Individual differences in the effects of disease and disability on depressive symptoms: the role of age and subjective health

Each person is affected by disease and disability differently. This study examined the role of age and subjective perception of health in determining the links of depressive symptoms with disease and disability among older adults of different ages. The hypothesized effects of age and subjective health were tested using 252 older adults divided into three age groups (i.e., 60s, 80s, and 100s). Two major findings emerged. First, individuals with advanced old age had higher levels of health problems, as expected. However, their perceptions of health and depressive symptoms were less affected by disability when compared to the younger old. Second, regardless of age, the effects of disease and disability on depressive symptoms were mediated through subjective health. Findings suggest age differences in the consequences of health problems, and the importance of subjective perception to bridge physical and mental health. Issues such as age differences within older populations, the resilience of centenarians, and the intervening roles of subjective health are further discussed.     

Hearing loss and depressive symptoms in elderly patients

Aims: Hearing loss is a common disability that has a profound impact on communication and daily functioning in the elderly. The present study assesses the effects of hearing aids on mood, quality of life and caregiver burden when hearing loss, comorbidity and depressive symptoms coexist in the elderly. Methods: A total of 15 patients aged older than 70 years suffering from hearing loss and depressive mood were recruited. Comorbidity was evaluated by the Cumulative Illness Rating Scale, functional ability by the Activities of Daily Living scale and the Lawton Instrumental Activities of Daily Living scale, cognitive capacity by the Mini‐mental State Examination and the Clock Drawing Test, psychological status by the Center for Epidemiological Studies‐Depression scale, and quality of life by the Short Form (36) Health Survey. Caregiver burden was appraised by the Caregiver Burden Inventory. Testing was carried out at baseline and at 1‐, 3‐ and 6‐month intervals, assessing the use of binaural digital and programmable hearing aids. Results: Reduction in depressive symptoms and improved quality of life at statistically significant levels were observed early on with the use of hearing aids. In particular, general health (P < 0.02), vitality (P < 0.03), social functioning (P < 0.05), emotional stability (P < 0.05) and mental health (P < 0.03) all changed for the better, and were maintained for the study duration. The degree of caregiver burden also declined, remaining low throughout the study. Conclusions: The benefits of digital hearing aids in relation to depressive symptoms, general health and social interactivity, but also in the caregiver – patient relationship, were clearly shown in the study. The elderly without cognitive decline and no substantial functional deficits should be encouraged to use hearing aids to improve their quality of life. Geriatr Gerontol Int 2012; 12: 440–445.     

Additive effects of cognitive function and depressive symptoms on mortality in elderly community-living adults

BACKGROUND: Poor cognitive function and depressive symptoms are common in the elderly, frequently coexist, and are interrelated. Both risk factors are independently associated with mortality. Few studies have comprehensively described how the combination of poor cognitive function and depressive symptoms affect the risk for mortality. Our aim was to examine whether the combination of varying levels of cognitive function and depressive symptoms affect the risk of mortality in community-living elderly adults. METHODS: We studied 6301 elderly adults (mean age, 77 years; 62% women; 81% white) enrolled in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study, a prospective study of community-living participants conducted from 1993 to 1995. Cognitive function and depressive symptoms were measured using two validated measures developed for the AHEAD study. On each measure, participants were divided into tertiles representing the best, middle, and worst scores, and then placed into one of nine mutually exclusive groups ranging from best functioning on both measures to worst functioning on both measures. Mortality rates were assessed in each of the nine groups. Cox proportional hazards models were used to control for potentially confounding characteristics such as demographics, education, income, smoking, alcohol consumption, comorbidity, and baseline functional impairment. RESULTS: During 2 years of follow-up, 9% (548) of the participants died. Together, cognitive function and depressive symptoms differentiated between elderly adults at markedly different risk for mortality, ranging from 3% in those with the best function on both measures to 16% in those with the worst function on both measures (p <.001). Furthermore, for each level of cognitive function, more depressive symptoms were associated with higher mortality rates, and for each level of depressive symptoms, worse cognitive function was associated with higher mortality rates. In participants with the best cognitive function, mortality rates were 3%, 5%, and 9% in participants with low, middle, and high depressive symptoms, respectively (p <.001 for trend). The corresponding rates were 6%, 7%, and 12% in participants with the middle level of cognitive function (p <.001 for trend), and 10%, 13%, and 16% in participants with the worst level of cognitive function (p <.001 for trend). After adjustment for confounders, participants with the worst function on both measures remained at considerably higher risk for death than participants with the best function on both measures (adjusted hazard ratio, 3.1; 95% confidence interval, 2.0-4.7). CONCLUSIONS: Cognitive function and depressive symptoms can be used together to stratify elderly adults into groups that have significantly different rates of death. These two risk factors are associated with an increased risk in mortality in a progressive, additive manner.     

Prevalence of depressive symptoms among the elderly: A longitudinal study

Aim:   Depression is a common psychiatric problem in late life. The purpose of the present study was to assess the prevalence of depressive symptoms among community-dwelling elderly, both cross-sectionally and longitudinally.
Methods:   This study was a part of the community study in a large cohort of elderly people aged 65 and over in Nangai Village, Japan. Data on depressive symptoms from the fifth survey in 2000 were analyzed cross-sectionally and also combined with data from the first survey in 1992 to assess aging and cohort effects. Depressive symptoms were measured by the short form of Geriatric Depression Scale.
Results:   Among 1195 respondents at the fifth survey, the prevalence of depressive symptoms was 22.3%. In 457 subjects who responded at both surveys, mean depression score or prevalence of depressive symptoms tended to be higher at the fifth survey than at the first survey. The difference in prevalence between the first survey and the fifth survey among individuals of the same age groups was significant only in the oldest group (77 years and over).
Conclusion:   Among Japanese community-dwelling elderly people, aging effects on depressive symptoms were found, though marked cohort effects were not confirmed.     

Social support and mobility limitation as modifiable predictors of improvement in depressive symptoms in the elderly: Results of a national longitudinal study

Few national longitudinal studies have investigated the predictors of a better depression outcome in geriatric depression. This study examined the predictors of improvement in case-level depressive symptoms in the elderly. In this prospective cohort and population-based study in Taiwan, 206 non-demented and case-level depressed subjects aged 65 and older were interviewed at baseline in 2003 and follow-up in 2007. The independent variables included demographics, chronic medical diseases, and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms, assessed using the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CESD-10) assessed at follow-up. Multivariate analyses were used to identify the predictors of improvement in depression. The independent predictors of improvement in depression over a 4-year follow-up period are more social support and fewer mobility limitations at baseline. With regards to practical health-related behaviors, the 2 items of social support most associated with improvement in depression were willingness of significant others to talk with you and satisfaction with dependence upon significant others; the 2 items of mobility limitations most associated with non-improvement of depression were difficulty in carrying things and squatting. These findings suggested that health-related behaviors were important to the depression outcome in the elderly; moreover, interventions to improve depression should include practical health-related behaviors aimed at these modifiable risk factors.     

Daily fluctuations in subjective age and depressive symptoms: the roles of attitudes to ageing and chronological age

Studies indicate that both subjective age—individuals’ perception of their own age as older or younger than their chronological age, and attitudes to ageing are related to physical and mental health. Less is known about the possible dual effect of these two constructs of subjective views of ageing. In the current study, 334 participants (aged 30–90, M?=?58.15) reported their daily subjective age and mental health along 14 consecutive days. Attitudes to ageing were measured at baseline. Results indicated that daily variation in subjective age was related to daily variation in depressive symptoms, such that people experienced more depressive symptoms at days they felt older. Furthermore, we found that attitudes to ageing (perceptions of losses, physical change, and psychological growth) moderated this relationship. The covariation between daily subjective age and daily depressive symptoms was stronger when attitudes to ageing were less favorable (e.g., high perceptions of losses and low psychological growth). The moderating effect of losses was especially prominent among older participants. This indicates that attitudes to ageing moderate the toll that feeling old takes on mental health, especially in older age. The results also emphasize the need to understand how different subjective views on ageing, measured in different time frames, operate interactively to shape individual’s daily experiences.

     

Relationship between the living-alone period and depressive symptoms among the elderly

ObjectiveThe study aims to understand the relationship between the living-alone period and depressive symptoms among the elderly in South Korea.MethodsThe study obtained data on the elderly over 65 years old from the 2006 to 2019 Korea Welfare Panel Study. Generalized estimating equation (GEE) analysis was performed to understand changes in depressive symptoms over periods of living alone. Additional subgroup analysis of age and gender was conducted to observe differences.ResultsA total 568 (19% of the study samples) elderly transitioned from living with others into a living-alone state. Males and females showed a significant increase in depressive symptoms as they started to live alone, which gradually decreased with prolonged periods of living alone. The result of the GEE analysis demonstrated high odds of depressive symptoms during the first (OR = 1.857; 95% CI: 1.492–2.310), second (OR = 1.414; 95% CI: 1.127–1.774), and third (OR = 1.413; 95% CI: 1.105–1.808) years of living alone compared with living with others. Regarding additional subgroup analysis, the female and old–old groups showed high odds of depressive symptoms in the first 3 years of living alone, whereas the male and young–old groups showed high odds for the first year only.ConclusionsThe study provides valuable insights into the relationship between the living-alone period and depressive symptoms among the elderly. Future research using the living-alone period on various social factors are recommended.     

A prospective study of Type 2 diabetes and depressive symptoms in the elderly: the Rancho Bernardo Study.

AIMS: The association between Type 2 diabetes and depressive symptoms was examined prospectively to assess possible causal relationships between the two diseases. METHODS: A cohort of 971 men and women aged 50 and older from the adult population of Rancho Bernardo, California had an oral glucose tolerance test and completed the Beck Depression Inventory (BDI) at two clinic visits, 1984-87 and 1992-96. RESULTS: Depressive symptoms at baseline were associated with higher follow-up levels of non-fasting plasma glucose (P = 0.001) and an increased risk of developing Type 2 diabetes [odds ratio (OR) = 2.50; 95% confidence interval (CI) = 1.29-4.87], independent of sex, age, exercise and body mass index. Conversely, baseline non-fasting plasma glucose was not significantly associated with follow-up depressive symptoms and Type 2 diabetes at baseline was not significantly associated with the onset of BDI scores > or = 11 by the second visit (OR = 0.73; 95% CI = 0.41-1.30). CONCLUSIONS: Depressed mood is more likely to be a risk factor for Type 2 diabetes in older adults than the reverse.     

Retirement transitions and spouse disability: effects on depressive symptoms

OBJECTIVES: The purpose of this study was to investigate the effects of type of retirement (forced, early, abrupt) and spouse's disability on longitudinal change in depressive symptoms. METHODS: The analyses rely on Waves 1-4 of the Health and Retirement Survey (N = 2,649). Generalized estimating equations models with bootstrapped standard errors and adjustment for survey design and non-independence of dyad members estimate effects of retirement, type of retirement, and spouse's disability on depressive symptoms, controlling for relevant covariates. RESULTS: The results suggest that depressive symptoms increase when retirement is abrupt and perceived as too early or forced. Women retirees who stopped employment and were either forced into retirement or perceived their retirement as too early report significantly more depressive symptoms with increasing spouse activities of daily living (ADLs) limitations. There is no similar effect for men. In contrast, for working retirees who retired on time, depressive symptoms decrease with increasing spouse ADLs. DISCUSSION: These results highlight the importance of retirement context on postretirement well-being. They suggest that both type of retirement transition and marital contexts such as spouse's disability influence postretirement well-being, and these effects differ by gender.     

Changes in instrumental activities of daily living disability after treatment of depressive symptoms in elderly women with chronic musculoskeletal pain: a double-blind, placebo-controlled trial

BACKGROUND AND AIMS: The purpose of this study was to assess the effect of antidepressant therapy on changes in instrumental activities of daily living disability in elderly female patients with musculoskeletal pain in a controlled study comparing active drugs with a placebo. METHODS: In an 8-week double-blind, placebo-controlled outpatient trial, 30 female patients (response rate 90.0%) between 70 and 79 were examined. They all had a history of clinically evident musculoskeletal pain, were afflicted with depressive symptoms, and could independently bathe, walk, dress, and transfer (e.g., from a chair) inside the house. The study was performed using the Center for Epidemiological Studies Depression Scale (CES-D), and Instrumental Activities of Daily Living (IADL). RESULTS: Compared with the placebo-group, significant changes in the CES-D (p<0.01) and IADL (p<0.01) scales were observed after eight weeks in the active drug-treated subjects. CONCLUSION: Treatment of depressive symptoms may be efficacious in reducing IADL disability in elderly female patients afflicted with musculoskeletal pain.     

Moderators of the effect of social support on depressive symptoms in cardiac patients

Social support and depression have been shown to affect the prognosis of coronary patients, and social support has been found to influence depression in community and patient samples. We investigated the characteristics of coronary patients whose depressive symptomatology was most likely to improve with social support. We predicted that social support would be most beneficial for the most severely depressed, the old, the poor, the most severely ill, and those with poor functional status. Patients (n = 590) with documented coronary artery disease were assessed for depressive symptoms, social support, and functional status while in hospital. They were reassessed for depression 1 month later during a home visit. Depression scores were lower at follow-up (p = 0.001), and improvement was more marked among those reporting more support (p <0.001). The social support effect was strongest among those with high levels of depression at baseline (p <0.001) and those with lower income (p = 0.01). Unexpectedly, social support was more strongly associated with improvement in younger patients (p = 0.01). Social support did not interact with gender, disease severity, or functional status. These findings are partially consistent with the notion that social support is most effective for those who are most vulnerable and/or have few coping resources. These findings also have implications for the design and interpretation of psychosocial interventions.     

Caregiver burden and depressive symptoms: analysis of common outcomes in caregivers of elderly patients

Despite widespread use of caregiver burden and depressive symptoms in caregiving research, the relationship between these two concepts and the way in which burden and depressive symptoms are affected are not clear. METHODS: The authors used structural equation modeling with an inception cohort of 488 family caregivers to examine the relationship between care recipients' mental and functional status and recency of care demands and caregivers' burden and depressive symptoms. RESULTS: Care recipients' mental and functional status and recency of care demands predicted caregiver burden; burden, in turn, was nearly significant in predicting depressive symptoms. Care recipients' mental status and recency of care demands had a near significant indirect effect on caregiver depressive symptoms. There were no significant direct paths between care recipients' mental status, functional status, recency of care demands, and caregivers' depressive symptoms. DISCUSSION: Health care practitioners should assist caregivers with new care demands stemming from care recipients' mental and functional status to decrease burdens and should monitor caregivers with higher levels of burden for the development of depressive symptoms.     

Change of depressive symptoms in a French nine-year longitudinal study of aging: Gender differences and relationships between social support,health status and depressive symptoms

ObjectivesThe aims of this study were to examine the trajectory of depressive symptoms among older French people, to investigate the role of gender in the developmental trajectory of depressive symptoms and to explore whether the linear increase in depressive symptoms might be accentuated or attenuated at time points during which the older adults’ scores on social support and health satisfaction scales were higher than their individual averages.Methods/materialsData were used from a subsample of older adults living at home who participated in a longitudinal study initiated by researchers from the University of Tours. They were collected at five time points over a 9-year period (T1: 2003; T2: 2005; T3: 2007; T4: 2009; T5: 2011). This study included 707 participants, and multilevel growth curve analysis was used on measures of depressive symptoms, gender differences, social support and health satisfaction.ResultsResults indicated (1) a significant positive linear effect of age on depressive symptoms; (2) that women reported significantly higher scores of depressive symptoms than men at 63 years old (i.e., intercept) and that this gender difference remained constant across age; (3) that the slope of depressive symptoms appeared to increase at time points during which participants had higher levels of social support and to decrease when they had greater health satisfaction.ConclusionThis study provides pertinent information about the change of depressive symptoms in older people living at home and particularly highlights the interest in studying gender, social support and health satisfaction.     

Correlates of depressive symptoms among HIV-positive injection drug users: the role of social support

Using cross-sectional data from an ethnically diverse sample of HIV-positive injection drug users (IDUs), we sought to identify correlates of depressive symptoms. We were particularly interested in whether perceived social support was associated with depression among HIV-positive IDUs and whether social support buffered adverse effects of other correlates. Data were collected from a sample of HIV-positive IDUs recruited from a variety of venues in the New York City and San Francisco metropolitan areas in the USA. Multiple regression analysis identified four significant correlates of depressive symptoms. Perceived social support and having a regular place for HIV medical care were significantly associated with lower levels of depressive symptoms, while history of mental health problems and non-injection polydrug use were significantly associated with higher levels of depressive symptoms. Moreover, a significant interaction effect was found between social support and non-injection polydrug use, indicating that social support buffers the association between non-injection polydrug use and depression. These results suggest that increasing social support might be a useful tool for HIV-positive IDUs in reducing depression and the adverse effect of non-injection polydrug use.     

Trajectories of impairment, social support, and depressive symptoms in later life

OBJECTIVE: Research has increasingly focused on the dynamic nature of disability and depressive symptoms in later life. Little research, however, has modeled disability and depressive symptoms as dynamic, related processes. Furthermore, virtually no research has considered social support as dynamic across age. Here, we investigate the relationship between long-term patterns of disability, perceived and received social support, and depressive symptoms in later life. METHODS: We use random coefficient (growth) models of four waves of Duke Established Populations for Epidemiologic Studies of the Elderly data to determine whether disability, support, and depressive symptoms follow linear trajectories across age and whether support mediates the relationship between disability and depressive symptoms. RESULT: The results show that (a) trajectories of disability are strongly related to trajectories of depressive symptoms and (b) trajectories of perceived support mediate the relationship between trajectories of disability and depressive symptoms, whereas trajectories of received support do not. DISCUSSION: Disability, social support, and depressive symptoms are strongly interrelated processes in later life. Our results are consistent with previous research in showing that perceived, rather than received, support mediates the relationship between disability and depressive symptoms, but our results extend previous research in showing that this mediation occurs across time.