Prevalence and correlates of anxiety among nursing home patients

BACKGROUND: Very little is known about the prevalence and correlates of anxiety among nursing home patients. The current knowledge is predominantly based on information from population-based studies among elderly. METHODS: Prevalence of anxiety was measured with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) in a sample of 333 nursing home patients of somatic wards of 14 nursing homes in the Netherlands. Participants were over 55 years, had a MMSE-score >14 and were able to communicate sufficiently. Information about demographic, health-related, psychosocial and care-related characteristics was collected in interviews with participants and from attending physicians and nursing home staff. RESULTS: The prevalence of anxiety disorders was 5.7%, of subthreshold anxiety disorders 4.2% and of anxiety symptoms 29.7%. Only health-related characteristics (MMSE-score >23, depression, stroke) were significantly associated with anxiety disorders and subthreshold anxiety disorders. Demographic (>6 years education), health-related (depression, impaired vision, pain) and psychosocial characteristics (a recent negative life event) were significantly associated with anxiety symptoms. No care-related characteristics were associated with anxiety. LIMITATIONS: The study population is a selective one (>55 years, MMSE >15, able to communicate sufficiently). The data were collected cross-sectionally. CONCLUSIONS: Anxiety disorders and anxiety symptoms occur frequently among nursing home patients and are mainly associated with health-related characteristics. Physicians should focus special attention on patients with depression or stroke.     

Prevalence of hearing impairment in the elderly living at home

Using pure tone audiometry, we assessed the prevalence of hearing impairment in a sample of elderly people living at home and aged 70 or more. Deafness was defined as an average loss over the speech frequencies at 1 kHz, 2 kHz and 4 kHz of 35 db or more in the better ear. We found that 60 per cent of the sample were deaf. This figure is substantially higher than previous estimates arrived at without the use of audiometry. We discuss some possible reasons for this discrepancy and consider the implications of this level of prevalence of hearing impairment for the health care of the elderly.     

Prevalence of depression in menopause: a pilot study

Summary Objective: The objective of this study was to determine whether women in peri-menopause are more likely to have a major mood disorder than those in pre- or postmenopause. Methods: We studied 100 women between the ages of 45 and 65 years old who were seen at four different women's health centers. Using menstrual and when available, laboratory criteria, each subject was determined to be pre-, peri- or postmenopausal. Each subject completed a Beck Depression Inventory (BDI) and provided psychiatric and medical history in a telephone interview. All patients with a BDI score greater than or equal to 10 were invited to have a psychiatric assessment, including a Structured Clinical Interview for DSM-IV Diagnoses (SCID-DSM IV). Results: The women in the perimenopausal group (n = 38) had statistically significant higher BDI scores than those women in the pre-menopausal (n = 17) and postmenopausal (n = 45) groups (p < 0.0001). Of those in the perimenopausal group who scored ≥ 10 and completed the SCID and met criteria for any psychiatric diagnosis, 11 out of 22 met criteria for Major Depressive Disorder, Recurrent. Conclusions: These data suggest that perimenopause may be a associated with recurrence of pre-existing depressive illness. The findings underscore the clinical importance of screening for and treating major depressive illness in women during the menopausal years.     

Prevalence and risk-factors for depression in elderly Turkish and Moroccan migrants in the Netherlands

BACKGROUND: Western societies host increasing number of elderly labour migrants from Turkey and Morocco. The article studied the prevalence of clinically significant depressive symptoms among elderly Turkish and Moroccan migrants compared with native Dutch elderly and if differences in prevalence rates were explained by known risk factors for depression and/or ethnic, migration-related factors. METHODS: 330 Turkish, 299 Moroccan, and 304 Dutch elderly (55-74 years) were interviewed (cross-sectionally) using the Center for Epidemiologic Depression Scale (CES-D). Potential risk factors included sex, income level, marital status, ethnic origin, chronic physical illnesses, limitations in daily functioning, migration and acculturation questions. RESULTS: The prevalence of self-reported depressive symptoms (CES-D>or=16) was very high in elderly migrants, 33.6% for Moroccan and 61.5% for Turkish elderly. The prevalence of depressive symptoms in the native Dutch sample was similar to earlier studies in the Netherlands and abroad: 14.5%. Among migrants education and income level was very low and they had a high number of physical limitations and chronic medical illnesses. This only explained part of the ethnic differences found. In all three samples, depressive symptoms were associated with sex, chronic physical illness and physical limitations. In multivariate analysis, ethnic origin was uniquely associated with the presence of clinically significant depressive symptoms. Only a small number of remigration and acculturation items were associated with depressive symptoms in bivariate analysis. CONCLUSIONS: The prevalence of clinically significant depressive symptoms among elderly migrants from Turkey and Morocco in the Netherlands is very high. Ethnicity was a strong independent risk factor.     

Prevalence of magnesium and zinc deficiencies in nursing home residents in Germany.

In a multicentric study with 345 seniors over 70 years old we investigated magnesium and zinc levels in serum together with the prevalence of their typical symptoms of deficiency in nursing home residents (NHR) and non-nursing home residents (nNHR). In addition calcium, sodium and potassium levels in serum were determined as well as creatinine and albumin. Considering all seniors 33 per cent exhibited hypomagnesemia and 19 per cent hypozincemia. Zinc levels of female and male NHR were significantly lower than levels of nNHR. Hypomagnesemia was significantly associated with calf cramps and with diabetes mellitus. Hypozincemia was significantly associated with impaired wound healing.     

Hepatitis B virus infection among residents of a nursing home for the elderly: seroepidemiological study and molecular evolutionary analysis

A seroepidemiological study of HBV infection was carried out to investigate the seroprevalence of hepatitis B surface antigen (HBsAg) and the transmission routes of hepatitis B virus (HBV) infection among residents of a nursing home for the elderly. HBV serum markers were examined in 119 residents and 71 healthcare workers in the institution, as also in 1330 healthy subjects from the same geographical area, as the control group. HBsAg was detected in 6 (5%), 0 and 20 (1.5%) residents, healthcare workers and healthy subjects, respectively. Four residents (A-D) who had HBV-DNA in the serum were studied by molecular evolutionary analysis. The strains derived from residents A, B and D were clustered together within a close range of evolutionary distances. Residents B and D, who were not positive for HBsAg at the time of admission to the institution, subsequently became HBsAg-positive asymptomatic carriers. These results suggested intrainstitutional transmission of HBV in the nursing home for the elderly, and confirmed that the source of transmission of HBV to residents B and D was resident A who was positive for HBsAg. Residents in a nursing home for the elderly should be considered as being a high-risk group for HBV infection, and vaccination against HBV of these groups is recommended.     

Exposure to light at night and risk of depression in the elderly

Background

Recent advances in understanding the fundamental links between chronobiology and depressive disorders have enabled exploring novel risk factors for depression in the field of biological rhythms. Increased exposure to light at night (LAN) is common in modern life, and LAN exposure is associated with circadian misalignment. However, whether LAN exposure in home settings is associated with depression remains unclear.

Methods

We measured the intensities of nighttime bedroom light and ambulatory daytime light along with overnight urinary melatonin excretion (UME) in 516 elderly individuals (mean age, 72.8). Depressive symptoms were assessed using the Geriatric Depression Scale.

Results

The median nighttime light intensity was 0.8 lx (interquartile range, 0.2–3.3). The depressed group (n=101) revealed significantly higher prevalence of LAN exposure (average intensity, ≥5 lx) compared with that of the nondepressed group (n=415) using a multivariate logistic regression model adjusted for daytime light exposure, insomnia, hypertension, sleep duration, and physical activity [adjusted odds ratio (OR): 1.89; 95% confidence interval (CI), 1.10–3.25; P=0.02]. Consistently, another parameter of LAN exposure (duration of intensity ≥10 lx, ≥30 min) was significantly more prevalent in the depressed than in the nondepressed group (adjusted OR: 1.71; 95% CI, 1.01–2.89; P=0.046). In contrast, UME was not significantly associated with depressive symptoms.

Limitation

Cross-sectional analysis.

Conclusion

These results suggested that LAN exposure in home settings is significantly associated with depressive symptoms in the general elderly population. The risk of depression may be reduced by keeping nighttime bedroom dark.     

广州市中专生的抑郁状况及影响因素分析

目的了解广州市中专生抑郁情绪的发生情况并探讨可能的影响因素,为其心理健康教育及咨询提供依据。方法应用Zung′s抑郁自评量表（SDS）及自制抑郁相关因素调查表对224名广州市某职业学校学生进行调查。结果 SDS总标准分为（47.92±9.50）,抑郁检出率为42.0%;非条件Logistic回归分析结果为和父母一起居住是抑郁的保护因素（OR=0.259）,学习成绩差、家庭经济困难是抑郁的危险因素（OR=1.783、1.896）;抑郁状况在1周内感到孤独的天数、是否想过离家出走、是否想过自杀等方面的分布差异均有统计学意义（P〈0.05）。结论广州市中专生抑郁较严重,可通过让学生和父母一起居住、改善由学习成绩差及家庭经济困难带来的心理负面影响以降低其抑郁情绪的发生。     

艾司西酞普兰与帕罗西汀治疗老年性抑郁症对照研究

目的:研究艾司西酞普兰治疗老年性抑郁症的疗效和安全性。方法:采用随机对照、开放性设计,将107例在精神病专科医院接受门诊和住院治疗的老年性抑郁症患者随机分配到两组,艾司西酞普兰治疗组52例,帕罗西汀治疗组55例,疗程8周。用汉密尔顿抑郁量表(Hamilton Rating Scale for Depres-sion,HRSD)和老年抑郁量表(Geriatric Depression Scale,GDS)评估患者疗效。用副反应量表(Treat-ment Emergent Symptom Scale,TESS)评估患者的药物不良反应。疗效分析采用意向性分析法(Intent to Treat Analysis,ITT),对中途退出或失访的病例采用末次分析截转法(Last Observation Carried Forward,LOCF)处理缺失值。结果:艾司西酞普兰组治疗期间脱落率低于帕罗西汀组(21.1%vs.40.0%,P=0.034)。在治疗8周末,艾司西酞普兰组患者痊愈10例(19.23%),显著进步11例(21.2%),好转17例(32.7%),无变化14例(26.9%);帕罗西汀组痊愈9例(16.4%),显著进步12例(21.8%),好转21例(38.2%),变化13例(23.6%),两组差异无统计学意义(P0.05)。艾司西酞普兰治疗组抑郁症状评分改善的时间早于帕罗西汀组[治疗第一周末艾司西酞普兰组GDS分(13.7±4.5)低于帕罗西汀组(17.3±5.1),P0.001;治疗第二周末艾司西酞普兰组HRSD评分(16.6±3.5)低于帕罗西汀组(24.4±6.1),P0.001),且不良反应率低于帕罗西汀组(28.8%vs.47.3%,P0.05)]。结论:与帕罗西汀相比,艾司西酞普兰治疗老年性抑郁症患者起效快和不良反应发生率低。     

老年前期抑郁症患者心理社会因素及其临床特点分析

采用世界卫生组织抑郁障碍标准化评定表格 WHO/SADD,及 Hamilton 抑郁量表,对30例(50—60岁)老年前期抑郁症患者。及30例50岁以下抑郁症患者进行对照研究。结果提示前者在负性生活事件、躯体疾病及躯体化症状,焦虑情绪及疑病倾向等方面,明显多于后者,有显著性异差,而两者之抑郁症的核心症状无明显差异。     

Increased risk of depression in patients with rheumatoid arthritis: a seven-year population-based cohort study

OBJECTIVE:

Rheumatoid arthritis (RA) is a costly and crippling autoimmune disease that can lead to the development of depression, contributing to suboptimal clinical outcomes. However, no longitudinal studies have identified an association between rheumatoid arthritis and subsequent depression. This study aimed to investigate the incidence and risk factors of depression among RA patients in Taiwan.

METHODS:

Using Taiwan''s National Health Insurance Research Database, we identified 3,698 newly diagnosed RA patients aged 18 years or older, together with 7,396 subjects without RA matched by sex, age and index date, between 2000 and 2004. The incidence of depression and the risk factors among RA cases were evaluated using Cox proportional-hazard regression.

RESULTS:

The incidence of depression was 1.74-fold greater in the RA cohort than in the non-RA cohort (11.80 versus 6.89 per 1,000 person-years; p<0.01). Multivariate analysis showed that RA subjects who were female, were older, or had comorbidities such as stroke, chronic kidney disease, or cancer had a significantly greater risk of depression compared with those without these conditions.

CONCLUSION:

This population-based cohort study showed a strong relationship between RA and a subsequent risk of depression. The findings could be beneficial to healthcare providers for identifying individuals with a higher predisposition for depression, thereby possibly facilitating the provision of an appropriate rehabilitation intervention after RA onset to support the patient''s adaptation.     

Insomnia as a risk factor for onset of depression in the elderly

There are at least 9 studies that provide evidence that insomnia is a significant risk factor for recurrent and new onset major depressive disorder (MDD), two of which suggest that this association also exists specifically for the elderly. In this study, archival data from a community sample of healthy elderly participants were used to assess the extent to which insomnia predicts future illness in this age cohort. Out of the 147 participants with no prior history of mental illness, 66 participants were classified as having no insomnia, 47 had indeterminate insomnia, and 34 had persistent insomnia. Twelve participants developed MDD during the 1-year follow-up period. Two had no insomnia, 4 had indeterminate insomnia, and 6 had persistent insomnia. Persistent insomnia with onset of depression occurred only in female participants and was significantly associated with middle insomnia. These data suggest that elderly participants with persistent insomnia are at greater risk for the development of new onset depression.     

Analysis of a general practitioner's work in a private nursing home for the elderly

A quantitative analysis was made over a fouryear period (1984-87) of the work and time involved for one rural general practitioner in caring for 42 elderly patients living in a private nursing home. The results were compared with those for the rest of the practice. The study showed that the consultation rate for nursing home patients was 50% higher than the rate for the remaining practice patients aged 65 years or over, and more than twice that for the whole practice. The prescribing rate in the nursing home was twice that of the 65+ years group and six times the rate for the whole practice. The hospital referral rate for nursing home patients was twice that of the 65-74 years group, and four times that for the whole practice. The time involved per year in looking after each nursing home patient was nearly twice that for the remaining practice patients aged 65-74 years, and three times that for practice patients aged under 65 years. From this study it would appear that concentrations of elderly patients in nursing homes in areas served by only a few general practitioners can cause considerable increases in workload. This could present problems in the organization of suitable care.     

Clinical correlates of anxious depression among elderly patients with depression

OBJECTIVE: The purpose of this study was to determine the clinical correlates of comorbid anxiety and depression in a sample of older patients with major depression. METHODS: 352 patients aged 59 and older with major depression were enrolled in the Study of Depression in Later Life at Duke University, of whom 148 met criteria for lifetime generalized anxiety disorder. Participants completed self-report assessments of performance in basic and instrumental activities of daily living, social support, suicidal ideation, life satisfaction, and stressful life events. Cognitive assessment was done with the Mini-Mental State Examination. RESULTS: The prevalence of lifetime anxiety in our depressed sample was 42%. Patients with anxious depression were significantly younger, and had greater suicidal ideation, more impairment of subjective social support, and more severe depressive symptoms. CONCLUSION: In elderly patients with anxious depression, psychosocial support and suicidal ideation should be assessed. Whether improvement of subjective social support leads to reduction in anxious depression should be investigated.     

Clinically significant changes in burden and depression among dementia caregivers following nursing home admission

Background  

Although extensive research exists on informal long-term care, little work has examined the clinical significance of transitions in family caregiving due to a lack of established clinical cut-points on key measures. The objectives of this study were to determine whether clinically significant changes in symptoms of burden and depression occur among caregivers within 12 months of nursing home admission (NHA) of their relatives with dementia, and to identify key predictors of clinically persistent burden and depression in the first year after institutionalization.     

Illumination levels in nursing home patients: effects on sleep and activity rhythms

Studies examining levels of illumination in adult populations have demonstrated that the level and amount of light exposure are lower in the elderly compared with younger adults, particularly in institutionalized patients with dementia. Although insufficient light exposure has been implied as a cause of sleep fragmentation, evidence for such a relationship is scant. Sixty-six institutionalized elderly had their activity and light exposure monitored for a 3-day period. Mean and median light levels, minutes spent over 1000 and over 2000 lux, percent sleep and wake, and number of naps were computed for daytime intervals, defined as 07.00-18.59. Percentages of sleep and wake, number of awakenings and mean duration of wake periods were computed for night-time intervals, defined as 22.00-05.59. Mesor, amplitude and acrophase of activity and of light were determined by cosinor analysis. A mixed linear model was used to assess the effects of daytime Actillume measures on subsequent night-time measures, and vice versa. Spearman correlations were computed, and multiple regression analyses were carried out with light variables and dementia level as predictors and sleep-wake and activity measures as dependent variables. The median light level was 54 lux and a median of only 10.5 min were spent over 1000 lux. Higher light levels predicted fewer night-time awakenings, and severe dementia predicted more daytime sleep and lower mean activity. Increased bright light exposure predicted later activity acrophase. There was an association between the acrophases of light and of activity, with maximum illumination preceding peak activity. These results suggest that daytime light exposure has an impact on both night-time sleep consolidation and timing of peak activity level.     

Prevalence, correlates and recognition of depression in the oldest old: the Leiden 85-plus study

BACKGROUND: Various studies support the notion that the clinical picture of depression in the oldest old differs from that in younger elderly. Moreover, withstanding the serious negative effects of depression on well being and functioning, the detection rate of depression in several medical settings is low. METHODS: Prevalence of depression, correlates and the rate of recognition by general practitioners were assessed in an 85-year-old community-based population. The GDS-S was applied in 500 participants with a MMSE >18, from a representative sample of 599 community based 85-year-old subjects. Demographic data, daily functioning, health correlates, use of medication and recognition of depression were recorded in home visits and from the general practitioner and pharmacists registers. RESULTS: The prevalence of depression, as measured with a GDS-S score of 5 points or more, was 15.4%, which is comparable to previous studies. No demographic factors were correlated with depression. Perceived health, loneliness, impaired mobility, cognitive decline and functional disability were major correlates of depression. From the participants who were seen by their general practitioner, 25% were recognised as depressed. Antidepressive pharmacotherapy was almost nonexistent. LIMITATIONS: Formal diagnosis of depression was not available. The data were collected cross-sectionally. CONCLUSIONS: Depression is highly prevalent in the oldest old and strongly associated with functional disability and cognitive impairment. It is important to enhance recognition of depression in community based oldest old as a first step to possible interventions.