scholarly journals Independent and synergistic effects of pain, insomnia, and depression on falls among older adults: a longitudinal study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yuxiao Li ◽  
Minhui Liu ◽  
Xiaocao Sun ◽  
Tianxue Hou ◽  
Siyuan Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Sex Education ◽  
Synergistic Effects ◽  
Living Arrangement ◽  
Community Dwelling ◽  
Wave Period ◽  
Falling Asleep ◽  
Independent Effects

Abstract Background Few studies have examined the relationship between falls and pain, insomnia and depressive symptoms which are common and risk factors in older adults. We aimed to examine the independent and synergistic effects of these risk factors on future falls among older adults. Methods We used data of 2558 community-dwelling older adults from 2011 (Y1) to 2015 (Y5) of the National Health and Aging Trends Study (NHATS). Pain was determined by whether participants reported bothersome pain in the last month. Insomnia was assessed by two questions about how often the participants had trouble falling asleep and maintaining sleep. Depressive symptoms were assessed by Patient Health Questionnaire-2. Generalized estimation equation (GEE) models were used to examine the independent effects of pain, insomnia and depressive symptoms at prior-wave (period y-1) on falls at current wave (period y) adjusting for covariates (age, sex, education, race/ethnicity, living arrangement, BMI, smoking, vigorous activities, number of chronic illnesses and hospitalization). The significance of the three-way interaction of these factors (pain*insomnia*depression) was tested using the aforementioned GEE models to determine their synergistic effects on falls. Results Overall, the participants were mainly 65–79 years old (68%), female (57%) and non-Hispanic White (70%). At Y1, 50.0% of the participants reported pain, 22.6% reported insomnia and 9.9% reported depressive symptoms. The incidence of falls from Y2 to Y5 was 22.4, 26.0, 28.3, and 28.9%, respectively. Participants with pain (Odds ratio [OR], 95% confidence interval [CI] = 1.36, 1.23–1.50) and depressive symptoms (OR, 95% CI = 1.43, 1.23–1.67) had high rates of falling adjusting for covariates. After further adjustment for insomnia and depressive symptoms, pain independently predicted falls (OR, 95% CI = 1.36, 1.22–1.51). Depressive symptoms also independently predicted falls after further adjusting for pain and insomnia (OR, 95% CI = 1.40, 1.20–1.63). After adjusting for pain and depression, the independent effects of insomnia were not significant. None of the interaction terms of the three risk factors were significant, suggesting an absence of their synergistic effects. Conclusions Pain and depressive symptoms independently predict falls, but synergistic effects seem absent. Further research is needed to develop effective strategies for reducing falls in older adults, particularly with pain and depressive symptoms.

scholarly journals Synergistic effects of hip/knee osteoarthritis and comorbidities on mobility and self-care limitations among older adults: Cross-sectional analysis of the Oxford pain, Activity and Lifestyle study

2020 ◽  
Vol 10 ◽  
pp. 2235042X2097452
Author(s):  
Philippa JA Nicolson ◽  
Esther Williamson ◽  
Hopin Lee ◽  
Alana Morris ◽  
Angela Garrett ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Knee Osteoarthritis ◽  
Synergistic Effects ◽  
Self Care ◽  
Postal Questionnaire ◽  
Community Dwelling ◽  
Mobility Limitations ◽  
Cross Sectional ◽  
Knee Oa

Objective: To estimate synergistic effects of hip/knee osteoarthritis (OA) and comorbidities on mobility or self-care limitations among older adults. Methods: We used baseline, cross-sectional data from the Oxford Pain, Activity and Lifestyle (OPAL) study. Participants were community-dwelling adults aged 65 years or older who completed a postal questionnaire. Participants reported demographic information, hip/knee OA, comorbidities and mobility and self-care limitations. We used modified Poisson regression models to estimate the independent and combined relative risks (RR) of mobility or self-care limitations, the relative excess risk due to interaction (RERI) between hip/knee OA and comorbidities, attributable proportion of the risk due to the interaction and the ratio of the combined effect and the sum of the individual effects, known as the synergy index. Results: Of the 4,972 participants included, 1,532 (30.8%) had hip/knee OA, and of them 42.9% reported mobility limitations and 8.4% reported self-care limitations. Synergistic effects impacting self-care limitations were observed between hip/knee OA and anxiety (RR: 3.09, 95% Confidence Interval (CI): 2.00 to 4.78; RERI: 0.93, 95% CI: 0.01 to 1.90), and between hip/knee OA and depressive symptoms (RR: 2.71, 95% CI: 1.75 to 4.20; RERI: 0.58, 95% CI: 0.03 to 1.48). The portion of the total RR attributable to this synergism was 30% and 22% respectively. Conclusions: This study demonstrates that synergism between hip/knee OA and anxiety or depressive symptoms contribute to self-care limitations. These findings highlight the importance of assessing and addressing anxiety or depressive symptoms when managing older adults with hip/knee OA to minimize self-care limitations.

scholarly journals The relationship between chronic stress, emotion regulation and depressive symptoms in healthy older adults

2021 ◽  
Author(s):  
Vivian Huang
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Sample Size ◽  
Chronic Stress ◽  
Sex Education ◽  
Allostatic Load ◽  
Small Sample Size ◽  
Small Sample ◽  
Community Dwelling ◽  
The Relationship

The current study examined the association between chronic stress (measured in allostatic load or AL), ER, and depressive symptoms in a group of community-dwelling older adults. It was hypothesized that chronic stress levels would mediate the relationship between ER and depressive symptoms. A total of 70 older adults aged 60 and older participated in the study. There were no significant associations found in the main analyses between the AL index and depressive symptoms, as well as no significant relationship was found between ER strategies and AL index, after controlling for age, sex, education, and perceived SES. However, perceived stress significantly mediated the relationship between maladaptive ER strategies and depressive symptoms, and the relationship between adaptive ER strategies and depressive symptoms. Given the small sample size and the lack of variability of the AL index, the study would benefit from a larger sample size to clarify the present results.

scholarly journals Association of Early-Life Family and Nieghborhood Circumstances With Depressive Symptoms in Chinese Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 441-442
Author(s):  
Yan Chen ◽  
Jie Tan
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Old Age ◽  
Early Life ◽  
Strong Association ◽  
Community Dwelling ◽  
Bivariate Analysis ◽  
Life Circumstances ◽  
Community Dwelling Older Adults

Abstract A growing body of literature suggests that early life circumstances can influence mental health throughout the lifespan. However, how these early life circumstances cumulatively contribute to depression in old age is not completely understood. The present study examined the associations of eight factors representing multifaceted early life experience at individual, family, and community levels with depression among community-dwelling older adults. Data were from the China Health and Retirement Longitudinal Study. We included 8,239 community-dwelling individuals who were ≥60 years, completed the life history questionnaire, and had assessment of depression. Chi-square test was used to examine the unadjusted associations between each of the eight early life risk factors and depression. An early life disadvantage index was established using risk factors that were significantly associated with depression. Logistic regression was used to examine the association of each early life risk factor and the index with depression. Of 8,239 individuals included, 2,055 (24.9%) had depression. In bivariate analysis, each of eight early life risk factors was significantly associated with depression. Except for maternal and paternal education, all risk factors persisted to be associated with depression after multivariable adjustment. In the multivariable-adjusted model, a one-point higher in the early life disadvantage index (range: 0-6) was associated with a 45% (95% CI: 37%, 53%) higher odds of depression. There was a strong association between early life environments and depressive symptoms among Chinese community-dwelling older adults. Adverse early life circumstances could contribute cumulatively to depression in old age.

scholarly journals The relationship between chronic stress, emotion regulation and depressive symptoms in healthy older adults

2021 ◽  
Author(s):  
Vivian Huang
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Sample Size ◽  
Chronic Stress ◽  
Sex Education ◽  
Allostatic Load ◽  
Small Sample Size ◽  
Small Sample ◽  
Community Dwelling ◽  
The Relationship

The current study examined the association between chronic stress (measured in allostatic load or AL), ER, and depressive symptoms in a group of community-dwelling older adults. It was hypothesized that chronic stress levels would mediate the relationship between ER and depressive symptoms. A total of 70 older adults aged 60 and older participated in the study. There were no significant associations found in the main analyses between the AL index and depressive symptoms, as well as no significant relationship was found between ER strategies and AL index, after controlling for age, sex, education, and perceived SES. However, perceived stress significantly mediated the relationship between maladaptive ER strategies and depressive symptoms, and the relationship between adaptive ER strategies and depressive symptoms. Given the small sample size and the lack of variability of the AL index, the study would benefit from a larger sample size to clarify the present results.

scholarly journals Haemoglobin A1c, fasting glucose and future risk of elevated depressive symptoms over 2 years of follow-up in the English Longitudinal Study of Ageing

2011 ◽  
Vol 41 (9) ◽  
pp. 1889-1896 ◽  
Author(s):  
M. Hamer ◽  
G. D. Batty ◽  
M. Kivimaki
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Longitudinal Study ◽  
Glucose Metabolism ◽  
Fasting Glucose ◽  
Community Dwelling ◽  
English Longitudinal Study ◽  
Hba1c Levels

BackgroundThe cross-sectional association between impaired glucose/diabetes and depression is inconsistent. We examined the longitudinal associations between diabetes, indicators of glucose metabolism and depressive symptoms over 2 years of follow-up.MethodParticipants were 4338 men and women from the English Longitudinal Study of Ageing, a prospective study of community-dwelling older adults [aged 62.9 (s.d.=9.0) years, 45.2% men]. Depressive symptoms were assessed at baseline and after 2 years of follow-up using the eight-item Centre of Epidemiological Studies – Depression (CES-D) scale. Glycated haemoglobin (HbA1c) levels, fasting glucose and other biological and behavioural risk factors were also assessed at baseline.ResultsApproximately 11.5% of the sample were categorized with elevated depressive symptoms at follow-up (a score ⩾4 on the CES-D). There was an association between HbA1c and depressive symptoms at follow-up [per unit increase, odds ratio (OR) 1.17, 95% confidence interval (CI) 1.03–1.33] after adjustment for age and baseline CES-D. Cross-sectionally, the probability of depressive symptoms increased with increasing HbA1c levels until the value of 8.0% after which there was a plateau [p(curve)=0.03]. Compared with those with normal fasting glucose, participants with diabetes (confirmed through self-report or elevated fasting blood glucose) at baseline had an elevated risk of depressive symptoms at follow-up (OR 1.52, 95% CI 1.01–2.30) after adjusting for depressive symptoms at baseline, behavioural and sociodemographic variables, adiposity and inflammation.ConclusionsThese data suggest that poor glucose metabolism and diabetes are risk factors for future depression in older adults. There was no evidence of a U-shaped association.

scholarly journals Longitudinal relationship of diabetes and depressive symptoms in older adults from Mexico: a secondary data analysis

2020 ◽  
Vol 8 (2) ◽  
pp. e001789
Author(s):  
Teresa Alvarez-Cisneros ◽  
Paloma Roa-Rojas ◽  
Carmen Garcia-Peña
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Secondary Data ◽  
Random Effects Models ◽  
Health Factors ◽  
Longitudinal Association ◽  
Common Risk Factors ◽  
Nationally Representative ◽  
Relationship Of

IntroductionSeveral studies have argued a causal relationship between diabetes and depression, while others have highlighted that their association is a result of common risk factors. Because Mexico is a country with a high prevalence of diabetes, and diabetes and depression are a frequent comorbidity, we chose this country to investigate the longitudinal relationship of these two conditions, focusing on the influence of demographic, health, and socioeconomic factors which could act as common risk factors for both conditions.Research design and methodsUsing the harmonized Mexican Health and Aging Study, a nationally representative sample of adults older than 50 with a response rate of 93%, we analyzed the longitudinal relationship of diabetes and depressive symptoms using ‘between-within’ random-effects models, focusing on the effect of demographic, socioeconomic and health factors.ResultsWhile older adults with diabetes reported a higher prevalence of depressive symptoms in the four waves of the study, there was no causal longitudinal association between them once controlling for demographic, socioeconomic and health factors (between-effect OR=0.88, 95% CI 0.77 to 1.01; within-effect OR=0.87, 95% CI 0.69 to 1.11).ConclusionsThere is no causal longitudinal association between diabetes and depression; the higher prevalence of depression among older adults with diabetes seems a result of socioeconomic and health factors that are not exclusive to respondents with diabetes but are more frequent in this group. Our results highlight the importance of prevention and control of chronic conditions as well as the role of socioeconomic inequalities in mental health.

scholarly journals Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

2021 ◽  
Vol 30 ◽  
Author(s):  
Shiyu Lu ◽  
Tianyin Liu ◽  
Gloria H. Y. Wong ◽  
Dara K. Y. Leung ◽  
Lesley C. Y. Sze ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Symptom Severity ◽  
Social Care ◽  
Late Life ◽  
Community Dwelling ◽  
Service Utilisation ◽  
Late Life Depression ◽  
Social Care Service ◽  
Health And Social Care

Abstract Aims Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. Methods We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. Results The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). Conclusions The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

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