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Impact of falls on depressive symptoms among the oldest old: results from the AgeQualiDe study
- Authors:
- HAJEK Andre, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 33(10), 2018, pp.1383-1388.
- Publisher:
- Wiley
Objective: The purpose of this study was to examine the impact of falls on depressive symptoms among the oldest old in Germany longitudinally. Methods: Data were used from 2 waves of the multicenter prospective cohort “Study on needs, health service use, costs and health‐related quality of life in a large sample of oldest‐old primary care patients (85+)” (AgeQualiDe). This study covers primary care patients ≥85 years (at baseline: n = 547, average age of 88.9 ± 3.0 years; ranging from 85 to 100 years). General practitioner‐diagnosed falls were used as explanatory variable. The Geriatric Depression Scale was used as outcome measure. Results: Linear fixed effects regressions showed that the occurrence of falls is associated with an increase in depressive symptoms (β = .60, P = .02), whereas changes in marital status, ageing, social support, functional decline (instrumental activity of daily living), cognitive impairment, and an increase in chronic diseases did not affect depressive symptoms. In sensitivity analysis, an increase in depressive symptoms was associated with functional impairment (basic activities of daily living; Barthel index; β = −.04, P = .005). Conclusions: Based on a large, population‐based longitudinal study, this study underlined the impact of falls on depressive symptoms and consequently extended previous knowledge about an association between falls and depressive symptoms in the oldest old. Developing strategies to prevent falls might also help to prevent depressive symptoms. (Edited publisher abstract)
Support for very old people in Sweden and Canada: the pitfalls of cross-cultural studies; same words, different concepts
- Authors:
- MIEDEMA Baukje (Bo), de JONG Jennifer
- Journal article citation:
- Health and Social Care in the Community, 13(3), May 2005, pp.231-238.
- Publisher:
- Wiley
The Swedish and Canadian 80+ studies are collecting longitudinal data regarding medical, psychological and sociological aspects of the lives of people who are 80 years of age and older. A paper entitled 'Informal and formal support from a multidisciplinary perspective: a Swedish follow-up between 80 and 82 years of age', was based on the Swedish 80+ study. It examined psychosocial and health measures by support type (i.e. no support, and formal and informal support). Support is defined as care given by either friends and family (informal support) or healthcare professionals (formal support). This article compares participant characteristics between two groups of 80-year-olds from two study sites (i.e. Lund, Sweden, and Fredericton, NB, Canada), using the Swedish study site data. Only those participants who participated at both 80 and 82 years of age were included in the analyses. The intent of the descriptive analyses was to compare cross-culturally the two groups of participants and the level of support that they received. Between the two groups, the level of support received by the participants was rather dissimilar: Canadians reported receiving far more informal and formal support compared to Swedes. This finding was despite the fact that the Swedish state provides more funded support than that of Canada to its citizens. Therefore, the present authors speculate that the concept of support has a different meaning in Sweden than in Canada. This speculation raises concerns about cross-cultural studies, particularly when survey questions involve culturally ambiguous concepts such as the term 'support'.
Prevalence and risk factors of depressive symptoms in latest life-results of the Leipzig Longitudinal Study of the Aged (LEILA 75+)
- Authors:
- LUPPA Melanie, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(3), March 2012, pp.286-295.
- Publisher:
- Wiley
As depressive symptoms are common in oldest age and associated with broad categories of risk factors, latest-life depression represents an important public health issue. The aim of this study was to determine the age-specific and gender-specific prevalence rates and risk factors of depressive symptoms of the oldest old people. The data was derived from the Leipzig Longitudinal Study of the Aged (LEILA 75+), a population-based study on the epidemiology of dementia and mild cognitive impairment (MCI). A sample of 1006 individuals aged 75 years and older were interviewed on socio-demographic, clinical and psychometric variables. Of the overall sample, 38.2% were classified as depressed. Analysis revealed that the following variables were significantly associated with depressive symptoms: divorced or widowed marital status; low educational level; poor self-rated health status; functional impairment; multi-domain MCI, stressful life events; and poor social networks.
Are terminal decline and its potential indicators detectable in population studies of the oldest old?
- Authors:
- MUNIZ-TERRERA Graciela, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(6), June 2011, pp.584-592.
- Publisher:
- Wiley
The terminal decline hypothesis states that individuals experience a decline in cognitive function before death, particularly in the last 3 to 8 years of life. The aim of this study was to discover whether this decline, measured using the MMSE, could be detected in a sample of participants from the Cambridge City Over 75s Cohort; a virtually extinct study in which 99% of participants had died. Potential risk profiles were also examined. Decline and acceleration of this decline were detectable in the period before death. Some between person variation was detected in this pattern, which included differences in cognitive performance by age at death, sex, initial cognitive impairment and mobility; in rate of decline by age at death, sex, initial cognitive impairment, and mobility; and differences in change in rate of decline by sex, initial cognitive impairment, and mobility. The data clearly demonstrate the phenomenon of decline in global cognition measurements with the proximity of death as well as potential variables that could influence that pattern. Further work is required on how to detect the onset of the acceleration of this decline in each individual together with the factors that could allow clinicians to distinguish between the normal and preterminal phases of change in extreme old age.
What matters, and what matters most, for change in life satisfaction in the oldest-old? A study over 6 years among individuals 80+
- Authors:
- INGEBORG BERG Anna, et al
- Journal article citation:
- Aging and Mental Health, 13(2), March 2009, pp.191-201.
- Publisher:
- Taylor and Francis
The study investigates whether markers of life satisfaction identified in a cross-sectional study-quality of social network, self-rated health, depressive symptoms, locus of control and widowhood, in addition to financial satisfaction and the personality traits of extraversion and neuroticism-predict change in life satisfaction (LSI-Z) across four measurement occasions during a 6-year period in individuals aged 80+. Data were drawn from the Swedish OCTO-Twin-study of individuals aged 80 and older. Growth curve analysis showed a relatively consistent significant linear decline in life satisfaction, but certain markers predicted change in life satisfaction. The loss of spouse, in particular in men, and higher levels of depressive symptoms were related to lower levels of life satisfaction over time. The results from the study question the notion of a life-long stability of life satisfaction.
Frailty and healthcare costs - longitudinal results of a prospective cohort study
- Authors:
- HAJEK Andre, et al
- Journal article citation:
- Age and Ageing, 47(2), 2018, pp.233-241.
- Publisher:
- Oxford University Press
Objective: to investigate how frailty and frailty symptoms affect healthcare costs in older age longitudinally. Methods: data were gathered from a prospective cohort study in Saarland, Germany (two waves with 3-year interval, n = 1,636 aged 57–84 years at baseline). Frailty was assessed by the five Fried frailty criteria. Frailty was defined as having at least three criteria, the presence of 1–2 criteria as ‘pre-frail’. Healthcare costs were quantified based on self-reported healthcare use in the sectors of inpatient treatment, outpatient treatment, professional nursing care and informal care as well as the provision of pharmaceuticals, medical supplies and dental prostheses. Results: while the onset of pre-frailty did not increase (log) total healthcare costs after adjusting for potential confounders including comorbidity, progression from non-frailty to frailty was associated with an increase in total healthcare costs (for example, costs increased by ~54 and 101% if 3 and 4 or 5 symptoms were present, respectively). This association of frailty onset with increased healthcare costs was in particular observed in the inpatient sector and for informal nursing care. Among the frailty symptoms, the onset of exhaustion was associated with an increase in total healthcare costs, whereas changes in slowness, weakness, weight loss and low-physical activity were not significantly associated with an increase in total healthcare costs. Conclusions: our data stress the economic relevance of frailty in late life. Postponing or reducing frailty might be fruitful in order to reduce healthcare costs. (Publisher abstract)
Cross-sectional and longitudinal relationship between neuroticism and cognitive ability in advanced old age: the moderating role of severe sensory impairment
- Authors:
- WETTSTEIN Markus, et al
- Journal article citation:
- Aging and Mental Health, 20(9), 2016, pp.918-929.
- Publisher:
- Taylor and Francis
Objectives: Gaining a comprehensive picture of the network of constructs in which cognitive functioning is embedded is crucial across the full lifespan. With respect to personality, previous findings support a relationship between neuroticism and cognitive abilities. However, findings regarding old age are inconsistent. In particular, little is known about potentially moderating variables which might explain some of the inconsistency. The authors' aim was to examine the moderating effect of severe sensory impairment on cross-sectional and longitudinal associations between neuroticism and cognitive functioning. Method: The study sample consisted of 121 visually impaired (VI), 116 hearing impaired (HI), and 150 sensory unimpaired older adults (UI). Mean age was 82.50 years (SD = 4.71 years). Neuroticism was assessed by the NEO Five Factor Inventory, and multiple established tests were used for the assessment of cognitive performance (e.g., subtests of the revised Wechsler Adult Intelligence Scale). Results: Bivariate correlations and multi-group structural equation models indicated stronger relationships between cognitive abilities and neuroticism in both sensory impaired groups (VI and HI) compared to UI older individuals. This relationship was attenuated but still significant in both sensory impaired groups when controlling for age, education and health (number of chronic conditions). In cross-lagged panel models, higher baseline neuroticism was significantly associated with lower cognitive performance four years later in VI and HI individuals. Conclusion: Results suggest that sensory impairment moderates both cross-sectional and longitudinal associations between neuroticism and cognitive function in advanced old age. (Edited publisher abstract)
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.
Characteristics of older Australian community aged care clients who fall: incidents reported by care staff
- Authors:
- BRETT Lindsey, et al
- Journal article citation:
- Health and Social Care in the Community, 30(2), 2022, pp.469-475.
- Publisher:
- Wiley
Falls are the leading cause of injury and hospitalisation for older adults (aged 65 years or older) worldwide. Data collected by community aged care providers are an underutilised source of information about precipitating risk factors and consequences of falls for older adults living in the community. The objective of this longitudinal, observational study was to describe and compare the characteristics of older Australians who did and did not have falls reported by community aged care staff. This study analysed 19 months of routinely collected care management and incident data for 1,596 older clients from a large Australian community care provider. Differences in sociodemographic characteristics, care needs and community care service use were compared between those who had one or more reported falls and those who had none. Fall-related outcomes (injuries, hospitalisations, relocation to residential aged care) were examined. The average age of clients was 82 years and most were women (66%). Seventy-seven (4.8%) clients had one or more reported falls over the study period (total falls = 92). Clients who had falls reported by care staff were more likely to be older adults, male and use more hours of community care services per week. There were 38 falls-related injuries, 5 falls-related hospitalisations and 20 clients relocated to residential aged care after a reported fall. This study demonstrates the potential for using routinely collected community aged care data to understand risk factors and monitor longitudinal outcomes for a population at high risk of falls. (Edited publisher abstract)
Caregivers for people at end of life in advanced age: knowing, doing and negotiating care
- Authors:
- WILES Janine, et al
- Journal article citation:
- Age and Ageing, 47(6), 2018, pp.887-895.
- Publisher:
- Oxford University Press
Background: the need for palliative and end of life care for the oldest old is growing rapidly. Family carers often report they do not feel well supported; for better practice and policy, we need better understanding of their experiences and how to support them. Design and setting: people in the LiLACS NZ longitudinal study of advanced age identified a carer to be interviewed after their death. Nominated caregivers were contacted 3–6 months after an older person’s death and invited to take part in the current study. Subjects: fifty-eight interviews were conducted with carers of 52 people in advanced age, 20 Maori and 32 non-Maori. The majority of the 58 carers were in their 60 s and were women. Methods: guided-conversation interviews covered end of life preferences and experiences, needs and gaps in support, arrangements after death, and experiences of bereavement. Rigorous data analysis included multiple researchers identifying and interrogating themes across and within: the transcripts, and feedback and discussion with participants. Results: we identify a typology of nine categories of care, and argue that the support and care provided by family should be understood as going beyond simple task-based transactions. We present a model of end of life care describing and explaining inter-related aspects of knowing, doing and negotiating care tasks. Conclusions: this work furthers current understandings of care, as multifaceted and negotiated. This has very practical implications for thinking about how best to support the complex end of life caregiving work of people caring for a person in advanced age. (Edited publisher abstract)