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Marital status and mortality in the elderly: a systematic review and meta-analysis
- Authors:
- MANZOLI Lamberto, et al
- Journal article citation:
- Social Science and Medicine, 64(1), January 2007, pp.77-94.
- Publisher:
- Elsevier
Although a relationship between marital status and mortality has long been recognized, no summary estimates of the strength of the association are available. A meta-analysis of cohort studies was conducted to produce an overall estimate of the excess mortality associated with being unmarried in aged individuals as well as to evaluate whether and to what degree the effect of marriage differs with respect to gender, geographical/cultural context, type of non-married condition and study methodological quality. All included studies were published after the year 1994, used multivariate analyses and were written in English. Pooling 53 independent comparisons, consisting of more than 250,000 elderly subjects, the overall relative risk (RR) for married versus non-married individuals (including widowed, divorced/separated and never married) was 0.88 (95% Confidence Interval: 0.85–0.91). This estimate did not vary by gender, study quality, or between Europe and North America. Compared to married individuals, the widowed had a RR of death of 1.11 (1.08–1.14), divorced/separated 1.16 (1.09–1.23), never married 1.11 (1.07–1.15). Although some evidence of publication bias was found, the overall estimate of the effect of marriage was robust to several statistical approaches and sensitivity analyses. When the overall meta-analysis was repeated with an extremely conservative approach and including eight non-significant comparisons, which were initially excluded because of data unavailable, the marriage protective influence remained significant, although the effect size was reduced (RR=0.94; 0.92–0.95). Despite some methodological and conceptual limitations, these findings might be important to support health care providers in identifying individuals “at risk” and could be integrated into the current programs of mortality risk estimation for the elderly.
Differences in heart rate variability between depressed and non-depressed elderly
- Authors:
- VAN DER KOOY Koen G., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(2), February 2006, pp.147-150.
- Publisher:
- Wiley
The aim was to determine whether older primary care patients with a Major Depressive Disorder (MDD) have lower heart rate variability (HRV) compared to non-depressed patients. HRV is a measure of cardiac autonomic functioning. A cross-sectional comparison of 136 elderly persons with MDD and 136 non-depressed controls (matched for age and gender) recruited in family practices in the Netherlands. Depression was determined according to the DSM-IV criteria using the PRIME-MD. HRV was measured with an electrocardiogram (ECG) during a 5-minute supine rest. Multivariate analyses showed statistically significant decrease in HRV in MDD patients compared with controls. Older primary care patients with MDD have a reduced HRV. This may explain why depression is a risk factor for cardiovascular disease and mortality.
Cold comfort: the social and environmental determinants of excess winter death in England, 1986-96
- Authors:
- WILKINSON Paul, et al
- Publisher:
- Policy Press
- Publication year:
- 2001
- Pagination:
- 33p.,bibliog.
- Place of publication:
- Bristol
This study makes a direct connection between the risk of winter mortality and housing quality in England. It demonstrates that people living in homes that are difficult or costly to h eat are at increased risk of winter and cold related deaths. It is based on epidemiological analysis, which links mortality data with data on housing quality from a large national survey.
The influence of thoughts of death and suicidal ideation on the course of depression in older depressed patients
- Authors:
- BOGERS Ista C.H.M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(8), 2017, pp.882-891.
- Publisher:
- Wiley
Objective: Thoughts of death are not regularly included in diagnostic instruments and rarely examined separately from thoughts of suicide. This exploratory study examined whether thoughts of death and thoughts of suicide affect the course of late-life depressive disorders. Methods: In 378 depressed older persons, thoughts of death and thoughts of suicide were assessed using questions from the Composite International Diagnostic Interview. After 2 years, the presence of a DSM-IV-TR diagnosis of minor or major depression or dysthymia was assessed with the Composite International Diagnostic Interview. The Inventory of Depressive Symptomatology was administered every 6 months up till 3-year follow-up. Results: Multinomial logistic regression showed that thoughts of death as well as thoughts of suicide predicted double depression at follow-up (OR = 2.14 [95% CI: 1.04–4.40] and OR = 6.47 [95% CI: 2.22–3.02], respectively), compared with patients without these thoughts. Results became non-significant when adjusted for baseline depression severity (OR = 1.17 [95% CI: 0.52–2.63] and OR = 2.57 [95% CI: 0.79–8.84], respectively). Mixed linear models showed that severity of depression was lowest in the reference group, while symptoms decreased more over time in those with either thoughts of death or suicide. Conclusions: Patients with thoughts of death or with thoughts of suicide were more severely depressed at baseline and follow-up, with the highest risk of being depressed at follow-up for patients with thoughts of suicide. These associations could be explained by baseline depression severity. The results suggest that thoughts of death and thoughts of suicide are important risk markers in predicting the course of depression. (Publisher abstract)
Risk of dementia and death in community-dwelling older men with bipolar disorder
- Authors:
- ALMEIDA Osvaldo P., et al
- Journal article citation:
- British Journal of Psychiatry, 209(2), 2016, pp.121-126.
- Publisher:
- Cambridge University Press
Background: Bipolar disorder has been associated with cognitive decline, but confirmatory evidence from a community-derived sample of older people is lacking. Aims: To investigate the 13-year risk of dementia and death in older adults with bipolar disorder. Method: Cohort study of 37 768 men aged 65–85 years. Dementia (primary) and death (secondary), as recorded by electronic record linkage, were the outcomes of interest. Results: Bipolar disorder was associated with increased adjusted hazard ratio (HR) of dementia (HR = 2.30, 95% CI 1.80–2.94). The risk of dementia was greatest among those with <5 years of history of bipolar disorder or who had had illness onset after 70 years of age. Bipolar disorder was also associated with increased mortality (HR = 1.51, 95% CI 1.28–1.77). Competing risk regression showed that bipolar disorder was associated with increased hazard of death by suicide, accidents, pneumonia or influenza, and diseases of the liver and digestive system. Conclusions: Bipolar disorder in later life is associated with increased risk of dementia and premature death. (Publisher abstract)
Mortality and causes of death in older patients with schizophrenia
- Authors:
- TALASLAHTI Tiina, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(11), November 2012, pp.1131-1137.
- Publisher:
- Wiley
This study evaluated mortality and causes of death in older patients with schizophrenia in comparison with the general population in Finland. The study sample consists of 9,461 patients over 65 years by the first of January 1999, with schizophrenia as the main diagnosis during the period 1969–1998. The sample was collected from nationwide registers and followed up between 1999 and 2008. Overall Standard Mortality Ratio (SMR) of the older schizophrenia patients was 2.69. For natural causes of death, overall SMR was 2.58, and for unnatural causes of death, it was 11.04. The most common causes of death matched those in the general population. Of patients who died during follow-up, 31% had at least one psychiatric hospitalization within 5 years before follow-up. The SMR for this group was higher than in those patients with no such treatment during that time. Mortality of older patients with schizophrenia was almost threefold that of general population. They died for similar reasons to the general population; however, deaths for unnatural causes, such as accidents and suicides, were especially common. The authors concluded that patients experiencing relapses in older age have an increased risk of death compared with those with schizophrenia in remission.
Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study
- Author:
- HUYBRECHTS K. F.
- Journal article citation:
- British Medical Journal, 17.3.12, 2012, pp.16-17.
- Publisher:
- British Medical Association
A population based cohort study was used to assess risks of mortality associated with use of individual antipsychotic drugs in elderly residents in nursing homes. Participants were 75 445 new users of antipsychotic drugs aged 65 years and over, eligible for Medicaid and living in a nursing home in 45 states in the United States between 2011-5. Data were used from Medicaid, Medicare, the Minimum Data Set, the National Death Index, and a national assessment of nursing home quality. Compared with risperidone, users of haloperidol had an increased risk of mortality and users of quetiapine a decreased risk. No clinically meaningful differences were observed for the other drugs. There was no evidence that the effect measure modification in those with dementia or behavioural disturbances. There was a dose-response relation for all drugs except quetiapine.
Coming of age
- Author:
- O’MARA Erin
- Journal article citation:
- Druglink, 25(3), May 2010, pp.12-15.
- Publisher:
- Drugscope
- Place of publication:
- London
Following the death of a friend, aged 60, due to a drug overdose the author discusses how long term addiction is affecting Britain’s rapidly ageing opiate users. The increasing number of older long-term drug users is highlighted and lifestyle issues are discussed. The ageing process not only increases the probability of overdose, even for long-term regular users, but it also increases the chances of an overdose being fatal. The author comments that older users often put up with mounting health problems as a result of decades of ambivalence when they have sought treatment. This trend needs to be reversed to instil in the older generation some hope of a better, healthier life.
What cognitive functions are associated with passive suicidal ideation? Findings from a national sample of community dwelling Israelis
- Authors:
- AYALON Liat, LITWIN Howard
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(5), May 2009, pp.472-478.
- Publisher:
- Wiley
This study aimed to identify the specific cognitive domains associated with passive suicidal ideation (e.g. thoughts of being better off dead). A cross sectional, national based study of 1,712 individuals over the age of 50. Outcome measure, passive suicidal ideation, was evaluated by the question, in the past month, have you felt that you would rather be dead?, taken from the Euro-D. Cognitive domains assessed were time orientation, verbal learning, verbal recall, word fluency, and arithmetic. After adjusting for demographic and clinical information, those reporting passive suicidal ideation were significantly more likely to have impaired performance on the time orientation task. None of the other cognitive domains were associated with passive suicidal ideation. Clinicians working with older adults need to be aware not only of demographic and clinical information, but also of cognitive functioning and more specifically, time orientation, as a potential determinant of passive suicidal ideation. Possibly, cognitive domains that are less affected by education and prior learning (e.g. time orientation) have a unique association with passive suicidal ideation.
Subjective cognitive functioning as a predictor of all cause mortality in an Israeli national sample of community dwelling older adults
- Author:
- AYALON Liat
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(8), August 2008, pp.830-836.
- Publisher:
- Wiley
Cognitive functioning has been identified as a predictor of all cause mortality in several epidemiological studies. As a result, researchers have suggested the use of short cognitive screens as prognostic indicators in older adults. Little is known, however, about subjective complaints of cognitive functioning as predictors of all cause mortality. A 7-year follow-up of a national sample of 4,921 Israelis over the age of 60. Main predictors were subjective complaints of memory problems, confusion, and recognition problems. Outcome was time to death. As expected, in the fully adjusted model, age, gender, subjective health, baseline health, and ADL and IADL impairments were significant predictors of all cause mortality. In addition, complaints about difficulties recognizing familiar people also were associated with a greater risk for mortality. Subjective complaints about recognition problems serve as a risk for all cause mortality above and beyond well-known risk factors. Health care professionals can use this information about subjective cognitive functioning in conjunction with other measures in order to identify older adults at risk for an earlier death.