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The prevalence of loneliness increases with age. The presence of loneliness in older adults has been found to be associated with health problems such as depression, decreased cognitive functioning, increases in systolic blood pressure and increased mortality. The underlying mechanisms of the higher mortality risk are largely unknown.
Meta-analysis to investigate the present evidence for the associations between loneliness and mortality. Cross-sectional studies investigating the associations between loneliness and cardiovascular disease and between loneliness and cortisol in 378 depressed and 132 non-depressed older adults.
Loneliness appears to be associated with increased mortality, although when only studies are included that consider depression as a covariate, the association is not significant. Therefore it seems likely that depression plays a mediating role in the higher mortality risk.
We did not find a significant association between loneliness and cardiovascular disease. In contrast, loneliness was significantly associated with lower cortisol output and decreased dexamethasone suppression.
The results and their implications for prevention and treatment will be discussed from a clinical perspective as well as a general health perspective. Is loneliness as potentially dangerous as depression?
More than a quarter of depressed older persons is physically frail. Understanding the associations between frailty and depression may help to improve treatment outcome for late-life depression. The aim of this study is to test whether physical frailty predicts the course of late-life depression.
A cohort study (N=285) of depressed older persons aged ≥60 years with two years follow-up. Depression was classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria at baseline and at two-year follow-up. Severity of depression was assessed with the sum score as well as subscale scores of the Inventory of Depressive Symptomatology (IDS) at six-month intervals. Physical frailty was defined as ≥3 out of 5 criteria (handgrip strength, weight loss, poor endurance, walking speed, low physical activity).
Frail patients were more severely depressed compared to their non-frail counterparts. Multivariable logistic regression showed that physical frailty at baseline was associated with depression at two years follow-up, adjusted for socio-demographics and lifestyle factors. Linear mixed models showed that improvement of mood symptoms over time was independent of frailty status, whereas frailty had a negative impact on the course of the somatic and motivational symptoms of depression.
The negative impact of physical frailty on the course of depression may point to the potential importance of incorporating multi-facetted interventions in the treatment of late-life depression. Further understanding of the mediating mechanisms underlying the association between frailty and depression may further guide the development of these interventions.
Seven to twelve year follow-up of ECT outcome in patients with geriatric depression. Do these patients develop dementia?
Depression and cognitive decline are highly prevalent in elderly as is comorbidity between the two. Depressed patients are at high risk to develop dementia. To date, knowledge has been limited on course and outcome in severe geriatric depression.
The association between depression and dementia remains unclear. Both white matter hyperintensities (WMH) and medial temporal lobe atrophy (MTA) are associated with depression, mild cognitive impairment and dementia, which possibly explains a common underlying mechanism of these diseases. The objective of this study was to identify associations between WMH, MTA, dementia and mortality in patients with severe geriatric depression formerly treated with ECT.
Data of 92.1% of the former patients was obtained. A total of 51.3 % (39 out of 76) of former patients participated in the follow-up study. Cognitive decline was identified in patients seven to 12 years after ECT, using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). WMH and MTA scores were available from the initial study.
56.6% of the patients were deceased and 35.5% of the patients were alive during FU. 61.5% (24 out of 39) of the included patients showed cognitive decline and 17.9% (7 out of 39) of the included patients were diagnosed with dementia. Depression with psychotic symptoms was significantly associated with no cognitive decline at follow-up (p=0.007). WMH and mortality were significantly associated (p=0.047).
Depression with psychotic symptoms is associated with cognitive decline at follow-up and WMH before ECT– not MTA or dementia – increases mortality after ECT.
Many older adults with depressive disorder manifest anxious distress. This longitudinal study examines the predictive value of worry as a maladaptive cognitive emotion regulation strategy, and resources necessary for successful emotion regulation (i.e., cognitive control and resting heart rate variability [HRV]) for the course of anxiety symptoms in depressed older adults. Moreover, it examines whether these emotion regulation variables moderate the impact of negative life events on severity of anxiety symptoms.
Data of 378 depressed older adults (CIDI) between 60 and 93 years (of whom 144 [41%] had a comorbid anxiety disorder) from the Netherlands Study of Depression in Older Adults (NESDO) were used. Latent Growth Mixture Modeling was used to identify different course trajectories of six-months BAI scores. Univariable and multivariable longitudinal associations of worry, cognitive control and HRV with symptom course trajectories were assessed.
We identified a course trajectory with low and improving symptoms (57.9%), a course trajectory with moderate and persistent symptoms (33.5%), and a course trajectory with severe and persistent anxiety symptoms (8.6%). Higher levels of worry and lower levels of cognitive control predicted persistent and severe levels of anxiety symptoms independent of presence of anxiety disorder. However, worry, cognitive control and HRV did not moderate the impact of negative life events on anxiety severity.
Worry may be an important and malleable risk factor for persistence of anxiety symptoms in depressed older adults. Given the high prevalence of anxious depression in older adults, modifying worry may constitute a viable venue for alleviating anxiety levels.
Physical frailty and depressive symptoms are reciprocally related in community-based studies, but its prognostic impact on depressive disorder remains unknown.
A cohort of 378 older persons (≥ 60 years) suffering from a depressive disorder (DSM-IV criteria) was reassessed at two-year follow-up. Depressive symptom severity was assessed every six months with the Inventory of Depressive Symptomatology, including a mood, motivational, and somatic subscale. Frailty was assessed according to the physical frailty phenotype at the baseline examination.
For each additional frailty component, the odds of non-remission was 1.24 [95% CI = 1.01–1.52] (P = 040). Linear mixed models showed that only improvement of the motivational (P < 001) subscale and the somatic subscale (P = 003) of the IDS over time were dependent on the frailty severity.
Physical frailty negatively impacts the course of late-life depression. Since only improvement of mood symptoms was independent of frailty severity, one may hypothesize that frailty and residual depression are easily mixed-up in psychiatric treatment.
Studying birth-cohort differences in depression incidence and their explanatory factors may provide insight into the aetiology of depression and could help to optimise prevention strategies to reduce the worldwide burden of depression.
Data were used from the Longitudinal Aging Study Amsterdam, a nationally representative study among community dwelling older adults in the Netherlands. Cohort differences in depression incidence over a 10-year-period (score ⩾16 on the Center for Epidemiologic Studies Depression scale) were tested using a cohort-sequential-longitudinal-design, comparing two identically measured cohorts of non-depressed 55–64-year-olds, born 10-years apart. Baseline measurements took place in 1992/93 (early cohort, n = 794), and 2002/03 (recent cohort, n = 771). As indicated by the dynamic equilibrium model of depression, potential explanatory factors were distinguished in risk and protective factors.
The incidence rates for depression in the early and recent cohort were 1.91 (95% confidence interval (CI) 1.59–2.27) and 1.60 (95% CI 1.31–1.94) per 100 person-years, respectively. A 29% risk reduction in depression incidence was observed in the recent cohort (HRcohort: 0.71, 95% CI 0.54–0.92, p = 0.011), as compared with the early cohort, even though average levels of risk factors such as chronic disease and functional limitations had increased. This reduction was primarily explained by increased levels of education, mastery and labour market participation.
These findings suggest that favourable developments of protective factors have counterbalanced unfavourable effects of risk factors on the incidence of depression, resulting in a net reduction of depression incidence among young-old adults. However, maintaining a good physical health must be a priority to further decrease depression rates.
Comorbid anxiety disorders are common in late-life depression and negatively
impact treatment outcome. This study aimed to examine personality
characteristics as well as early and recent life-events as possible
determinants of comorbid anxiety disorders in late-life depression, taking
previously examined determinants into account.
Using the Composite International Diagnostic Interview (CIDI 2.0), we
established comorbid anxiety disorders (social phobia (SP), panic disorder
(PD), generalized anxiety disorder (GAD), and agoraphobia (AGO)) in 350
patients (aged ≥60 years) suffering from a major depressive
disorder according to DSM-IV-TR criteria within the past six months.
Adjusted for age, sex, and level of education, we first examined previously
identified determinants of anxious depression: depression severity,
suicidality, partner status, loneliness, chronic diseases, and gait speed in
multiple logistic regression models. Subsequently, associations were
explored with the big five personality characteristics as well as early and
recent life-events. First, multiple logistic regression analyses were
conducted with the presence of any anxiety disorder (yes/no) as dependent
variable, where after analyses were repeated for each anxiety disorder,
In our sample, the prevalence rate of comorbid anxiety disorders in late-life
depression was 38.6%. Determinants of comorbid anxiety disorders were a
lower age, female sex, less education, higher depression severity, early
traumatization, neuroticism, extraversion, and conscientiousness.
Nonetheless, determinants differed across the specific anxiety disorders and
lumping all anxiety disorder together masked some determinants (education,
Our findings stress the need to examine determinants of comorbid anxiety
disorder for specific anxiety disorders separately, enabling the development
of targeted interventions within subgroups of depressed patients.
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