Depression in the elderly.

Depression in the elderly is very common and may be difficult to diagnose. Because of its varied presentation and its frequent association with physical illness it will be encountered increasingly by all physicians as the elderly population expands. Depression, though treatable, is often not treated, and suicide rates are high among depressed elderly persons. Diagnostic difficulties lie in distinguishing depression from organic brain syndromes, from so-called masked depressions and from normal grief reactions. Pharmacologic treatment is effective, but care must be taken to recognize side effects and to use adequate doses. Psychologic approaches should focus on reducing feelings of helplessness and failing self-esteem. The importance of the losses borne by elderly persons in the pathogenesis of depression continues to be of theoretical and practical interest.     

Depression among elderly Chinese-Canadian immigrants from Mainland China

Background This study examined the prevalence of depressive symptoms among elderly immigrants from Mainland China to Canada and the impact of various psychosocial factors as predictors of the number of depressive symptoms reported by the elderly Chinese immigrants.Methods The participants were 444 elderly immigrants who migrated from Mainland China to Canada. They were a part of a random sample of 2272 elderly Chinese living in the communities and took part in a face-to-face interview to answer questions in an orally administrated questionnaire. The depressive symptoms of the participants were measured by a Chinese version of the Geriatric Depression Scale. Data obtained from the 444 elderly Chinese immigrants was analyzed to assess the impact of various psychosocial factors on the number of depressive symptoms that they reported.Results The findings indicated that 23. 2% of the elderly immigrants were assessed to have some depressive symptoms. When other predicting variables were adjusted, elderly immigrants with more chronic illnesses, less positive attitude towards ageing, poorer physical health, less adequate financial situation, lower level of ethnic identification as Chinese, more service barriers, lower level of life satisfaction, shorter length of residency in Canada and those who lived alone tended to have more depressive symptoms.Conclusions The findings indicate that the prevalence rate of depressive symptoms among our elderly immigrant sample is higher than the one reported in a general elderly population. While further research is recommended to examine the reasons for such a difference, culturally appropriate health services, including health promotion programs, should be promoted to reduce mental health disparities.     

Depression in elderly medical inpatients: a meta-analysis of outcomes

OBJECTIVE: To determine the prognosis of elderly medical inpatients with depression. DATA SOURCES: A MEDLINE search for relevant articles published from January 1980 to September 1996 and a search of the PSYCH INFO database for articles published from January 1984 to September 1996. The bibliographies of identified articles were searched for additional references. STUDY SELECTION: Eight reports (involving 265 patients with depression) met the following 5 inclusion criteria: original research, published in English or French, population of general medical inpatients, mean age of depressed patients 60 years and over, and affective state reported as an outcome. The validity of the studies was assessed according to the criteria for prognostic studies described by the Evidence-Based Medicine Working Group. DATA EXTRACTION: Information about the patient population, the proportion of cases detected and treated by attending physicians, the length of follow-up, the affective outcome and the prognostic factors was abstracted from each report. DATA SYNTHESIS: All of the studies had some methodologic limitations. A meta-analysis of outcomes at 3 months or less indicated that 18% of patients were well, 43% were depressed and 22% were dead. At 12 months or more, 19% were well, 29% were depressed and 53% were dead. Factors associated with worse outcomes included more severe depression, more serious physical illness and symptoms of depression before admission. CONCLUSIONS: Elderly medical inpatients who are depressed appear to have a very poor prognosis: the recovery rate among these patients is low and the mortality rate high.     

浏阳市农村社区老年人抑郁状况及其影响因素

目的 探讨农村社区老年人的抑郁状况及其影响因素.方法 按分层整群随机的方法在湖南省浏阳市农村社区进行抽样,对符合条件的老年人进行一般情况、老年抑郁量表、社会支持、日常生活能力和负性生活事件等内容的调查.结果 有效样本412人,GDS的得分范围为0～30分,平均得分(12.6±7.7)分.按抑郁水平的划分标准,46.4%的老年人无抑郁,34.9%轻度抑郁,18.7%中重度抑郁.多因素Ordinal回归分析显示女性(OR=2.425)、自评经济状况差(OR=2.195)、自评健康状况差(OR=1.962)、在家庭中的地位低(OR=1.699)、获得的社会支持少(OR=2.790)、日常生活能力有障碍(OR:2.863)、经受的负性生活事件刺激量大(OR=3.370)是抑郁水平趋于严重的危险因素.结论 农村社区老年人抑郁问题较为严重,应加强心理健康指导.     

我国老年高血压患者抑郁状况及其影响因素分析

目的 分析我国老年高血压患者抑郁状况及其影响因素。方法 基于中国老年健康影响因素跟踪调查项目第8轮的全国数据,纳入符合研究标准的5210名老年高血压患者,采用CES-D-10量表识别老年人抑郁状况。采用多重插补法填补缺失数据,利用二分类logistic 回归模型分析老年高血压患者抑郁的影响因素。结果 12.84%（669/5210）老年高血压患者出现抑郁症状。logistic回归分析显示,男性（OR=1.355）,低经济收入（OR=3.132）、ADL障碍（轻度：OR=1.894;重度：OR=2.951）是老年高血压患者抑郁的危险因素。年龄≥90岁（90-99岁：OR=0.527;≥100岁：OR=0.517）,高经济收入（OR=0.701）,体育锻炼（OR=0.551）,睡眠时长≥6h（6.0-7.9h：OR=0.286;8.0-9.9h：OR=0.203;≥10.0h：OR=0.205）是老年高血压患者抑郁的保护因素。结论 老年高血压患者抑郁状况受多种因素影响,其发生率高于一般老年人水平。     

安徽省某镇空巢老人抑郁因素分析

目的:了解安徽省某镇空巢老人抑郁现状,分析其相关影响因素。方法:采用整群抽样方法选择安徽省某镇作为研究地区,以生活质量问卷SF-36及抑郁自评量表SDS对60岁以上老人进行调查。结果:共调查695名老人,抑郁症状检出率为20.43%;其中非空巢老人352人,抑郁症状检出率为13.92%;空巢老人343人,抑郁症状检出率为27.11%,其中空巢夫妻同住老人256人,抑郁症状检出率为25.78%;空巢独居老人87人,抑郁症状检出率为31.03%;空巢独居老人抑郁症状检出率最高,差异有统计学意义(P<0.001)。Logistic回归分析显示性别(OR=0.543)、经济收入(OR=0.518)、对生活满意度(OR=0.499)、家庭关系(OR=1.632)与抑郁症状相关。结论:空巢老人的抑郁症状发生率较高,影响因素复杂,我们应加强对空巢老人特别是独居空巢老人的关注,从提高经济收入、改善家庭关系等方面有针对性地提供更多的社会支持。     

Depression in the physically ill

The risk of depression is increased in many medical and surgical conditions. Specific serotonin reuptake inhibitors are generally recommended as first line treatment in the physically ill. Care must be taken in prescribing antidepressants in the physically ill, because of side-effects, hepatic and renal impairment, and potential for drug interactions.     

Infections in the elderly

Infections are a leading cause of morbidity and mortality in the elderly. Altered host defences, a senescent immune system, chronic illnesses, and environmental factors all contribute to the aged's predisposition to infection. Infections can present in atypical fashion contributing to diagnostic and therapeutic delays. Awareness of altered antibiotic absorption, metabolism, and excretion in the elderly is essential to correct antibiotic selection and dosing. Additionally, antibiotic interactions with medications commonly used to treat chronic illnesses should be taken into consideration prior to antibiotic prescribing. Prevention of infectious complications in the elderly requires interest, education, vaccination, and early intervention.     

抑郁症与中医"郁证"的关系探讨

结合古代文献及临床研究,从文献记载和临床症状、病因病机等方面论述抑郁症与郁证的差异及共性.认为中医"郁证"本身含有两层含义,一为以病机而立病名,二为情志之病,中医有关抑郁症的描述只见于后者,而且有关抑郁症的描述也在多种中医病名的症状群中出现,因此抑郁症与郁证二者不是简单的等同关系.并提出抑郁症中医辨证应以虚证为纲,结合临床观察,以益肾补虚为大法治疗抑郁症,取得了较好的疗效.     

Pharmacotherapeutics in the elderly

Drugs are the most cost-effective modality of chronic care, and older adults with multiple illnesses often need multiple drugs. Because this may lead to drug interactions, adverse drug effects, and problems with compliance, drug regimens should be individualized and as few drugs as possible used. When a new drug is indicated, it is important for the physician reassess the appropriateness and continued need for the existing regimen. Patients and providers must agree on a particular regimen, its goals, promises, and limitations.     

Cancer in the elderly

Cancer, the dreaded killer disease, has its aetiology in several factors like genetic, environmental, diet habits, etc. Age over 65 years is generally considered elderly and the cancer incidence increases with age. Cancer is second to cardiovascular disease for the cause of death in the elderly. The behaviour of certain cancers also differ in the elderly thus adding to the ultimate outcome that is usually confounded by several comorbid illnesses. The prognostic factor varies with type of cancer. Older patients with Hodgkin's disease and acute myeloid leukaemia do worse than breast cancer. Radiation therapy is well tolerated by the elderly.