Depression and Its Correlates Among Older Adults Accessing Aging Services

doi:10.1097/JGP.0b013e3182107e50

The American Journal of Geriatric Psychiatry

Volume 20, Issue 4, April 2012, Pages 346-354

https://doi.org/10.1097/JGP.0b013e3182107e50 Get rights and content

Objectives

To define the prevalence and correlates of depression among older adults receiving assessments by nonmedical community-based care managers at the point of entry to care and thus prior to provision of aging services. Our long-term goal is to inform development of collaborative care models for late life depression that incorporate Aging Services Providers.

Methods

Aging Services Provider Network (ASPN) clients receiving in-home assessments were administered the Structured Clinical Interview for DSM-IV-TR (SCID) module for affective disorders and measures of depression symptom severity, alcohol use, physical health, functional status, social support, stressful life events, and religiosity. Engagement in mental healthcare was documented.

Results

Subjects (N = 378) were primarily white (84%) and women (69%) with household incomes under $1,750/month (62%). Half lived alone (48%). Their mean age was 77 years. Thirty-one percent had clinically significant depressive symptoms and 27% met criteria for a current major depressive episode, of which 61% were being treated with medication and 25% by a mental health provider. Nearly half (47%) had experienced one or more episodes of major depression during their lives. Disability, number of medical conditions, number and severity of recent stressful life events, low social support, and low religiosity were independently associated with current major depression.

Conclusion

Depressive illness was common among this sample of ASPN clients. Because ASPN care managers have expertise in managing many of the problems correlated with depression, they may play a significant role in identifying, preventing, and collaborating in the treatment of depressive illnesses among community-dwelling older adults.

Section snippets

Service Setting

Eldersource is the primary entry point to the ASPN in the Monroe County, NY region. It is one of over 1,800 agencies throughout the United States certified by the Council on Accreditation,¹⁶ an optional accreditation for aging and social service agencies that promotes adherence to quality standards. Eldersource serves seniors and caregivers with a wide range of needs, from information and referral to ongoing nonmedical case management. The majority of clients have functional, financial,

Sample Characteristics

The sample (N = 378) was primarily white (N = 319 [84.4%]), non-Hispanic (N = 371 [98.4%]), and women (N = 259 [68.5%]) with household incomes under $1,750/month (<150% of the New York State poverty level for a family of 2; N = 234 [61.9%]). Their mean age (± SD) was 76.5 (9.2) years. Most were unmarried (N = 229 [60.6%]) and had 12 or more years of education (N = 265 [70.1%]). Using Eldersource administrative data, we found no statistically significant differences in race, gender, income, or

DISCUSSION

We found a point prevalence of 26.7% for major depression among older adults receiving assessments for care management from a community-based aging services provider at the point of entry to care and thus prior to linkage with services. Thirty-one percent of subjects scored 10 or more on the Patient Health Questionnaire-9, a cut-point typically used to designate clinically significant depressive symptoms. Summary figures for any depressive disorder are comparable to some prior studies¹⁴,¹⁵ but

CONCLUSIONS

Many seniors receiving services from ASPN agencies present at the point of entry to care with clinically significant depression, often a recurrent episode of illness. Many of the risk factors associated with major depression in ASPN clients are social in nature, potentially modifiable, and within the expertise of aging services CMs. These findings indicate the need to understand better the barriers to effective management of depression among older adults who reside in the community, in

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Cited by (48)

Depressive Symptoms in Recipients of Home- and Community-Based Services in the United States: Are Older Adults Receiving the Care They Need?
2017, American Journal of Geriatric Psychiatry
Citation Excerpt :
These services are designed to help older adults remain safely in their homes and avoid institutionalization. However, many factors that characterize HCBS recipients, such as low socioeconomic status, disability, and homebound status, are also known depression risk factors;1,2 therefore, we might expect their prevalence of depression is also very high. However, nationally representative studies of HCBS recipients have not evaluated the mental health of those using HCBS.
To understand unmet depression needs of older adults, the current study investigates depressive symptoms, psychiatric treatment, and home- and community-based service (HCBS) use in a nationally representative sample of older adults in the United States.
Participants included 5,582 adults aged 60 and over from the 2010–2012 waves of the nationally representative Health and Retirement Study. Weighted bivariate analyses were used to examine the frequency of depressive symptoms (Center for Epidemiologic Studies Depression Scale) and psychiatric treatment among HCBS recipients compared with non-HCBS recipients. Weighted logistic regression models were used to evaluate the effect of depressive symptoms on HCBS use.
HCBS recipients had a higher frequency of depressive symptoms compared with nonrecipients (27.5% versus 10.4%, respectively). In particular, transportation service recipients had the highest frequency of depressive symptoms (37.5%). HCBS recipients with depressive symptoms were no more likely than nonrecipients to receive psychiatric services. Depressive symptoms were associated with HCBS use, above and beyond sociodemographic and health risk factors.
Depressive symptoms are more frequent among HCBS recipients compared with nonrecipients; however, depressed HCBS recipients are no more likely to receive psychiatric services, suggesting unmet depression needs. HCBS may be a key setting for depression detection and delivery of mental health interventions.
Multimorbidity and depression: A systematic review and meta-analysis
2017, Journal of Affective Disorders
Multimorbidity, the presence of two or more chronic conditions, is increasingly common and complicates the assessment and management of depression. The aim was to investigate the relationship between multimorbidity and depression.
A systematic literature search was conducted using the databases; PsychINFO, Medline, Embase, CINAHL and Cochrane Central. Results were meta-analysed to determine risk for a depressive disorder or depressive symptoms in people with multimorbidity.
Forty articles were identified as eligible (n = 381527). The risk for depressive disorder was twice as great for people with multimorbidity compared to those without multimorbidity [RR: 2.13 (95% CI 1.62–2.80) p<0.001] and three times greater for people with multimorbidity compared to those without any chronic physical condition [RR: 2.97 (95% CI 2.06–4.27) p<0.001]. There was a 45% greater odds of having a depressive disorder with each additional chronic condition compared to the odds of having a depressive disorder with no chronic physical condition [OR: 1.45 (95% CI 1.28–1.64) p<0.001]. A significant but weak association was found between the number of chronic conditions and depressive symptoms [r = 0.26 (95% CI 0.18–0.33) p <0.001].
Although valid measures of depression were used in these studies, the majority assessed the presence or absence of multimorbidity by self-report measures.
Depression is two to three times more likely in people with multimorbidity compared to people without multimorbidity or those who have no chronic physical condition. Greater knowledge of this risk supports identification and management of depression.
Dietary zinc and iron intake and risk of depression: A meta-analysis
2017, Psychiatry Research
The associations between dietary zinc and iron intake and risk of depression remain controversial. Thus, we carried out a meta-analysis to evaluate these associations. A systematic search was performed in PubMed, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases for relevant studies up to January 2017. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random effects model. A total of 9 studies for dietary zinc intake and 3 studies for dietary iron intake were finally included in present meta-analysis. The pooled RRs with 95% CIs of depression for the highest versus lowest dietary zinc and iron intake were 0.67 (95% CI: 0.58–0.76) and 0.57 (95% CI: 0.34–0.95), respectively. In subgroup analysis by study design, the inverse association between dietary zinc intake and risk of depression remained significant in the cohort studies and cross-sectional studies. The pooled RRs (95% CIs) for depression did not substantially change in the influence analysis and subgroup analysis by adjustment for body mass index (BMI). The present meta-analysis indicates inverse associations between dietary zinc and iron intake and risk of depression.
Efficacy and tolerability of antidepressants in people aged 65 years or older with major depressive disorder – A systematic review and a meta-analysis
2016, Journal of Affective Disorders
Citation Excerpt :
Moreover, depression is expected to take second place, following only heart disease, in its contribution to the global burden of disease, measured as disability-adjusted life years (Chapman and Perry, 2008). Major depressive disorder (MDD) is the most prevalent mental disorder among elderly patients (Hybels and Blazer, 2003), but despite the high prevalence and the serious sequelae, the condition often remains undetected, untreated or inadequately treated (Richardson et al., 2012; Wilson et al., 1999). The use of antidepressants in elderly people has increased steadily, especially among the older-old (Sonnenberg et al., 2008).
There has been a steady increase in the prescription of antidepressants for the elderly. This study comprises a systematic review of randomized, placebo-controlled trials of antidepressants for treatment of depressive disorder in people aged 65 years or more.
PubMed, EMBASE, Cochrane Library, CINAL, and PsycINFO were searched until May 2016. Where appropriate, the results were synthesized in meta-analyses.
Twelve trials met the inclusion criteria. For patients with major depressive disorder, selective serotonin re-uptake inhibitors (SSRI) were not superior to placebo in achieving remission (OR: 0.79, 95% CI: 0.61–1.03) or response (OR=0.86, 95% CI: 0.51–1.10) after 8 weeks of treatment (three trials). However, maintenance treatment with SSRIs was superior to placebo in preventing relapse (OR: 0.22, 95% CI: 0.13–0.36; NNT=5, 95% CI: 3–6; two trials). Duloxetine was superior to placebo in achieving remission (OR: 1.78, 95% CI: 1.20–2.65; NNT=9, 95% CI: 6–20; three trials) and response (OR: 1.83, 95% CI: 1.96–4.08; two trials) in recurrent major depression after 8 weeks, but increased the risk of adverse events that can be problematic in the elderly.
The quality of evidence was generally low or moderate, emphasizing the uncertainty of the results. Study populations only partly covered the heterogeneous population of elderly with depressed mood, limiting the generalizability.
The results underscore the importance of close monitoring of the effects of antidepressants in treatment of elderly patients with a depressive disorder. Methods for early detection of non-responders and effective treatment options for this group are needed.
Improving Mental Health Treatment Initiation among Depressed Community Dwelling Older Adults
2016, American Journal of Geriatric Psychiatry
Depression screening has been widely implemented in community settings to increase detection of late-life depression. Rates of treatment initiation are low without additional structured follow-up, however. The current study evaluates the effectiveness of a brief psychosocial intervention, Open Door, designed to improve initiation of mental health treatment among clients of aging service meals programs.
Older adult social service clients with depressive symptoms were randomized to either the Open Door intervention or a Service Referral control condition. In Open Door, the counselor collaborates with the client to identify and address both attitudinal and structural barriers to seeking mental health treatment. Independent research assessments were conducted 12 and 24 weeks after baseline to document treatment initiation (at least one session).
At follow up, 64.6% (104 out of 161) of participants had initiated a provider visit. Participants in Open Door were more likely to initiate treatment compared with those in the control condition (χ² = 5.83, df = 2, p = 0.016). Among participants with at least mild depressive symptoms, Open Door remained significantly more effective than the control condition (p < 0.05). In multivariate analyses controlling for gender differences, both participation in the Open Door group and depression severity predicted treatment initiation (χ² = 15.18, df = 3, p = 0.002).
High rates of depression have been documented among older adults receiving social services (case management or home meals). The Open Door program offers a useful strategy to overcome the barriers to treatment initiation while fitting within the responsibilities of aging service staff. The intervention can improve initiation of late-life depression care.
The association of social support networks and loneliness with negative perceptions of ageing: Evidence from the Irish Longitudinal Study on Ageing (TILDA)
2019, Ageing and Society

View all citing articles on Scopus

The authors thank Eldersource and its entire staff for making this work possible. They also thank Connie Bowen and Judy Woodhams for their project coordination and data collection, Paul Winter and Arthur Watts for their assistance with data management and statistical programming, and Dr. Xin Tu for his biostatistics consultation.

This work was supported in part by grants from NIMH to Dr. Knox (KO1MH66317) and Dr. Conwell (R24MH071604), and the American Foundation for Suicide Prevention to Dr. Conwell.

Portions of this study were presented at the American Association of Geriatric Psychiatry Annual Meeting in New Orleans, LA on March 2, 2007, and the Gerontological Society of America Annual Conference in San Francisco, CA on November 19, 2007.

Disclosure of Interests: There are no disclosures to report.

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Regular Research ArticlesDepression and Its Correlates Among Older Adults Accessing Aging Services

Objectives

Methods

Results

Conclusion

Section snippets

Service Setting

Sample Characteristics

DISCUSSION

CONCLUSIONS

Biol Psychiatry

Biol Psychiatry

Gen Hosp Psychiatry

Brain Res

Am J Prev Med

Ann Epidemiol

Biol Psychiatry

Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. A 4-year prospective study

JAMA

Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study

Am J Psychiatry

Diagnosis and treatment of depression in late life. Consensus statement update

JAMA

Factors associated with depression in a representative sample of 14 217 people aged 75 and over in the United Kingdom: results from the MRC trial of assessment and management of older people in the community

Int J Geriatr Psychiatry

Adverse life events and cognitive-personality characteristics in the prediction of major depression and antidepressant response

Am J Psychiatry

The Aging Services Network: Accomplishments and Challenges in Serving a Growing Elderly Population

Depressive symptoms and suicidal ideation among older adults receiving home delivered meals

Int J Geriatr Psychiatry

Behavioral health needs and problem recognition by older adults receiving home-based aging services

Int J Geriatr Psychiatry

Outcomes of community-based social service interventions in homebound elders

Int J Geriatr Psychiatry

Depression in public community long-term care: implications for intervention development

J Behav Health Serv Res

Council on Accreditation

Structured Clinical Interview for DSM-IV-TR Axis I Disorders

Depression in medically ill hospitalized older adults: prevalence, characteristics, and course of symptoms according to six diagnostic schemes

Am J Psychiatry

Regular Research Articles
Depression and Its Correlates Among Older Adults Accessing Aging Services