• A comparison of the screening potential of the geriatric depression scale (GDS) and the hospital anxiety and depression scale (HADS) in diagnosing depression at a geriatric day hospital setting

      Das, Sujata (2010)
      Background Depression is a common condition in older people affecting approximately 10% of elderly people of all age groups living at home (Morgan et al 1987). Some studies suggest that prevalence is higher in those with medical conditions. There are several screening tools used in diagnosing depression, but it is unknown which tool is most effective in a setting such as the Medical Geriatric Day Hospital. Aim of this study was to compare the usefulness of two commonly used screening tools; the Geriatric Depression Scale (GDS) and the Hospital Anxiety and Depression Scale (HADS), by employing the Diagnostic and Statistical manual (DSM IV) as the "gold standard" method of diagnosing depression. Method Consecutive patients aged over 65 years attending the Medical Geriatric Day Hospital were recruited. GDS (15) and HADS were administered by a trained nurse. An independent Old Age Psychiatrist, blinded to the screening tool results, performed the DSM IV assessment in a standardised manner. Results 101 participants (58 women) were recruited. Mean age (SD; range) of the study population was 79.4 (6.7; 65-93) years. Prevalence of depression in the studied population using the DSM IV was 22.8%. Sensitivities and specificities(95%CI) of the GDS (15) in diagnosing depression were 78.3%(70.3-86.3) and 73.0%(64.4-81.6) and those of HADS were 69.6%(60.6-78.6) and 78.2%(70.1-86.3) respectively. Positive predictive values for GDS (15) and HADS were 46.2%(36.5-55.9) and 48.5%(38.7-57.7) and the negative predictive values were 91.9%(86.6-97.2) and 89.7%(83.8-95.6) respectively. False positive rates were 53.8%(44.1-63.5) and 51.5%(41.8-61.2) and false negative rates were 8.1%(2.8-13.4) and 10.3%(4.4-16.2) respectively. Conclusions Both GDS (15) and HADS had a relatively high negative predictive value suggesting that they may have value in ruling out depression. However the false positive rates mean that patients screened positive in both tools require a more comprehensive assessment as approximately half will not have depression. The two screening tools performed similarly.
    • Changing prevalence and treatment of depression among older people over two decades

      Dening, Tom (2019)
      Background: Depression is a leading cause of disability, with older people particularly susceptible to poor outcomes. Aims: To investigate whether the prevalence of depression and antidepressant use have changed across two decades in older people. Method: The Cognitive Function and Ageing Studies (CFAS I and CFAS II) are two English population-based cohort studies of older people aged >= 65 years, with baseline measurements for each cohort conducted two decades apart (between 1990 and 1993 and between 2008 and 2011). Depression was assessed by the Geriatric Mental State examination and diagnosed with the Automated Geriatric Examination for Computer-Assisted Taxonomy algorithm. Results: In CFAS I, 7635 people aged >= 65 years were interviewed, of whom 1457 people were diagnostically assessed. In CFAS II, 7762 people were interviewed and diagnostically assessed. Age-standardised depression prevalence in CFAS II was 6.8% (95% CI 6.3-7.5%), representing a non-significant decline from CFAS I (risk ratio 0.82, 95% CI 0.64-1.07, P - 0.14). At the time of CFAS II, 10.7% of the population (95% CI 10.0-11.5%) were taking antidepressant medication, more than twice that of CFAS I (risk ratio 2.79, 95% CI 1.96-3.97, P < 0.0001). Among care home residents, depression prevalence was unchanged, but the use of antidepressants increased from 7.4% (95% CI 3.8-13.8%) to 29.2% (95% CI 22.6-36.7%). Conclusions: A substantial increase in the proportion of the population reporting taking antidepressant medication is seen across two decades for people aged >= 65 years. However there was no evidence for a change in age-specific prevalence of depression.
    • Effects of a mutual recovery intervention on mental health in depressed elderly community-dwelling adults: A pilot study

      Crawford, Paul (2017)
      Background: The prevalence of depression in the elderly is growing worldwide, and the population aging in China makes depression a major health problem for the elderly adults and a tremendous burden to the society. Effective interventions should be determined to provide an approach solving the problem and improving the situation. This study examined the effectiveness of a mutual recovery program intervention on depressive symptom, sleep quality, and well-being in community-dwelling elderly adults with depressive symptom in Shanghai. Methods: Recruitment was performed between July 2012 and August 2012. Using a cluster randomized wait-list controlled design, we randomized 6 communities (n = 237) into either the intervention group (3 communities, n = 105) or to a wait-list control group (3 communities, n = 132). All participants met the inclusion criteria for depression, which were defined by The Geriatric Depression Scale (GDS-15). From March to May of 2013, participants in the intervention group underwent a 2-month mutual recovery program intervention. The intervention included seven 90-min, weekly sessions that were based on a standardized self-designed schedule. Depression was used as primary outcome at three measurement moments: baseline (T1), before intervention at 24 weeks (T2), and immediately after intervention at 32 weeks (T3). Well-being and sleep quality were used as the secondary outcomes, and were evaluated based on the WHO-5 Well-being Index (WHO-5) and the Self-administered Sleep Questionnaire (SSQ). Finally, a total of 225 participants who completed all the sessions and the three measurements entered the final analysis. Mixed-model repeated measures ANOVAs were performed to estimate the intervention effects. Results: There was no significant difference in gender, marriage, age structure, post-work type, and education background between the intervention and control group at baseline. Multivariate ANOVAs showed that there was no significant difference within the groups in terms of sleep, well-being, and depression at baseline and before the intervention. Mixed-model repeated measures ANOVAs detected a group × time interaction on depression, sleep, and well-being and showed a favorable intervention effect within groups immediately after the intervention. Conclusions: The mutual recovery program could be a creative and effective approach to improve mental health in older community-dwelling adults with depressive symptom. © 2017 The Author(s)
    • Emotional distress mediates the relationship between cognitive failures, dysfunctional coping and life satisfaction in older people living in sheltered housing: A structural equation modelling approach

      Orrell, Martin (2018)
      OBJECTIVES: Little is known about the relationship between cognitive failures, emotional distress and life satisfaction in late life. Experiencing cognitive failures is a known risk for declining life satisfaction in older people, though the mechanisms that may explain cognitive failures remain unclear. This study investigated the associations between psychosocial factors, cognitive failures and coping strategies and their influence on life satisfaction in older people living in sheltered housing. METHODS: A total of 204 older people living in sheltered housing in London were recruited (mean age = 75.08 years). We used structural equation modelling path analysis to test several hypotheses based on theories of emotional distress (anxiety and depression) and cognitive failures and their influence on life satisfaction. RESULTS: Self-reported depressive symptoms (29.5%), anxiety symptoms (33%) and cognitive failures (41%) were common. The final model had a good fit (X(2) =2.67; DF=2; P=0.26; NFI=.99, CFI=.99; RMSEA=0.04); analyses showed that both cognitive failures and dysfunctional coping were significantly associated and exerted a moderate effect on emotional distress. Cognitive failures and dysfunctional coping had an indirect effect on life satisfaction through emotional distress which directly decreased levels of life satisfaction (beta=-.70, p</=0.001). CONCLUSIONS: This study found that experiencing emotional distress helped to explain the association and negative effects of cognitive failures and dysfunctional coping on life satisfaction in older people living in sheltered housing. These findings contribute to our understanding of the key mechanisms of experiencing cognitive failures in late life and can help guide future interventions of well-being in later life.
    • What are subjective cognitive difficulties and do they matter?

      Yates, Jennifer A. (2018)
      Background: subjective cognitive difficulties (SCD) have been associated with a higher risk of developing dementia. However, there is large variation in the way SCD are assessed and in their associations with cognitive functioning. Objective: to compare the agreement of different SCD measures in identifying people with SCD and to investigate whether SCD are more strongly associated with cognitive functioning, mood, subjective age or background variables. Methods: this cross-sectional study included 206 community-dwelling people aged ≥65. SCD were assessed with individual domain specific questions and a multiple-item scaled measure. Performance on tests of memory, attention, and executive function, and ratings of mood, subjective age and demographic information were recorded. Results: there was some classification overlap between the five measures of SCD, however of the 64 people identified as having SCD, only one person appeared in all five measures of SCD and 34 people were classified by one measure only. There were limited associations between SCD and objective cognition, with more consistent associations with mood and subjective age. Conclusions: the conflicting evidence regarding whether SCD are related to objective cognition and future risk of dementia may be due to different measures of SCD being employed. Careful consideration and standardisation is recommended regarding the cognitive domains and the reference groups for comparison, the response structure and the classification criteria. Longitudinal studies of SCD that include these considerations are needed to clarify the conceptual utility of SCD.