Absence of depression in elderly adults

Depressive symptomatology has been reported to be most prevalent over the age of 65. This study examined the effects of age (young less than or equal to 60 years, old greater than 60 years) and sex on the Beck Depression Inventory (BDI), MMPI Scale 2 (Depression), and Geriatric Depression Scale (GDS). Responses to somatic versus psychological complaints on the BDI were examined separately, and the physical malfunctioning subscale (D3) of the MMPI-2 was also evaluated. No age effects were found on any of the depression scales' total scores. On the BDI, the older group reported more somatic complaints than the younger group. Psychological complaints were reported equally for young and old groups. Women reported more depressed items on the MMPI-2 and reported a greater number of symptoms of physical malfunctioning (D3) than men for both age groups. No age by sex interaction reached significance. A report of greater physical malfunctioning (D3) was significantly associated with higher scores on all the depression scales. The increased prevalence of somatic complaints on self-report depression scales probably results in higher scores, which are misinterpreted as representing more depression in the elderly population. It is recommended that a depression scale such as the GDS, which excludes somatic items, be used to assess depression in older adults.     

Determinants of depressive reactions in the aged

A community sample of older adults was investigated to test some of the current hypothesis about the etiology of depression in the elderly. Multiple regression analysis showed that cognitive disturbances (memory, concentration), previous depressive episodes, and somatic health problems accounted for most of the etiological variance. Other variables, like stressful life events, financial problems, social isolation, alcohol use, age, sex, and previous somatic illnesses are significant but their numerical values are very small. Etiological insignificant were the variables: physical activities, competency in daily living, and support by ones own children.     

Disability and depressive symptoms in the elderly: the effects of instrumental support and its subjective appraisal.

This article explores the buffering effect of social support on depressive symptoms in a community sample of elderly with varying levels of disability. Baseline interviews were conducted in respondents' homes. Results show that higher levels of disability are associated with higher levels of depression. Instrumental support and subjective appraisal of the network are associated with depressive symptoms, but instrumental support has a weak positive correlation, while subjective appraisals show a negative relationship. Social support mitigates the depressive effect of disability only when the network's efforts are appraised positively. However, no such relationship is shown for instrumental support. One's perception of the network's helpfulness appears to be more potent than the actual help provided by friends and family.     

Interdigestive plasma motilin concentrations in aged adults

The interdigestive plasma motilin concentrations were evaluated in 13 over-65 healthy adults with no evidence of significant disease and in 19 younger individuals. Plasma motilin levels were determined every 15 min during a 3-hr fasting period, using a radioimmunological method. The individual median values of plasma motilin concentrations during the entire study period were significantly higher in aged than younger adults. The individual median coefficients of variation of motilin concentrations and the percentage increases of plasma motilin above baseline at each peak were significantly lower in the aged than in the young group. The results of this study indicate that during the interdigestive period aged individuals have markedly elevated circulating motilin levels, with less pronounced fluctuations than younger persons. This particular hormone pattern could be involved in motor disturbances of the stomach in elderly adults.     

Survival and cell mediated immunity after burn injury in aged mice

The elderly are less able to survive burn injury than young healthy individuals. Regardless of age, burn victims often succumb to secondary infections rather than the primary injury. Since immune responses diminish with age, it is likely that aged individuals are predisposed to a poor outcome by virtue of their weak immune system. Elevated production of macrophage-derived mediators, including interleukin-6 (IL-6), may lead to post-injury immunosuppression in young adults. Healthy aged individuals produce high circulating levels of these mediators; therefore, the combination of the age and burn trauma could further suppress immune responses and contribute to the rapid demise of aged burn patients. Herein, the effects of age and burn trauma using a murine scald injury model were examined. After injury, aged mice are less likely to survive, are unable to mount immune responses, and produce more IL-6 when compared to young adult mice given the same size injuries. Enhancing our understanding of the mechanisms responsible for regulating cell-mediated immune responses after injury could lead to the development of therapies designed to treat aged burn patients.     

Chronic rheumatologic symptoms in a tri-ethnic sample of men and women aged 75 and older

BACKGROUND: The high prevalence of musculoskeletal symptoms in elderly persons tends to obscure the recognition of specific medical conditions. The purpose of this study is to describe the prevalence of chronic rheumatologic symptoms and the associated measures of health status in an older population. METHODS: This is a cross-sectional study of 507 noninstitutionalized tri-ethnic men and women aged 75 and older living in Galveston County, Texas. A home interview collected data on demographics, chronic medical conditions, cognition, depression, and functional status. Site, severity, and duration of rheumatologic symptoms such as morning stiffness, body tenderness, and body aching in the past month were also collected. RESULTS: There was a high prevalence of nonspecific rheumatologic symptoms such as morning stiffness (32% in the shoulder girdle, 31% in the hip girdle), tenderness to touch (9%), and generalized body aching (11%) in the study population. Twenty-one percent of the subjects reported either bilateral shoulder or hip girdle stiffness or tenderness lasting more than 30 minutes almost every day or every day or generalized body aching most of the time during the past month. Age-, gender-, and ethnicity-adjusted multivariate analyses showed that more than three self-reported chronic medical conditions, poor or fair self-reported health, impairment in instrumental activities of daily living (IADL), and the presence of depressive or anxiety symptoms were associated with the presence of these chronic rheumatologic symptoms. CONCLUSION: Chronic rheumatologic symptoms are common in people aged 75 and older. Such symptoms are markers for underlying poor health and for anxiety and depression among older subjects.     

What Symptoms of Depression Predict Mortality in Community‐Dwelling Elders?

OBJECTIVES: To determine which symptoms of depression are most likely to increase the risk of mortality in a biracial sample of older adults. DESIGN: Cross-sectional and longitudinal study. SETTING: Baseline and mortality follow-up in urban and rural North Carolina. PARTICIPANTS: Four thousand one hundred sixty-two African-American and white elders aged 65 to 105 at baseline (mean age 73). MEASUREMENTS: Sociodemographic and health factors and four subscales of the Center for Epidemiologic Studies Depression Scale (negative affect, positive affect, somatic symptoms, and interpersonal function) were determined at baseline (1986-87). Mortality was assessed over 10 years of follow-up (through 1996). RESULTS: Fifty-one percent of the sample died over the 10-year follow-up. In controlled Cox proportional hazards modeling, those who scored lower on the positive affect scale were significantly more likely to die over the 10-year follow-up (hazard ratio=1.12, 95% confidence interval=1.05-1.18). For those who scored higher on the negative affect scale, the somatic scale, and the interpersonal scale, there was no increased risk for mortality in controlled analyses. CONCLUSION: These findings suggest that subjective views of well-being may be more important predictors of mortality in older adults than the classic symptoms of depression, such as negative affect and somatic symptoms.     

Delusional depression in the elderly: a community study

The prevalence of delusional depression, its symptoms and signs, and social and health status of delusional depressives were studied in a Finnish population aged 60 years or over. The prevalence was six per 1,000 men, 12 per 1,000 women, and 10 per 1,000 for both sexes. The overall symptomatology of delusional depressives was more severe than that of nondelusional major depressives or of all nondelusional depressives. The mean age at the onset of depression and the mean duration of depression did not differ between delusional and nondelusional major depressives. Although delusional depressed elderly did not significantly differ statistically from nondelusional major depressives in social status, somatic health status, functional capacity, or occurrence of social or health stress factors; they tended to have a better somatic health status and they tended to be more lonely. The small number of delusional depressives does not give us the opportunity to draw straightforward conclusions about whether elderly delusional depressives are a subcategory differing from other elderly major depressives.     

Satisfaction with general practitioner treatment of depression among residents of aged care facilities

OBJECTIVE: This article investigates consumer perspectives on the treatment for depression among older people in residential facilities. METHOD: Aged care residents who were aware of being treated for depression in the past 6 months (24 women and 7 men, mean age = 83 years) participated in an interview that assessed their perspective on treatments. RESULTS: Although more than half of the participants in the sample reported overall satisfaction with the medical treatments received for depression, qualitative data provided indications of unsatisfactory service delivery, including perceptions of low treatment efficacy, short consultation times, the failure to assess affective symptomatology, and negative responses to residents' disclosure of symptoms. DISCUSSION: The findings are discussed in relation to previous research on consumer satisfaction with health services and issues that may be pertinent to the elderly depressed. Training for general practitioners providing treatment in aged care is indicated.     

Clinical correlates of age of onset in psychotic depression

The issue whether the clinical characteristics of unipolar psychotic major depression (PMD) vary according to the age of onset remains still unclear. Thus, the aim of this study was to assess comparatively a broad set of clinical characteristics of three groups of PMD patients, namely young early-onset (n = 30), elderly early-onset (n = 34) and elderly late-onset (n = 35). Ninety-nine inpatients suffering from DSM-IV unipolar PMD were assessed on the basis of Structured Clinical Interview for DSM-IV (SCID-IV), Hamilton Rating Scale for Depression (HRSD) and a physical impairment rating scale. The elderly late-onset patients suffered from overall more severe depression compared to both early-onset ones, more psychic anxiety compared to elderly early-onset patients and more gastrointestinal symptoms compared to young early-onset patients. Additionally, they expressed significantly more frequently delusions of somatic content and higher scores on the HRSD item of hypochondriasis than their young early-onset counterparts. The group of elderly early-onset PMD patients was found to hold an intermediate position between the young early-onset and elderly late-onset PMD patients with regard to hypochondriacal ideation, gastrointestinal symptoms and delusions of somatic, guilt, and paranoid content. Their stability of delusional content across successive episodes was found to extend into old age. Nevertheless, they expressed additional somatic delusions. Overall, the findings of the present study suggest considerable differences between young early-onset, elderly early-onset and elderly late-onset PMD patients with respect to their clinical features.     

Prevalence of back symptoms in elders

OBJECTIVE: The prevalence of back pain has not been well studied in elders in the US. We describe the prevalence of back symptoms in a cohort of elderly subjects residing in the US by age, sex, examination site, and location of pain. METHODS: Data from this study are based on 1037 surviving members of the original Framingham Heart Study cohort aged 68-100 years who participated in the 22nd biennial examination in 1992-93. Subjects were questioned about back pain and timing and location of pain. RESULTS: Prevalence estimates varied, depending on the question used to assess back symptoms and the manner in which the question was asked. For example, back symptoms on most days occurred in 22.3 of 100 elders. Low back symptoms were more prevalent than those in the mid or upper back. Prevalence was higher among women than men, especially for symptoms in the mid or upper back area. Age did not affect the prevalence of back symptoms in this elderly cohort. Back symptoms were also more prevalent among subjects who were examined in their residence than among those who were examined at the examination site. Most subjects who were examined at their residence chose this location for health reasons. CONCLUSION: Back symptoms are highly prevalent in the elderly, although, among elders, they do not increase in prevalence with age. They are more common in women than men. Elders confined mostly to their homes have an especially high prevalence of back symptoms.     

Anemia in the elderly

We measured red blood cell counts, hemoglobin levels, hematocrit values, serum iron levels, total iron binding capacity, transferrin saturation, and serum ferritin levels in 364 elderly subjects in the eighth decade, who consisted of 283 subjects (171 males, 112 females) living in their own homes and 81 subjects (28 males, 53 females) living in an old-age home. The mean values of RBC, Hb, Ht, SI, s-Ft in both male and female subjects living in their own homes were 469 X 10(4)/microliters vs 439 X 10(4)/microliters, 14.6 g/dl vs 13.3 g/dl 44.3% vs 40.6%, 95.6 micrograms/dl vs 84.8 micrograms/dl, 50.2 ng/ml vs 42.6 ng/ml, respectively. On the other hand, the mean values of RBC, Hb, Ht, SI, s-Ft in both male and female subjects living in an old-age home were 421 X 10(4)/microliters vs 390 X 10(4)/microliters, 13.8 g/dl vs 12.6 g/dl, 39.9% vs 36.7%, 74.2 micrograms/dl vs 58.6 micrograms/dl, 98.8 ng/ml vs 69.1 ng/ml, respectively. All erythrocyte parameters were significantly lower in females than in males in both groups, and significantly lower in subjects living in an old-age home than in subjects living in their own homes. The erythrocyte parameters of subjects living in their own homes showed little difference compared with those of normal young adults. These results suggest that a sedentary lifestyle in the elderly people contribute to the tendency to have anemia and this is considered to relate to age-associated pathology such as inflammation. As anemia in elderly people often follows a underlying illness, we must always give attention to the factors which cause anemia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Nutritional status of the very old: anthropometric and biochemical findings in apparently healthy women in old people's homes.

To obtain reference values for comparison with malnourished geriatric patients, the nutritional status of 50 apparently healthy women aged 75 or older living independently in two old people's homes in Heidelberg was examined. All women were able to walk, and were free from overt disease and signs of mental deterioration. Anthropometric measurements (body height and weight, triceps skinfold thickness, midarm circumference) and biochemical determinations of protein and vitamin status were performed. Anthropometric parameters were similar to those obtained in "younger" samples of healthy elderly, lower than those reported in younger adults, and markedly greater than those reported in geriatric patients. The majority of biochemical findings were within normal reference ranges established for healthy young adults. Only plasma retinol concentrations were below the reference limit in 8 women (16%). These findings show clearly that even in the very old, major alterations in biochemical indicators of nutritional status are rare. Neither advanced age nor institutionalization are associated with malnutrition. This obviously suggests that malnutrition in old age is mainly related to physical and mental disabilities.     

西安市养老机构入住人员医养结合现状调查

目的调查西安市养老机构内入住老年人医养结合的现状。 方法于2017年9月至2018年1月对西安市不同区划内12家养老机构的111例老年人进行问卷调查,调查内容包括老年人基本情况、养老支持情况和医养结合相关需求。 结果入住老年人主要以80～89岁的老年人为主（占44.5%）,受教育程度多为小学及以下水平（占40.2%）;月收入1 500～4 000元者最多（占43.4%）,养老月花费为1 000～3 000元者最多（占78.2%）;89例（80.4%）处于丧偶状态;76例（68.4%）老年人不了解、也不曾听说医养结合的相关知识和政策;48.5%的老年人因需要照护而入住养老院。大部分[71例（63.9%）]老年人对服务满意。 结论目前的养老机构医护水平参差不齐,无法满足日增增多的老年人的医疗和照护需求,政府指导下的社会养老亟待进一步完善和快速发展。     

Beyond nosography of depression in elderly

The patterns of depressive symptoms that occur in the elderly are appreciably different from those manifested in younger-age groups. Older depressed patents tend to report more somatic and cognitive symptoms than affective ones. An exclusively categorical approach to depression among the elderly does not provide adequate means for an exhaustive classification of mood disorders in old age. Taking into account clinical features, high comorbidity and the overlap with the physiological somatic changes due to aging, a dimensional approach seems to better account for depressive symptoms in the elderly.     

Relationship between balance performance and musculoskeletal pain in lower body comparison healthy middle aged and older adults

The purpose of this study was to determine relationship between balance performance and pain in lower body among healthy adults. Two hundred and forty volunteer subjects (125 middle aged and 115 elderly people) aged 50 years and above participated. The average age was 61.52+/-8.22 years (range 50-75 years). The functional reach test (FRT) was used to measure balance ability. The visual analog scale (VAS) was used to measure pain intensity. Subjects were also asked to indicate sites they experienced pain in their lower body (e.g., low back, hip, knee, ankle, toes). Falls history was also recorded. The elderly people had a lower FRT score as compared to the middle-aged adults (p<0.001). Knee, low back, and hip pain were most common in both groups. The elderly people reported more frequency of falls than the middle-aged adults. The score of the FRT was higher among men (20.67+/-7.16cm) than among women (18.77+/-6.59cm). In both groups; the women had a higher VAS score than those of matched the men. Although the middle-aged adults had higher and better scores than the elderly people, the data showed that the middle-aged adults are also at risk and should be prepared properly for healthy aging.     

Acute idiopathic pericarditis in the aged.

Eleven elderly patients with idiopathic pericarditis are reported. All but one were older than 60 yr. Evidence of ischemic cardiovascular disease was present in 8 patients. The initial diagnosis was heart failure with pulmonary complications in 4 cases and myocardial infarction in 3. Respiratory infection preceded the onset of pericarditis in 5 cases. Presenting symptoms were typical precordial pain, fever and dyspnea. Pericardial friction was found in 7 cases and transient rhythm disturbances in 5. Four patients had ST elevation and 3 had ST depression in their electrocardiograms. Other findings included an increased sedimentation rate, leukocytosis, elevated venous pressure and normal SGOT levels. Antibiotics were of no avail but prednisone had a dramatic effect. Two patients had a relapsing course lasting 2 yr or more. One patient, who died at the age of 75 from bleeding ulcer, had patent coronary arteries and mild perimyocardial fibrosis. The diagnosis of idiopathic pericarditis in the aged is difficult because the disease simulates ischemic heart disease in patients who frequently have evidence of arteriosclerotic cardiovascular involvment.     

Depressive symptoms as a predictor of memory decline in older adults: A longitudinal study using the dual change score model

The directionality of the longitudinal association between depressive symptoms and memory remains a topic of intense debate. A unidirectional association where depression impacts the change in memory (or vice-versa) and a bidirectional association where the trajectories of both dimensions affect each other lead to different clinical implications. Method: This study investigated the depression-memory longitudinal association in a sample of 2057 older adults aged between 60 and 99 years old from the Virginia Cognitive Aging Project. The bivariate dual change score model was used to investigate the directionality of the association between episodic memory and three dimensions of depression (somatic symptoms, depressed affect, and positive affect) throughout ten years (five measurement points), controlling for education and sex. Results: the bidirectional model showed the best fit between somatic symptoms and memory, with a significant coupling effect observed from initial somatic symptoms to subsequent changes in memory. For depressed and positive affect, the unidirectional model with initial levels of depression predicting following changes in memory showed the best fit to the data, with significant coupling effects observed. Higher initial levels of somatic symptoms and depressed affect predicted a subsequent decline in memory, and higher initial levels of positive affect predicted subsequent better memory performance. Statistical adjustments for covariates (education and sex) had no significant influence on these associations. Conclusions: Our findings support a unidirectional association with higher depressive symptoms preceding a steeper decline in memory in older adults. We discuss the clinical implications for depressive symptoms as a predictor of subsequent memory decline.     

Housing facilities for the elderly in India

In India, the aged prefer to live with their children. Sons consider it their duty to look after their aged parents, and they do not allow them to be sent to old-age homes. The joint family is the predominant household form in rural and urban areas, and even in the slums. But when the elderly do not have family members to care for them, old-age homes are their last resort. However, the demand for spaces in these homes far exceeds supply. About the author: Shabeen Ara, Ph.D., is the Head of Research and Development and Computer Establishment of HelpAge India. She is also the editor of the Research and Development Journal. She is the author of the book, Old Age among Slum Dwellers.