Psychic and somatic symptoms of depression among young adults, institutionalized aged and noninstitutionalized aged.

Beck Depression Inventory scores were obtained from 48 elderly who had been residing in homes for the aged for more than one year, 31 elderly residing in the community and waiting to enter an old-age home, and 424 young adults enrolled in a fist-year psychology course. The residents of old-age homes reported no more symptoms of depression than the waiting-list controls, a finding that provides no support for the hypothesis that the institional nature of old-age homes increases depression in the elderly. Both the institutionalized and noninstitutionalized aged reported more somatic symptoms of depression than the young adults, but no greater cognitive or affective symptoms of depression. These results were interpreted as providing no support for the widely belief that the aged are more depressed than any other age group. Finally, it was argued that somatic complaints can be valid indicators of depression in the elderly if normative differences between young and old are taken into account.     

Depression and mortality among institutionalized aged.

This study examined the association between depression and mortality among a group of nursing home and congregate apartment residents (initial n = 898) over a 30-month period. Baseline [Time 1 (T1)] and 1-year follow-up [Time 2 (T2)] assessments yielded research-based diagnoses of possible major, minor, or no depression, along with measures of functional disability, cognitive status, and physician-rated health. Event history analyses were used to assess differential mortality as a function of level of depression after T1 and of change in depressive status from T1 to T2. Significant effects for T1 depression at 6, 12, and 18 months after the interview reflected an increased death rate among possible major depressives as compared with other respondents. An effect of change in depressive status from T1 to T2 appeared to be caused by long-term negative effects of T1 depression. Finally, none of the observed associations remained significant when controlled for effects of physical health, functional disability, and cognitive status. Thus, the effects of depression on mortality among this sample appeared to be attributable strictly to the correlation of depression with ill health. However, cautious interpretation is recommended inasmuch as causal paths between depression, ill health, and death remain unclear.     

Psychotropic drug use among caregivers of patients with dementia

The majority of research on "caregiver burden" focuses on mental health consequences. These stresses are associated with psychotropic drug use among some caregivers. The purposes of this paper are to identify the correlates of psychotropic drug use among caregivers of demented older adults and to determine whether or not certain types of psychotropics (ie, antianxiety, antidepressant, and sedative/hypnotic agents) have common or unique correlates. The prevalence of psychotropic drug use among caregivers in the sample (n = 510) is substantially higher than previously reported prevalence rates in the general population and among community-dwelling elderly. Using logistic regression techniques, caregiver characteristics (eg, gender, health, relationship to the patient) rather than severity of the patient's condition emerge as predictors of antianxiety, antidepressant, and sedative/hypnotic use. The caregiver's perception of how well he or she is supported in the caregiving role emerges as an important correlate of psychotropic drug use in general and especially of antidepressant consumption. Results suggest that caregivers are a high-risk group for the development of emotional symptoms such as nervousness, exhaustion, decreased appetite, and difficulty sleeping, symptoms that may or may not constitute a psychiatric disorder. Characteristics of the caregiver, especially aspects of the support system, should be important considerations in decisions to prescribe psychotropic drugs.     

Taste acuity in institutionalized and noninstitutionalized elderly men

Taste detection thresholds were determined in young men (18 to 25 years of age, n = 15), noninstitutionalized elderly men (63 to 88 years of age, n = 17), and institutionalized elderly men (61 to 92 years of age, n = 15). The technical procedure utilized a single blind format. The tastants were presented to the subjects in a multiple forced-choice sample presentation with an ascending series. Additional testing conditions included adequate oral hygiene, 10 ml of tastant, timed intervals, and deionized water rinses. The major findings were that sour, salt, and bitter thresholds increased with age. Sweet threshold did not change with age. The institutionalized elderly men had significantly higher sour detection thresholds when compared with the noninstitutionalized elderly men. The use of salt and tobacco had no apparent effect on detection thresholds for sweet, salt and bitter, but medication ingestion elevated the sour thresholds. Elderly subjects on antihypertensive medications had significantly higher salt detection thresholds.     

Latitude of choice and well-being in institutionalized and noninstitutionalized elderly

While important positive effects on the psychological and physical well-being of the elderly often result from increased perceived and actual personal control, the literature also reflects many inconsistent findings. The lack of consensus on aging and the psychology of control has been variously attributed to differences in methodology, measurement devices, theoretical assumptions and the impact of moderator variables. To help bring order to this area the present study evaluated the Latitude of Choice model to determine whether Latitude of Choice scores differ across living arrangements, gender or age. Analysis of covariance tests, controlling for measures of education, perceived health and economic satisfaction, yielded significant main effects but no significant interactions. Partial correlations between Latitude of Choice and measures of psychological well-being, for the total sample and each of the main effect samples, were all significant. These findings provide substantive support for the theoretical approach that underlies Latitude of Choice as a measure of personal control of everyday activities and the potential value of personal control as a moderator of well-being in different environments.     

Illicit drug initiation among institutionalized drug users in China

Aims To examine the circumstances and correlates associated with initiation of illicit drug use among institutionalized drug users in China. Design Cross‐sectional, retrospective study. Settings Six compulsory drug cessation programs in Yunnan Province and Gunagxi Zhuang Autonomous Region of China. Participants A gender‐stratified random sample of 833 drug users (88% males and 12% females) enrolled in compulsory drug cessation programs in November 1996. Measurements Circumstances of illicit drug initiation (age, type of drugs, routes of drug administration, social setting, source of drugs, reasons for drug use), the risk behaviors and risk perceptions prior to drug initiation. Findings The majority of participants initiated drug use with heroin (90%). Initial drugs were frequently administered through sniffing/snorting (55%) and smoking cigarettes mixed with a drug (38%). First drug use occurred most commonly at a friend’s home (65%) and in the company of other drug users (83%). Drugs were generally provided free for first‐time use by other drug users (72%). Reasons for first drug use included experimentation (90%), being lured into drugs by other people (44%) and relaxation (42%). Most drug users had a history of regular cigarette smoking (89%), alcohol consumption (49%) and deviant behaviors (51%) prior to their drug initiation. The majority perceived that their friends (90%) and neighbors (88%) used illicit drugs. Conclusions The findings are similar to studies in western countries with respect to the pattern and correlates of illicit drug initiation, and underscore the need for drug prevention efforts in China.     

Depression among institutionalized aged: assessment and prevalence estimation

Aged nursing home and congregate apartment residents were screened for symptoms of depression and cognitive impairment. Of 708 survey respondents, 12.4% met DSM-IIIR criteria (33) for major depression; about half this group also displayed significant cognitive deficits. Another 30.5% of the total sample reported less severe but nonetheless marked depressive symptoms. Such "minor" depressive syndromes were much more common among congregate housing than nursing home residents. Possible major depression was more prevalent among newly admitted residents of both housing components. Comparison of cognitively impaired vs intact respondents revealed that the two groups' self-reports of depression were equally internally consistent, and bore equivalent correlations with observer ratings made by interviewers and direct care staff. Checks of medical records of a group of survey nonrespondents (n = 203) indicated that, excepting the extremely demented, the active sample of 708 accurately represents institution residents as a whole. Finally, comparison with clinical diagnoses made by facility psychology and psychiatry department staff indicated good concurrent validity of research screening measures and methods.     

Cognitive and mnemonic information processing in institutionalized and noninstitutionalized elderly patients

Older subjects (institutionalized in a home for the aged and non-institutionalized) were compared in a test battery according to the recommendations of the NINCDS-ADRA. The institutionalized subjects were not distinguishable from the controls when only a small amount of information was to be processed or when the information had to be recalled with no distraction. Possible reasons for the observed differences are discussed.     

Psychotropic drug use in an ambulatory elderly population

Medication histories were obtained from 3,192 ambulatory elderly persons participating in a health screening program. A total of 2,009 (63%) women and 1,183 (37%) men were included in the drug use study. Flurazepam, pentobarbital and the combination of amobarbital and secobarbital were used by 4.5, 0.6 and 0.4% of participants, respectively, and these three agents accounted for 87.6% of all prescribed hypnotic drugs. Diazepam, meprobamate and chlordiazepoxide were the most commonly used minor tranquilizers. Barbiturates were contained in nearly one fourth of minor tranquilizers used by these elderly subjects. Less than 1% (0.5%) of the participants in this program reported the use of a neuroleptic. Approximately 3% of the participants reported the use of an antidepressant drug. Nearly 90% of participants who reported the daily use of a hypnotic agent state they had been using the product on a daily basis for longer than 1 year.     

The relation of pain to depression among institutionalized aged

Nursing home and congregate apartment residents (N = 598) were classified on the basis of a DSM-IIIR symptom checklist as suffering possible major, minor, or no depression; they also completed the Geriatric Depression Scale (GDS) and the Profile of Mood States (POMS). Possible major depressives reported more intense pain and a greater number of localized pain complaints than did minor depressives; nondepressed individuals reported the least intense pain and fewest localized complaints. The effect remained strong even when functional disability and health status were controlled statistically. Both pain intensity and number of localized complaints were correlated with GDS and POMS factor scores, but strength and direction of associations varied with level of depression. Item-by-item examination of localized complaints again indicated that more depressed individuals were more likely to report pain, particularly where physicians had identified a physical problem that might account for the pain. Results are compared with previous research on pain among younger individuals. Implications for treatment of depressed elderly are discussed.     

The relationship of impulse control to cognition and adjustment among institutionalized aged women.

Several dimensions of impulse control (i.e., delay of gratification, reflectivity, and motor control) were related to intelligence, mental status, and adjustment among 91 institutionalized aged women. Four different types of impulse control measures were used: Self reports of impulse control, staff ratings, interviewer's ratings, and tests of impulse control. Impulse control measures yielded statistically significant multiple correlations with all outcome measures except life satisfaction. The findings suggest that impulse control in its various forms has a consistent and significant relationship with indices of adaptation. Utilizing stepwise regression analyses, the best predictors of outcome among impulse control measures are presented.     

Social integrations related to institutionalized and noninstitutionalized forms of care of elderly people

This is a report about a research project analyzing costs and effectiveness of institutionalized and ambulatory care of older people. For this analysis economic factors as well as social factors are considered. On the sociological part multiple objective conditions (e.g. state health, financial situation and family relations) were correlated with subjective factors as feelings of well-being and various personal attitudes. To this purpose approximately 900 elderly persons (3 samples: 1. inhabitants of homes of the aged, 2. ambulant served (meals on wheels, home help and community nurses), 3. random sample of persons living at their own home. The 3 samples were taken in an urban, semiurban and rural area. Some remarkable differences between the 3 samples could be shown referring to the general physical and mental status and rate of impairment, in the state of care, familiar situation, social integration and subjective attitude (e.g. demonstrating that the inhabitants of homes for the aged were less socially integrated and less satisfied.     

Psychotropic drug use in long-term care facilities: a review of the literature.

We reviewed 19 studies of psychotropic drug use for residents of long-term care facilities, located through a MEDLINE search of the literature published between 1978 and 1990. The review compares each study in terms of its sample, research design, and findings. The studies reviewed found that a substantial proportion of nursing home residents are taking psychotropic drugs on a regular, long-term basis and this usage is accompanied by prescribing and monitoring problems and many potential adverse risks.