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.
Depression in older adults is associated with decreased quality of life and increased utilization of healthcare services. Behavioral activation (BA) is an effective treatment for late-life ...depression, but the cost-effectiveness compared to treatment as usual (TAU) is unknown.
An economic evaluation was performed alongside a cluster randomized controlled multicenter trial including 161 older adults (≥65 years) with moderate to severe depressive symptoms (PHQ-9 ≥ 10). Outcome measures were depression (response on the QIDS-SR), quality-adjusted life-years (QALYs) and societal costs. Missing data were imputed using multiple imputation. Cost and effect differences were estimated using bivariate linear regression models, and statistical uncertainty was estimated with bootstrapping. Cost-effectiveness acceptability curves showed the probability of cost-effectiveness at different ceiling ratios.
Societal costs were statistically non-significantly lower in BA compared to TAU (mean difference (MD) -€485, 95 % CI -3861 to 2792). There were no significant differences in response on the QIDS-SR (MD 0.085, 95 % CI -0.015 to 0.19), and QALYs (MD 0.026, 95 % CI -0.0037 to 0.055). On average, BA was dominant over TAU (i.e., more effective and less expensive), although the probability of dominance was only 0.60 from the societal perspective and 0.85 from the health care perspective for both QIDS-SR response and QALYs.
Although the results suggest that BA is dominant over TAU, there was considerable uncertainty surrounding the cost-effectiveness estimates which precludes firm conclusions.
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•Behavioral activation was dominant (less costly, more effective) compared to treatment as usual from a societal perspective.•Behavioral activation was also dominant from a health care perspective.•Behavioral activation is probably cost-effective compared to treatment as usual.•Differences in societal costs and effects were not statistically significant.
•Building on previous cross-sectional findings, this study explores predictors of complete remission (no depression nor anxiety diagnoses at 2-year follow-up) and of the course of comorbid anxiety ...symptoms.•Depressed patients with a comorbid anxiety disorder at baseline less often achieved complete remission. The severity of depressive and anxiety symptomatology, the presence of a comorbid anxiety disorder, and a poorer physical health at baseline predicted non-remission.•In the face of negative life-events, maladaptive personality traits may play a central role in the prognosis of late-life depression due to its impact on anxiety.•Interventions to reduce depression and anxiety symptomology need to incorporate techniques that enhance aspect of psychological well-being, like the sense of mastery for daily life-stress continues to be a risk factor among non- or partly remitted older adults.
Studies on the course of depression often ignore comorbid anxiety disorders or anxiety symptoms. We explored predictors of complete remission (no depression nor anxiety diagnoses at follow-up) and of the course of comorbid anxiety symptoms. We additionally tested the hypothesis that the course of anxiety disorders and symptoms in depressed patients is explained by negative life-events in the presence of high neuroticism or a low sense of mastery.
An observational study of 270 patients (≥60 years) diagnosed with major depressive disorder and 2-year follow-up data, who participated in the Netherlands Study of Depression in Older persons (NESDO). Sociodemographic, somatic, psychiatric, and treatment variables were first explored as possible predictors. A multiple logistic regression analysis was used to examine their predictive value concerning complete remission. Subsequently, negative life-events, personality and their interaction were tested as potential predictors. Linear Mixed Models were used to assess whether the personality traits modified the effect of early and recent life-events, and time and their interactions on the course of the anxiety symptoms.
A total of 135 of 270 patients achieved complete remission. Depressed patients with a comorbid anxiety disorder at baseline less often achieved complete remission: 38 of 103 (37.0%) versus 97 of 167 (58.1%). The severity of depressive and anxiety symptomatology, the presence of a comorbid anxiety disorder, and a poorer physical health at baseline predicted nonremission. In line with our hypothesis, a less favorable course of self-reported anxiety symptoms was associated with more recent negative life-events, but only among patients with a high level of neuroticism or a low level of mastery.
Comorbid anxiety in depression as a negative impact on complete remission at 2-year follow-up. The course of anxiety severity seems dependent on the interaction of personality traits and life-events.
Leukocyte telomere length and late-life depression Schaakxs, Roxanne; Verhoeven, Josine E; Oude Voshaar, Richard C ...
The American journal of geriatric psychiatry,
04/2015, Letnik:
23, Številka:
4
Journal Article
Recenzirano
Depressive disorders have been associated with increased risk for aging-related diseases, possibly as a consequence of accelerated cellular aging. Cellular aging, indexed by telomere length (TL) ...shortening, has been linked to depression in adults younger than 60 years; however, it remains unclear whether this is the case in late-life depression (age >60 years). The objective of this study was to assess differences in TL between persons with current late-life depression and never-depressed comparisons and to examine the association between characteristics of late-life depression and TL.
In this cross-sectional study using the Netherlands Study of Depression in Older Persons, 355 persons with current late-life depression and 128 never-depressed comparisons, aged 60-93 years (mean age SD: 70.5 7.4 years, 65% women), were recruited through primary care and mental healthcare. Late-life depression was established using a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-based structured psychiatric interview. Leukocyte TL, expressed in base pairs (bp), was determined in fasting blood samples by performing quantitative polymerase chain reaction.
Mean TL did not differ between depressed persons (bp SD: 5,035 431) and never-depressed (bp SD: 5,057 729) comparisons. Further, TL was not associated with severity, duration, and age at onset of depression; comorbid anxiety disorders; anxiety symptoms; apathy severity; antidepressant use; benzodiazepine use; cognitive functioning; and childhood trauma.
Late-life depression was not associated with increased cellular aging. This absent association, which contradicts observations in younger adults, may be due to the potential larger heterogenic nature of late-life depression and lifetime cumulative exposure to other TL-damaging factors, possibly overruling effects of late-life depression.
•Heavy drinking is more prevalent in people aged 55–70 compared to those aged 23–54.•Level of education of heavy drinkers differs between these age groups.•In those aged 55–70 heavy drinking ...prevention should focus on the higher educated.
Prevention of problematic alcohol use is mainly focused on younger adults, while heavy drinking in middle-aged and older adults might be more frequent with more impact on functioning and health care use. Therefore, alcohol use and alcohol disorder in both age groups was compared. To facilitate age-specific prevention, it was examined whether risk factors of heavy drinking and impact on functioning and health care use differs across the life-span.
Data of people (23–70 years) were used from the Netherlands Mental Health Survey and Incidence Study-2 (N = 4618), a general population-based cohort. Heavy alcohol use was defined as >14 drinks/week for women and >21 drinks/week for men. Alcohol disorder was defined as DSM-IV disorder of alcohol abuse and/or alcohol dependence. (Multinomial) logistic regression analyses were used to study risk factors of alcohol use and associations between alcohol use and health care use and functioning.
The past-year prevalence of heavy alcohol was higher in older (55–70 years) compared to younger people (6.7% versus 3.8%), whereas alcohol disorder was less prevalent (1.3% versus 3.9%). Heavy alcohol use was associated with higher level of education in older adults compared to younger adults. Other characteristics of problematic alcohol use and its impact on functioning and health care use did not differ between age groups.
Heavy drinking is more prevalent among middle-aged and older people. Contrary to younger adults, prevention of heavy alcohol use in those aged 55–70 should focus on higher educated people.
Although anxiety disorders are common in later life, only a minority of patients receive appropriate treatment. The scarcity of clinical trials and decreasing effectiveness of current treatment ...modalities with advancing age, as shown by Wetherell and colleagues in this issue, argue for more clinical trials and development of age-specific psychotherapeutic techniques.
General anxiety and depressive symptoms following a myocardial infarction are associated with a worse cardiac prognosis. However, the contribution of specific aspects of anxiety within this context ...remains unclear.
To evaluate the independent prognostic association of cardiac anxiety with cardiac outcome after myocardial infarction.
We administered the Cardiac Anxiety Questionnaire (CAQ) during hospital admission (baseline, n = 193) and 4 months (n = 147/193) after discharge. CAQ subscale scores reflect fear, attention, avoidance and safety-seeking behaviour. Study end-point was a major adverse cardiac event (MACE): readmission for ischemic cardiac disease or all-cause mortality. In Cox regression analysis, we adjusted for age, cardiac disease severity and depressive symptoms.
The CAQ sum score at baseline and at 4 months significantly predicted a MACE (HR
= 1.59, 95% CI 1.04-2.43; HR
= 1.77, 95% CI 1.04-3.02) with a mean follow-up of 4.2 (s.d. = 2.0) years and 4.3 (s.d. = 1.7) years respectively. Analyses of subscale scores revealed that this effect was particularly driven by avoidance (HR
= 1.23, 95% CI 0.99-1.53; HR
= 1.77, 95% CI 1.04-1.83).
Cardiac anxiety, particularly anxiety-related avoidance of exercise, is an important prognostic factor for a MACE in patients after myocardial infarction, independent of cardiac disease severity and depressive symptoms.
•What is the primary question addressed by this study?Can cerebral small vessel disease (CSVD) cause apathy, even when no other symptoms of CSVD are present yet?•What is the main finding of this ...study?A causal relationship between CSVD and apathy was established, but the specificity of this relationship is low.•What is the meaning of the finding?When a CSVD patient presents with apathy we recommend looking for other contributing factors, such as depression or cognitive deterioration.
The vascular apathy hypothesis states that cerebral small vessel disease (CSVD) can cause apathy, even when no other symptoms of CSVD are present. In order to examine this hypothesis, the objectives of this narrative review are to evaluate the evidence for a pathophysiological mechanism linking CSVD to apathy and to examine whether CSVD can be a sole cause of apathy. The nature of the CSVD-apathy relationship was evaluated using the Bradford Hill criteria as a method for research on the distinction between association and causation. Pathological, neuroimaging, and behavioral studies show that CSVD can cause lesions in the reward network, which causes an apathy syndrome. Studies in healthy older individuals, stroke patients and cognitively impaired persons consistently show an association between CSVD markers and apathy, although studies in older persons suffering from depression are inconclusive. A biological gradient is confirmed, as well as a temporal relationship, although the evidence for the latter is still weak. The specificity of this causal relationship is low given there often are other contributing factors in CSVD patients with apathy, particularly depression and cognitive deterioration. Differentiating between vascular apathy and other apathy syndromes on the basis of clinical features is not yet possible, while in-depth knowledge about differences in the prognosis and efficacy of treatment options for apathy caused by CSVD and other apathy syndromes is lacking. Since we cannot differentiate between etiologically different apathy syndromes as yet, it is premature to use the term vascular apathy which would suggest a distinct clinical apathy syndrome.
To evaluate the feasibility, usability and clinical value of daily diary assessments combined with actigraphy in older persons with cognitive impairment.
For 63 days, patients ≥60 years with ...cognitive impairments filled out a daily diary (including standardized questionnaires and cognitive test battery), and wore an actiwatch (sleep). After the study, participants and clinicians received personal feedback about patterns and daily triggers of depressive symptoms, sleep and cognitive performance. We assessed feasibility (participation rate, compliance and subjective burden), usability (variability and floor- or ceiling effects) and clinical value for patients and their clinicians (questionnaires).
Of 96 eligible patients, 13 agreed to participate (13.5%). One patient dropped out after 2 days, another after 37 days, and another did not complete the cognitive test battery. Compliance rate was high (6.7-10% missing values). Subjective burden was relatively low. Time-series data showed sufficient variability and no floor- or ceiling effects, except for one relevant ceiling effect on the One Back task. The personal feedback report was considered insightful by 4 out of 11 participants and 5 out of 7 clinicians.
Daily assessments are suitable for a minority of cognitively impaired older persons, but is helpful to increase insight into their symptoms.
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