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Depression: a modifiable factor in fearful older fallers transitioning to frailty?
- Authors:
- MHAOLÁIN Aine M. Ni, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(7), July 2012, pp.727-733.
- Publisher:
- Wiley
It is suggested that fear of falling, one of the most common fears among community-dwelling older people, is as serious a health problem as the falls themselves. It often leads to activity avoidance. The authors believe that understanding fear of falling may help to identify strategies to reduce concern in the vulnerable old. This cross sectional study evaluated the psychological factors associated with fear of falling in a group of fallers transitioning to frailty compared with robust or non-frail fallers. A total of 301 fallers (mean age 75 years) underwent assessment. Fear of falling was measured using the Modified Falls Efficacy Scale, and frailty using the Biological Syndrome Model. Psychological assessment included anxiety, depression, loneliness, personality factors and cognition. Frailer fallers had increased fear of falling compared to robust fallers. Age, female gender and lower cognitive scores were associated with greater fear of falling in the robust group. For frailer fallers, higher depression score was the only factor associated with fear of falling. The odds ratio of having case level depressive disorder if a frail faller was significantly higher than if robust. The authors conclude that fallers at a transitional level of frailty may be particularly vulnerable group psychologically and would benefit most from interventional strategies focussing on depressive symptoms.
Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults
- Authors:
- GALLAGHER Damien, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(10), October 2010, pp.981-987.
- Publisher:
- Wiley
Late onset depression is often associated with acquired organic pathology, with patients less likely to report a family history of depression. The majority of previous studies have been in hospital populations. This study addressed this question in a sample of community dwelling older adults. Participants included 89 subjects with GMS-AGECAT depression who were identified from a sample of 1,231 community dwelling adults aged 65 and over. Subjects were analysed across a range of aetiological and phenomenological variables according to age of onset of first depressive episode. Findings indicated that subjects with late onset depression were significantly less likely to report a family history of depression, were less likely to report previous hospitalisation for depression and had greater cognitive impairment. Late onset subjects were also less likely to report feelings of guilt or thoughts that life was not worth living in the previous month. While patients with late onset depression differed from early onset patients according to certain aetiological risk factors, there was not a distinctive profile of depressive symptomatology which might be considered clinically useful – findings consistent with previous hospital-based studies.
The ‘Wish to Die’ in later life: prevalence, longitudinal course and mortality. Data from TILDA
- Authors:
- BRIGGS Robert, WARD Mark, KENNY Rose Anne
- Journal article citation:
- Age and Ageing, 50(4), 2021, pp.1321-1328.
- Publisher:
- Oxford University Press
Background: ‘Wish to Die’ (WTD) involves thoughts of or wishes for one’s own death or that one would be better off dead. Objective: To examine the prevalence, longitudinal course and mortality-risk of WTD in community-dwelling older people. Design: Observational study with 6-year follow-up. Setting: The Irish Longitudinal Study on Ageing, a nationally representative cohort of older adults. Subjects: In total, 8,174 community-dwelling adults aged ≥50 years. Methods: To define WTD, participants were asked: ‘In the last month, have you felt that you would rather be dead?’ Depressive symptoms were measured using the CES-D. Mortality data were compiled by linking administrative death records to individual-level survey data from the study. Results: At Wave 1, 3.5% of participants (279/8,174) reported WTD. Both persistent loneliness (OR 5.73 (95% CI 3.41–9.64)) and depressive symptoms (OR 6.12 (95% CI 4.33–8.67)) were independently associated with WTD. Of participants who first reported WTD at Wave 1 or 2, 72% did not report WTD when reassessed after 2 years, and the prevalence of depressive symptoms (−44%) and loneliness (−19%) was more likely to decline in this group at follow-up. Fifteen per cent of participants expressing WTD at Wave 1 died during a 6-year follow-up. Conclusions: WTD amongst community-dwelling older people is frequently transient and is strongly linked with the course of depressive symptoms and loneliness. An enhanced focus on improving access to mental health care and addressing social isolation in older people should therefore be a public health priority, particularly in the current context of the Covid-19 pandemic. (Edited publisher abstract)
The spectrum of worry in the community-dwelling elderly
- Authors:
- GOLDEN Jeannette, et al
- Journal article citation:
- Aging and Mental Health, 15(8), November 2011, pp.985-994.
- Publisher:
- Taylor and Francis
This study investigated the prevalence and distribution of worry, its associations with quality of life and depression, based on a large sample of community-dwelling elderly. Participants included 2,136 people aged 65 to 96 recruited through general practitioners. Interviews was used to rate symptoms which were classified into five levels of severity of worry ranging from simple, non-excessive to generalised anxiety disorder (GAD). Findings revealed that 79% of participants reported worrying, 37% worrying excessively, 20% reported excessive, uncontrollable worry and 6.3% met criteria for GAD. Prevalence of all types of worry declined with age and was lower in men. Major depressive disorder was absent in those who did not worry, and had a prevalence of only 0.2% in those with non-severe worry. It had a significantly elevated prevalence at all levels of excessive worry, and a significantly higher prevalence in those with GAD. All levels of excessive worry were associated with reduced quality of life.
Depression, cognitive reserve and memory performance in older adults
- Authors:
- MURPHY Mike, O’LEARY Eleanor
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(7), July 2010, pp.665-671.
- Publisher:
- Wiley
This study examined the relationship between education and leisure, as markers of cognitive reserve, depressive symptoms and memory performance in a sample of cognitively normal Irish older adults. It was hypothesised that greater education level and leisure activity and lower depressive symptoms would emerge as predictors of superior recall performance. The sample consisted of 99 community-dwelling volunteers (65 female, 34 male) living in the area of Cork city, Ireland. All participants were aged between 60 and 83 years, were deemed cognitively normal on the basis of Mini-Mental State Examination scores, and were not taking antidepressant or anxiolytic medications. A cross-sectional survey was employed, involving a face-to-face meeting with each of the participants. The results showed that, controlling for age and gender, depressive symptoms were associated with poorer immediate recall performance, while greater than 12 years of education was positively associated with delayed recall and savings. Leisure did not emerge as being associated with any of the dimensions of memory assessed. The article concludes that depressive symptoms emerged as associated with immediate recall. This may indicate a need for intervention in cases of subclinical depression with associated memory complaints. The association between education level and both delayed recall and savings provides support for the cognitive reserve hypothesis, and may suggest useful non-pharmacological approaches to memory deficits in later life.
Age-friendly environments and psychosocial wellbeing: a study of older urban residents in Ireland
- Authors:
- GIBNEY Sarah, ZHANG Mengyang, BRENNAN Cathal
- Journal article citation:
- Aging and Mental Health, 24(12), 2020, pp.2022-2033.
- Publisher:
- Taylor and Francis
Objective: This article aims to estimate the association between age-friendly urban environments and psychosocial wellbeing in adults aged 55+ living in four Irish cities. Method: Data is from the Healthy and Positive Ageing Initiative ‘Age-friendly Cities and Counties Survey’ from four cities; Dublin, Cork, Limerick, and Galway (n = 2,094). The Age-friendly Urban Index (AFUI), a perception-based measure of safety, access to services, and walkability, is used to measure urban environment quality on a scale of 35 (least favourable) to 105 (most favourable). Wellbeing was estimated using the following composite measures: quality of life (comprising hedonic (pleasure) and eudaimonic (control, autonomy, self-realisation) wellbeing); affective (depressive mood); and social (loneliness). Multivariate regression analyses (negative binomial and Poisson regression) were used to investigate the association between the AFUI and each wellbeing indicator. Models were fully adjusted for known demographic (age, gender, household structure, marital status), socio-economic (material deprivation, employment/occupation, education), social (social engagement, community activities) and health (self-rated health, mobility limitations) correlates of psychosocial wellbeing. Results: Older people living in cities with higher AFUI score were more likely to report higher quality of life overall, and higher hedonic and eudaimonic wellbeing. These adults also had lower depressive mood scores and reported lower loneliness levels. Results remain significant in the fully adjusted model. Limitations: Causal conclusions cannot be made because of cross-sectional data. Conclusion: This study provides evidence of the relationship between the age-friendliness (safety, services, and walkability) of urban environments and multiple aspects of psychosocial wellbeing for older adults in Ireland. (Edited publisher abstract)
Factors associated with perceived health in older adult Irish population
- Authors:
- BURKE Kate E., et al
- Journal article citation:
- Aging and Mental Health, 16(3), April 2012, pp.288-295.
- Publisher:
- Taylor and Francis
Perceived health status or self-reported health is a reliable indicator of overall health status and is a widely used measure in health and aging surveys. Self-reported health declines with age and is associated with increased morbidity, mortality, poor mental health and functional outcomes and health care utilisation. The aim of this study was to investigate how older people perceive their health and the physical, psychological and social factors that influence and potentially predict such perceptions. The participants were 492 community-dwelling older people with a mean age of 72.5 years living in Dublin. The participants underwent a comprehensive assessment using standardised measures of medical morbidity, personality, functional status, depression, anxiety, perceived stress, cognition, loneliness and social support. Analysis of the findings revealed that self-rated health is best predicted by instrumental activities of daily living (IADL), Charlson Co-morbidity Index (CCI), extraversion and perceived stress. The effects of cognition and social support from friends on self-rated health were found to be mediated by elements of these identified factors. The article concludes that self-rated health is not simply the absence of physical illness but is also strongly influenced by the degree of functional impairment, personality factors and the level of stress experienced by the older person.
Risk factors and mediating pathways of loneliness and social support in community-dwelling older adults
- Authors:
- SCHITTGER Rebecca I. B., et al
- Journal article citation:
- Aging and Mental Health, 16(3), April 2012, pp.335-346.
- Publisher:
- Taylor and Francis
Loneliness is a pervasive issue among the elderly. Two forms of loneliness are: emotional loneliness, which involves the lack of a close attachment relationship; and social loneliness, which stems from the lack of a satisfying and engaging social network. The aim of this study was to identify the biopsychosocial and cognitive risk factors of emotional loneliness, social loneliness, and social support. The study participants were 579 community-dwelling older adults living in Dublin. The participants completed a battery of biopsychosocial, physiological, cognitive, and demographic assessments. Analysis of the results was used to develop comprehensive models of emotional loneliness, social loneliness, and social support. The risk factors in the model for: emotional loneliness included depression, neuroticism, perceived stress, living alone and accommodation type; social loneliness included neuroticism, perceived stress, animal naming and number of grandchildren; and social support included extraversion, executive functioning, history of falls, age and whether the participant drives or not. Social support influenced emotional loneliness predominantly through indirect means, while its effect on social loneliness was more direct. The differing nature of these models confirms the importance of distinguishing between different types of loneliness and also between a lack of social support and loneliness.
Loneliness and cognition in older people: the Dublin Healthy Ageing study
- Authors:
- O'LUANAIGH C., et al
- Journal article citation:
- Aging and Mental Health, 16(3), April 2012, pp.347-352.
- Publisher:
- Taylor and Francis
Several studies have shown that social isolation has a detrimental effect on cognition. However, relatively few have examined the relationship between cognition and loneliness. The aims of this study were to explore the relationship between loneliness and cognition, and to determine whether specific cognitive domains are associated with loneliness. The findings are taken from the Dublin Healthy Ageing Study, a prospective examination of the psychiatric, cognitive, physical and social well-being of community-dwelling elderly in inner-city Dublin. This study included 466 participants with mean age 75.45 years, of which 44% were males. Analyses were done of the relationship between loneliness, social networks, depression, and demographics, and global cognition. The main finding is that loneliness in older people is significantly associated with impaired global cognition independent of social networks and depression. The domains of psychomotor processing speed and delayed visual memory were specifically associated with self-reported loneliness. The mechanism for this association is unclear and warrants further investigation.
Self-efficacy for managing dementia may protect against burden and depression in Alzheimer's caregivers
- Authors:
- GALLAGHER Damien, et al
- Journal article citation:
- Aging and Mental Health, 15(6), August 2011, pp.663-670.
- Publisher:
- Taylor and Francis
Self-efficacy can be described as an individual's assessment of his or her ability to perform a specific task successfully; it is a modifiable attribute which has been shown to influence health behaviours, and can be learned and enhanced. This study aimed to determine whether self-efficacy for different domains of dementia care could be considered independent predictors of symptoms of burden and depression. The study used 84 pairs of patients with Alzheimer's disease and their carers, recruited at the memory clinic of a university teaching hospital in Dublin in the course of the Enhancing Care in Alzheimer's Disease study conducted in 2009. Patient function, cognition and symptoms were assessed, together with caregiver burden, personality, depressive symptoms, coping strategies and self-efficacy for completing tasks related to dementia care. 33% of the caregivers reported significant depressive symptoms. The study findings indicated that self-efficacy for tasks related to dementia care had an important role to play among other predictors of burden and depression in caregivers, and that self-efficacy for symptom management had a direct beneficial impact on the psychological health of caregivers.