Positive and negative affect and health functioning indicators among older adults with chronic illnesses

Emotional states have been linked with physical and mental health outcomes. In this study the role of positive and negative affect was investigated as determinants of health functioning for a community-dwelling sample of 153 older adults (age 60 or older) with chronic illnesses. High positive affect and low negative affect were found to be associated with lower levels of symptom distress, fewer depressive symptoms, higher daily activity scores, and higher perceived physical and mental health-related quality of life. These results have important clinical implications for the use of positive and negative affect as an indicator of life functioning among older adults. The relationship of positive and negative affect to reported health functioning found in this study suggests that measuring affect can provide a valuable means for understanding how individuals view their mental health as well as their symptoms of illness.     

Positive and Negative Affect and Health Functioning Indicators among Older Adults with Chronic Illnesses

Emotional states have been linked with physical and mental health outcomes. In this study the role of positive and negative affect was investigated as determinants of health functioning for a community-dwelling sample of 153 older adults (age 60 or older) with chronic illnesses. High positive affect and low negative affect were found to be associated with lower levels of symptom distress, fewer depressive symptoms, higher daily activity scores, and higher perceived physical and mental health-related quality of life. These results have important clinical implications for the use of positive and negative affect as an indicator of life functioning among older adults. The relationship of positive and negative affect to reported health functioning found in this study suggests that measuring affect can provide a valuable means for understanding how individuals view their mental health as well as their symptoms of illness.     

Gender differences in the relationship between physical functioning and depressive symptoms in low‐income older adults living alone

This study examined gender differences in the relationship between physical functioning and depressive symptoms in low‐income older adults living alone in Korea, and the variables influencing these symptoms. Data from a total of 317 older adults in the 2011 Korean National Survey were used. Upper limb mobility, lower limb mobility, activities of daily living, instrumental activities of daily living, and depressive symptoms were measured. Data were analyzed using multiple regression analysis. Low‐income older men and women living alone experienced depressive symptoms. Regression analysis showed that lower limb mobility and age together explained 35.4% of the variance in depressive symptoms in men. Subjective health status explained 16.7% of the same in women. These findings suggest that low‐income older adults living alone should be carefully monitored by public healthcare managers to improve their physical and mental health, considering gender‐specific elements.     

Relation of Age With Symptom Severity and Quality of Life in Patients With Fibromyalgia

ObjectiveTo examine the relation of age with symptom severity and quality of life (QOL) in patients with fibromyalgia, and to compare physical and mental health of our female patients with those of the US female general population.Patients and MethodsWe studied 978 patients with fibromyalgia from May 1, 2001 through April 30, 2004, and divided them into age groups of young (≤39 years), middle-aged (40-59 years), and older (≥60 years). They completed the Fibromyalgia Impact Questionnaire and the Short Form-36 Health Status Questionnaire (SF-36). Standardized SF-36 physical and mental health summary scores were compared with those of the US female general population of similar age. One-way analysis of variance and post hoc paired t test analyses were performed to detect differences across age groups.ResultsPairwise comparison found young and middle-aged patients having worse fibromyalgia symptoms in all subscales except the anxiety subscale compared with older patients (P≤.01). Similarly, these young and middle-aged patients had worse QOL in the SF-36 mental component summary, as well as SF-36 general health perceptions, vitality, social functioning, and mental health index, compared with older patients (all P<.001). When the QOL of our female patients was compared with that of the US female general population of similar age with standardized SF-36 scores, all age groups had lower QOL in physical, as well as mental, health, with more reduction in physical health, particularly in young patients.ConclusionOur study shows that symptom severity and QOL differ across age groups in patients with fibromyalgia, with young and middle-aged patients having poorer QOL and worse fibromyalgia symptoms than do older patients. QOL in physical health was reduced more than in mental health, particularly in young patients, compared with the general population.     

The role of psychological and behavioral variables in quality of life and the experience of bodily pain among persons living with HIV

With increased life expectancy of individuals living with HIV, quality of life (QOL) has become a focus of treatment. More research is needed to address pain-related QOL and modifiable variables, such as health behaviors, depressive symptoms, and coping styles, which could be included in treatment protocols to improve QOL among individuals with HIV. Objectives of this study were to (1) examine relationships among health behaviors, psychological variables, and QOL, particularly pain-specific QOL, (2) examine the relationships among coping, depressive symptoms, and QOL, and (3) compare QOL scores of individuals with HIV and population-based normative data. HIV positive men and women not currently on highly active antiretroviral therapy were recruited during regular visits to an HIV outpatient clinic. They completed the Medical Outcome Study Health Survey SF-36 scale, which includes a physical components scale, a mental components scale, and a bodily pain subscale. They also completed questionnaires assessing health behaviors, depressive symptoms, and coping styles. Participants (n = 97) scored significantly lower on most aspects of QOL than age-matched Canadian and U.S. norms. Hierarchical multiple regressions revealed that physical activity and CD4 cell count were independently related to lower physical components scale scores; smoking and depressive symptoms were independently associated with lower mental components scale scores; and education, physical activity, and depressive symptoms were independently associated with lower pain-related QOL. Depressive symptoms mediated the relationship between coping styles and the mental components scale and pain-related QOL. Results suggest that targeting depressive symptoms, physical activity, and coping strategies as part of comprehensive treatment protocols could help improve pain-specific QOL and overall QOL among individuals with HIV.     

Social support as a mediator between depression and quality of life in Chinese community-dwelling older adults with chronic disease

The older adults with chronic disease usually show poor mental health and experience low quality of life (QOL). This study aimed to examine the mediating role of social support in the relationship between depression and QOL in community-dwelling older adults with chronic disease. A total of 387 Chinese older adults aged 60 or above with chronic disease were included in this cross-sectional study. Social support was negatively associated with depression and positively associated with physical component scale (PCS) and mental component scale (MCS). Depression and social support were all predictors of PCS and MCS. Mediation analysis suggested that social support partially mediated the impact of depression on PCS and MCS. Understanding the mediating role of social support might be beneficial in reducing the adverse impact of depression on QOL in community-dwelling older adults with chronic disease.     

The use of technology for mental healthcare delivery among older adults with depressive symptoms: A systematic literature review

Depression has been identified as the single largest contributor to poor health and functioning worldwide. Global estimates indicate that 4.4% of the world's population lives with depression, equating to about 322 million individuals. Research demonstrates that telehealth interventions (i.e. delivering therapy by phone or videoconferencing) have potential for improving mental health care among community‐based older adults. This review analyses scholarly literature on telehealth interventions among older adults with depressive symptoms. Following PRISMA guidelines, a systematic search of peer‐reviewed papers was conducted using the following key terms: telemedicine, telepsychogeriatrics, telepsychiatry, eHealth, mental health, depression, and geriatric. The review included nine articles examining telehealth for mental health care, published in English between 1946 and 26 September 2017. Telehealth for mental health care among older adults demonstrates a significant impact on health outcomes, including reduced emergency visits, hospital admissions, and depressive symptoms, as well as improved cognitive functioning. Positive or negative influences on the use of telehealth among older adults are identified. This review highlights keys aspects to consider in using telehealth interventions, including levels of education, cognitive function, and prior technology experience. The review highlights vital factors for designing interventions which aim to capitalize on the benefits of the use of telehealth for mental healthcare service delivery, especially in older adults with depressive symptoms.     

Prostate cancer in African Americans: relationship of patient and partner self-efficacy to quality of life

This study examined the relationship between patient and partner ratings of self-efficacy for symptom control and quality of life (QOL) among 40 African American prostate cancer survivors and their intimate partners. Data analyses revealed that cancer survivors who had rated their self-efficacy for symptom control higher reported better QOL related to urinary, bowel, and hormonal symptoms and better general health QOL (i.e., better physical functioning and better mental health). Data analyses also revealed that partners who rated their self-efficacy for helping the patient manage symptoms as higher reported better QOL (i.e., less negative mood and less caregiver strain). Finally, exploratory analyses indicated that higher self-efficacy in patients was associated with less anxiety and caregiver strain in partners, and higher self-efficacy in partners was associated with better adjustment to bowel and hormonal symptoms and better mental health in patients. The clinical implications of these findings are discussed and future directions for research on self-efficacy in African American prostate cancer survivors are identified.     

The relationship between psychosocial state and exercise behavior of older women 2 months after hip fracture.

Despite the potential benefits associated with exercise after hip fracture, those who have sustained hip fractures are among the least likely to engage in regular exercise (resistive or aerobic). This article describes the psychosocial state, specifically the self-efficacy expectations and outcome expectations related to exercise, mood, fear of falling, pain, and health status of older women who enrolled in either of two Baltimore Hip Studies (BHS), BHS-4 and BHS-5, and to test a self-efficacy-based model to explain exercise behavior after hip fracture. A total of 389 older women with hip fractures participated in these studies. The participants reported moderate confidence in their ability to exercise and a general belief in the benefits of exercise, high perceived health status, limited depressive symptoms, and some pain and fear of falling. Consistently across these two samples, age and mental status or depressive symptoms influenced outcome expectations, such that older women with more depressive symptoms or lower mental health status had weaker outcome expectations for exercise. Self-efficacy expectations consistently influenced exercise behavior across both samples. It was also consistent across both models that age, cognitive status, physical and mental health status, pain, fear, outcome expectations, and depressive symptoms did not directly influence exercise behavior.     

Predictors of depressive symptomatology of geriatric patients with colorectal cancer

Colorectal cancer constitutes a major health problem for elderly patients. The disease and its stage, treatment, and attendant symptoms can have significant negative impact on the mental functioning of these patients. As part of a larger longitudinal study, 158 patients 65 years of age or older with an incident diagnosis of colorectal cancer were recruited from 23 sites within a Midwestern state. Random effects regression analysis techniques were used to analyze how age, gender, race, presence of a family caregiver, co-morbid conditions, stage of disease at diagnosis, and the time-dependent variables marital status, employment status, symptoms, physical functioning, social functioning, and treatment predict depressive symptomatology at four assessments over the 1st year following diagnosis. Gender, race, co-morbid conditions, physical functioning, social functioning, and symptoms were significant predictors of depressive symptomatology over the four waves of the study. Female patients, African Americans, and patients with two or more co-morbid conditions exhibited more depressive symptomatology. Both more symptoms and more restricted physical and social functioning corresponded to higher levels of depressive symptomatology. At a clinical level of patient care, these findings mandate early identification of psychosocial difficulties experienced, an individualized symptom management plan and the application of other interventions, such as information giving, reassurance and referral to other resources, with particular attention to African American and female patients.     

A biopsychosocial pilot study of overweight youth and care providers' perceptions of quality of life

This pilot study examined the relationship between youth and care provider self-reports of depressive symptoms assessed through the Patient Health Questionnaire and reports of youth physical and psychosocial functioning assessed by PedsQL4.0 in a rural outpatient overweight pediatric population (N = 66 child and care provider pairs). The relationship between youth body mass index (BMI), youth and care provider depression, youth quality of life (QOL), care provider perception of youth QOL, and youth and care provider congruence of QOL perceptions was examined. Paired t tests were completed to assess the differences between QOL scores for youth and care providers for subgroups based on age, age and gender, and age and race. The mean age of youth participants was 11.9 years; youth BMI ranged from 26.76 to 54.10 (M = 37.20). Our results showed that there are significant differences in youth and care providers' perceptions of QOL when specific demographic categories are assessed by age, gender, and race.     

Depressive symptomatology among Turkish older adults with low incomes in a rural community sample

Aims and objectives. To identify the characteristics that are associated with depressive symptomatology among Turkish older adults with low income. Background. Depression is a major threat to mental health in older people, but little is known about older adults with low income at risk for depressive symptomatology in Turkey. Design. This was a cross‐sectional study, based in one area of Istanbul. Methods. The sample included 132 older adults in a rural setting living in Istanbul, Turkey. The participants were 55 years of age or older and chosen from among older adults with low income. Data were collected through a structured interview conducted in the homes of the participants. Results. High depressive symptoms (Geriatric Depression Scale ≥11) were reported by 50% of the participants. Compared with non‐depressed individuals, those with depressive symptomatology were more likely to be women, widowed, lack health insurance and to live alone. Depressed participants significantly more often reported chronic health conditions compared to non‐depressed participants (OR = 4·11, 95% CI = 1·35, 12·57). Overall well‐being scores were significantly higher in men and in the non‐depressed group. The result of the Pearson correlation provided support for the association between depression scores and overall well‐being scores (r = ?0·60). Conclusions. Depressive symptomatology is prevalent within Turkish older adults with low income. Further research is needed to examine potential risk factors associated with depressive symptomatology for this population. Relevance to clinical practice. Findings may assist health care professionals in assessing high‐risk older people who could benefit from interventions aimed at minimizing depressive symptoms.     

The association of psychological factors, physical activity, neuropathy, and quality of life in type 2 diabetes

The objective of this study was to determine the relationship of sociodemographics; diabetes-related factors, including diabetes-related microvascular complications; cardiac risk factors; and psychological factors with quality of life (QOL). Participants enrolled at three sites in the Detection of Ischemia in Asymptomatic Diabetics (DIAD) study were invited to participate in this ancillary study. Questionnaires assessing psychological factors were completed by participants, and the remainder of the data was obtained as part of the DIAD study. Many participants had elevated levels of anxiety (n = 91; 82%), depressive symptoms (n = 16; 14%), anger (n = 38; 34%), and hostility (n = 17; 17%). Results of multivariate analyses conducted for each of the eight domains on the Medical Outcomes Study Short Form-36 and two Diabetes Quality of Life domains demonstrated that in the majority of models (42% to 68% of the variance explained), female sex, peripheral or autonomic neuropathy, physical inactivity, higher body mass index, and the presence of depressive symptoms and anxiety were associated with poorer QOL (p = .0001). These findings demonstrate that anxiety, depressive symptoms, and neuropathy are prevalent in older adults with type 2 diabetes. In addition, potentially important correlations were demonstrated between psychological factors, neuropathy, body mass index, and physical inactivity.     

Symptom clusters in hospitalized older adults: Characteristics and outcomes

Hospital care in medical patients relies mostly on objective measures with limited assessment of subjective symptoms. We subgrouped 331 hospitalized older adults with medical diagnosis (age 75.5 ± 7.1) according to the severity of multiple symptoms to explore if these subgroups differed in health-related characteristics on admission and functional outcomes one month post-discharge.Cluster analysis identified three subgroups based on experiences with five highly distressing symptoms (fatigue, dyspnea, dizziness, sleep disturbance, pain): low levels of all symptoms, high levels of all symptoms; moderate levels of four symptoms with high dyspnea. Belonging in different subgroups was accompanied by different levels of cognitive and mental, but not physical or health status. Patients in the subgroup “Moderate Levels with High Dyspnea” had significantly lower risk of decline in post-discharge instrumental activities of daily living than other subgroups. Better understanding of older hospitalized adults’ symptom profiles may yield important information on health condition and recovery.     

Cognitive function in community-dwelling elderly women. Attentional demands and capacity to direct attention

As individuals get older, their capacity to direct attention (CDA) appears to decline. The decline in CDA may be caused by age-related changes in the brain and demands on attentional mechanisms. These demands require older adults to expend significant attentional effort to maintain focus and achieve mental clarity while negotiating activities of daily life. The purpose of this study was to examine the relationship between attentional demands and CDA among a convenience sample of 72 community-dwelling older women with normal mental status. Findings indicate attentional demands correlated significantly with CDA and accounted for a significant proportion of the variance. No relationship was found between depressive symptoms and CDA. Implications for practice are nursing interventions aimed at decreasing attentional demands, thereby supporting attentional processes and functioning by community-dwelling older adults.     

Changes in impairment level, functional status, and use of assistive devices by older people with depressive symptoms.

OBJECTIVE: We sought to understand how functional status, impairment level, and use of assistive devices change over 3 years for older adults with depressive symptoms. We further explored factors that predict change in severity of depressive symptoms. METHOD: This study used data from the Rehabilitation Engineering Research Center on Aging Consumer Assessment Study, a longitudinal study of coping strategies of elders with disabilities. Seventy-three participants with depressive symptoms were interviewed at baseline and 3 years later. RESULTS: During 3 years, participants experienced increased physical disability (p = .001), a decline in severity of depressive symptoms (p = .03), and an increase in the total number of assistive devices owned. CONCLUSION: A significant number of older adults will experience a decrease in depressive symptoms over 3 years, despite an increase in physical disability. They also will obtain more assistive devices as they age.     

Síntomas depresivos,síntomas de insomnio y eventos estresantes en ancianos hipertensos: estudio de corte transversal

ObjectivesThe aim of this study was to determine whether symptoms of insomnia and intensity of stressful life events are independently associated with depressive symptoms in community-dwelling hypertensive older adults.MethodsThis was an observational cross-sectional study. Participants were 438 older adults with arterial hypertension who completed questionnaires about depressive symptoms, stressful events, self-reported symptoms of insomnia and socio-demographic characteristics. Cluster analysis was performed to obtain groups according to insomnia symptoms. The following groups were identified: Poor Sleep Quality, Early Waking and Good Sleep Quality. Associations were tested using linear regression analysis and multiple Poisson regression analysis.ResultsThe factors that independently contributed to the increase of depressive symptoms were belonging to the Poor Sleep Quality group (P<.001) and Early Waking group (P=.005), reporting higher intensity of stressful life events (P<.001) and having less schooling (P=.003).Conclusionolder adults with hypertension need a comprehensive approach to their health care that considers depressive symptoms and their relationship with intensity of stressful events, insomnia symptoms and schooling.