Abstract Background Knowledge about characteristics explaining low level of physical activity in late-life depression is needed to develop specific interventions aimed at improving physical health in ...depressed people above the age of 60. Methods This cross-sectional study used data from the Netherlands Study of Depression in Older Persons (NESDO), a longitudinal multi-site naturalistic cohort study. People aged 60 and over with current depression and a non-depressed comparison group were included, and total amount of PA per week was assessed with the short version of the International Physical Activity Questionnaire (IPAQ). Depression characteristics, socio-demographics, cognitive function, somatic condition, psycho-social, environment and other lifestyle factors were added in a multiple regression analysis. Results Depressed persons >60 y were less physically active in comparison with non-depressed subjects. The difference was determined by somatic condition (especially, functional limitations) and by psychosocial characteristics (especially sense of mastery). Within the depressed subgroup only, a lower degree of physical activity was associated with more functional limitations, being an inpatient, and the use of more medication, but not with the severity of the depression. Limitation This study is based on cross-sectional data, so no conclusions can be drawn regarding causality. Conclusions This study confirms that depression in people over 60 is associated with lower physical activity. Patient characteristics seem more important than the depression diagnosis itself or the severity of depression. Interventions aimed at improving physical activity in depressed persons aged 60 and over should take these characteristics into account.
Anxiety might be a risk factor for cognitive decline, but previous studies had short follow-up or small sample sizes or studied general or single cognitive domain functioning.
Anxiety symptoms were ...assessed with the Symptom Checklist-90 in 918 participants of the Maastricht Aging Study aged 50 years or older. Anxiety was analyzed both dichotomously (highest versus lower quartiles as a group) and continuously. Neuropsychological tests measured executive function, memory, speed of information processing, and verbal fluency. Linear mixed models were conducted with anxiety symptoms as predictor and change in cognitive scores as outcome. Differences of associations by age and gender were studied with three-way interactions.
Higher anxiety symptoms were significantly associated with more decline in verbal memory in those aged 65 years and older (delayed recall: χ
= 9.30, df = 2, p = 0.01; immediate recall: χ
= 11.81, df = 2, p = 0.003). There were sex differences in executive function (χ
= 6.63, df = 2, p = 0.036), fluency (χ
= 6.89, df = 2, p = 0.032), and processing speed (χ
= 8.83, df = 2, p = 0.012), with lower performance in women over time.
In participants without cognitive impairments at baseline, anxiety symptoms were associated with a decline in verbal memory in older adults and with poorer performance in nonamnestic domains in women. Adequate treatment of anxiety symptoms could have a beneficial influence on the risk of developing neurodegenerative diseases. Further research is needed to elucidate whether this association is causal.
Although the public importance of frailty is widely acknowledged by the World Health Organization, physical frailty is still largely neglected in geriatric mental health care. Firstly in this ...narrative review, we summarize the knowledge on the epidemiology of the association between depression and frailty, whereafter implications for treatment will be discussed. Even though frailty and depression have overlapping diagnostic criteria, epidemiological studies provide evidence for distinct constructs which are bidirectionally associated. Among depressed patients, frailty has predictive validity being associated with increased mortality rates and an exponentially higher fall risk due to antidepressants. Nonetheless, guidelines on the treatment of depression neither consider frailty for risk stratification nor for treatment selection. We argue that frailty assessment enables clinicians to better target the pharmacological and psychological treatment of depression as well as the need for interventions targeting primarily frailty, for instance, lifestyle interventions and reduction of polypharmacy. Applying a frailty informed framework of depression treatment studies included in a meta-analysis reveals that the benefit-harm ratio of antidepressants given to frail depressed patients can be questioned. Nonetheless, frail-depressed patients should not withhold antidepressants as formal studies are not available yet, but potential adverse effects should be closely monitored. Dopaminergic antidepressants might be preferable when slowness is a prominent clinical feature. Psychotherapy is an important alternative for pharmacological treatment, especially psychotherapeutic approaches within the movement of positive psychology, but this approach needs further study. Finally, geriatric rehabilitation, including physical exercise and nutritional advice, should also be considered. In this regard, targeting ageing-related abnormalities underlying frailty that may also be involved in late-life depression such as low-grade inflammation might be a promising target for future studies. The lack of treatment studies precludes firm recommendations, but more awareness for frailty in mental health care will open a plethora of alternative treatment options to be considered. Keywords: frailty, depression, depressive disorder
Abstract
The aim of this study was to investigate trends in frailty and its relationship with mortality among older adults aged 64–84 years across a period of 21 years. We used data from 1995 to 2016 ...from the Longitudinal Aging Study Amsterdam. A total of 7,742 observations of 2,874 respondents in the same age range (64–84 years) across 6 measurement waves were included. Frailty was measured with a 32-item frailty index, with a cutpoint of ≥0.25 to indicate frailty. The outcome measure was 4-year mortality. Generalized estimating equation analyses showed that among older adults aged 64–84 years the 4-year mortality rate declined between 1995 and 2016, while the prevalence of frailty increased. Across all measurement waves, frailty was associated with 4-year mortality (odds ratio = 2.79, 95% confidence interval: 2.39, 3.26). There was no statistically significant interaction effect between frailty and time on 4-year mortality, indicating a stable association between frailty and mortality. In more recent generations of older adults, frailty prevalence rates were higher, while excess mortality rates of frailty remained the same. This is important information for health policy-makers and clinical practitioners, showing that continued efforts are needed to reduce frailty and its negative health consequences.
Late Life Depression (LLD) is associated with increased mortality rates, but it remains unclear which depressed patients are at increased risk. This study examined the mortality risk of previously ...identified subgroups of depressed older patients based on age-related clinical features (the presence of physical and cognitive frailty).
A six-year follow-up of a clinical cohort study including 375 depressed older patients and 132 non-depressed persons (NESDO). Depressed patients were diagnosed with the Composite International Diagnostic Interview (CIDI) according to DSM-IV criteria and classified by latent profile analysis on depressive symptom severity, cognitive domains and physical frailty. We estimated the hazard rate of mortality for the four depressed subgroups compared to non-depressed persons by applying Cox-regression analyses. Models were adjusted for age, sex and education as confounders and for explanatory variables per pathway in separate models: somatic burden, lifestyle characteristics, vascular burden or inflammation markers.
A total of 61/375 (16.3%) depressed patients and 8/132 (6.1%) non-depressed persons died during the 6-year follow-up. Two of the four subgroups (n = 186/375 (50%) of the depressed sample) had a higher hazard rate (HR) for mortality compared to non-depressed participants, that is, frail-depressed patients (HR = 5.25, 95%-CI: 2.13-13.0) and pure mild depressed patients (HR = 3.32 95%-CI: 1.46-7.58) adjusted for confounders. Adding possible underlying pathways did not explain these associations.
Age-related features (the presence of physical and cognitive frailty) contribute to the increased mortality risk in late-life depression. Future studies in depressed older patients should study the additional value of a clinical geriatric assessment and integrated treatment aimed to at reduce frailty and ameliorate their mortality risk.
To systematically review of the available literature to (1) examine the association between death anxiety and hypochondriasis and (2) examine the association between death anxiety and medically ...unexplained symptoms (MUS).
A systematic literature search was conducted in Embase, PsycINFO, Pubmed and Ovid databases and reference lists of selected articles. Articles were included when the research population concerned people with hypochondriasis and/or MUS in who death anxiety was assessed by a validated research method. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted relevant characteristics and data. The data were descriptively analysed.
Of the 1087 references identified in the search, six studies on the association between death anxiety and hypochondriasis and three studies on the association between death anxiety and MUS met inclusion criteria. All studies found a positive association of death anxiety with hypochondriasis and/or MUS. The design of all studies was cross-sectional and the overall quality of the studies was low. The influence of age or sex on these associations was not analysed in any of the studies. Given the diversity in setting, population, study design, and methods used, a meta-analysis was not possible.
All studies found a positive association of death anxiety with hypochondriasis and/or MUS. Acknowledging that death anxiety may play a prominent role in hypochondriasis/MUS populations, future research should address (potentially modifiable) determinants of death anxiety in these populations.
•A search on the association death anxiety with hypochondriasis and/or medically unexplained symptoms yielded nine studies.•Although methodological quality was generally low, results were robust.•All studies found a positive association of death anxiety with hypochondriasis and/or MUS.•Future research should address (potentially modifiable) determinants of death anxiety in these populations.
Comorbidity between depression and cognitive impairment is common in older adults, increases the disease burden disproportionally, and leads to diagnostic uncertainty. Insight into individual daily ...associations between affect and cognitive performance may help in personalizing diagnosis and treatment decisions. Our objective was to get insight into the daily associations between affect and cognitive performance within individual older adults.
In this single-subject study seven older adults with both depression and cognitive impairment filled in electronic diaries daily for 62-93 consecutive days evaluating positive affect (PA), negative affect (NA), working memory (WM) and visual learning (VL). Time-series analyses using vector autoregressive modelling, Granger causality tests and cumulative orthogonalized impulse response function analyses were performed for each individual separately.
In one patient higher NA was associated with better WM the next day. For another patient days with higher NA and lower PA were days with worse WM. For a third patient better VL was associated with lower NA and higher PA the next day. No associations were found for four patients.
These results highlight heterogeneity in the daily associations between affect and cognitive performance and stress the relevance of single-subject studies. These studies may be an important step towards personalized diagnosis and treatment in old age psychiatry.
Pain and depression are both common in old age, but their (long-term) temporal relationship remains unknown. This study is designed to determine whether pain predicts the onset of depression and vice ...versa.
This is a prospective, population-based cohort study with 12-year follow-up and 3-year intervals in the Netherlands (Longitudinal Aging Study Amsterdam). At baseline, participants were aged 55 to 85 years (n = 2028). Main measurements outcomes were incident depression defined as crossing the cutoff of 16 and showing a relevant change (≥ 5 points) on the Center for Epidemiological Studies-Depression Scale among nondepressed participants and incident pain defined as a score of 2 or higher on the pain scale of the 5-item Nottingham Health Profile in pain-free participants. Multiple imputations were adopted to estimate missing values.
In nondepressed participants (n = 1769), a higher level of pain was predictive of incident depression in multiple extended Cox regression analyses (hazard rate HR = 1.13 95% confidence interval {CI}: 1.05-1.22, p = .001), which all remained significant after correction for sociodemographic characteristics, life-style characteristics, functional limitations, and chronic diseases (HR = 1.09 95% CI = 1.01-1.18, p = .035). In the pain-free participants (n = 1420), depressive symptoms at baseline predicted incident pain (HR = 1.02 95% CI: 1.01-1.04, p = .006). This depression measure did not independently predicted the onset of pain in the fully adjusted models.
As pain precedes the onset of depression, strategies to prevent depression in chronic pain patients are warranted. In contrast, no effects of depression on the development of subsequent pain were found when adjusting for covariates.
Objectives: Frailty, a state of increased risk of negative health outcomes, is increasingly recognized as a relevant concept for identifying older persons in need of preventative geriatric ...interventions. Even though broader concepts of frailty include psychological characteristics, frailty is largely neglected in mental health care. The aim of the present study is to examine the prevalence of physical frailty in depressed older patients and its potential overlap with depression criteria.
Method: Cross-sectional observational study including 378 depressed and 132 non-depressed adults aged ≥60 years according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Physical frailty was defined as ≥3 out of 5 criteria (handgrip strength, weight loss, poor endurance, walking speed, low physical activity).
Results: Prevalence rates of physical frailty were 27.2% and 9.1% among depressed and non-depressed participants, respectively, which remained significant after controlling for relevant covariates (odds ratio OR = 2.66 95% confidence interval C.I. = 1.36, 5.24, p = .004). Physical frailty in depression was associated with more severe depressive symptoms; this association remained significant in subsequent analyses with purely physical proxies for frailty (hand grip strength, walking speed) and different severity measures of depressive symptoms.
Conclusion: A quarter of depressed older patients is physically frail, especially the most depressed group. This cannot be explained by overlap in criteria and should be examined in future studies, primarily on its presumed clinical relevance.
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