Association between insomnia symptoms and weight change in older women: caregiver--study of osteoporotic fractures study

OBJECTIVES: To determine whether self‐reported insomnia symptoms were associated with weight change in older women and whether caregiving, comorbidities, sleep medication, or stress modified this association. DESIGN: One‐year prospective study conducted in four communities from 1999 to 2003 nested within a larger cohort study. SETTING: Home‐based interviews. PARTICIPANTS: Nine hundred eighty‐eight participants (354 caregivers and 634 noncaregivers) from the Caregiver—Study of Osteoporotic Fractures. MEASUREMENTS: Self‐reported insomnia symptoms in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble getting back to sleep. Weight was measured at baseline and 12 months. RESULTS: The average weight change was ?1.9±7.8 pounds. Trouble staying asleep was significantly associated with an average weight loss of 1.3 pounds (P=.03) in multivariable analyses. Neither of the other insomnia symptoms was associated with weight change. Use of sleep medications modified the association between trouble falling asleep (interaction term P=.03) and weight change. Insomnia symptoms were associated with weight loss only in women not taking sleep medications. Neither caregiving status, presence of multiple comorbidities, nor stress modified the association. CONCLUSION: Trouble staying asleep was associated with weight loss over 12 months in older women. Practitioners should inquire about sleep habits of patients presenting with weight loss, because this may identify a marker of declining health and may be a factor that can be modified.     

Positive Affect and Incidence of Frailty in Elderly Women Caregivers and Noncaregivers: Results of Caregiver–Study of Osteoporotic Fractures

OBJECTIVES: To determine whether positive affect is associated with a lower incidence of frailty over 2 years in elderly community-dwelling women and to test the stress-buffering hypothesis by evaluating whether these associations differed in caregivers and noncaregivers.
DESIGN: Prospective cohort study with three annual interviews conducted in four U.S. communities between 1999 and 2004.
SETTING: Home-based interviews.
PARTICIPANTS: Three hundred thirty-seven caregiver and 617 noncaregiver participants from the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF) who were not frail at the baseline Caregiver-SOF interview.
MEASUREMENTS: High and low positive affect and depressive symptoms were derived from the baseline 20-item Center for Epidemiologic Studies Depression Scale. Frailty was the development of three or more indicators (weight loss, exhaustion, slow walking speed, or weak grip strength) at the first or second follow-up interview.
RESULTS: Respondents' mean age was 81.2. Caregivers and noncaregivers had similar levels of positive affect (56.3% vs 58.3%) and frailty incidence (15.4% vs 15.9%) but differed in perceived stress (mean Perceived Stress Scale score 16.7 vs 14.8, P <.001). Frailty risk was lower in respondents with high positive affect than in those with low positive affect in the total sample (adjusted hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35–0.70), caregivers (adjusted HR=0.44, 95% CI=0.24–0.80) and noncaregivers (adjusted HR=0.50, 95% CI=0.32–0.77).
CONCLUSION: These findings add to the evidence that positive affect protects against health decline in older adults, although it had no additional stress-buffering effect on health in elderly caregivers.     

Mortality Associated with Caregiving,General Stress,and Caregiving‐Related Stress in Elderly Women: Results of Caregiver‐Study of Osteoporotic Fractures

OBJECTIVES: To investigate the separate and combined effects of caregiver status and high stress on mortality risk over 8 years in elderly women. DESIGN: Prospective cohort study conducted in four U.S. communities followed from 1999/01 (baseline) to December 31, 2007. SETTING: Home‐based interviews. PARTICIPANTS: Three hundred seventy‐five caregiver and 694 noncaregiver participants from the Caregiver‐Study of Osteoporotic Fractures (Caregiver‐SOF) who participated in the baseline Caregiver‐SOF interview. MEASUREMENTS: Caregiver status was based on SOF respondents' self‐report of performing one or more instrumental or basic activities of daily living for a relative or friend with impairments. Two measures of stress were used: Perceived Stress Scale and stress related to caregiving tasks. All‐cause mortality was the outcome. RESULTS: Caregivers were more stressed than noncaregivers; 19.7% of caregivers and 27.4% of noncaregivers died. Mortality was lower in caregivers than noncaregivers (adjusted hazard ratio, (AHR)=0.74, 95% confidence interval (CI)=0.56–0.89). High‐stress respondents had greater mortality risk than low‐stress respondents over the first 3 years of follow‐up (AHR=1.81, 95% CI=1.16–2.82) but not in later years. Likewise, high‐stress caregivers and noncaregivers had higher mortality risk than low‐stress noncaregivers, although low‐stress caregivers had significantly lower mortality than did noncaregivers, whether perceived stress or caregiving‐related stress was measured (AHR=0.67 and 0.57). Similar results were observed in analyses comparing spouse caregivers with married noncaregivers. CONCLUSION: Short‐term effects of stress, not caregiving per se, may increase the risk of health decline in older caregivers.     

Osteoarthritis and sleep: the Johnston County Osteoarthritis Project

OBJECTIVE: Little is known about the association of symptomatic osteoarthritis (OA) with sleep disturbance. We compared the prevalence and severity of current sleep problems among individuals with and without symptomatic hip or knee OA in a large, community-based sample. METHODS: Participants (N = 2682, 28% with symptomatic hip or knee OA) were from the Johnston County Osteoarthritis Project. Six sleep variables were grouped into 2 categories: insomnia (trouble falling asleep, trouble staying asleep, or waking early) and insufficient sleep (daytime sleepiness, not enough sleep, or not feeling rested). The presence of any sleep problem (insomnia or insufficient sleep) was also assessed, as were annual frequency and cumulative days of sleep problems. Adjusted models examined associations of symptomatic OA with sleep problems controlling for demographic characteristics, obesity, self-reported health, and depressive symptoms. RESULTS: Symptomatic hip or knee OA was associated with increased odds of any sleep problem (odds ratio 1.25, 95% confidence interval 1.02-1.54), insomnia (OR 1.29, 95% CI 1.07-1.56), and insufficient sleep (OR 1.35, 95% CI 1.12-1.62) in adjusted models. Among participants with sleep problems, those with symptomatic OA reported higher median numbers of annual and cumulative days of insomnia and insufficient sleep, although these associations were not statistically significant in adjusted models. CONCLUSION: Symptomatic hip and knee OA are significantly associated with sleep problems, independent of other factors related to sleep difficulties, including self-rated health and depression. Patients with OA should be regularly screened for sleep disturbance as part of routine care.     

Subjective and objective sleep quality and aging in the sleep heart health study

OBJECTIVES: To examine the extent to which subjective and objective sleep quality are related to age independent of chronic health conditions.
DESIGN: Cross-sectional study.
SETTING: The Sleep Heart Health Study (SHHS) is a multicenter study designed to determine the cardiovascular consequences and the natural history of sleep disordered breathing.
PARTICIPANTS: Five thousand four hundred seven community-dwelling adults who participated in the SHHS (mean age 63, range 45–99; 52% women).
MEASUREMENTS: Unattended home polysomnography (PSG) and sleep questionnaires.
RESULTS: Older age was associated with shorter sleep time, diminished sleep efficiency, and more arousals in men and women. In men, age was independently associated with more Stage 1 and Stage 2 sleep and less slow-wave (Stage 3 to 4) and rapid eye movement sleep. In women, older age was less strongly associated according to linear trend with sleep stage. Conversely, poor subjective sleep quality was not associated with older age in men, but older women had more trouble falling asleep, and there was a trend toward older women having more problems with waking up during the night and waking up too early. Associations between self-report and directly measured sleep time and sleep latency were low to moderate across age groups (correlation coefficient=0.06–0.32).
CONCLUSION: Older age was more strongly associated with poorer sleep according to PSG in men than women, yet the subjective report of poor sleep with older age was stronger in women. The higher prevalence of chronic health conditions, including sleep apnea, in older adults did not explain changes of sleep parameters with aging and age–sex differences in these relationships.     

Depressive symptoms, inflammation, and ischemic stroke in older adults: a prospective analysis in the cardiovascular health study

OBJECTIVES: To investigate the mediator role of inflammation in any relationship between depressive symptoms and ischemic stroke.
DESIGN: Longitudinal prospective study.
SETTING: Review of medical records, death certificates, and the Medicare healthcare utilization database for hospitalizations.
PARTICIPANTS: Total of 5,525 elderly men and women aged 65 and older who were prospectively followed from 1989 to 2000 as participants in the Cardiovascular Health Study.
MEASUREMENTS: Depression symptom scores, inflammatory markers.
RESULTS: Greater depressive symptoms were associated with risk of ischemic stroke (unadjusted hazard ratio (HR)=1.32, 95% confidence interval (CI)=1.09–1.59; HR=1.26, 95% CI=1.03–1.54, adjusted for traditional risk factors). When a term for inflammation (C-reactive protein (CRP)) was introduced in the model, the HRs were not appreciably altered (unadjusted HR=1.31, 95% CI=1.08–1.58; adjusted HR=1.25, 95% CI=1.02–1.53), indicating that CRP at baseline was not a mediator in this relationship. In analyses stratified according to CRP levels, a J-shaped relationship between depressive symptoms and stroke was evident in the unadjusted analyses; in the fully adjusted model, only CRP in the highest tertile was associated with a higher risk for stroke in the presence of higher depressive symptoms scores.
CONCLUSION: The analyses from this prospective study provide evidence of a positive association between depressive symptoms and risk of incident stroke. Inflammation, as measured according to CRP at baseline, did not appear to mediate the relationship between depressive symptoms and stroke.     

Effect of a Risk-Based Multifactorial Fall Prevention Program on the Incidence of Falls

OBJECTIVES: To evaluate the effects of a multifactorial fall prevention program on falls and to identify the subgroups that benefit the most.
DESIGN: Randomized controlled trial.
SETTING: Community-dwelling subjects who had fallen at least once during the previous 12 months.
PARTICIPANTS: Five hundred ninety-one subjects randomized into intervention (IG) (n=293) and control (CG) (n=298) groups.
INTERVENTION: A multifactorial 12-month fall prevention program.
MEASUREMENTS: Incidence of falls.
RESULTS: The intervention did not reduce the incidence of falls overall (incidence rate ratio (IRR) for IG vs CG=0.92, 95% confidence interval (CI)=0.72–1.19). In subgroup analyses, significant interactions between subgroups and groups (IG and CG) were found for depressive symptoms ( P =.006), number of falls during the previous 12 months ( P =.003), and self-perceived risk of falling ( P =.045). The incidence of falls decreased in subjects with a higher number of depressive symptoms (IRR=0.50, 95% CI=0.28–0.88), whereas it increased in those with a lower number of depressive symptoms (IRR=1.20, 95% CI=0.92–1.57). The incidence of falls decreased also in those with at least three previous falls (IRR=0.59, 95% CI=0.38–0.91) compared to those with one or two previous falls (IRR=1.28, 95% CI=0.95–1.72). The intervention was also more effective in subjects with high self-perceived risk of falling (IRR=0.77, 95% CI=0.55–1.06) than in those with low self-perceived risk (IRR=1.28, 95% CI=0.88–1.86).
CONCLUSION: The program was not effective in reducing falls in the total sample of community-dwelling subjects with a history of falling, but the incidence of falls decreased in participants with a higher number of depressive symptoms and in those with at least three falls.     

Association between depressive symptoms and sleep disturbances in community-dwelling older men

OBJECTIVES: To examine the association between depressive symptoms and subjective and objective measures of sleep in community-dwelling older men.
DESIGN: Cross-sectional.
SETTING: Six U.S. clinical centers.
PARTICIPANTS: Three thousand fifty-one men aged 67 and older.
MEASUREMENTS: Depressive symptoms assessed using the 15-item Geriatric Depression Scale and categorized as 0 to 2 (normal, referent group), 3 to 5 (some depressive symptoms), and 6 to 15 (depressed); objective sleep measures ascertained using wrist actigraphy (mean duration 5.2 nights); and subjective sleep measures assessed using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale.
RESULTS: There was a strong multivariable-adjusted association between level of depressive symptoms and subjective sleep disturbances ( P -trend <.001). For example, the odds of reporting poor sleep quality were 3.7 times (95% confidence interval (CI)=2.5–5.3) higher for depressed men as for normal men, and 2.1 times (95% CI=1.7–2.6) higher for men with some depressive symptoms. For objectively measured sleep disturbances, men with more depressive symptoms had greater odds of sleep latency of 1 hour or more ( P -trend=.006). There was no association between level of depressive symptoms and sleep efficiency, awakening after sleep onset, multiple long-wake episodes, or total sleep time. Excluding 384 men taking antidepressants, benzodiazepines, or other anxiolytic or hypnotics did not alter the results.
CONCLUSION: Depressive symptoms have a strong, graded association with subjective sleep disturbances and are moderately associated with objectively measured prolonged sleep latency. Future studies should address temporality of depression and sleep disturbances.     

The impact of insomnia on cognitive functioning in older adults

OBJECTIVES: To examine whether self-reported symptoms of insomnia independently increase risk of cognitive decline in older adults. DESIGN: Longitudinal cohort study. SETTING: The four sites of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS: Six thousand four hundred forty-four community-dwelling men and women age 65 and older who had no more than one error on the Short Portable Mental Status Questionnaire (SPMSQ) at baseline and an in-person interview at the third annual follow-up (FU3). MEASUREMENTS: Insomnia was defined as report of trouble falling asleep or waking up too early most of the time. Cognitive decline was defined as two or more errors on the SPMSQ at FU3. Logistic regression was used to determine risk of cognitive decline associated with insomnia, controlling for demographic, behavioral, and health-related factors. Analyses were stratified by sex and depressed mood. RESULTS: Among nondepressed men, those reporting symptoms of insomnia at both baseline and FU3 had an adjusted odds ratio (OR) of 1.49 (95% CI = 1.03-2.14) for cognitive decline, relative to those with no insomnia at FU3. Men with insomnia at FU3 only were not at increased risk (OR = 1.16, 95% CI = 0.82-1.65). These relationships were not found in women. Men and women with depressive symptoms at FU3 were at increased risk for cognitive decline independent of insomnia. CONCLUSION: Chronic insomnia independently predicts incident cognitive decline in older men. More sensitive measures of cognitive performance may identify more subtle declines and may confirm whether insomnia is associated with cognitive decline in women.     

Lost in Summation: Depression Among African American Female Caregivers and Noncaregivers

Ethnic differences in mental health have been established using large between-group research designs. Across ethnicity, studies have found that caregivers are at increased risk for depression, but little is known about within-group variability in depressive symptomatology. African American caregivers and noncaregivers were compared on different factors of depressive symptoms as measured by the Center for Epidemiologic Studies Depression subscales. Caregivers reported significantly less positive affect than noncaregivers. Rates were similar for negative affect, somatic complaints, and interpersonal relations. Depression may present itself in different ways among African Americans in the caregiving context, and results suggest information may be lost when global measures of depression are used.     

Caregiver stress and noncaregiver stress: exploring the pathways of psychiatric morbidity

PURPOSE: This study examines depressive symptoms among adult children of elderly parents; it views the parents' care needs and child's care activities as two separate stressors, different combinations of which may affect both caregiving and noncaregiving family members. Design and Methods: A sample of 4,380 women and 3,965 men from the first wave of the Health and Retirement Study was analyzed by use of four alternative forms of multiple regression analysis. Using the Center for Epidemiological Studies Depression scale, respondents reported on their depressive symptoms, as well as on parental disability and care provided by themselves, their spouses, and siblings. RESULTS: Noncaregivers reporting severe parental disability were significantly more likely to experience depression symptoms. Evidence of increased manifestations of depression was not found among those caring for severely disabled relatives; nor was it found among those providing care in the absence of severe parental care needs. Having a caregiving sibling was associated with increased CES-D scores among noncaregivers. IMPLICATIONS: In the current literature, personal care needs of a close relative are named among significant disturbances in the lives of caregivers. By extending this approach to members of a family network regardless of caregiver status, this study allows us to distinguish the magnitude of negative outcomes of serious parental care needs while clarifying the impact uniquely attributable to caregiving activities.     

Caregiving and volunteering: are private and public helping behaviors linked?

OBJECTIVE: The purpose of this study was to examine the relationship between two forms of helping behavior among older adults--informal caregiving and formal volunteer activity. METHODS: To evaluate our hypotheses, we employed Tobit regression models to analyze panel data from the first two waves of the Americans' Changing Lives survey. RESULTS: We found that older adult caregivers were more likely to be volunteers than noncaregivers. Caregivers who provided a relatively high number of caregiving hours annually reported a greater number of volunteer hours than did noncaregivers. Caregivers who provided care to nonrelatives were more likely than noncaregivers to be a volunteer and to volunteer more hours. Finally, caregivers were more likely than noncaregivers to be asked to volunteer. DISCUSSION: Our results provide support for the hypothesis that caregivers are embedded in networks that provide them with more opportunities for volunteering. Additional research on the motivations for volunteering and greater attention to the context and hierarchy of caregiving and volunteering are needed.     

Self-Efficacy and Sleep Quality as Mediators of Perceived Stress and Memory and Behavior Problems in the link to Dementia Caregivers’ Depression in Taiwan

ABSTRACT

Objectives: Caregivers’ perceived stress and reactions to patients’ memory and behavior problems have been commonly regarded as outcomes in caregiving research; however, these variables may also serve as predictors of caregivers’ depressive symptoms. The current study investigated the relationship between perceived stress and reactions to patients’ problems and depression among the family caregivers of persons with Alzheimer’s disease. Additionally, we examined caregiving self-efficacy and sleep quality as possible mediators in the relationship between perceived stress and reactions to patients’ memory and problem behaviors and depression.

Methods: This study is a cross-sectional study. The study sample consisted of 72 family members caring for a loved one with Alzheimer’s disease who completed a set of questionnaires that included the Perceived Stress Scale, the Chinese Pittsburg Sleep Quality Index, the Revised Scale for Caregiving Self-efficacy, and the Revised Memory and Behavior Checklist (RMBPC).

Results: The results indicated that both higher perceived stress and RMBPC reaction scores were directly and indirectly associated with higher depressive symptoms. A specific domain of caregivers’ self-efficacy and sleep quality mediated the indirect path.

Conclusion: These findings suggest that caregiving self-efficacy and sleep quality may function as mechanisms through which perceived stress and reactions influence depressive symptoms and that this mechanism may be domain specific.     

Factors associated with incidence and persistence of symptoms of disturbed sleep in an elderly cohort: the Cardiovascular Health Study

BACKGROUND: There are limited data pertaining to the factors influencing the incidence and persistence of sleep symptoms in the elderly. The purpose of this study was to determine the incidence and nonremission rates of the following sleep symptoms: trouble falling asleep (TFA), frequent awakenings (FA), and excessive daytime sleepiness (EDS) in the Cardiovascular Health Study (CHS), a prospective multicenter study of cardiovascular disease in a large cohort of elderly adults. Factors influencing these rates were assessed as well. METHODS: 4467 participants in CHS were surveyed for the presence of TFA, FA, and EDS as well as other health problems at their baseline examination and at a follow-up examination 1 to 4 years later. RESULTS: Annualized incidence and nonremission rates were the following: TFA (2.8% and 15.4%), FA (12.3% and 22.7%), and EDS (4.4% and 13.4%). Women were more likely to have incident and persistent TFA. Depression was the primary factor predicting the incidence of all three sleep symptoms. However, other health conditions, including respiratory symptoms and cardiovascular disease, and limitation in activities of daily living were important as well. Depression also was the most important factor associated with persistence of these sleep symptoms. The role of other health conditions in determining nonremission was much more limited. CONCLUSIONS: Incidence of sleep disturbances in the elderly is related to depression, health conditions, and physical functioning. However, persistence of sleep disturbances is best predicted by the presence of depression.     

Daytime sleepiness and napping amongst the elderly in relation to somatic health and medical treatment

Objectives. To investigate daytime sleepiness and napping in relation to age, health and nocturnal sleep.
Design. An epidemiological survey by means of a questionnaire.
Setting. The counties of Västerbotten and Norrbotten in northern Sweden.
Subjects. All 10216 members of the pensioners' association SPF.
Main outcome measures. Daytime sleep, daytime sleepiness, health, night sleep, somatic diseases and medication.
Results. Daytime sleepiness was 4.9 (3.7–6.4) and 5.1 (4.2–6.1) times more common in men and women, respectively, in poor health than in those in good health. It was also more common in subjects suffering from cardiac diseases, diabetes and musculo-skeletal diseases, urological symptoms, and diseases with sensory and neurological impairments, compared with symptomless subjects. Stepwise regression analysis showed an increase in daytime sleepiness in men in association with impaired general health ( r ²=0.067), frequent awakenings ( r ² =0.098), higher age ( r ²=0.109) and difficulty in falling asleep again after nocturnal awakening ( r ²= 0.115), and in the women, in association with impaired health ( r ²=0.118), difficulty in falling asleep again ( r ²=0.149), frequent awakenings (r ²=0.160) and higher age ( r ²=0.171). There was no further increase in r ²=either for men or women in relation to use of hypnotics.
Conclusion. Age, poor health and different somatic diseases, but not hypnotics, are associated with daytime sleepiness in elderly persons.     

Caregiving in the presence of chronic pain

BACKGROUND: Chronic pain sufferers and caregivers share the risk of higher levels of psychological distress and adverse effects on well-being. This study examined the joint impact of chronic pain and primary caregiving on older people. METHODS: Data came from the New South Wales (NSW) Older People's Health Survey 1999, a state-wide general health survey of over 9000 NSW residents 65 years old or older. Using survey logistic regression modeling, we examined the relationship between chronic pain with different levels of disability, caregiving status, self-reported physical functioning, and two dependent variables--poor/fair self-rated health and psychological distress. RESULTS: Caregivers with chronic pain reported more psychological distress and poorer self-rated health than caregivers without pain, when both were compared to noncaregivers without pain (age-adjusted and sex-adjusted odds ratios [ORs] for caregivers with pain were 3.4 and 2.8, respectively, both p <.001). Caregivers with pain and noncaregivers with pain had similar patterns of results. Physical function significantly declined for both caregivers and noncaregivers with pain when compared with noncaregivers without pain. CONCLUSIONS: Older people coping with caregiving and chronic pain are a potentially vulnerable group. Chronic pain status should be ascertained in older people who are caregivers, with particular attention to the issue of caregiver psychological distress and physical well-being.     

Role of Early Symptoms in Assessment of Syncope in Elderly People: Results from the Italian Group for the Study of Syncope in the Elderly

OBJECTIVES: To assess the ability of specific early symptoms to predict cardiac and noncardiac syncope in elderly people.
DESIGN: Multicenter cross-sectional observational study.
SETTING: Inpatient geriatric acute care departments and outpatient clinics.
PARTICIPANTS: Two hundred forty-two patients with syncope (mean age 79±8) consecutively referred for evaluation of transient loss of consciousness to any of six clinical centers participating in the Italian Group for the Study of Syncope in the Elderly (GIS Study).
MEASUREMENTS: All patients were assessed according to European Society of Cardiology Syncope guidelines and interviewed about symptoms and signs present before syncope.
RESULTS: One hundred seventy-four of 242 patients (75.4%) had noncardiac syncope, and 34 (14.7%) had cardiac syncope; 165 patients (71.1%) related symptoms before the loss of consciousness. When elderly patients with syncope were stratified for the presence and absence of symptoms, noncardiac syncope showed the highest prevalence of symptoms (75.3%, P <.01). Awareness of being about to faint, sweating, blurred vision, and nausea are more prevalent in noncardiac syncope. Dyspnea is more prevalent in cardiac syncope. All symptoms except awareness of being about to faint and weakness had good specificity, but sensitivity was low for all symptoms considered. Multivariate regression analysis adjusted for sex and age indicated that nausea (relative risk (RR)=3.7, 95% confidence interval (CI)=1.26–11.2), blurred vision (RR=3.5, 95% CI=1.34–9.59), and sweating (RR=2.8, 95% CI=.21–6.89) were predictive of noncardiac syncope. Dyspnea (RR=5.5, 95% CI=1.0–30.2) was the only symptom predictive of cardiac syncope.
CONCLUSION: The data show that symptoms such as nausea, blurred vision, and sweating are predictive of noncardiac syncope, whereas only dyspnea is predictive of cardiac syncope in elderly people.     

Association between family caregivers and depressive symptoms among community-dwelling older adults in Japan: A cross-sectional study during the COVID-19 pandemic

ObjectivesNovel coronavirus disease (COVID-19) pandemic could increase the mental health burden of family caregivers of older adults, but related reports are limited. We examined the association between family caregiving and changes in the depressive symptom status during the pandemic.MethodsThis cross-sectional study included 957 (mean age [standard deviation] = 80.8 [4.8] years; 53.5% females) community-dwelling older adults aged ≥ 65 years from a semi-urban area of Japan, who completed a mailed questionnaire. Based on the depressive symptom status assessed with the Two-Question Screen between March and October 2020, participants were classified into four groups: “non-depressive symptoms,” “incidence of depressive symptoms,” “remission from depressive symptoms,” or “persistence of depressive symptoms.” Participants were assessed in October 2020 for the family caregiving status, caregiving role, the severity of care recipients’ needs, and increased caregiver burden during the pandemic, each with the simple question. Multinomial logistic regression analysis was applied to obtain the odds ratios (ORs) and 95% confidence intervals (CIs) for changes in depressive symptom status.ResultsCompared to non-caregivers, family caregivers were associated with the incidence (OR [95% CI] = 3.17 [1.55–6.51], p < 0.01) and persistence of depressive symptoms (OR [95% CI] = 2.39 [1.30–4.38], p < 0.01). Primary caregivers, caregivers for individuals with severe care needs, and caregivers with increased burden during the pandemic had a high risk of depressive symptoms.ConclusionsFamily caregivers had a high risk of depressive symptoms during the pandemic. Our findings highlight the need for a support system for family caregivers.     

Depressive Symptoms and Incident Cognitive Impairment in Cognitively Well-Functioning Older Men and Women

OBJECTIVES: To investigate whether the effect of depressive symptoms on the risk of cognitive decline and incident cognitive impairment (CI) in cognitively well-functioning older persons differed between men and women and whether sex differences in cerebrovascular factors might explain this.
DESIGN: Prospective cohort study.
SETTING: General community.
PARTICIPANTS: One thousand four hundred eighty-seven well-functioning Chinese older adults (Mini-Mental State Examination (MMSE) score ≥24) assessed at baseline for the presence of depressive symptoms (Geriatric Depression Scale score ≥5), and covariates (age, apolipoprotein E ɛ4, education, smoking, alcohol drinking, and vascular risk factors and diseases).
MAIN OUTCOME MEASURES: Incident CI and change in MMSE were assessed at 2-year follow-up.
RESULTS: In the whole sample, participants with depression showed significantly more incident CI than those without (5.7% vs 2.6%, P =.04; adjusted odds ratio (OR)=2.29, 95% confidence interval (CI)=1.05–5.00. Significantly higher OR was observed only in men (OR=4.75, 95% CI=1.22–18.5) and not for women (OR=1.29). There was a correspondingly greater rate of cognitive decline in participants with depressive symptoms that was observed to be marked only in men and not in women. The association was accentuated in subgroups with hypertension or vascular factors, but the sex differences in association were consistently observed.
CONCLUSION: The association between depressive symptoms and risk of cognitive decline was observed only in men and was not explained by sex differences in vascular factors. The comorbid presence of underlying cerebral vascular pathology or multi-infarct disease was possibly not a mediating factor but might amplify the process of cognitive decline.