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.     

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.     

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.     

Activity and mortality among aged persons over an eight-year period

The influence of level of activity examined with data from an eight-year (1976 to 1984) longitudinal study of 508 older Mexican Americans and Anglos. Over the study interval, 119 subjects were confirmed to have died. Activity was a significant predictor of mortality at the univariate level. However, when age, gender, education, marital status, ethnicity, and self-rated health were controlled for in the analysis, activity was not a significant predictor of mortality. The popular notion that an active life among elderly persons might lead to extended longevity was not supported by these data.     

Dental status and mortality in institutionalized elderly people

Background:   Inadequate dentition for mastication is one of the major issues associated with systemic health for institutionalized elderly people, but its prognostic value and related deaths have not been fully examined.
Methods:   Four hundred and three patients aged 65 and older were recruited from nine nursing homes and were prospectively followed up for morbidity and mortality for 5 years in Japan. These patients were classified into three groups according to dental status: patients who had adequate dentition with natural teeth only or natural teeth with partial dentures (Group A); those who were edentulous but wearing full dentures (Group B); and those who had inadequate dentition without dentures (Group C).
Results:   Dental status was strongly related to age, cognitive function and activities of daily living. After allowing for confounding effects, the 2-year risk of mortality among those in Group C was 1.84 times that of Group A (95% confidence interval 1.01–3.36, P  = 0.047). Furthermore, the 5-year mortality rate in Group C was higher than that in Group A, whereas that was not significant with a hazard ratio of 1.30 (0.90–1.88, P  = 0.168). The main causes of death were respiratory infections, which explained 14.1% of all causes of death in Group A, 14.3% in Group B and 18.3% in Group C. Any associations between a specific cause of death and the different dental status did not reach a significant level.
Conclusion:   Inadequate dental status is associated with high overall mortality. Our findings suggest that systemic attention to dental status should be recommended in institutionalized elderly people.     

Drugs and aged subjects institutionalized in geriatric units]

Our one-year retrospective study evaluated drug use in a population of 136 patients over 60 years old hospitalized in a geriatric ward (moderate--and long-term institutionalization). After having classified the reason for hospitalization, the length of stay and the number of pathologies per patient, the number of prescribed medications was quantified by means of a drug-day unit (D-D). The mean number was 3.36 D-D, which was independent of sex, age and reason for admission. The most frequently prescribed medications treated central nervous system, cardiovascular and metabolic disorders. These results were compared to those of CREDOC 1981 and CREDES 1987. In addition, 14 iatrogenic episodes were identified in this study; aminoglycosides and cardiovascular drugs were responsible for the majority of them, despite the precautions taken in light of the therapeutic indications. The iatrogenesis thus identified was not due to biological abnormalities found in the elderly. In our opinion, this evaluation of drug use is a good predictive element for understanding iatrogenicity on a larger scale and thereby to attempt to avoid it.