Dissertations / Theses on the topic 'Depression in old age Macau'

Background The prevalence and incidence of stroke are known to increase with age, which, combined with demographic change, means that very old patients with stroke are a growing patient group. Risk factors for incident stroke among very old people have not been widely investigated. The impact of depression on mortality in very old people who have had a stroke also remains unclear.  The aim of this thesis was to investigate the risk factors for incident stroke, the epidemiology of stroke and depression, and the consequences of having had a stroke regarding the risk of depression and mortality among very old people. Methods A randomly selected half of 85-, all 90-, and all ≥95-year-olds in certain municipalities in Västerbotten County, Sweden, and Pohjanmaa County, Finland were targeted in a population-based cohort study from 2000-2012. The 65-, 70-, 75-, and 80-year-olds in all the rural and random samples from the urban municipalities in the same counties were furthermore targeted in a survey in 2010. In the cohort study patients were assessed in their homes, by means of the 15-item Geriatric Depression Scale (GDS-15) and other assessment scales, as well as blood pressure measurements, several physical tests, and a review of medical diagnoses appearing in the medical charts. Incident stroke data were collected from medical charts guided by hospital registry records, cause of death records, and reassessments after 5 years. Depression was defined as a GDS-15 score ≥5. A clinical definition of all depressive disorders, based on assessment scale scores and review of medical charts was also used. A specialist in geriatric medicine evaluated the diagnoses. The survey included yes/no questions about stroke and depression status, and the 4-item Geriatric Depression Scale. Associations with mortality and incident stroke were tested using Cox proportional-hazard models.  Results In the ≥85-year-olds examined in 2005-2007 (n=601), the stroke prevalence was 21.5%, the prevalence of all depressive disorders was 37.8% and stroke was independently associated with depressive disorders (odds ratio 1.644, p=0.038). The prevalence of depression according to GDS-15 scores was 43.2% in people with stroke compared with 25.0% in people without stroke (p=0.001). However, in ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, depression was not independently associated with incident stroke.  In ≥65-year-olds who responded to a survey in 2010 (n=6098), the stroke prevalence rose with age from 4.7% among the 65- to 11.6% among the 80-year-olds (p<0.001). The prevalence of depression rose from 11.0% among the 65- to 18.1% among the 80-year-olds (p<0.001). In the group with stroke, depression was independently associated with dependence in personal activities of daily living and having a life crisis the preceding year, while in the non-stroke group, depression was independently associated with several additional demographic, social and health factors. In ≥85-year-olds examined in 2005-2007 with valid GDS-15 tests (n=452), having had a stroke was associated with increased 5-year mortality [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.15-2.03]. Having had a stroke and depression was associated with increased 5-year mortality compared with having only stroke (HR 1.90, 95% CI 1.15-3.13), having only depression (HR 1.59, 95% CI 1.03-2.45), and compared with having neither stroke nor depression (HR 2.50, 95% CI 1.69-3.69). Having only stroke without a depression did not increase mortality compared with having neither stroke nor depression. In ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, the stroke incidence was 33.8/1000 person-years during a mean follow-up period of about three years. In a comprehensive multivariate model, atrial fibrillation (HR 1.85, 95% CI 1.07–3.19) and higher systolic blood pressure (SBP; HR 1.19, 95% CI 1.08–1.30 per 10-mmHg increase) were associated with incident stroke overall. In additional multivariate models, diastolic blood pressure (DBP) ≥90 mmHg (HR 2.45, 95% CI 1.47–4.08) and SBP ≥160 mmHg (v. <140 mmHg; HR 2.80, 95% CI 1.53–5.14) were associated with incident stroke. Conclusion The prevalence of both stroke and depression increased with age, and rates were especially high among very old people. Having had a stroke was independently associated with a higher prevalence of depression among very old people, however, depression was not independently associated with a higher incidence of stroke. Having had a stroke was associated with increased all-cause mortality among very old people, but only among those who were also depressed. High SBP (≥160 mmHg), DBP (≥90 mmHg) and atrial fibrillation were the only consistent independent risk factors for incident stroke among very old people.
I västvärlden inklusive Sverige så ökar gruppen av människor som uppnår åldern 80 år eller äldre. Människorna som uppnår denna mycket höga ålder har en hög förekomst av kardiovaskulära riskfaktorer, har ofta flera samtidiga sjukdomar och ofta funktionsnedsättningar. Medicinska behandlingsåtgärder är ofta mindre effektiva och förknippade med biverkningar i åldersgruppen. Stroke är en sjukdom som beror på skada av hjärnvävnad till följd av minskad blodtillhörsel till delar av hjärnan. Det är känt att såväl förekomsten av och insjuknandet i stroke ökar med stigande ålder. Den som drabbas av stroke löper risk att få en bestående funktionsnedsättning och att dö i förtid. En vanlig komplikation efter att ha drabbats av stroke är nedstämdhet eller depression. Vetenskapliga studier om stroke har tidigare negligerat mycket gamla människor, vilket i takt med den pågående demografiska utvecklingen framstått som allt mer orimligt. Det är ej helt klarlagt vilka riskfaktorer som leder till att insjukna med stroke i mycket hög ålder. Överdödligheten förknippad med att drabbas av depression efter stroke är också oklar i åldersgruppen. Det är också oklart vad som skiljer depression efter stroke från depression bland den övriga befolkningen av åldrade människor. Den populations-baserade kohortstudien GErontologisk Regional DAtabas (GERDA) inleddes år 2000 för att kartlägga faktorer förknippade med gott åldrande bland mycket gamla människor. Hälften av 85-åringarna, alla 90-åringar och alla ≥95-åringar i utvalda kommuner i Västerbotten erbjöds att delta i studien. Därefter har återbesök hos tidigare deltagare i sina nya åldersgrupper och rekrytering av nya deltagare genomförts vart femte år. Studien utvidgades med utvalda kommuner i Österbotten, Finland vid den första femårsuppföljningen. Datainsamlingen i studien bestod av demografiska frågor, skattningsskalor, blodtrycksmätning och kognitiva test genomförda vid ett hembesök i deltagarens hem, samt genomgång av journalhandlingar. År 2010 skickades även en enkät ut till 65-, 70-, 75- och 80-åringar i alla kommuner i Västerbotten och Österbotten. Enkäten innehöll frågor om demografi, hälsa, sjukdomar och intressen. Bland deltagarna i kohortstudien bestämdes förekomsten av tidigare stroke baserat på genomgång av journaluppgifter och uppgifter från hembesöken. Förekomsten av depression bestämdes baserat på poängsättning från en validerad skattningsskala för depression, samt baserat på en sammanvägning av journaluppgifter och skattningsskalor. En specialist i geriatrik fattade det slutliga beslutet om diagnoser. Insjuknande i stroke bestämdes baserat på journalgenomgång av individer med stroke-relaterade diagnoskoder i sjukhusregistret, i dödsorsaksregistret eller uppgift om stroke vid femårsuppföljningen i studien. Bland deltagarna i enkätstudien bestämdes förekomsten av tidigare stroke baserat på självrapportering, och förekomsten av depression bestämdes baserat på en sammanvägning av självrapportering och en skattningsskala för depression.  Förekomsten av stroke i enkätstudien steg med ålder, från 4.7% bland 65-åringar till 11.6% bland 80-åringar. Förekomsten av stroke var omkring 20% bland ≥85-åringar, med minimal variation mellan 85-, 90- och ≥95-åringar. Förekomsten av depression var högre bland dem med stroke jämfört med de övriga deltagarna, både gällande den sammavägda diagnosen och baserat endast på poängsättning. Stroke och sömnproblem var oberoende associerade med depression. Bland ≥65-åringar i enkätstudien var funktionsnedsättning och genomgången livskris associerade med depression hos dem med en tidigare stroke. Bland deltagare utan stroke var ett antal ytterligare externa faktorer, inklusive subjektiv upplevelse av dålig ekonomi och att inte ha någon att anförtro sig till, associerade med depression. Både stroke och depression var associerade med ökad dödlighet bland ≥85-åringar. De med stroke utan depression hade en dödlighet i linje med normalbefolkningen utan stroke eller depression. Förekomsten av samtidig stroke och depression var associerad med högre dödlighet än normalbefolkningen, jämfört med dem med enbart stroke eller enbart depression. Högt systoliskt blodtryck (≥160 mmHg), högt diastoliskt blodtryck (≥90 mmHg) och förmaksflimmer var oberoende riskfaktorer för att insjukna i stroke bland ≥85-åringarna. Sambandet mellan blodtryck och strokerisk försvagades ej hos människor med kognitiv eller funktionell nedsättning. Tidigare stroke, hjärtsvikt, kognitiv nedsättning, näringsbrist, depressiva symtom och låg gånghastighet var också associerade med att insjukna i stroke, men ej oberoende av varandra. Sammanfattningsvis så stiger förekomsten av stroke med åldern och är särskilt hög bland mycket gamla människor. Depression är betydligt vanligare hos mycket gamla människor med stroke, även justerat för störningsfaktorer. Depression är främst associerat med funktions-nedsättning hos människor med stroke, men med ett större antal externa faktorer hos människor utan stroke. Mycket gamla människor med stroke har särskilt hög dödlighet om de samtidigt är deprimerade, men en dödlighet i linje med normalbefolkningen om de inte är deprimerade. Högt systoliskt och diastoliskt blodtryck samt förmaksflimmer är viktiga och behandlingsbara orsaker till att drabbas av stroke i mycket hög ålder.

A rapidly growing senior population is facing loneliness, desolation andisolation in our ageist society. Age-linked detachment and a number of socialinteractors are closely related to general health, physical condition anddepression.Using standardized instruments, the UCLA Loneliness Scale (Russellet al., 1980), the Multidimensional Scale of Perceived Social Support (Zimetet al., 1988), and the Geriatric Depression Scale (Brink et al., 1982), this nonexperimental-study investigated the level of perceived loneliness, socialsupport and the causative relationship of these factors to the presence ofdepression among 50 independent, relatively healthy elders in a Montrealsenior centre.Findings suggest that loneliness is a major predictor of elderdepression. Lack of perceived social support could contribute to sensedloneliness and that depression may be present in healthy, independentelderly.Intergenerational workshops for seniors are suggested to improve lifesatisfaction through social interaction. Further goals are to modify myths,stereotypes and contradictory attitudes inherent to the cohort.
fr

Mestrado em Gerontologia - Intervenção Comunitária
Background: Falls have a high incidence in old age people and it results in severe consequences representing a public health problem. Falls are the second worldwide cause of accidental deaths (1). The literature shows that people with high depression and anxiety symptoms have impaired balance and this is more problematic in old age people (12). Some studies have shown a relationship between depression/anxiety symptoms and balance (18) however little is known how just anxiety symptoms affect balance. It is also unknown which systems responsible for balance are more affected/preserved in this population in the absence or presence of different levels of anxiety and depression symptoms. Aim: The aims of this study were to explore: the balance differences between old age people with presence/absence of anxiety and depression symptoms and how balance may be affected/preserved by the different levels of anxiety and depression symptoms in the same population. Methods: A quantitative cross-sectional study was conducted. The protocol included socio-demographic, anthropometric and general clinical data. Balance confidence was evaluated with the Activities-specific Balance Confidence (ABC), the balance with the Balance Evaluation System Test (BESTest) and with the Berg Balance Scale (BBS). The level of significance considered was set at p<0.05. Results: 136 old age people with a mean age of 75.9±8.8 years old, participated in this study. All BESTest sections were significantly affected by the presence of anxiety or depression symptoms (p<0.001). Similar results were observed in BBS (p<0.001). However, the Reactive section presented the larger difference between present or not present (49.4±21.1 vs 84.2±14.9; p<0.001) of anxiety symptoms and present or not present (46.3±30.3 vs 88.5±15.3; p<0.001) depression symptoms. Participants’ balance confidence (ABC) was also decrease significantly in both of cases (respectively: p=0.010; p=0.001). The severity of the symptoms influenced significantly the balance (BBS (anxiety: p=0.013; depression: p=0.029) and BESTest (0.001

0.046). However, balance confidence shows not be significantly affected by the level of both of symptoms (anxiety: p=0.516; depression: p=0.274). Conclusion: The presence of anxiety and depression symptoms significantly decreases balance performance and balance confidence in old age people. Additionally, the severity of symptoms significantly decreases balance performance but do not seem to significantly impact on balance confidence.
Enquadramento: As quedas apresentam uma elevada incidência em pessoas idosas, representando um problema de saúde pública. Estas são a segunda causa de mortes acidentais a nível mundial (1). A literatura indica que pessoas com maior grau de sintomatologia ansiógena e depressiva tem o equilíbrio mais comprometido, e em pessoas idosas é ainda mais problemático (12). Alguns estudos mostram uma relação entre sintomas de depressão e ansiedade e equilíbrio (18), contudo, pouco se sabe, como apenas a ansiedade afeta o equilíbrio. É também desconhecido qual/quais são os sistemas responsáveis pelo equilíbrio mais afetados/preservados nesta população na ausência ou presença de diferentes níveis de sintomatologia ansiógena ou depressiva. Objetivos: Este estudo teve como objetivos explorar as diferenças no equilíbrio entre pessoas idosas com presença/ausência de sintomas de ansiedade e depressão e como o equilíbrio pode ser afetado/preservado pelos diferentes níveis de ansiedade e depressão na mesma população. Métodos: Foi realizado um estudo transversal quantitativo. O protocolo incluiu recolha de dados sociodemográficos, antropométricos e de clínica geral. A confiança no equilíbrio foi avaliada através da Activities-specific Balance Confidence (ABC), o equilíbrio através do Balance Evaluation System Test (BESTest) e da Berg Balance Scale (BBS). O nível de significância considerado foi de p<0.05. Resultados: Participaram neste estudo 136 pessoas idosas com uma média de idades de 75.9±8.8 anos. Todas as secções do BESTest mostraram ser significativamente afetadas quando estão presentes sintomas de ansiedade ou depressão (p<0.001). Resultados semelhantes foram observados na avaliação com a BBS (p<0.001). Contudo, a secção Respostas posturais reativas apresentou uma diferença maior aquando da presença versus ausência (49.4±21.1 vs 84.2±14.9; p<0.001) de sintomas de ansiedade e da presença vs ausência (46.3±30.3 vs 88.5±15.3; p<0.001) de sintomas depressivos. A confiança no equilíbrio (ABC) na presença de sintomas de ansiedade e depressão também diminuiu significativamente em ambos os casos (respetivamente: p=0.010; p=0.001). A severidade dos sintomas influenciou significativamente o equilíbrio (BBS (ansiedade: p=0.013; depressão: p=0.029) e BESTest (0.001

0.046) No entanto, a confiança no equilíbrio não mostrou ser afetada significativamente pela severidade de ambos os sintomas (ansiedade: p=0.516; depressão: p=0.274). Conclusão: A presença de sintomas ansiógenos ou depressivos, nas pessoas idosas, afeta significativamente o equilíbrio e a auto perceção do equilíbrio. Este estudo demonstrou também que o equilíbrio diminui, significativamente, à medida que a severidade desses sintomas aumenta, mas a auto-perceção do equilíbrio não parece ser afetada.

The number of adults in the United States who are age 65 or older is rapidly increasing. With longer lifespan comes an increase in chronic diseases such as dementia, diabetes, and depression. This study used archival data from a larger study conducted at the Memory Clinic at John Peter Smith County Hospital in Ft. Worth, Texas to examine several hypotheses and research questions related to the influence of type of dementia, presence of Type II diabetes, and presence of depression on neuropsychological test performance. First, this study attempted to identify specific patterns of performance on neuropsychological measures for those with Alzheimer's dementia (AD), vascular dementia (VaD), or mild cognitive impairment (MCI). The results indicated that those with MCI perform better than those with AD or VaD on all neuropsychological measures, and that those with VaD perform better than those with AD on a measure of verbal memory. Another purpose of the study was to determine how the presence of Type II diabetes affects this pattern of functioning; the overall finding in this study was that the presence or absence of diabetes did not affect performance on measures of cognitive functioning. Additionally, the study attempted to add to literature examining the influence of depression on older adults with diabetes and/or dementia; no significant differences emerged.

Background: Depression is the leading cause of premature death and disability worldwide. The globally aging population with increasing burdens of chronic diseases is certain to face increasing problems. Elderly people in whom physical and mental co-morbidities are common represent a group that is highly susceptible to the harm of depression. Worse still, the reduced accessibility of elderly to healthcare implies that the public health burden of depression seen in the healthcare sector is only tip of the clinical iceberg. Objectives: This review aims to synthesize the current evidence of public health burden of geriatric depression, and the public health challenges in tackling this growing threat in the context of under-detection, social disparities and population ageing, and to summarize its current situation in Hong Kong and compare with other Methods: A literature search was conducted in databases PubMed, Medline and Cochrane (January 2002-June 2012) using the keywords “depression, depressive episode, epidemiology, prevalence, incidence, elderly”. A total of 1285full-text articles were obtained, out of which 52 articles were potentially relevant. Critical appraisal was performed on articles after a priori specified inclusion and exclusion criteria were applied. After removing the duplicates and examining the contents, 15 articles were adopted for review. Results: Depression brings along heavy disease burden which highly associated with mortality and morbidity. Late-life depression accounts for 17-37% in primary care settings, while around 3% in the community. The ongoing problems of under-detection, under-treatment and the progressive population ageing increase the challenges and complexity of matter. Gender difference is identified, while social support, social relationships and socioeconomic status were shown to be highly correlated with elderly depression in both the East and the West. Conclusions: Elderly depression is a global threat causing increasing public health burden to healthcare systems and societies worldwide. Over the decades, public health sector is facing numerous challenges intackling it, including the practice-related challenges complicated by characteristics of elderly, policy-related challenges explained by the clinical iceberg concept, and societal related challenges. By understanding the older population and challenges in the community control of depression, it is the time to action and turn public health over a new leaf.
published_or_final_version
Public Health
Master
Master of Public Health

The purpose of this research was to examine specific coping methods used by the elderly as they adjust to the environment of a long-term care facility, and to examine the correlations between these coping methods and levels of depressive symptomatology.

Severity and pattern of depressive symptomatology were examined among four groups of elderly individuals, i.e., patients with DSM-III diagnoses of major depression (n = 54), patients with presumed dementia of the Alzheimer's type (DAT) (n = 27), patients with idiopathic Parkinson's disease (PD) (n = 30), and normal controls (n = 29). The depressed elderly group obtained significantly (p < .001) higher means, and the control group obtained significantly (p < .01) lower means, than the neurologically impaired groups on clinician ratings (Hamilton Rating Scale for Depression, HRS-D) and self-report (Beck Depression Inventory, BDI) of depression. However, HRS-D means of the PD and DAT groups did not differ significantly (p < .125). The depressed elderly group also obtained significantly (p < .001) higher means than the contrast groups on HRS-D vegetative and cognitive depression primary factors (adapted from Rhoades & Overall, 1983), while the control group obtained significantly (p < .001 to 0.01) lower means. At the intermediate level, the PD mean on the vegetative factor was significantly (p < .05) higher than the DAT mean, while the groups did not differ significantly (p < .79) on the cognitive factor. The depressed elderly group obtained a substantially lower interfactor correlation coefficient than the neurologically impaired groups, suggesting greater heterogeneity in manifestation of depression at moderate than at mild levels of severity. However, the finding of zero variance on some HRS-D items for the neurologically impaired groups suggested that factor structures may differ for PD, DAT, and depressed groups. For PD patients, the prediction that PD symptom severity ratings would correlate more highly with clinician ratings (HRS-D) than self-report (BDI) of depression, due to PD symptoms that resemble depression, was not supported. Speculation that the DAT group might report less depression due to loss of insight was not supported in this group of mildly to moderately demented patients. Only 22% demonstrated loss of insight, while 93% exhibited some degree of depressed mood on the HRS-D. Over 50% of the control group of PD spouses and community volunteers endorsed some degree of fatigue, work inhibition, and decreased libido, illustrating the need for considering base-rates in assessment.

The extent of cognitive deficit in depressed elderly remains unclear. Recent follow-up studies of elderly patients diagnosed as depressed suggest that depression may present as the initial sign of progressive dementia. This raises questions regarding the nature of the depression in those individuals who deteriorate cognitively over time, and encourages the search for clinical indicators of those depressed who are likely to deteriorate. Thirty-five depressed older adult outpatients were comprehensively examined and re-evaluated with a brief neuropsychological battery after one or more years. Twenty-three probable dementia of the Alzheimer's type patients (DAT) provided a comparison with a known progressive disorder. Patients with a decline of four points from their original score on a mental status examination comprised the "depressed with cognitive deterioration" sample (N = 8) and all others made up the "depressed without cognitive deterioration" sample (N = 27). These two samples were then compared on clinical variables from the initial neuropsychological, medical, radiological, and patient history examination. A Multivariate analysis of variance using the following variables: initial age, education, modified Hachinski, initial Mini-Mental State, Wechsler Memory Quotient, vocabulary, digit span, similarities, picture completion, block design, and digit symbol subtests of the Wechsler Adult Intelligence Scale-Revised, initial Geriatric Depression Scale, and Grocery Store Test of verbal fluency failed to differentiate those depressed elderly that declined from those who did not. A series of Chi-square analyses using the medical and radiological variables demonstrated a significant association between depressed with deterioration and magnetic resonance imaging (MRI) abnormalities, computerized tomography (CT) abnormalities, and Electrocardiogram (EKG) abnormalities. Those depressed patients with cognitive deterioration demonstrated a higher frequency of white matter abnormalities on the combined CT and MRI than did those depressed patients with no deterioration. Leuko-araiosis in depressed elderly may represent a clinical marker for the identification of later cognitive deterioration. Results indicate: (1) a need for the development of more sensitive neuropsychological measures for accurate prediction of deterioration; (2) the importance of follow-up neuropsychological evaluations on depressed elderly; (3) relationship between white matter abnormality and cognitive deterioration in depressed elderly, and (4) support for the hypothesis that depression may present as an early sign of a later developing progressive dementia.

Introduction Geriatric depression is one of the major public health issues around the world. Geriatric depression is often being misinterpreted as a normal aspect of aging process, but it is indeed a complex psychological problem that would result in significant increases in DALYs. With effective treatments, depressive symptoms and signs can be reduced. Nevertheless, pharmacological intervention is often used as the first-line treatment for geriatric depression. In recent years, different types of non-pharmacological intervention have been getting more attention in terms of theirs effectiveness in treating geriatric depression. Objectives Primary objective is to determine whether two categories of non-pharmacological intervention (physical activity and reminiscence therapy) are effective in relieving depression in elderly that are 60 years old or older. The other objectives are to examine enduring effects of physical activity and reminiscence therapy, and compare the effectiveness of reminiscence therapy and physical activity in alleviating depressive symptoms in elderly compared with no intervention and/or other intervention. Methods Relevant studies published between the year of 2000 and 2013 were searched and identified through several electronic databases, including the Cochrane Library, PubMed, Medline, PsycINFO and Google Scholar, with a combination of keywords. All randomized controlled trials that examine physical activity and reminiscence therapy on elderly that are 60 years old or older, being diagnosed or indicated as suffering from depression were included. The methodological quality of each study was assessed. The outcome measure of this review is the depression symptom level. Main Result A total of 12 randomized controlled trials met the inclusion criteria, in which seven were about physical activity and five of them were about reminiscence therapy. Significant immediate reduction in depressive symptoms was found in five out of seven physical activity studies and in four out of five reminiscence studies. Three and two studies respectively on physical activity and reminiscence therapy had assessed the effect at follow-up and looked at the lasting effect. In two physical activity studies that have assessed the short-term effect beyond the completion of intervention, incongruent findings were found. Only one physical activity study has examined the long-term effect and it reported significant positive result. On the other hand, there were two reminiscence therapy studies assessing the short-term effect on depressive symptoms. These two studies reported significant improvement in depressive symptoms. Since there were few studies reporting the medium and long-term effect of physical activity and reminiscence therapy, no conclusion can be made on their enduring effect of reducing depressive symptoms. Conclusions Physical activity and reminiscence therapy appear to be effective non-pharmacological interventions for relieving depressive symptoms in elderly. They may complement pharmacological intervention and/or may offer alternative treatment option for elderly with depression. However, the mode, intensity, duration, type, format of physical activity and reminiscence therapy on depressive symptoms in elderly remain unclear. Further testing is need before these interventions can be routinely used to alleviate depressive symptoms in elderly with depression.
published_or_final_version
Public Health
Master
Master of Public Health

The recognition and diagnosis of elderly depression has been the focus of much research over the last 20 years (Brink, 1982; Goodstein, 1985; Klerman, 1983). One problem in diagnosing depression in the elderly has been adequate assessment devices that are sensitive, specific, and predictable with this population (Yesavage et al., 1983). One assessment device developed specifically for the elderly is the Geriatric Depression Scale (GDS) (Brink et al., 1982;Yesavage et al., 1983). This depression scale has yielded high reliability and validity with other self-rating depression scales. In recent research a Short Form Geriatric Depression Scale was produced containing 15 items, all from the original Long Form GDS. A problem with the Short Form involves the lack of research concerning its construct validity. The purpose of the present study was to demonstrate that the Short Form Geriatric Depression Scale does measure depression in the elderly, and therefore, does possess construct validity. To accomplish this task, it was believed that if significant correlations could be identified between various psychosocial variables highly associated with depression in the elderly and the Short Form GDS, validity could be established. The five psychosocial variables chosen: gender differences, physical/health problems, insufficient social support, marital status, and socioeconomic status (finances), have all been shown to be highly related-to depression in the elderly.The information used for this project was gathered from a survey questionnaire developed by the Institute of Gerontology at Ball State University in Muncie, Indiana. The survey questionnaire was sent to over 5,000 randomly selected elderly in the state of Indiana ranging in age from 60 to 85. Of the approximately 5,000 surveys, 2,979 were completed and returned. The survey incorporated questions concerning the five psychosocial variables reviewed and a modification of the Short Form GDS.In order to test the various hypotheses of the study, several analyses were conducted. Based upon the outcome of these analyses, it was concluded that the Short Form Geriatric Depression Scale does possess construct validity. It was also concluded that the Short Form Geriatric Depression scale does assess depression in the elderly and thus is a valid instrument to use in the assessment of depression with the elderly adult.Based upon the information obtained from the survey following hypotheses were supported:a. Elderly individuals with physical disabilities and/or health related problems had higher total GDS scores on the Short Form. b. A positive relationship was found between physiological problems in the elderly and total GDS score.c. Elderly individuals having no social support system had higher total GDS scores on the Short Form.d. A negative relationship existed between an elderly individual's social support system and total GDS score.e. Elderly widows and widowers produced higher total GDS scores than married elderly.f. Elderly individuals with low economic status had higher total GDS scores than elderly individuals with high economic status.
Department of Counseling Psychology and Guidance Services

The older adult population in the United States is rapidly expanding both because of longer life expectancies as well as the aging of the baby boomers. While vision impairment is a growing concern among older adults, there have been few, mostly small studies, of the impact of vision impairment on this population. The present study uses a national data set, the Second Supplement on Aging (1994 -1996) from the National Health Interview Survey, in a cross-sectional study of 9,447 civilian non-institutionalized persons, aged 70 years and over at the time of their interview. The SOA II has been studied in the context of a social theory of aging that emphasizes interdependence through the life course using a stress process model that has been refined into a disability model. Disability is understood as a social construction outcome rather than as a medical outcome. Vision impairment is the stressor which is mediated by health (falls, functioning and self-health report), financial resources (education, income and having only public health insurance) and social support (marital, living along, having no living children, social activities in number and intensity). Depression is a possible, but not a necessary result of vision impairment. Disability may result when a medical pathology leads to an impairment which results in a functional limitation and finally a social disability. This secondary analysis used a multinomial logistic regression for both the whole sample as well as separately for each gender. For the whole sample the results indicate that a typical profile of a vision-impaired older adult depressed some/all of the time, would be a younger-old White woman (aged 70-74 years old) who has fallen in the past 12 months, has difficult with one or more Activities of Daily Living or with both one or more Activities of Daily Living and Instrumental Activities of Daily Living, has a poor to fair self-heath report, a family income under $20,000, a high school or less education, lives alone, has a living child and lacks social activities in number and intensity. In the gender samples, only the female sample at the some/all of the time depression category is significant. Older vision-impaired adults, especially older women who have more social supports are less likely to be depressed and so disabled. There is a need for social policies that will educate, encourage and support older vision-impaired adults as they seek to compensate for the loss of vision, often late in life.

The purpose of the current study was to explore the relationship between cognitive status and depression in a sample of geriatric patients. Participants included 282 geriatric patients ranging in age from 65 to 96 years who were classified according to diagnosis as: DAT, VaD, MCI, and Norm. All were referred for neurocognitive testing from the Geriatric Assessment Program (GAP) at the University of North Texas Health Science Center (UNTHSC) in Fort Worth, Texas. This study sought to identify factor structures for two versions of the GDS using a geriatric sample of cognitively impaired and intact patients. It then compared these factors to each other to determine whether the GDS-15 is truly a shorter version of the GDS-30. These were then compared to a previously determined factor structure. This study explored whether the four-factors of the GDS-30 are able to differentiate cognitive diagnostic groups. Further, this study sought to identify whether the severity of cognitive decline impacted GDS factor score for each of the cognitively impaired groups. Results revealed a two-factor model of the GDS - 15 and a four-factor model with the GDS - 30. The GDS-15 factors did not differ from the first two factors of the GDS-30. Comparison between the GDS-30 factor structure and that reported by Hall and Davis (in press) revealed no significant differences despite the inclusion of a normal, non-demented group in the current study. Comparisons of subscale scores revealed that DAT patients tended to score lower than the other groups on all but the cognitive impairment subscale. Severity level analyses indicated that as severity of deficits increases, awareness of deficits decreases. This study found that although the GDS-30 is a good screening tool for depression in geriatric patients, it is not particularly useful in differentiating cognitive status group. Also, the GDS-15 was not found to be a good substitute for the GDS-30.

Depression has become a medical condition that affects more and more of the aged Hong Kong population, yet this condition is often overlooked. Depression is a treatable condition. Nevertheless, the current practice in Hong Kong relies heavily on medication and cognitive-behavioural therapy. The effectiveness of these two types of therapy is limited by the side-effects of the medications and the accessibility to medical facilities for cognitive-behavioural therapy. Physical activity is suggested by many studies to be effective in managing depressive symptoms in the population. Physical exercise is a relatively economic and convenient activity that can be self-administered for health. Some studies have suggested that physical activity is effective for managing depression, yet the number of theses on this topic for the aged population is limited. In this thesis, studies related to the effectiveness of physical activity on depressive symptoms alleviation among older adults were reviewed and critically appraised. The potential to apply the findings of these studies to the aged Chinese population in Hong Kong is discussed and presented. Studies were searched using the databases Pubmed and CINAHL, and a total of 15 relevant studies were found. The 15 studies were analyzed and listed as tables of evidence and appraised with the SIGN checklist for their quality. The results of these studies and the quality of the papers were summarized. Regarding the physical activity types examined in these studies, aerobic exercise involving controlled-breathing or deep-breathing (e.g. TaiChi) and activities to promote posture including flexibility and balance (e.g. Yoga) were found to be effective for alleviating depressive symptoms among the aged population. The feasibility and transferability of the desired intervention to the target population and setting were discussed. An evidence-based guideline with 8 recommendations was also developed. Finally, a plan for communication with different parties (e.g., administrators, users and staff) to administer the intervention was devised. A pilot test was also planned, with and evaluation plan for the pilot test to allow for adjustments to the intervention. This thesis discussed an alternative to treatment of depressive symptoms among the aged population. With the practice of physical activity effective in managing depressive symptoms in this population, it gave rise to the possibility that to promote the innovation to all of this population.
published_or_final_version
Nursing Studies
Master
Master of Nursing

The "understandability phenomenon" as defined by Blanchard (1992) is the notion that older adults believe depression is a normal consequence of old age. The concept is referred to frequently in the gerontology literature as one of the factors responsible for the under detection and under treatment of late life depression. However, there is little empirical evidence to support this concept. This study assessed the understandability of late life depression in a sample of community dwelling depressed and non-depressed older adults. A measure was developed which examined older adult's belief in the understandability of depression. Specifically, the items in the measure covered depression as a natural consequence of old age, low expectations of treatment, and accepting there are good reasons for depression in late life. Two explanations for the phenomenon were tested. It was hypothesised that the understandability phenomenon is a negative cognition associated with depression. Second, it was also hypothesised that the understandability phenomenon is a function of older adult's beliefs about ageing and old age. It was found that the understandability phenomenon was not related to depression but was related to older adults beliefs about their own ageing. The clinical implications of older adults belief in the understandability of late life depression are discussed.

Late-life depression (LLD) is common illness, frequently associated with neuropsychological impairment. Disruption of frontal-subcortical and limbic networks may play a key role in LLD and can be examined using magnetic resonance imaging (MRI). Grey matter (GM) can be examined using T1-weighted MRI, white matter (WM) using diffusion tensor imaging (DTI), and functional connectivity using resting-state functional MRI (fMRI). To clarify the roles of GM, WM and functional connectivity in LLD, systematic reviews and meta-analyses of T1-weighted MRI, DTI and resting-state fMRI studies of depression were performed. The literature provided evidence for GM and WM abnormalities within frontal-subcortical and limbic networks, and increased functional connectivity within the default-mode network, in depression. To examine whether results gained from different techniques are complementary, multi-modal MRI was used to compare GM, WM and functional connectivity between thirty-six participants with LLD and twenty-five control participants. WM integrity was widely reduced in LLD, without significant group differences in GM or functional connectivity. To investigate whether neuropsychological deficits represent independent processes with specific neural correlates, or whether they can be explained by a core deficit, the relationships between neuropsychological and MRI measures were explored. Executive function and processing speed were found to represent core deficits that contribute to impairment in other domains; and impaired performance was correlated with reduced frontal WM integrity. Episodic memory deficits were dependent on executive function and processing speed; and associated with reduced frontal and hippocampal WM integrity. The relationships between age at onset, severity and MRI measures of GM, WM and functional connectivity were also investigated. Later onset was associated with reduced WM integrity, in line with the vascular hypothesis. Earlier onset was associated with greater duration of illness and reduced hippocampal volume, consistent with the glucocorticoid cascade hypothesis. Severity was not associated with any MRI measure. This thesis strongly supports the hypothesis that WM abnormalities in frontal-subcortical and limbic networks play a key role in LLD, with abnormalities related to neuropsychological impairment and compatible with the vascular hypothesis.

Compared to the general population, diabetic patients experience a higher prevalence of depression, which can often exacerbate diabetic symptoms and complicate treatment. Studies show that religion is associated with both better physical health and better psychological functioning; however, studies incorporating religion and depression among diabetic individuals are scarce. The present study addressed this gap in the literature by examining archival data from the 2008 and 2010 data waves of the Health and Retirement Study (HRS). Cross-sectional findings confirmed that stronger religiosity was positively correlated with perceived diabetes control and positive diabetes change, and negatively correlated with total number of depressive symptoms and total number of weeks depressed. Longitudinal findings confirmed that stronger religiosity in 2008 was positively correlated with perceived diabetes change in 2010 and negatively correlated with total number of depressive symptoms in 2010. Logistic regression and multiple regression analyses were performed to test four moderation models. Results showed that religiosity significantly moderated the relationship between perceived diabetes control and total number of weeks depressed. More specifically, for diabetics with low levels of religiosity, whether they believed their diabetes was under control or not did not make a significant difference in the total number of weeks depressed. However, high levels of religiosity served as a buffer against the duration of depressive symptoms but only for diabetics who perceived to have their diabetes under control. Understanding how these constructs jointly influence diabetes management and psychological functioning is critical in that medical professionals may utilize such knowledge to enhance treatment outcomes.

This study will examine depression among the elderly in an assisted living facility. The main problem in depression in the elderly is the lack of diagnosis and treatment. Left untreated it affects the elderly person's overall well-being and may eventually lead to their mortality.

The purpose of this study was to investigate whether biological variables could predict how older adults would respond to different types of treatment for depression. Fifty-six adults over the age of sixty-five, diagnosed with major depression (DSM III criteria) were assigned to one of four treatment conditions: group Cognitive Behavior Therapy with alprazolam or placebo medications, and minimal support therapy with alprazolam or placebo medication. Before and after treatment, REM latency and REM density were measured by polysomnograph in the sleep laboratory and the Dexamethasone Suppression Test (DST) was administered. Depression was measured by weekly by the Hamilton Depression rating Scale and the Beck Depression Inventory. Subjects presented with normal (i.e. nondepressed) values on REM latency and REM density. Thirty five percent of subjects were DST nonsuppressors, a similar percentage to that found in other studies of depressed subjects, but mean DST for the whole group was below the selected cutoff of 4 mcg/dl. The expected correlations among the biological variables and between these variables and baseline depression levels were not found. It was concluded, therefore, that depression in this group of subjects was not characterized by biological abnormalities. Multiple regression analyses of baseline variables and depression scores at mid and end of treatment and at followup indicated that initial depression levels and DST predicted later depression levels for subjects who received Cognitive Behavior Therapy, regardless of medication assignment. Low baseline DST levels were associated with good response to psychotherapy, confirming the findings of previous studies. Sleep variables were not predictive of response to treatment at any time point.

The longitudinal relationship between loneliness and depression as predictors of chronic health conditions in middle-aged to older adults was investigated utilizing data collected by the Health and Retirement Study (HRS), a national representative longitudinal study of health, retirement, and aging, conducted by the Institute for Social Research (ISR) Survey Research Center (SRC) at the University of Michigan, funded by the National Institute on Aging and the Social Security Administration. The correlation between these loneliness and depression was moderate (r = .32 to r = 51). The single-item subjective self-report of loneliness was found to be an adequate measure of loneliness. A cross-lagged panel correlation and regression design was used to examine the longitudinal relationship between loneliness, depression, and chronic health conditions. A temporal precedence was indicated implying a causal relationship with depression leading to subsequent loneliness. The relationship between recurring loneliness and chronic health conditions was weak (r = .13).