Prediction of functional disability by depressive state among community‐dwelling elderly in Japan: A prospective cohort study

Aim: We carried out a prospective cohort study to evaluate the risk factors of functional disability by depressive state. Methods: A total of 783 men and women, aged 70 years and over, participated in this study. We followed the participants in terms of the onset of functional disability by using a public long‐term care insurance database. The Geriatric Depression Scale (GDS) was used to measure depressive state. Age, sex, history of chronic disease, living alone, fall experience, cognitive impairment, instrumental activities of daily living (IADL), the Motor Fitness Scale (MFS), frequency of going out and social support at baseline were used as the main covariates. The Cox regression analysis was used to examine the difference in functional disability stratified according to depressive state. Results: The incidence of functional disability was 38 persons in the non‐depression group and 42 persons in the depression group (RR 2.34; 95% CI 1.46–3.79). The results of the depression group showed a significant difference in cognitive impairment (HR 3.51; 95% CI 1.39–8.85), MFS (HR 5.60; 95% CI 1.32–23.81) and IADL (HR 3.37; 95% CI 1.65–6.85). The results of the non‐depression group showed a significant difference in MFS (HR 2.97; 95% CI 1.47–6.96), and frequency of going out (HR 3.21; 95% CI 1.47–6.96). Conclusions: In conclusion, risk factors for functional disability were found to differ on the basis of whether or not community‐dwelling elderly individuals experience depressive state. The type of support offered must be based on whether or not depressive state is present. Geriatr Gerontol Int 2012; ??: ??–?? .     

Depressive symptoms and incidence of mild cognitive impairment and probable dementia in elderly women: the Women's Health Initiative Memory Study

OBJECTIVES: To examine whether significant depressive symptoms in postmenopausal women increases the risk of subsequent mild cognitive impairment (MCI) and dementia. DESIGN: Prospective cohort study. SETTING: Thirty nine of the 40 Women's Health Initiative (WHI) clinical centers that participated in a randomized clinical trial of hormone therapy. PARTICIPANTS: Six thousand three hundred seventy‐six postmenopausal women without cognitive impairment aged 65 to 79 at baseline. MEASUREMENTS: Depressive disorders were assessed using an eight‐item Burnam algorithm and followed annually for a mean period of 5.4 years. A central adjudication committee classified the presence of MCI and probable dementia based on an extensive neuropsychiatric examination. RESULTS: Eight percent of postmenopausal women in this sample reported depressive symptoms above a 0.06 cut point on the Burnam algorithm. Depressive disorder at baseline was associated with greater risk of incident MCI (hazard ratio (HR)=1.98, 95% confidence interval (CI)=1.33–2.94), probable dementia (HR=2.03, 95% CI=1.15–3.60), and MCI or probable dementia (HR=1.92, 95% CI=1.35–2.73) after controlling for sociodemographic characteristics, lifestyle and vascular risk factors, cardiovascular and cerebrovascular disease, antidepressant use, and current and past hormone therapy status. Assignment to hormone therapy and baseline cognitive function did not affect these relationships. Women without depression who endorsed a remote history of depression had a higher risk of developing dementia. CONCLUSION: Clinically significant depressive symptoms in women aged 65 and older are independently associated with greater incidence of MCI and probable dementia.     

Contribution of multiple chronic conditions to universal health outcomes

OBJECTIVES: To determine the relative effect of five chronic conditions on four representative universal health outcomes. DESIGN: Cross‐sectional. SETTING: Cardiovascular Health Study. PARTICIPANTS: Five thousand two hundred and ninety‐eight community‐living participants aged 65 and older. MEASUREMENTS: Multiple regression and Cox models were used to determine the effect of heart failure (HF), chronic obstructive pulmonary disease (COPD), osteoarthritis, depression, and cognitive impairment on self‐rated health, 12 basic and instrumental activities of daily living (ADLs and IADLs), six‐item symptom burden scale, and death. RESULTS: Each condition adversely affected self‐rated health (P<.001) and ADLs and IADLs (P<.001). For example, persons with HF performed 0.70±0.08 fewer ADLs and IADLs than those without; persons with depression and persons with cognitive impairment performed 0.59±0.04 and 0.58±0.06 fewer activities, respectively, than those without these conditions. Depression, HF, COPD, and osteoarthritis were associated with 1.18±0.04, 0.40±0.08, 0.40±0.05, and 0.57±0.03 more symptoms, respectively, in individuals with these conditions than in those without. HF (hazard ratio (HR)=2.84, 95% confidence interval (CI)=1.97–4.10), COPD (2.62, 95% CI=1.94–3.53), cognitive impairment (2.05, 95% CI=1.47–2.85), and depression (1.47, 95% CI=1.08–2.01) were each associated with death within 2 years. Several paired combinations of conditions had synergistic effects on ADLs and IADLs. For example, individuals with HF plus depression performed 2.0 fewer activities than persons with neither condition, versus the 1.3 fewer activities expected from adding the effects of the two conditions together. CONCLUSION: Universal health outcomes may provide a common metric for measuring the effects of multiple conditions and their treatments. The varying effects of the conditions across universal outcomes could inform care priorities.     

Neuropsychiatric symptoms and the risk of institutionalization and death: the aging, demographics, and memory study

OBJECTIVES: To examine the association between neuropsychiatric symptoms and risk of institutionalization and death. DESIGN: Analysis of longitudinal data. SETTING: The Aging, Demographics, and Memory Study (ADAMS). PARTICIPANTS: Five hundred thirty‐seven adults aged 71 and older with cognitive impairment drawn from the Health and Retirement Study (HRS). MEASUREMENTS: Neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) and caregiver distress were identified using the Neuropsychiatric Inventory. A consensus panel in the ADAMS assigned cognitive category. Date of nursing home placement and information on death, functional limitations, medical comorbidity, and sociodemographic characteristics were obtained from the HRS and ADAMS. RESULTS: Overall, the presence of one or more neuropsychiatric symptoms was not associated with a significantly higher risk for institutionalization or death during the 5‐year study period, although when assessing each symptom individually, depression, delusions, and agitation were each associated with a significantly higher risk of institutionalization (hazard rate (HR)=3.06, 95% confidence interval (CI)=1.09–8.59 for depression; HR=5.74, 95% CI=1.94–16.96 for clinically significant delusions; HR=4.70, 95% CI=1.07–20.70 for clinically significant agitation). Caregiver distress mediated the association between delusions and agitation and institutionalization. Depression and hallucinations were associated with significantly higher mortality (HR=1.56, 95% CI=1.08–2.26 for depression; HR=2.59, 95% CI=1.09–6.16 for clinically significant hallucinations). CONCLUSION: Some, but not all, neuropsychiatric symptoms are associated with a higher risk of institutionalization and death in people with cognitive impairment, and caregiver distress also influences institutionalization. Interventions that better target and treat depression, delusions, agitation, and hallucinations, as well as caregiver distress, may help delay or prevent these negative clinical outcomes.     

Depression and functional recovery after a disabling hospitalization in older persons

OBJECTIVES: To determine the association between depression and functional recovery in community‐living older persons who had a decline in function after an acute hospital admission. DESIGN: Prospective cohort study. SETTING: General community in greater New Haven, Connecticut, from March 1998 to December 2008. PARTICIPANTS: Seven hundred fifty‐four persons aged 70 and older. MEASUREMENTS: Hospitalization and disability in essential activities of daily living (ADLs) and mobility were assessed each month for up to 129 months, and depressive symptoms were assessed every 18 months using the Center for Epidemiologic Studies‐Depression Scale (CES‐D). Functional recovery was defined as returning to the community within 6 months at or above the prehospital level of ADL function and mobility. RESULTS: A decline in ADL function and mobility was observed after 42% and 41% of the hospitalizations, respectively. After controlling for several potential confounders, clinically significant depressive symptoms (CES‐D score ≥20) was associated with a lower likelihood of recovering mobility function (hazard ratio (HR)=0.79, 95% confidence interval (CI)=0.63–0.98) but not ADL function (HR=0.91, 95% CI=0.75–1.10) within 6 months of hospitalization. CONCLUSION: After a disabling hospitalization, community‐living older persons with preexisting depression may be less likely to recover their prehospitalization level of mobility function but not ADL function, although the reasons remain to be elucidated.     

Depressive Symptoms in Middle Age and the Development of Later‐Life Functional Limitations: The Long‐Term Effect of Depressive Symptoms

OBJECTIVES: To determine whether middle‐aged persons with depressive symptoms are at higher risk for developing activity of daily living (ADL) and mobility limitations as they advance into older age than those without. DESIGN: Prospective cohort study. SETTING: The Health and Retirement Study (HRS), a nationally representative sample of people aged 50 to 61. PARTICIPANTS: Seven thousand two hundred seven community living participants in the 1992 wave of the HRS. MEASUREMENTS: Depressive symptoms were measured using the 11‐item Center for Epidemiologic Studies Depression Scale (CES‐D 11), with scores of 9 or more (out of 33) classified as significant depressive symptoms. Difficulty with five ADLs and basic mobility tasks (walking several blocks or up one flight of stairs) was measured every 2 years through 2006. The primary outcome was persistent difficulty with ADLs or mobility, defined as difficulty in two consecutive waves. RESULTS: Eight hundred eighty‐seven (12%) subjects scored 9 or higher on the CES‐D 11 and were classified as having significant depressive symptoms. Over 12 years of follow‐up, subjects with depressive symptoms were more likely to reach the primary outcome measure of persistent difficulty with mobility or difficulty with ADL function (45% vs 23%, Cox hazard ratio (HR)=2.33, 95% confidence interval (CI)=2.06–2.63). After adjusting for age, sex, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging 1 mile, and difficulty climbing several flights of stairs, the risk was attenuated but still statistically significant (Cox HR=1.44, 95% CI=1.25–1.66). CONCLUSION: Depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle‐aged persons advance into later life. Middle‐aged persons with depressive symptoms may be at greater risk for losing their functional independence as they age.     

Prognostic Significance of Potential Frailty Criteria

OBJECTIVES: To determine the independent prognostic effect of seven potential frailty criteria, including five from the Fried phenotype, on several adverse outcomes. DESIGN: Prospective cohort study. SETTING: Greater New Haven, Connecticut. PARTICIPANTS: Seven hundred fifty‐four initially nondisabled, community‐living persons aged 70 and older. MEASUREMENTS: An assessment of seven potential frailty criteria (slow gait speed, low physical activity, weight loss, exhaustion, weakness, cognitive impairment, and depressive symptoms) was completed at baseline and every 18 months for 72 months. Participants were followed with monthly telephone interviews for up to 96 months to determine the occurrence of chronic disability, long‐term nursing home (NH) stays, injurious falls, and death. RESULTS: In analyses adjusted for age, sex, race, education, number of chronic conditions, and the presence of the other potential frailty criteria, three of the five Fried criteria (slow gait speed, low physical activity, and weight loss) were independently associated with chronic disability, long‐term NH stays, and death. Slow gait speed was the strongest predictor of chronic disability (hazard ratio (HR)=2.97, 95% confidence interval (CI)=2.32–3.80) and long‐term NH stay (HR=3.86, 95% CI=2.23–6.67) and was the only significant predictor of injurious falls (HR=2.19, 95% CI=1.33–3.60). Cognitive impairment was also associated with chronic disability (HR=1.82, 95% CI=1.40–2.38), long‐term NH stay (HR=2.64, 95% CI=1.75–3.99), and death (HR=1.54, 95% CI=1.13–2.10), and the magnitude of these associations was comparable with that of weight loss. CONCLUSION: The results of this study provide strong evidence to support the use of slow gait speed, low physical activity, weight loss, and cognitive impairment as key indicators of frailty while raising concerns about the value of self‐reported exhaustion and muscle weakness.     

Predictive value of depressive symptoms and B-type natriuretic peptide for new-onset heart failure and mortality

Depression and natriuretic peptides predict heart failure (HF) progression, but the unique contributions of depression and biomarkers associated with HF outcomes are not known. The present study determined the additive predictive value of depression and aminoterminal pro-B-type natriuretic peptide (NT-proBNP) for new-onset HF in HF-free subjects and mortality in patients with HF. The participants in the Cardiovascular Health Study were assessed for depressive symptoms using the Center for Epidemiologic Studies Depression Scale and NT-proBNP using an electrochemiluminescence immunoassay. The validated cutoff values for depression (Center for Epidemiologic Studies Depression Scale ≥8) and NT-proBNP (≥190 pg/ml) were used. The risks of incident HF and mortality (cardiovascular disease-related and all-cause) were examined during a median follow-up of 11 years, adjusting for demographics, clinical factors, and health behaviors. In patients with HF (n = 208), depression was associated with an elevated risk of cardiovascular disease mortality (hazard ratios [HR] 2.07, 95% confidence interval [CI] 1.31 to 3.27) and all-cause mortality (HR 1.49, 95% CI 1.05 to 2.11), independent of the NT-proBNP level and covariates. The combined presence of depression and elevated NT-proBNP was associated with substantially elevated covariate-adjusted risks of cardiovascular disease mortality (HR 5.42, 95% CI 2.38 to 12.36) and all-cause mortality (HR 3.72, 95% CI 2.20 to 6.37). In the 4,114 HF-free subjects, new-onset HF was independently predicted by an elevated NT-proBNP level (HR 2.27, 95% CI 1.97 to 2.62) but not depression (HR 1.08, 95% CI 0.92 to 1.26) in covariate-adjusted analysis. In conclusion, depression and NT-proBNP displayed additive predictive value for mortality in patients with HF. These associations can be explained by complementary pathophysiologic mechanisms. The presence of both elevated depression and NT-proBNP levels might improve the identification of patients with HF with a high risk of mortality.     

Overweight and Obesity in Old Age Are Not Associated with Greater Dementia Risk

OBJECTIVES: To describe the association between body mass index (BMI) and dementia risk in older persons. DESIGN: Prospective population‐based study, with 8 years of follow‐up. SETTING: The municipality of Lieto, Finland, 1990/91 and 1998/99. PARTICIPANTS: Six hundred five men and women without dementia aged 65 to 92 at baseline (mean age 70.8). MEASUREMENTS: Weight and height were measured at baseline and at the 8‐year follow‐up. Dementia was clinically assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. RESULTS: Eighty‐six persons were diagnosed with dementia. Cox regression analyses, adjusted for age, sex, education, cardiovascular diseases, smoking, and alcohol use, indicated that, for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio (HR)=0.92, 95% confidence interval (CI)=0.87–0.97). This association remained significant when individuals who developed dementia early during the first 4 years of follow‐up were excluded from the analyses (HR=0.93, 95% CI=0.86–0.99). Women with high BMI scores had a lower dementia risk (HR=0.90, 95% CI=0.84–0.96). Men with high BMI scores also tended to have a lower dementia risk, although the association did not reach significance (HR=0.95, 95% CI=0.84–1.07). CONCLUSION: Older persons with higher BMI scores have less dementia risk than their counterparts with lower BMI scores. High BMI scores in late life should not necessarily be considered to be a risk factor for dementia.     

Long-term risk for depressive symptoms after a medical diagnosis

BACKGROUND: This study examines the risk of development of significant depressive symptoms after a new diagnosis of cancer, diabetes, hypertension, heart disease, arthritis, chronic lung disease, or stroke. METHODS: The study used 5 biennial waves (1992-2000) of the Health and Retirement Study to follow a sample of 8387 adults (aged 51 to 61 years and without significant depressive symptoms in 1992) from 1994 to 2000. Time-dependent Cox regression models estimated adjusted hazard ratios (HRs) for an episode of significant depressive symptoms after a new diagnosis for each of the 7 medical conditions. RESULTS: Within 2 years of initial diagnosis, subjects with cancer had the highest hazard of depressive symptoms (HR, 3.55; 95% confidence interval [CI], 2.79-4.52), followed by subjects with chronic lung disease (HR, 2.21; 95% CI, 1.64-2.79) and heart disease (HR, 1.45; 95% CI, 1.09-1.93). The hazard for depressive symptoms for most of these diseases decreased over time; however, subjects with heart disease continued to have a higher risk for depressive symptoms even 2 to 4 years and 4 to 8 years after diagnosis, and a significantly higher hazard for depressive symptoms developed for persons with arthritis 2 to 4 years after diagnosis (HR, 1.46; 95% CI, 1.11-1.92). CONCLUSION: The findings identify several high-risk patient groups who might benefit from depression screening and monitoring to improve health outcomes in this vulnerable population facing new medical illnesses.     

Longitudinal associations between depression and diabetes complications: a systematic review and meta‐analysis

To conduct a systematic review and meta‐analysis of longitudinal studies assessing the bi‐directional association between depression and diabetes macrovascular and microvascular complications. Embase, Medline and PsycINFO databases were searched from inception through 27 November 2017. A total of 4592 abstracts were screened for eligibility. Meta‐analyses used multilevel random/mixed‐effects models. Quality was assessed using the Newcastle‐Ottawa scale. Twenty‐two studies were included in the systematic review. Sixteen studies examined the relationship between baseline depression and incident diabetes complications, of which nine studies involving over one million participants were suitable for meta‐analysis. Depression was associated with an increased risk of incident macrovascular (HR = 1.38; 95% CI: 1.30–1.47) and microvascular disease (HR = 1.33; 95% CI: 1.25–1.41). Six studies examined the association between baseline diabetes complications and subsequent depression, of which two studies involving over 230 000 participants were suitable for meta‐analysis. The results showed that diabetes complications increased the risk of incident depressive disorder (HR = 1.14; 95% CI: 1.07–1.21). The quality analysis showed increased risk of bias notably in the representativeness of selected cohorts and ascertainment of exposure and outcome. Depression in people with diabetes is associated with an increased risk of incident macrovascular and microvascular complications. The relationship between depression and diabetes complications appears bi‐directional. However, the risk of developing diabetes complications in depressed people is higher than the risk of developing depression in people with diabetes complications. The underlying mechanisms warrant further research.     

Development of a Frailty Index for Patients with Coronary Artery Disease

OBJECTIVES: To construct a brief frailty index for older patients with coronary artery disease (CAD) undergoing coronary angiography that includes physical, cognitive, and psychosocial criteria and accurately predicts future disability and decline in health‐related quality of life (HRQL). DESIGN: Prospective cohort. SETTING: An urban tertiary care hospital in Alberta, Canada. PARTICIPANTS: Three hundred seventy‐four patients aged 60 and older (73% male) undergoing cardiac catheterization for CAD between October 2003 and May 2007. MEASUREMENTS: Potential frailty criteria examined at baseline (before the procedure) included measures of balance, gait speed, cognition, self‐reported health, body mass index (BMI), depressive symptoms, and living alone. The outcomes assessed over 1 year were dependency in activities of daily living (ADLs) and HRQL. RESULTS: The five best‐fitting criteria from regression analyses for ADL decline were poor balance (risk ratio (RR)=2.4, 95% confidence interval (CI)=1.4–4.0), abnormal BMI (RR=1.8, 95% CI=1.1–3.0), impaired Trail‐Making Test Part B performance (RR=2.3, 95% CI=1.3–4.2), depressive symptoms (RR=1.8, 95% CI=1.1–3.1), and living alone (RR=2.2, 95% CI=1.3–3.8). Using the five criteria as separate variables or as a summary frailty index yielded identical areas under the receiver operating characteristic curve (0.76, 95% CI=0.66–0.84). Patients with three or more criteria (vs none) were at statistically significant greater risk for increased disability (RR=10.4, 95% CI=4.4–24.2) and decreased HRQL (RR=4.2, 95% CI=2.3–7.4) after 1 year. CONCLUSION: This brief frailty index including physical, cognitive, and psychosocial criteria was predictive of increased disability and decreased HRQL at 1 year in older patients with CAD undergoing angiography. This index may have applications for clinicians and researchers but requires further validation.     

Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction

OBJECTIVES: We sought to compare symptoms of depression and anxiety as predictors of incomplete recovery after a first myocardial infarction (MI). BACKGROUND: Depressive symptoms have been related to post-MI mortality and health care consumption, but little is known about the effect of anxiety. We wanted to examine the effect of emotional distress on health care consumption and whether depressive symptomatology is a better predictor of prognosis than anxiety. METHODS: Subjects were 318 men (mean age 58 years) who completed the depression, anxiety, and hostility scales from the 90-item symptom check list after they survived a first MI. RESULTS: After an average follow-up of 3.4 years, there were 25 cardiac events (fatal or non-fatal MI). Symptoms of both depression (hazard ratio [HR] 2.32, 95% confidence interval [CI] 1.04 to 5.18; p = 0.039) and anxiety (HR 3.01, 95% CI 1.20 to 7.60; p = 0.019) were associated with cardiac events, adjusting for age, left ventricular ejection fraction, and use of antidepressants. However, a multivariate analysis including all three negative emotions indicated that symptoms of anxiety (HR 2.79, 95% CI 1.11 to 7.03; p = 0.029) explained away the relationship between depressive symptoms and cardiac events. Regarding health care consumption, anxiety (OR 2.00, 95% CI 1.24 to 3.22; p = 0.005), but not depression/hostility, was a predictor of cardiac rehospitalization and frequent visits at the cardiac outpatient clinic. CONCLUSIONS: Symptoms of depression and anxiety were associated with cardiac events. Anxiety was an independent predictor of both cardiac events and increased health care consumption and accounted for the relationship between depressive symptoms and prognosis. Symptoms of anxiety need to be considered in the risk stratification and treatment of post-MI patients.     

Exploring the association between childhood and adolescent obesity and depression: a meta‐analysis

This meta‐analysis aimed to evaluate the association between childhood and adolescent obesity and depression. We systematically searched PubMed, PsycInfo, EMBASE and Science Direct for studies that compared prevalence of depression and depressive symptoms in normal weight and obese children and adolescents. Observational studies were included if they reported body mass index and assessed depression by validated instruments or diagnostic interviews. Quality assessment was performed using the Newcastle–Ottawa scale. We used the random‐effect model to calculate the pooled odds ratios, standard mean differences (SMDs) and subgroup analysis. Findings for a total of 51,272 participants were pooled across 18 studies and examined. Our analyses demonstrated a positive association between childhood and adolescent obesity and depression (pooled odds ratio = 1.34, 95% confidence interval [CI]: 1.1–1.64, p = 0.005) and more severe depressive symptoms (SMD = 0.23, 95% CI: 0.025–0.44, p = 0.028) in the obese groups. Overweight subjects were not more likely to have either depression (pooled odds ratio = 1.16, 95% CI: 0.93–1.44, p = 0.19) or depressive symptoms (SMD = 0, 95% CI: ?0.101 to 0.102, p = 0.997). Non‐Western and female obese subjects were significantly more likely to have depression and severe depressive symptoms (p < 0.05). In conclusion, obese children and adolescents are more likely to suffer from depression and depressive symptoms, with women and non‐Western people at higher risk.     

Depressive symptoms are prominent among elderly hospitalised heart failure patients

BACKGROUND: There are limited data on the prevalence of depressive symptoms in hospitalised elderly HF patients and demographic and clinical characteristics associated with depressive symptoms are not known. METHODS: A sample of 572 HF patients (61% male; age 71+/-12 years; LVEF 34%+/-15) was recruited from 17 Dutch hospitals during HF admission. Depressive symptoms were assessed by the CES-D. Demographic, clinical variables and HF symptoms were collected from patient chart and interview. RESULTS: Forty one percent of the patients had symptoms of depression with women significantly more often reporting depressive symptoms than men 48% vs. 36% (chi(2)=8.1, p<0.005). HF patients with depressive symptoms reported more clinical HF symptoms than patients without depressive symptoms. Even after deleting HF related symptoms (sleep disturbances and loss of appetite) from the CES-D scale, 36% of patients were still found to have symptoms of depression. Multivariable logistic regression analyses revealed that depressive symptoms were associated with female gender (odds 1.68, 95% CI 1.14-2.48), COPD (odds 2.11, 95% CI 1.35-3.30), sleep disturbance (odds 3.45, 95% CI 2.03-5.85) and loss of appetite (odds 2.61, 95% CI 1.58-4.33). CONCLUSIONS: Depressive symptoms are prominent in elderly hospitalised HF patients especially in women. Depressive symptoms are associated with more pronounced symptomatology, despite the fact that other indices of severity of left ventricular dysfunction are similar.     

Association Between Depressive Symptom Patterns and Clinical Profiles Among Persons Living with HIV

To describe patterns of depressive symptoms across 10-years by HIV status and to determine the associations between depressive symptom patterns, HIV status, and clinical profiles of persons living with HIV from the Multicenter AIDS Cohort Study (N = 980) and Women’s Interagency HIV Study (N = 1744). Group-based trajectory models were used to identify depressive symptoms patterns between 2004 and 2013. Multinomial logistic regressions were conducted to determine associations of depression risk patterns. A 3-group model emerged among HIV-negative women (low: 58%; moderate: 31%; severe: 11%); 5-groups emerged among HIV-positive women (low: 28%; moderate: 31%; high: 25%; decreased: 7%; severe: 9%). A 4-group model emerged among HIV-negative (low: 52%; moderate: 15%; high: 23%; severe: 10%) and HIV-positive men (low: 34%; moderate: 34%; high: 22%; severe: 10%). HIV+ women had higher odds for moderate (adjusted odds ratio [AOR] 2.10, 95% CI 1.63–2.70) and severe (AOR 1.96, 95% CI 1.33–2.91) depression risk groups, compared to low depression risk. HIV+ men had higher odds for moderate depression risk (AOR 3.23, 95% CI 2.22–4.69), compared to low risk. The Framingham Risk Score, ART use, and unsuppressed viral load were associated with depressive symptom patterns. Clinicians should consider the impact that depressive symptoms may have on HIV prognosis and clinical indicators of comorbid illnesses.     

Leisure activity, mobility limitation and stress as modifiable risk factors for depressive symptoms in the elderly: results of a national longitudinal study

Few national longitudinal studies have investigated the modifiable risk factors for depression in the elderly. This study investigated the risk factors and health-related behaviors associated with depressive symptoms using a national survey of Taiwanese elderly with a 4-year follow-up period. In this prospective cohort study, 1481 non-demented population-based elderly were interviewed at baseline in 2003 and at 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 at follow-up. Reduced rank regression was applied to characterize independent factors related to depressive symptoms. The prevalence of depressive symptoms at follow-up was 21.1%. The results of multivariate analyses revealed three independent risk factors for depressive symptoms: fewer leisure activities (odds ratio, OR=0.56, 95% confidence interval, CI=0.38-0.83, p=0.0034), more mobility limitations (OR=1.93, 95% CI=1.30-2.86, p=0.0011) and higher stress levels (OR=2.43, 95% CI=1.68-3.50, p<0.0001). The leisure activities least associated with depression were reading newspapers/books and doing outdoor building projects; the two mobility limitations most associated with depression were difficulty in lifting things and in climbing stairs. The two stresses most associated with depression were perceived health stress and financial stress. These results indicated that interventions to prevent or reduce depression in older adults should include practical strategies aimed at these modifiable risk factors.     

Depressive symptoms, inflammation, and ischemic stroke in older adults: a prospective analysis in the cardiovascular health study

OBJECTIVES: To investigate the mediator role of inflammation in any relationship between depressive symptoms and ischemic stroke.
DESIGN: Longitudinal prospective study.
SETTING: Review of medical records, death certificates, and the Medicare healthcare utilization database for hospitalizations.
PARTICIPANTS: Total of 5,525 elderly men and women aged 65 and older who were prospectively followed from 1989 to 2000 as participants in the Cardiovascular Health Study.
MEASUREMENTS: Depression symptom scores, inflammatory markers.
RESULTS: Greater depressive symptoms were associated with risk of ischemic stroke (unadjusted hazard ratio (HR)=1.32, 95% confidence interval (CI)=1.09–1.59; HR=1.26, 95% CI=1.03–1.54, adjusted for traditional risk factors). When a term for inflammation (C-reactive protein (CRP)) was introduced in the model, the HRs were not appreciably altered (unadjusted HR=1.31, 95% CI=1.08–1.58; adjusted HR=1.25, 95% CI=1.02–1.53), indicating that CRP at baseline was not a mediator in this relationship. In analyses stratified according to CRP levels, a J-shaped relationship between depressive symptoms and stroke was evident in the unadjusted analyses; in the fully adjusted model, only CRP in the highest tertile was associated with a higher risk for stroke in the presence of higher depressive symptoms scores.
CONCLUSION: The analyses from this prospective study provide evidence of a positive association between depressive symptoms and risk of incident stroke. Inflammation, as measured according to CRP at baseline, did not appear to mediate the relationship between depressive symptoms and stroke.     

Drug-induced lithium toxicity in the elderly: a population-based study

Objectives: To study the association between hospital admission for lithium toxicity and the use of diuretics, angiotensin‐converting enzyme (ACE) inhibitors, and nonsteroidal antiinflammatory drugs (NSAIDs) in the elderly. Design: Population‐based nested case‐control study. Setting: Ontario, Canada. Participants: Ontario residents aged 66 and older treated with lithium. Measurements: Estimated relative risk of hospital admission for lithium toxicity. Results: From January 1992 to December 2001, 10,615 elderly patients continuously receiving lithium were identified, of whom 413 (3.9%) were admitted to the hospital at least once for lithium toxicity. After adjustment for potential confounders, a dramatically increased risk of lithium toxicity was seen within a month of initiating treatment with a loop diuretic (relative risk (RR)=5.5, 95% confidence interval (CI)=1.9–16.1) or an ACE inhibitor (RR=7.6, 95% CI=2.6–22.0). Conversely, neither thiazide diuretics nor NSAIDs were independently associated with a significantly increased risk of hospitalization for lithium toxicity. Conclusion: The use of loop diuretics or ACE inhibitors significantly increases the risk of hospitalization for lithium toxicity, particularly in naïve recipients.     

Transitions in metabolic health status over time and risk of heart failure: A prospective study

Aims- Evidence for the effects of metabolically healthy obese (MHO) status on heart failure (HF) is limited and ignores the dynamic change of metabolic health and obesity phenotypes. We aimed to investigate the associations of metabolic health and its transition with HF across body mass index (BMI) and waist circumference (WC) categories.Methods- This prospective cohort study was conducted with 93,288 Chinese adults who were free of cardiovascular disease, cancer or HF at baseline (2006–2007). Metabolic health was defined as having no or only one abnormality in blood pressure, glucose, high-density lipoprotein cholesterol, or triglyceride levels. Participants were cross-classified at baseline by metabolic health and obesity (defined by BMI and WC criteria). Transitions in metabolic health status from 2006 to 2007 to 2010 to 2011 were considered. The hazard ratios (HRs) and 95% confidence intervals (CIs) for HF were assessed by Cox proportional hazards regression.Results- During a mean ± standard deviation follow-up of 9.7 ± 1.5 years, 1,628 participants developed HF. Individuals with MHO (HR: 1.78, 95% CI: 1.45, 2.19 for BMI criteria; HR: 1.51, 95% CI: 1.30, 1.76 for WC criteria) had higher risk of HF than those with metabolically healthy normal weight (MHNW). Individuals with initial MHO who shifted to metabolically unhealthy phenotype during follow-up had higher risk of HF compared with stable MHNW individuals (HR 3.12; 95% CI: 2.01, 4.85 for BMI categories; HR 1.98; 95% CI: 1.42, 2.77 for WC categories). Even stable MHO individuals were at an increased risk of HF compared with stable MHNW individuals (HR: 2.17; 95% CI: 1.39, 3.39 for BMI categories; HR: 1.33; 95% CI: 0.96, 1.85 for WC categories).Conclusions- MHO phenotype is dynamic and its transition to metabolically unhealthy phenotype or even stable MHO is associated with increased risk of HF. Maintaining metabolic health may provide a clue for preventing HF.