The interplay between life stressors and depressive symptoms among older adults

This study examined mutual predictive associations between life stressors and depressive symptoms in later life. A sample of late-middle-aged and older adults (N = 1,291) was surveyed at baseline and 1 year, 4 years, and 10 years later. At each contact point, participants completed an inventory that assessed chronic and acute life stressors and depressive symptoms. Over the 10-year interval, there was evidence of both social causation and social selection processes: More life stressors were associated with subsequent increases in depressive symptoms (social causation), and more depressive symptoms were associated with subsequent increases in stressors (social selection or stress generation). These findings reflect a mutual influence process in which life stressors and depressive symptoms can alter each other.     

Urban neighborhoods and depressive symptoms among older adults

OBJECTIVE: This study seeks to determine whether depressive symptoms among older persons systematically vary across urban neighborhoods such that experiencing more symptoms is associated with low socioeconomic status (SES), high concentrations of ethnic minorities, low residential stability and low proportion aged 65 years and older. METHODS: Survey data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a 1993 U.S. national probability sample of noninstitutionalized persons born in 1923 or earlier (i.e. people aged 70 or older). Neighborhood data are from the 1990 Census at the tract level. Hierarchical linear regression is used to estimate multilevel models. RESULT: The average number of depressive symptoms varies across Census tracts independent of individual-level characteristics. Symptoms are not significantly associated with neighborhood SES, ethnic composition, or age structure when individual-level characteristics are controlled statistically. However, net of individual-level characteristics, symptoms are positively associated with neighborhood residential stability, pointing to a complex meaning of residential stability for the older population. DISCUSSION: This study shows that apparent neighborhood-level socioeconomic effects on depressive symptoms among urban-dwelling older adults are largely if not entirely compositional in nature. Further, residential stability in the urban neighborhood may not be emotionally beneficial to its aged residents.     

Stress and sex differences in depressive symptoms among older adults

The purpose of this study was to determine whether elderly women experience more symptoms associated with depression than elderly men and, if such sex differences exist, to examine several factors that might account for the greater preponderance of psychological distress among women. Unlike previous studies of elderly adults, this study attempted to explain sex differences in depression in terms of differential-exposure and differential-vulnerability to the effects of life stress. The results from a random community survey of 351 older adults indicate that women are more depressed than men. Moreover, a series of demographic-mean decomposition analyses suggest that greater vulnerability among women to the effects of chronic life strains explains a substantial portion of the observed sex differences in distress. Stressful life events were found to be a less important factor in this process.     

Negative daily events, positive and negative social ties, and psychological distress among older adults

This study examined whether positive and negative social ties moderate the effects of negative daily events on psychological distress of 110 community-dwelling elders age 60-89. In accord with the stress-buffering hypothesis, the effect of negative daily events on psychological distress significantly (p less than .05) decreased as positive social ties increased. Contrary to the stress-amplifying hypothesis, negative social ties did not interact with negative daily events to influence psychological distress, but instead, had a significant (p less than .01) additive effect on it.     

Black-white differences in depressive symptoms among older adults over time

This study examines racial differences in depressive symptoms among older adults over time. The subjects were 4,275 community-dwelling persons aged 65 and older (62% Black) who participated in the Chicago Health and Aging Project (CHAP) during a period of 9 years. Depression was measured using a summary score of the 10-item Center for Epidemiologic Studies-Depression scale (CES-D). We modeled depressive symptoms using the method of General Estimating Equations and a Poisson error structure. We found a significant race effect at baseline with Blacks reporting approximately 60% more symptoms than Whites (beta = 0.467 on the log scale, p < .001). The differences were larger for men than for women. After controlling for age, sex, time, education, income, and related interaction terms, the baseline race effect was reduced by almost half (beta = 0.225, p < .001) but remained robust. The racial differences increased slightly over time. Our findings support heightened awareness of depression in older Black populations.     

Social relationships and depressive symptoms among older adults in southern Brazil

OBJECTIVES: This research tests hypotheses from equity theory and social integration theory regarding the effect of social relationships on depressive symptoms. METHODS: The data are based on a representative sample of people aged 60 and older from southern Brazil. The baseline sample consists of 871 subjects interviewed in 1995. Among those baseline subjects, 551 responded in 1999. Cross-sectional and longitudinal multivariate regression models estimate the effect of two dimensions of social relationships (i.e., social exchanges and social integration) on depressive symptoms, controlling for demographic, socioeconomic, and health characteristics. RESULTS: The results indicate that unbalanced exchange increases depressive symptoms, and social integration decreases depressive symptoms. Specifically, older Brazilians who overbenefit or underbenefit from exchanges with relatives have more depressive symptoms than those with balanced exchanges. In addition, depressive symptoms are lower when an older adult who is receiving support is able to reciprocate. More intensive exchanges with relatives, being married, and satisfaction with family relationships decrease depressive symptoms, whereas living alone increases depressive symptoms. DISCUSSION: The results highlight the relevance of social relationships to depressive symptoms among older Brazilians. In addition, the results indicate there is a nonlinear relationship between exchange balance and depressive symptoms in this population. The implications for policy are discussed.     

Acetylcholinesterase inhibitors and depressive symptoms in patients with mild to moderate Alzheimer's disease

BACKGROUND AND AIMS: Acetylcholinesterase inhibitor (AChEis) therapy in Alzheimer Disease (AD) has been shown to provide cognitive benefits and to slow progression of the disease. AChEis have also been demonstrated to improve behavioral symptoms, although there seem to be subtle differences in the magnitude of response. The aim of our study was to evaluate the effect of 16 weeks treatment with AChEis on depressive symptoms in a selected sample of AD patients in routine clinical practice. SUBJECTS AND METHODS: A study of 135 patients with Alzheimer's disease. All subjects were assessed at baseline (upon initiation of AChEis therapy) and re-evaluated after 16 weeks. RESULTS: At baseline, "Depressed" and "Not depressed" patients were categorized according to DSM IV criteria for depression in Alzheimer Disease. After 16 weeks of treatment with AchEis, we observed an improvement of mood in the "Depressed" patients. In this group "Mood symptoms", measured with GDS, were independently associated with GDS "Mood symptoms" at baseline, but not with improvement on cognition (mean change of MMSE), age or sex. CONCLUSIONS: In depressed AD subjects, AChEis treatment improves depressive symptoms evaluated by GDS. This improvement is independent of cognition enhancement.     

A supervised exercise intervention fails to improve depressive symptoms and quality of life among sedentary older adults with HIV infection

ABSTRACT

Older people living with HIV (PLWH) experience multimorbidity that can negatively impact quality of life (QoL). Exercise can improve physical function, but effects on QoL are not well understood. 32 PLWH and 37 controls aged 50–75 completed 12-weeks of moderate-intensity exercise, then were randomized to moderate or high-intensity for 12 additional weeks. Depressive symptoms (CES-D scores) were significantly greater and QOL (SF-36 mental and physical summary scores) significantly lower among PLWH at baseline (all p?<?0.05). PLWH had significantly greater worsening in CES-D scores compared to controls (3.4 [0.7, 6.0]; p?=?0.01) between 13and 24 weeks. Mental QoL changed minimally, with no significant difference in changes by serostatus between weeks 0 and 12 or weeks 13 and 24 (p?≤?0.22). Changes in physical function summary scores were similar by serostatus between 0 and 12 weeks (1.5 [?1.6, 4.6], p?=?0.35), but declined significantly more among PLWH between 13 and 24 weeks (?4.1 [?7.2,?1], p?=?0.01). Exercise intensity had no significant effect on changes in CES-D or SF-36 summary scores; high-intensity exercise was associated with greater improvements in vitality/fatigue (4.1 [0.8, 7.3], p?=?0.02), compared to moderate-intensity. Exercise initiation failed to improve depressive symptoms or QoL among PLWH. Additional interventions may be needed to maximize these patient-reported outcomes among older PLWH initiating an exercise program.     

The association of depressive symptoms and urinary incontinence among older adults

OBJECTIVES: To examine the relationship of urinary incontinence (UI) and depressive symptoms (DS) in older adults. DESIGN: A randomized, controlled trial to determine the effects of clinical practice guideline implementation on provider attitudes and behavior, and patients' UI, health status, quality of life, and satisfaction with care. Baseline and endpoint data were collected from patients via computer-assisted telephone interviewing. SETTING: Forty-one nonacademic primary care practices (PCP) in North Carolina. PARTICIPANTS: A total of 668 community-dwelling adults (age > 60) who had visited the one of the selected PCPs. INTERVENTION: PCPs in the intervention group were given instruction in the detection and management of UI, educational materials for providers and patients, office system supports, and academic detailing. MEASUREMENTS: The dependent measure was assessed using an eight-item screener for DS. UI (status, frequency, amount), health (physical, mental), and demographic (age, gender, marital status) and self-report information about bladder control served as predictors. RESULTS: Wilcoxon rank sum tests showed that UI status was associated with moderate to severe DS (43% vs 30%, P = .05). Multivariate analyses showed that UI status, physical and mental health, and gender were significant predictors of DS. Among UI adults (n = 230), physical and mental health, life satisfaction, and the perception that UI interfered with daily life were significant predictors of DS. CONCLUSIONS: This study provides clear evidence that UI is related to DS in older adults.     

Level of depressive symptoms and life stresses for culturally diverse older adults

Interviews were conducted with 181 people 65 years of age or older to study depressive symptoms and life stresses. The sample was approximately equally divided between men and women, blacks and whites, and higher and lower socioeconomic classes. Few life events were significantly related to level of depression either before or after controlling for physical disability and living with a spouse. Findings of Linn et al. (1980) were therefore generally confirmed with a broader sample.     

Changes in driving patterns and worsening depressive symptoms among older adults.

OBJECTIVES: This study examined whether changes in driving patterns-driving cessation and reduction-have negative consequences for the depressive symptoms of older Americans and whether these consequences are mitigated for people with a spouse who drives. METHODS: The project used data from 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Depressive symptoms were assessed with an abbreviated Center for Epidemiologic Studies-Depression scale. Using 2 models, the project examined how driving cessation and reduction that occurred between Waves 1 and 2 contributed to increases in depressive symptoms between Waves 2 and 3. The first model included the entire sample (N = 5,239), and the second model focused on drivers only (n = 3,543). A third model added interaction terms to the analysis to consider whether respondents who stopped driving but had a spouse who drove were less at risk of worsening depressive symptoms. RESULTS: Respondents who stopped driving had greater risk of worsening depressive symptoms. Drivers who restricted their driving distances before the study began also had greater risk of worsening depressive symptoms, but seemingly less so than the respondents who stopped driving altogether. For respondents who stopped driving, having a spouse available to drive them did not mitigate the risk of worsening symptoms. DISCUSSION: Changes in driving patterns can be deleterious for older people's depressive symptoms. Initiatives for assisting older people should focus on strategies that help them retain driving skills, that prepare them for the possible transition from driver to ex-driver, and that ensure that they have access to mental health therapies if driving changes are imminent.     

Longitudinal relationships between cognitive functioning and depressive symptoms among Hispanic older adults

This study examines the relationship between cognitive functioning and depressive symptoms across 3 years in a prospective study of 273 community-dwelling, Hispanic older adults in Miami. The analyses extend the literature by testing for a bidirectional or reciprocal relationship between depressive symptoms and cognitive functioning over time and by examining the relationship between these variables among Hispanics, an understudied population at risk of developing depressive symptoms and cognitive impairments. Structural equation modeling with a cross-lagged panel design showed that depressive symptoms were unrelated to subsequent cognitive functioning. However, cognitive functioning was related to subsequent depressive symptoms at every time point, such that poorer cognitive functioning was related to higher depressive symptoms. Findings suggest that cognitive declines may predict depressive symptoms in community-dwelling Hispanic older adults.     

The longitudinal relationship between the use of long-term care and depressive symptoms in older adults

PURPOSE: The aim of this study was to estimate the longitudinal relationship between transitions in the use of long-term care and older adults' depressive symptoms and to investigate whether this relationship could be explained by markers of older adults' underlying health, or other variables including demographics, personality, and partner status. DESIGN AND METHODS: Data were from the Longitudinal Aging Study Amsterdam, which consists of a random, community-based sample of 3,107 older Dutch people (55-85 years of age) stratified by age and gender. The use of informal care, professional home care, and institutional care was recorded, and respondents were screened on depressive symptoms. Follow-up measurements took place at 3 and 6 years. RESULTS: Longitudinal analyses showed significant associations between the enduring use of professional long-term care and an increase in depressive symptoms. Transitions to professional home care or institutional care were also associated with considerably more depressive symptoms after 3 years, whereas transitions from professional home care or institutional care to no care or informal care only were not associated with a change in depressive symptoms. Most of the associations remained significant after indicators of underlying health and other covariates were adjusted for, and also after the data were reanalyzed for respondents with and without functional limitations. IMPLICATIONS: This study does not involve a controlled experiment of professional long-term care among older adults. However, the findings suggest the possibility that receiving professional long-term care could introduce new stressors and increase the risk of depressive symptoms. Our analyses illuminate the concerns of elders regarding their use of professional long-term care and may help in planning for more effective delivery of this type of care.     

Urinary incontinence and psychological distress in community-dwelling older adults

OBJECTIVES: To examine the relationship between urinary incontinence (UI) and psychological distress in older adults. We hypothesized that persons with UI associated with condition-specific functional loss would be most likely to report psychological distress. DESIGN: A population-based longitudinal survey. SETTING: Continuing participants in a study of community-dwelling adults who were initially living in East Baltimore in 1981. PARTICIPANTS: Persons aged 50 and older (n=781) at follow-up interviews conducted between 1993 and 1996 for whom complete data were available. MEASUREMENTS: Participants were classified as incontinent if they reported any uncontrolled urine loss within the 12 months preceding the 13-year follow-up interview. Condition-specific functional loss secondary to UI was further assessed based on a series of questions relating directly to participants' inability to engage in certain activities due to their UI. Psychological distress was assessed using the General Health Questionnaire (GHQ) at interviews in 1981 and at the 13-year follow-up. RESULTS: Persons with UI were more likely to experience psychological distress as measured by the GHQ than were persons without UI (unadjusted odds ratio (OR)=1.74, 95% confidence interval (CI)=1.13-2.68). Persons with condition-specific functional loss secondary to UI were substantially more likely to have psychological distress as measured by the GHQ than were persons without UI (unadjusted OR=4.02, 95% CI=1.86-8.70). In multivariate models that controlled for potentially influential characteristics such as age, gender, ethnicity, and chronic medical conditions the association between condition-specific functional loss secondary to UI and psychological distress remained statistically significant. Among people with UI, persons with persistently elevated GHQ scores were much more likely to report condition-specific functional impairment from UI (adjusted OR=6.55, 95% CI=1.94-22.12). CONCLUSION: Individuals with UI, especially when incontinence was associated with condition-specific functional loss, were more likely to have psychological distress than were other older adults. Our findings support a general conceptual model that condition-specific functional impairment mediates the relationship between a chronic medical condition and psychological distress.     

Chronic illness and depressive symptoms among Chinese older adults: a longitudinal study

Depression is quite common among the elderly members of Hong Kong Chinese society. This study examined the impact of a series of chronic illnesses on change in depressive symptoms among the older people. The respondents were 260 people aged 70 years or older from a longitudinal study of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that, of six chronic illnesses examined, only arthritis was associated with depressive symptoms three years later, even after controlling socio-demographic, functional impairment, and social support variables were applied. Service and policy implications of the findings are discussed.     

Profiles of reminiscence among older adults: perceived stress,life attitudes,and personality variables

The goal of the present study was to identify subgroups of older participants on the basis of unique configurations of variables among functions of reminiscence, personality traits, life attitudes, and perceived stress by means of cluster analysis. Ninety-three older adults (M = 66.7 years of age) completed the NEO-Five Factor Inventory, the Life Attitude Profile-Revised, the Reminiscence Functions Scale, and the Psychological State of Stress Measure. Cluster membership was determined on the basis of intra-personal functions of reminiscence (Boredom Reduction, Death Preparation, Identity, Bitterness Revival). These groups were subsequently compared on personality traits (Neuroticism, Extraversion, Openness to experience), life attitudes (Existential Vacuum, Goal Seeking), and perceived stress. Three distinct groupings emerged. A greater tendency to ruminate about negative memories and lower extraversion characterized the negative reminiscers. Higher frequency of reminiscence related to issues of identity, life meaning and death, together with a tendency toward openness to experience, typified the meaning seekers. Lower reminiscence frequency for each of the four functions, combined with lower perceived stress and neuroticism, characterized the infrequent reminiscers. These results are interpreted in terms of differential patterns of coping and adaptation.     

Physical symptoms and psychological distress among patients with HIV infection

There are many questions about the relationship between HIV-related symptoms and psychological distress, and how this relationship affects the immunological and clinical stage of illness. This article reviews the most recent research studies in this field, and encourages new research projects which will help in the management of physical and psychological symptoms associated with HIV infection.