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Depression status as a reliable predictor of functional decline among Japanese community-dwelling older adults: a 12-year population-based prospective cohort study
- Authors:
- IWASA Hajime, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(11), November 2009, pp.1192-1200.
- Publisher:
- Wiley
Depression is a common health issue among older adults. This study aimed to examine a longitudinal relationship between depression status and functional decline among Japanese community-dwelling older people. A total of 710 men and women, aged 65 years and over, participated in the study, and took part in face-to-face interviews and medical checkups at the start of the study in 1992 and 12 annual follow-up surveys administered in broadly the same manner with the final survey carried out in 2004. Katz’s Index and the Tokyo Metropolitan Institute of Gerontology Index of Competence were used to measure the functional capacities of basic activities of daily living, comprising the basic self-care tasks necessary for an adult to live independently, and higher-level competence, respectively. The study found an independent relationship between depression status and longitudinal change in functional capacity, suggesting that depression status is a reliable predictor of functional decline in older adults.
Longitudinal assessment of psychotherapeutic day hospital treatment for neuropsychiatric symptoms in dementia
- Authors:
- WEBER Kerstin, et al
- Journal article citation:
- Aging and Mental Health, 13(1), January 2009, pp.92-98.
- Publisher:
- Taylor and Francis
Behavioural and psychological symptoms (BPSD) of dementia are associated with more rapid cognitive deterioration as well as increased caregiver stress. The effectiveness of psychiatric day hospital care for this condition remains disputed. This study reports on the assessment of a psychotherapeutic day hospital program in a series of elderly people with dementia and concomitant BPSD. The day hospital program combined music, movement, psychodynamic group therapies, sociotherapy as well as individual interviews and family interventions. Participants were 76 individuals with mild to moderate dementia. Outcome measures were the Neuropsychiatric Inventory (NPI), Therapeutic Community Assessment scale including staff (SAS) and client assessments (CAS) and a Group Evaluation Scale (GES) were administrated at admission, 3, 6 and 12 months and discharge. Linear regression analysis showed that SAS (but not CAS) and GES scores significantly increased while the NPI total scores decreased across the different time points. NPI item score modifications were significant for anxiety and apathy. These changes remained significant when demographic variables, drug treatment changes and occurrence of life events were also considered. It is concluded that a psychotherapeutic day hospital program designed for older people with dementia and neuropsychiatric symptoms allows for a significant reduction of anxiety and apathy, better adhesion to therapeutic community treatment and clinical progress in group therapy. Controlled interventional studies are needed to further confirm these data.
Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up
- Authors:
- LICHT E., et al
- Journal article citation:
- British Medical Journal, 21.2.09, 2009, pp.463-466.
- Publisher:
- British Medical Association
This study aimed to investigate the duration of depression, recovery over time, and predictors of prognosis in an older cohort (55 years) in 32 general practices in West Friesland, the Netherlands. Participants were 234 patients aged 55 years or more with a prevalent major depressive disorder. Main outcome measures were depression at baseline and every six months using structured diagnostic interviews (primary care evaluation of mental disorders according to diagnoses in Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and a measure of severity of symptoms (Montgomery Åsberg depression rating scale). The main outcome measures were time to recovery and the likelihood of recovery at different time points. Multivariable analyses were used to identify variables predicting prognosis. The median duration of a major depressive episode was 18.0 months (95% confidence interval 12.8 to 23.1). 35% of depressed patients recovered within one year, 60% within two years, and 68% within three years. A poor outcome was associated with severity of depression at baseline, a family history of depression, and poorer physical functioning. During follow-up functional status remained limited in patients with chronic depression but not in those who had recovered. Depression among patients aged 55 years or more in primary care has a poor prognosis. Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.
The social connectedness of older Europeans: patterns, dynamics and contexts
- Authors:
- KOHLI Martin, HANK Karsten, KUNEMUND Harald
- Journal article citation:
- Journal of European Social Policy, 19(4), October 2009, pp.327-340.
- Publisher:
- Sage
Maintaining social connectedness through the transitions of later life, with their potential for isolation, is an important prerequisite for successful ageing. Social relationships have been shown to buffer the effects of spousal bereavement, to reduce mortality risks, and to serve as a social protection mechanism. This study used longitudinal data from the first 2 waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) to show that Europe’s population aged 50 or older is socially connected in several ways. Roughly one-third of the respondents reported having some kind of formal social relationships, more than one-tenth provided or received informal social support, and two-thirds exchanged functional support with family members outside their household. The various dimensions of social connectedness turned out to be complementary rather than subjective, except for the relationship between informal social relations and family relations which tended to be characterised by substitution. This analysis revealed that the dynamics of formal and informal social relations as well as family relations tended to be driven by individuals’ resources and need. While the associations between elders’ social connectedness and individual characteristics were very similar across countries, there were significant regional variation regarding the levels and the dynamics of social connectedness.
Childlessness at the end of life: evidence from rural Wales
- Author:
- WENGER G. Clare
- Journal article citation:
- Ageing and Society, 29(8), November 2009, pp.1243-1259.
- Publisher:
- Cambridge University Press
When the frailties of advanced old age result in the need for help, after the spouse, adult children are the most important source of support. Despite developing closer relationships with next-of-kin or non-kin, older childless people in times of need are socially vulnerable and in need of more formal support services. Using data from the 1979-1999 Bangor Longitudinal Study of Ageing, the author explores the effects of childlessness on adults aged 65 or more, at the start of the study, for twenty years. Generally, childless people in old age had expectations consistent with being childfree, had developed closer relationships with next-of-kin and friends and placed a high value on independence. Marital status, gender, and wealth, in terms of social as well as financial capital were all important variables. In some cases expectations of inheritance were clearly associated with support received. It was noted however that unless death was sudden or after a short, acute illness, almost all childless people entered residential care or a long stay hospital at the close of their lives.
The English Longitudinal Study of Ageing (ELSA)
- Author:
- BREEZE Elizabeth
- Journal article citation:
- Generations Review, 19(4), October 2009, Online only
- Publisher:
- British Society of Gerontology
The English Longitudinal Study of Ageing (ELSA) follows cohorts of older people with biennial interviews. It covers key elements of quality of life, with design assumed that there are connections between our health and functioning, our social networks, our economic position, and our perceptions of wellbeing. This paper briefly looks at the aims of the ELSA and looks at how the data have been used in the area of health inequalities and timing retirement.
Intergenerational relations across 4 years: well-being is affected by quality, not by support exchange
- Authors:
- MERZ Eva-Maria, SCHUENGEL Carlo, SCHULZE Hans-Joachim
- Journal article citation:
- Gerontologist, 49(4), August 2009, pp.536-548.
- Publisher:
- Oxford University Press
Providing support to an aging parent may pose challenges to adult children but also provide an opportunity to "give back" to loved ones. The current study investigated changes in emotional and instrumental support and quality across a period of 4 years. Additionally, associations between intergenerational support and well-being in adult children over time were investigated. Data from the first and second waves of the Netherlands Kinship Panel Study (N = 6,062) were analyzed to investigate the relative importance of relationship quality and support exchange and to test the potential buffering role of relationship quality for effects of the changing balance of support on well-being. It was found that provision of instrumental and emotional support to parents increased during a period of 4 years. At the same time, instrumental support children received from parents decreased, whereas emotional support from parents increased. Intergenerational support exchange between children and parents was not associated with well-being in children, whereas the quality of the intergenerational relationship strongly predicted their well-being. Implications: Decreasing relationship quality seems a greater threat to the well-being of caregiving children than increased support and care tasks. Family counselling and public awareness to address this decline in intergenerational relationship quality may be important for well-being of families.
Intellectual activity and likelihood of subsequently improving or maintaining instrumental activities of daily living functioning in community-dwelling older Japanese: a longitudinal study
- Authors:
- FUJIWARA Yoshinori, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(6), June 2009, pp.547-555.
- Publisher:
- Wiley
This study aimed to test the a priori hypothesis that increase or maintenance of the level of cognitive activity would be independently associated with a subsequent beneficial impact (i.e. improvement or maintenance) on instrumental activity of daily living (IADL) functioning. An observational study was carried out using 4-year longitudinal data from 1477 community-dwelling Japanese who were 66 years and older and living in Yoita town, a rural community located in the northwest along the Sea of Japan. Baseline assessment occurred in November 2000. Intellectual Activity and IADL were evaluated using the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence. Results showed that an Increase or maintenance of exposure to intellectual activities over a period of 2 years was associated with increased likelihood of better IADL functioning trajectory (i.e. improvement or stability) over the subsequent 2 years, even after adjustment for major confounders. The authors conclude that this study documented a longitudinal, independent association of exposure to intellectual activities with better IADL functioning over time. These findings provide preliminary support for promotion of exposure to intellectual activities among older adults as an opportunity to prevent disability in the older segment of the population. Assessment of public health programs targeting such an opportunity is warranted.
Structural relationships between social activities and longitudinal trajectories of depression among older adults
- Authors:
- HONG Song-Lee, HASCHE Leslie, BOWLAND Sharon
- Journal article citation:
- Gerontologist, 49(1), February 2009, pp.1-11.
- Publisher:
- Oxford University Press
This study examines the structural relationships between social activities and trajectories of late-life depression. Latent class analysis was used with a nationally representative sample of older adults (N = 5,294) from the Longitudinal Study on Aging II to classify patterns of social activities. A latent growth curve model captured longitudinal changes in depression and tested the impact of social activities while controlling for residential relocation, health status, insurance, and sociodemographics. Three different patterns of participation were found across 8 social activities. Specific activities of volunteering and exercise, self-perception of social activity level as "enough," and a higher participation level pattern were associated with lower initial status and longitudinal changes in depression. Assessing involvement in multiple social activities is important when using social activities to prevent and treat depression. Future work with improved measures can further clarify how specific activities may reduce risk for depression.
Residential outcomes for nursing facility applicants who have been diverted: where are they 5 years later
- Authors:
- CHAPIN Rosemary, et al
- Journal article citation:
- Gerontologist, 49(1), February 2009, pp.46-56.
- Publisher:
- Oxford University Press
The purpose of this longitudinal study was to determine the length of community tenure for adults aged 60 and older after application for nursing facility (NF) admission and to examine the proportion of older adults who lost community tenure due to either (a) death while a community resident or (b) permanent NF admission. In this 5-year prospective study, older adults who had applied for NF admission and were diverted (residing in the community 30 days later) were tracked. Four waves of NF applicants (N = 2,882) were identified, and those diverted (n = 599) were tracked for 60 months at 3-month intervals. Sixty months after diversion, 18.0% of older adults (n = 108) were residing in the community, 39.2% died as community residents (n = 235), and 42.7% (n = 256) became permanent NF residents. In all, 414 diverted older adults (69.1%) died during the 5 years following NF application, with the majority of deaths occurring while older adults were community residents.