, maize/potatoes and sausage”. The likelihood of adherence to the “Dairy, bread, green leaves, maize/potatoes and sausages” DP decreased by 0.026 as sleep period time increased by 1 h per day. For a sleep period time of more than 10 h per day, the average marginal effect of sleep period time on the likelihood of adherence to the this dietary pattern was significant and negative.ConclusionsSleep period time was inversely associated with adherence to the “Dairy, bread, green leaves, maize/potatoes and sausages” DP; children who slept more than 10 h per day were less likely to present this pattern.     

Health status and well‐being of older adults living in the community and in residential care settings: Are differences influenced by age?

The objective is to identify the differences and the main factors influencing health status and well-being variables between institutionalized and non-institutionalized older adults, as well as the interaction effect of institutionalization and age. Data on a total of 468 older adults from a national survey on non-institutionalized and from a study on institutionalized older people were analyzed. Socio-demographic variables and measures on well-being (Personal Well-being Index, PWI), health status (EQ-5D), functional ability (Barthel Index), depression (Hospital Anxiety and Depression Scale-Depression subscale), loneliness and comorbidity were used. Analysis of variance and Kruskal-Wallis tests to examine differences between groups and multiple regression analyses to identify factors associated to health and well-being were performed. Significant differences in health status variables, but not in well-being were detected between groups. Controlling for age, differences in health status (EQ-VAS) were found to be not significant in both groups. In the non-institutionalized group, people aged 78 years or more reported a significantly lower well-being (PWI) than younger counterparts. Step-wise multiple regression analysis showed that depression, functional dependence, loneliness and sex were associated with health status; while depression, health status, loneliness and the interaction of age-institutionalization were related to well-being. The results suggest that age influences community-dwelling older adults' well-being to a greater extent than it does to institutionalized older people. This finding has implications for resource allocation and interventions addressed to improve health and well-being in older adults.