Veteran Status and Old Age Depression: A Life Course Epidemiology Study

Military service and exposure to war may influence the development of depression, leading to disparities in the condition among veterans and non-veterans. This study included 10,512 older men from the 1996 to 2014 waves of the Health and Retirement Study (HRS). We estimated Center for Epidemiology Depression (CESD) score trajectories among veterans and non-veterans and veterans of different war cohorts in growth curve models, controlling for early, mid, and late life characteristics. CESD score trajectories were lower among veterans and war veterans than non-veterans and non-war veterans, respectively. The highest levels of depression were among war veterans who served in more than one war. Veterans demonstrated lower levels of depression than non-veterans, calling into question the health advantage of veterans and selection mechanisms into the military and out of HRS. Multiple war veterans showed the highest levels of depression, representing the greatest mental health threat to veterans in the study. Part of a symposium sponsored by the Aging Veterans: Effects of Military Service across the Life Course Interest Group.

The course of depression in late life: a longitudinal perspective

Depression in old age deserves special attention in view of the fact of progressive population ageing, because of the way in which depression and risk factors interact in this period of life and the particularly negative impact of late-life depression on health and quality of life. This editorial aims to provide some insight into longitudinal aspects of depression in old age. Depression may follow varying trajectories (e.g. episode emergence, recurrence) across the lifespan. Late-life depression is not an exception. A symptom-based approach is presented as an appropriate research method to study the predictors and course of affective syndromes in old age. Findings from our studies on depressive symptom trajectories in old age revealed that participants with a course of unremitting elevated symptoms showed the highest levels of loneliness across the trajectory groups and that participants with subclinical symptoms also showed higher levels of loneliness than their counterparts with a minimal-symptom course trajectory. This highlights the need to address loneliness as a way of dealing with depression in old age.

ROLE OF AHARA IN GRACEFUL AGING

Aging has become an important issue in developing countries. Ageing is an inevitable process. Although one cannot escape from this reality but one can be able to age gracefully. Ayurveda and its principles can play an important role in to relieve the hardships of old age. As Ahara, Nidra and Bramhacharya are three pillars of Life, Certain Dietary rules and sleeping pattern can increase healthy life span and prevent the development of diseases. The key to balance Vatadosha in old age is regularity, rest and warmth One should pay equal attention to physical as well as mental health. Depression is also a very common problem in old age. Depression can hamper digestive one should adopt capacity of an individual. Sattvik ahara, fresh and hot food, green leafy vegetables & seasonal fruit, proper nidra as part and parcel of old age. Rasayan chikitsa, Sattvavajay chikitsa, yoga, can add years to the life of old persons.

Routine Data Indicators of Treatment for Dementia and Old-Age Depression

Complications in the course of dementia are one of the leading reasons for treatment in German psychiatric hospitals. One way to assess treatment quality with a moderate effort is to analyze existing routine data. A large routine dataset exists for psychiatric hospitals in Germany. This work reports on the indicators of inpatient treatment of patients with dementia and compares them to those found with old-age depression. Among other results it was shown that no specific dementia diagnosis was defined in more than 15% of all cases, and that the readmission rate within 30 days was more than 25%. Depressed people, on the other hand, showed lower readmission rates: They got more specific diagnoses and more therapeutic contacts. In conclusion, several aspects of diagnosis and treatment demand improvement among patients with dementia.

Distinction of dementia and depression in various stages of the disease processes

Old age depression is often difficult to discriminate from dementia (particularly of Alzheimer type) – particularly cross-sectionally. Incident dementia is frequently associated with depressed mood and agitation; depression in the elderly goes together with executive and memory dysfunctions; associated psychotic symptoms and activity-of-daily-life dysfunctions are shared by both conditions as well as major risk factors as vascular and metabolic factors. Frequently both syndromes are “masking” each other; depression may furthermore present as the first clinical sign of Alzheimers disease.Yet, both clinical syndromes/disorders emerging from quite different are pathogenic neurobiological mechanisms with differentiating neuropsychological, – imaging and – chemical features. Clinical tools can be derived and enable accurate differential diagnosis. Thus, the distinction between both syndromes is a first instance for biomarker supported differential diagnoses in psychiatry.Disclosure of interestThe author has not supplied his declaration of competing interest.

Clinical pharmacological management of polypharmacy in old age depression

Polypharmacy is the rule in psychogeriatric patients, as they present frequently comorbidities such as depression, dementia [often including Behavioral and Psychological Symptoms of Dementia (BPSD)] and somatic diseases. Recommended treatments for geriatric depression are antidepressant medications, psychotherapy and psychosocial interventions [1]. Besides antidepressants, other psychotropic drugs are often co-prescribed, but somatic drugs are also needed for the treatment of other concomitant diseases. This situation increases the risk for adverse effects due to pharmacokinetic and pharmacodynamic interactions, especially since the organism of elderly patients displays a lowered homeostatic reserve and a decrease of functions, which allows resisting to xenobiotic influences.On the other hand, there are also studies which suggest that in hospitalized psychogeriatric patients, the incidence of severe adverse reactions is lower in patients > 60 y than in those < 60 y [2]. This is one of the results of the AMSP-study group, which in German speaking countries has developed a pharmacovigilance program in psychiatric hospitals.Disclosure of interestThe authors have not supplied their declaration of competing interest.