Fatigue, depression, and cognitive performance among aged persons

Previous research by the authors has suggested that older persons who are depressed may be especially susceptible to the effects of fatigue in situations where multiple skills are assessed. The impact of fatigue and the effects of depression on cognitive performance have long been recognized as impediments to the accurate assessment of competence in the aged. To investigate such influences, data were gathered from 72 aged persons who had been screened for depression and assigned to one of three conditions varying in effort and the fatigue-inducing nature of the tasks to be solved. Results suggested depressed persons were more prone to fatigue. For measures of both active and passive short-term memory, depression and task effort impacted on performance. Such effects were considerably weaker for measures of intelligence.     

Distress,depression and anxiety among persons seeking HIV testing

We investigated psychological distress and symptoms of depression and anxiety among 485 South Africans seeking HIV testing. The mean scores of the sample were 45.78 (SD?=?16.81) on the Hopkins Symptom Checklist; 15.8 (SD?=?12.4) on the Beck Depression Inventory and 12.44 (SD?=?13.00) on the Beck Anxiety Inventory, which fell in the elevated, mild and low ranges on these instruments, respectively. For more than a third of participants, symptoms of depression and clinically significant distress were at least moderate and in some cases severe, indicating that they may have benefitted from psychological help. We make the case that symptoms of depression and distress are common among persons seeking HIV testing and are therefore not a consequence of an HIV-positive test result.     

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.     

Color vision deficits and Rorschach performance in aged persons.

Forty-two community residing older adults (M age = 69.28) (32 color normal, 10 color deficient) were administered the Rorschach and measures of both verbal and nonverbal intelligence in order to explore the effect of color vision deficiencies on affective responsivity. Among the sample of older persons screened for both visual and auditory acuity, when controls for intelligence and numbers of responses were made, greater affective constriction was found in the protocols of color vision deficient persons, relative to color normal individuals. These data suggest that Rorschach indicators of affective constriction may be biased in the case of individuals who have experienced color vision decrements. Consequently, first screening for color vision decrements when assessing older persons' personality dynamics may be desirable.     

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.     

Sensory impairments and subjective well-being among aged African American persons

The limited number of studies concerning the prevalence of hearing loss and vision impairment and their causes, and the lack of strategies to prevent or treat the deleterious effects of hearing loss and vision impairment, point to a significant gap in the knowledge base concerning aged minority populations. This cross-sectional study evaluated the relationship between vision and hearing impairment and psychological well-being among a sample of 988 elderly African American persons. Fair or poor vision or hearing was reported for 36.5% and 26% of our sample, respectively. Reported prevalence rates for these impairments are considerably higher than rates previously documented in comparable studies of elderly people conducted in general (i.e., predominantly White) populations. Eighty-four percent of our study participants attempted to improve their vision through the use of eyeglasses. By contrast, only 4.3% of individuals in the study who described their hearing as poor reported using hearing aids. Using multivariate analysis and other related variables that have previously been identified as common predictors of psychological well-being, the findings of this study suggest that poor vision is independently associated with a lower level of psychological well-being among aged African Americans even after adjusting for sociodemographic characteristics, functional limitations, perceived health status, and cognition. Poor hearing was also found to be associated with a lower level of psychological well-being; however, this relationship was not independent but was mediated by the effect of hearing on functional status. These data indicate considerable potential for improved psychological well-being for African American elderly people through visual and audiological rehabilitation.     

Spouse depression and disease course among persons with rheumatoid arthritis

Objective

To examine the role of spouse mood in the disability and disease course of persons with rheumatoid arthritis (PWRA).

Methods

A total of 133 married PWRA completed questionnaires, including the Rheumatoid Arthritis Disease Activity Index and the Disabilities of the Arm, Shoulder, and Hand, assessing PWRA arthritis disease activity and disability, respectively, at 2 time points 1 year apart. In addition, both PWRA and their spouses completed the Center for Epidemiologic Studies Depression Scale, a standardized community measure of depression at both time points.

Results

Multiple regression analysis revealed spouse depressive symptoms at initial assessment to be predictive of followup PWRA disability and disease activity, even after controlling for initial levels of PWRA depression, disability, disease activity, age, number of years married, education, disease duration, and employment. Specifically, higher levels of spouse depression predicted worse disease course over a 1‐year period for PWRA, as indicated by higher reports of subsequent PWRA disability and disease activity.

Conclusion

Our findings highlight the key role played by the spouse in PWRA disease course, and point to the importance of including the spouse in clinical interventions. Implications for theory, research, and treatment are discussed with a focus on examining pathways through which spouse depressive symptoms may affect PWRA disease course and disability.     

Influence of level of activity on cognitive performance and cognitive plasticity in elderly persons

As a result of the rapid increase in the elderly population over recent decades, the analysis of factors influencing cognitive aging has become a focus of great interest for current research. In this area, numerous papers have indicated a relation between specific psychosocial variables and the level of activity and cognitive performance and plasticity in old age. This study aimed at testing a theoretical model, which establishes relations between level of activity, cognitive performance and cognitive plasticity in old age. In this study 176 elderly persons participated and were evaluated by means of a cognitive screening test, two cognitive plasticity evaluation tests and a questionnaire on the level of activity before and after retirement. A structural equation analysis was carried out on the data, which reveal significant relations between level of activity after retirement and cognitive performance and plasticity. Similarly, a significant relation is established between cognitive functioning and plasticity. The findings lend support to studies affirming that a high level of activity protects against cognitive decline and is related to cognitive plasticity in old age.     

Anemia and decline in physical performance among older persons

PURPOSE: Anemia is prevalent in old age and is potentially modifiable, but its effects on physical function have not been determined. We examined whether anemia in older persons increases the risk of subsequent decline in physical function, as measured by objective performance-based tests. METHODS: Participants in this 4-year prospective cohort study included 1146 participants, aged 71 years or older, living in Iowa and Washington counties, Iowa. Anemia was defined according to World Health Organization (WHO) criteria as a hemoglobin concentration below 12 g/dL in women and below 13 g/dL in men. An assessment of standing balance, a timed 2.4-m walk, and a timed test of five chair rises were used to assess physical performance; these were combined into a 0 (poor) to 12 (excellent) summary scale. RESULTS: After adjustment for baseline performance score, health status, and demographic characteristics, anemia was associated with greater mean decline in physical performance over 4 years; the adjusted mean decline was 2.3 (95% confidence interval [CI]: 1.7 to 2.8) in subjects with anemia and 1.4 (95% CI: 1.2 to 1.5) in those without anemia (P = 0.003). The association between anemia and greater physical decline was also present in participants who were free of diseases associated with anemia (cancer, infectious disease, and renal failure), and after adjustment for serum cholesterol, iron, and albumin levels. Persons with borderline anemia, a hemoglobin concentration within 1 g/dL above the WHO criteria, also showed greater mean physical decline (1.8; 95% CI: 1.5 to 2.2) than did those with higher hemoglobin concentrations (P = 0.02). CONCLUSION: This study suggests that anemia in old age is an independent risk factor for decline in physical performance.     

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.     

Analyzing reliability of change in depression among persons with rheumatoid arthritis

OBJECTIVE: To examine several methods of determining reliability of change constructs in depressive symptoms in patients with rheumatoid arthritis (RA) and to demonstrate the strengths, weaknesses, and uses of each method. METHODS: Data were analyzed from a cohort of 54 persons with RA who participated in a combined behavioral/pharmacologic intervention of 15 months duration. These longitudinal data were used to examine 3 methodologies for assessing the reliability of change for various measures of depression. The specific methodologies involved the calculations of reliable change, sensitivity to change, and reliability of the change score. RESULTS: The analyses demonstrated differences in reliability of change performance across the various depression measures, which suggest that no single measure of depression for persons with RA should be considered superior in all contexts. CONCLUSION: The findings highlight the value of utilizing reliability of change constructs when examining changes in depressive symptoms over time.     

Training-induced changes in performance self concept and cognitive abilities in the aged

204 healthy elderly subjects (age range 65-85) participated in a training and retest programme leading to marked performance increases in two types of fluid intelligence tests (figural relations and inductive thinking). Effects of testing and training on self-perceived abilities and competence beliefs were measured on a battery of more and less situation-specific, task-related self-report instruments. The strongest and most consistent positive changes in self-concept of abilities attributable to training were found on judgements of task-related self-efficacy and beliefs in personal utility of acquired competence. Judgements of ability as causes for success and failure in future tests were also affected. The results support the view that fluid ability training is a valuable instrument to increase subjective as well as objective efficacy in thinking related to fluid intelligence. Training can therefore be considered helpful in supporting compensatory efforts to counteract age-related losses in perceived as well as actual ability.     

Somatic chronic diseases and 6-year change in cognitive functioning among older persons

The influence of seven highly prevalent somatic chronic diseases on changes in cognitive functioning is investigated in older persons in a prospective design covering a 6-year follow-up period. The data were collected as part of the Longitudinal Aging Study Amsterdam (LASA). The associations between chronic diseases and cognitive functioning during 6 years of follow-up were analyzed among 1358 respondents (age 62-85) using generalized estimated equations (GEE). Cognitive tests were used to assess: general cognitive functioning, fluid intelligence, information processing speed and memory performance. In the fully adjusted models diabetes mellitus, stroke and peripheral artherosclerosis were associated with cognitive decline during a 6-year follow-up period in older persons. In the unadjusted models cardiac disease was negatively associated with memory function. However, after the correction for possible confounders this association became positive. Cancer was also associated with better memory function. A faster decline in especially memory function was found for diabetes mellitus, stroke, cancer, and peripheral artherosclerosis. The study shows that in older persons specific chronic diseases (diabetes mellitus, stroke, cancer, and peripheral artherosclerosis) are associated with decline in one or more domains of cognitive functioning during a 6-year follow-up period. These findings further stress that careful clinical evaluation of cognitive functioning in older persons with these diseases is required in order to provide adequate care.     

Smoking,alcohol use and engagement in exercise and cognitive performance among older adults

Objectives: To examine cross‐sectional and longitudinal effects of history of smoking, alcohol use and engagement in exercise on cognitive performance. Method: Health habits and cognitive performance of a large community sample of older adults were assessed at measurement points two years apart. Results: Past smokers performed more poorly on tests of recall and speed of information processing at times 1 and 2 than those who had never smoked. Past smokers and moderate users of alcohol performed better on confrontation naming and working memory, than those who had never smoked or drank alcohol. Engagement in exercise was related to immediate recall and speed of processing before, but not after, controlling for covariates. Health habits were not related to longitudinal change in cognition. Conclusions: The results suggest a negative effect of history of smoking on effortful cognitive tasks and a protective effect of alcohol use on more automatic cognitive tasks among older adults.