Increased health burden associated with comorbid depression in older diabetic Mexican Americans. Results from the Hispanic Established Population for the Epidemiologic Study of the Elderly survey.

OBJECTIVE: To examine the health burden associated with concomitant depressive symptoms and diabetes in older Mexican Americans. RESEARCH DESIGN AND METHODS: Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly were used to assess the association between high levels of depressive symptoms, measured with the Center for Epidemiologic Studies of Depression scale, and comorbid chronic health conditions, diabetic complications, functional disability, health service use, and medication use among 636 older diabetic Mexican Americans, in comparison with 2,196 older nondiabetic Mexican Americans. RESULTS: Overall, 31.1% of the older diabetic individuals reported high levels of depressive symptoms. The risks of comorbid myocardial infarction, hypertension, arthritis, and angina were significantly higher in the presence of concomitant depressive symptoms, as were the risks of diabetic complications, functional disability, incontinence, vision impairment, poorer perceived health status, and health service use among both diabetic and nondiabetic individuals. Rates were substantially higher among depressed diabetic individuals, however, in comparison to depressed nondiabetic individuals. Importantly, this increased health burden was evident even when controlling for sociodemographic risk factors, including sex, age, level of education, marital status, immigrant status, and living arrangements. CONCLUSIONS: The presence of concomitant depressive symptoms among older diabetic Mexican Americans is associated with a substantially greater health burden than is seen among diabetic individuals without depression or depressed individuals without diabetes. This association of depression with higher rates of chronic conditions, poorer functioning, and increased health service use is particularly significant in that this study was conducted among community-dwelling adults and was not confounded by the potential association of health care-seeking behavior that might occur in a medically ill sample.     

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.     

Study on the quality of life and its related factors for older adults in communities in Beijing,China

Objectives: To describe the quality of life (QOL) of adults ≥60 years of age in communities in Beijing and explore demographic, clinical, and psychological factors associated with QOL. Methods: This was a cross-sectional study. A total of 363 older adults were recruited, in which 313 completed the questionnaires. Depressive symptoms were measured with the Self-Rating Depression Scale (SDS) and QOL was analyzed with the 36-item shor t form (SF-36). The t-test and Mann-Whitney U tests were used to compare QOL by gender and age group. Factors associated with QOL were determined using multiple linear regression. Results: Among 313 older adults, depressive symptoms were observed to be prevalent to the extent of 16.6％. Overall, participants had higher QOL in the domains of social role functioning and emotional role functioning, with lower QOL in the domains of physical functioning and general health perceptions. There were no significant differences in QOL between women and men. However, there were significant differences between different age groups, with older adults having better mental QOL than younger adults. Better physical QOL was associated with less depressive symptoms, having a partner, and younger age (R2 = 28.7％). Better mental QOL was associated with less depressive symptoms, less chronic disease, and older age (R2 = 34.7％). Conclusions: With aging, physical QOL was lower and mental QOL was better. Less depressive symptoms, having a spouse or par tner, and young–old age asser t positive influence on physical QOL of the older adults; and less depressive symptoms, no chronic disease, and older age asser t positive influence on mental QOL.     

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 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.     

Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes

OBJECTIVE: To examine the separate and combined effects of depression and diabetes on the incidence of adverse health outcomes among older Mexican Americans. RESEARCH DESIGN AND METHODS: Longitudinal data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) survey were used to examine the main effects and interaction effects of diabetes and depressive symptoms (measured with the Center for Epidemiologic Study of Depression) or clinical diagnostic criteria (measured with the Composite International Diagnostic Interview Depression Module) on the development of macrovascular complications (including cardiovascular disease, stroke, and kidney disease), microvascular complications (including nephropathy, neuropathy, retinopathy, and amputations), functional disability, and mortality over 7 years in a sample of 2,830 Mexican Americans aged >or=65 years. RESULTS: The interaction of diabetes and depression was found to be synergistic, predicting greater mortality, greater incidence of both macro- and microvascular complications, and greater incidence of disability in activities of daily living, even when controlling for sociodemographic characteristics such as sex, age, education, acculturation, and marital status. Importantly, this interaction was found to predict not only greater incidence but also earlier incidence of adverse events in older adults. CONCLUSIONS: Whether a marker for underlying disease severity, an indicator of diminished self-care motivation, or the result of physiologic changes, the interaction of depression and diabetes has a synergistic effect on the health of older Mexican Americans, increasing the risk for poor outcomes. This is of particular clinical importance because although depression is often underrecognized in older adults, effective treatment is available and can result in improved medical outcomes.     

Prevalence and correlates of depressive symptoms in the elderly of rural communities in southern Taiwan

The purpose of this study was to determine the prevalence and level of depressive symptoms and the influence of demographic characteristics on depressive symptoms in elders residing in rural Taiwan. Also, the association was explored between depressive symptoms and life stressors in the Taiwanese Elderly Stress Inventory (TESI). A cross-sectional design utilizing face-to-face administered instruments was used. A total of 195 older community residents participated in the study. Levels of depressive symptoms wese measured by the Geriatric Depression Scale - Short Form (GDS-SF) while life stressors were assessed with the Taiwanese Elderly Stress Inventory (TESI). Overall, 57% of the subjects had a GDS-SF score of 7 or above (M = 7.58, SD = 3.89), indicating that the majority were depressed. Additionally, gender, educational level, marital status, living arrangements, and socioeconomic status (SES) were significant factors to depressive symptoms. Women were more likely to experience depression than men. Elders who had received no formal education, were separated from their spouse due to death or divorce, lived alone, or had lower SES were at higher risk of more severe depression. Also, significant correlations were found between depressive symptoms and 19 stressors identified in the TESI. These stressors mostly include events related to physical functioning and family issues. The findings of this study will provide community health professionals in Taiwan with a better recognition of depressive symptoms in rural elders and stressors that are associated with depressive symptoms. This information can be used to plan health-related services and interventions for rural elders.     

Inconsistent use of diabetes medications, diabetes complications, and mortality in older mexican americans over a 7-year period: data from the Hispanic established population for the epidemiologic study of the elderly

OBJECTIVE: The aim of this study was to examine the relationship between inconsistency in use of diabetes drugs and risk of renal, eye, and circulation problems and death over a 7-year period in community-dwelling older Mexican Americans. RESEARCH DESIGN AND METHODS: Data are from the four waves of the Hispanic Established Population for the Epidemiologic Study of the Elderly. In-home interviewers assessed consistency in use of diabetes medications among 908 diabetic Mexican Americans, aged >or=65 years. Diabetes and complications were by self-report. Subjects with poor consistency in use of medication were those who, at any time during the 7-year follow-up, discontinued or inconsistently used their diabetes medications and those who had no diabetic medications at home despite self-report of taking medicine for diabetes. RESULTS: Thirty-six percent of our sample were inconsistent with diabetes medication usage. Older age and lack of supplemental health insurance were significantly associated with inconsistency of use of medication. In a multivariate logistic regression model, subjects with poor consistency in use of medication were more likely to report kidney problems (odds ratio [OR] 1.59; 95% CI 1.13-2.23; P = 0.008) at follow-up compared with those with good consistency, after controlling for age, sex, medication type, duration of diabetes, education, income, marital status, language of interview, insurance status, cognitive function, presence of depressive symptoms, activities of daily living, and instrumental activities of daily living. In Cox regression models, poor consistency with diabetic medication was also associated with increased all-cause mortality (hazard ratio [HR] 1.43; 95% CI 1.13-1.82; P = 0.003) and diabetes-related deaths (1.66; 1.20-2.30; P = 0.002) over a 7-year period after adjusting for relevant confounders. CONCLUSIONS: Inconsistent use of diabetic medication was associated with an increased risk of kidney problems and deaths over a 7-year period in older Mexican Americans.     

Sleep disturbance and depression as barriers to adherence

This study examined the relationships among subjective sleep disturbance, depressive symptoms, and adherence to medications among HIV-infected women. HIV-infected women (N = 173) were recruited through community AIDS service organizations throughout South Carolina. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Centers for Epidemiological Studies Depression Scale (CES-D), and a modified version of the Adults AIDS Clinical Trials Group Adherence Baseline Questionnaire. Women who reported greater sleep disturbance also reported a higher level of depressive symptoms and reported poor adherence to their medication regimen. Depression helped to explain the relationship between sleep quality and adherence. Results indicate that assessment and management of sleep disturbance and depressive symptoms in women with HIV disease is important to promote medication adherence.     

Factors associated with depressive symptoms in low-income, older Korean women with hypertension

The purpose of this study was to identify the factors that are associated with depressive symptoms in community-dwelling, low-income, older Korean women with hypertension. A total of 107 low-income, older (aged 74 ± 6 years) Korean women with hypertension participated in the study. Information about depressive symptoms, functional status, and social support were collected by interviews that used the Geriatric Depression Scale, Katz's Activities of Daily Living, and the Lubben Social Support Network Scale, respectively. A logistic regression analysis was used to determine the factors that affected depressive symptoms. The results indicated that the depressed women had been diagnosed with hypertension for a longer period of time and took a larger number of medications than the women in the non-depressive group. They also had poorer functional status and an "isolated" social support network. The social support network, length of time since diagnosis, number of medications, and functional status were associated independently with depressive symptoms. It was concluded that clinicians should assess for the factors that are associated with depressive symptoms, including a poor social support network, poor daily activity, the number of medications, and the length of time since diagnosis in order to prevent the symptoms of comorbidities worsening in low-income, hypertensive, older women.     

Depressive symptoms and quality of life in adolescents with type 2 diabetes: baseline data from the TODAY study

OBJECTIVE

The study objective was to examine the prevalence of depressive symptoms and relationships to quality of life and demographics in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study’s large, ethnically diverse youth with type 2 diabetes.

RESEARCH DESIGN AND METHODS

A total of 704 youth with type 2 diabetes <2 years’ duration, aged 10–17 years, and BMI ≥85th percentile completed depressive symptoms and quality of life measures.

RESULTS

Some 14.8% reported clinically significant depressive symptoms, and older girls had significantly higher rates than older boys.

CONCLUSIONS

Rates of significant depressive symptoms were similar to those of healthy adolescents and lower than those of teens with type 1 diabetes. Elevated depressive symptoms, particularly in older girls, suggest clinicians assess vulnerability.Little is known about physiologic and psychosocial correlates of type 2 diabetes in adolescents, whereas data on adults with type 2 diabetes are available, with rates of depressive symptoms approximately twice as high as for adults without diabetes (1), underscoring the importance of examining depressive symptoms in adolescents with type 2 diabetes. Depression in adults is also associated with significant psychosocial and physical complications (2). To date, we have not had access to large samples of patients needed to study depression systematically in youth with type 2 diabetes. Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) offers unique data concerning the psychosocial functioning of youth with type 2 diabetes.     

Acceptance,cognitions, and resourcefulness in women with diabetes

The coexistence of diabetes and depression occurs frequently among young and middle-age women. Unless one is resourceful, simultaneous management of the symptoms of both conditions is especially challenging. Skills constituting resourcefulness are learned throughout life and are important for the optimal performance of daily activities. Little is known about specific factors that influence resourcefulness. In this study contextual factors (diabetic and depressive symptoms) and cognitive factors (positive cognitions and acceptance of diabetes) were examined as antecedents of learned resourcefulness in 82 women with type 2 diabetes. Regression analyses showed that depressive symptoms and positive cognitions were significant antecedents of learned resourcefulness: Positive cognitions mediated the effects of depressive symptoms on learned resourcefulness. The findings suggest the need for interventions thatfocus on development of positive cognitions to better promote resourcefulness in women with type 2 diabetes who are at risk for depression.     

Factors related to chronic obstructive pulmonary disease readmission in Taiwan

This study examines the relationships among physiological, psychological, and social factors and hospital readmission to develop a model predicting chronic obstructive pulmonary disease (COPD) readmission for 145 patients with COPD following hospital discharge at 14 days and 90 days in Taiwan. Daily functioning, comorbidity, severity of illness, self-efficacy, depressive symptoms, and perceived informal support were regressed on hospital readmission. Daily functioning was the only significant variable to predict COPD readmission at 90 days in the Taiwan population living in a rural area. Age was significantly correlated with 14 days readmission. Post hoc analyses examined differences in three ethnic groups. Mainlanders perceived less family support, had higher depressive symptoms and lower daily functioning than the majority culture Fukiens and Hakkas, or the Aborigines. The study reinforced the need for identification of cultural differences and low functioning as risk factors for early readmission so they can be addressed in discharge planning.     

Depressive symptomatology and the prevalence of cardiovascular risk factors among older men and women from Cyprus; the MEDIS (Mediterranean Islands Elderly) epidemiological study

Aims. The purpose of this paper is to explore the link between symptoms of depression and the prevalence of cardiovascular risk factors in older adults. Methods. During 2005, 136 older men and 164 women from various parts of Cyprus agreed to participate in the study. The sampling was random and multistage (according to age–sex distribution of the referent population). All participants were living in the community and not in institutions. Among several socio‐demographic, bioclinical, lifestyle and dietary characteristics, depressive symptoms were assessed using the short version of the Geriatric Depression Scale (GDS). Results. Participants without signs of depression, typically, have fewer cardiovascular risk factors (i.e. hypertension, hypercholesterolemia, diabetes and obesity) than those with moderate or severe symptoms. Even when behavioural variables (e.g. diet, smoking, exercise) are statistically controlled, participants that are higher than others on depression are more likely to have hypertension and/or hypercholesterolemia than those with lower scores. Every one‐unit increase in GDS score (range 0–15) is associated with a 12% higher likelihood of having an additional cardiovascular disease risk factor. Conclusions. Symptoms of depression are positively associated with the number of cardiovascular risk factors in ‘healthy’ older adults, irrespective of lifestyle behaviours (e.g. smoking, dietary intake and physical activity). Relevance to clinical practice. Healthcare providers should consider the implications of both the presence and nature of this relationship in their continuing care of older adults.     

The relationships among health functioning indicators and depression in older adults with diabetes

A common health problem among the elderly with diabetes is the onset of depressive symptoms that can adversely affect self-care and control of diabetes. The study examined the relationships of gender, race, comorbid conditions, symptom distress, and functional status with depression in a sample (N = 55) of older adults with diabetes. Most participants were female and black; mean age was 73 years. Gender and symptom distress were the strongest predictors of depression, accounting for 53% of the variance in depression. Although the sample was reasonably high functioning with only moderate levels of symptom distress, these findings serve as an important reminder for nurses that even moderate levels of symptom distress may be an indicator of depressive symptomatology among older diabetic adults.     

甘肃省成年人业余锻炼情况及其影响因素分析

目的调查和分析甘肃省成年人业余锻炼情况及影响因素分析，为甘肃省成人开展身体活动指导提供理论依据。方法采用多阶段分层整群抽样方法选取具有甘肃代表性的样本，对甘肃省14个市州56个乡镇中≥18岁常住居民随机抽样开展调查。结果甘肃省成年人经常锻炼率为14.3%（标化率13.95%），男性16.0%（标化率16.28%）高于女性13.0%（标化率12.27%）（χ2=13.789，P<0.05），城市经常锻炼率（16.2%）高于农村（12.3%）（χ2=23.113，P<0.05）, 轻体力职业（22.4%）高于重体力职业（10.7%）（χ2=183.314，P<0.05），糖尿病患者（20.4%）高于非糖尿病患者（13.6%）（χ2=25.330，P<0.05），男性不吸烟人群（18.8%）高于吸烟人群（13.9%）（χ2=14.274，P<0.05）；城市、城市女性均随年龄增长而线性增加（χ2=11.992、5.707，均P<0.05），随教育水平升高城乡均呈线性上升趋势（χ2=107.668、263.053, 均P<0.05）。 Logistic回归分析结果显示，城乡、年龄、文化程度、职业、糖尿病、体质指数是影响甘肃省成人经常锻炼的主要因素，其中以农村为负向因素；男性经常锻炼的正向因素依次为年龄、糖尿病、职业、文化程度，负向因素为男性吸烟和农村；女性依次为职业、文化程度和年龄，均为正向因素。结论甘肃省成年人经常锻炼率总体较低，农村、重体力劳动者、教育水平低者更低；男性吸烟人群较低。影响经常锻炼的因素有城乡、年龄、文化程度、职业、糖尿病、体质指数、男性吸烟。针对主要影响因素及相关薄弱群体加大宣传和干预力度。     

The impact of informal caregivers on depressive symptoms among older adults receiving formal home health care

This study evaluated the association between presence and types of informal caregivers and the presence of depressive symptoms among older adults receiving formal home health care (HHC). A secondary analysis of data was conducted using a computerized patient care database, the Outcome and Assessment Information Set. Logistic regression analyses were used to examine the data of 8448 patients aged 65 years or older who had been admitted to an HHC agency from acute care hospitals between January 1, 2002 and June 30, 2002. The outcome variable was the presence of depressive symptoms. The primary predictor variable was the presence and types of informal caregivers. Covariates included demographic variables, health status, length of time enrolled in formal HHC, patient living arrangements, and the frequency and types of care received from informal caregivers. A lower percentage of older adults receiving care from both informal caregivers and a formal HHC agency (13.3%) had depressive symptoms than older adults receiving only formal HHC (14.9%) at the end of a 60-day episode in formal HHC. Older adults without an informal caregiver were more likely to experience depressive symptoms than those with an informal caregiver after a 60-day episode in HHC (odds ratio = 1.229, 95% confidence interval = 1.027-1.471). There was no significant association between the types of informal caregivers and the presence of depressive symptoms.