Abstract
Background: As evidence on depression and health-related quality of life (HRQoL) among the oldest-old is currently limited, this study aimed to re-examine the association between depression and HRQoL among centenarians.Methods: We analyzed cross-sectional data from the China Hainan Centenarian Cohort Study (CHCCS). The 15-item Geriatric Depression Scale (GDS-15) and three-level EuroQol five-dimensions (EQ-5D-3L) were used to evaluate depression and HRQoL, respectively. Poor health states were defined as EQ-5D index <0.665. Based on their GDS-15 score, individuals were categorized into three stages of depression: major depressive disorder (MDD; score ≥10), minor depressive disorder (MnDD; score between 6 and 9), and normal (score ≤ 5). Based on sex and comorbidity stratification, multivariable logistic regression was used to calculate the risk of poor health state in different levels of depression. We also used restricted cubic splines with a knot at 5 points (GDS-15) to flexibly model the association of GDS-15 scores with poor health states.Results: Totally, 1,002 participants were included in this study for analysis. Participants' median age was 102 years, and 82.04% were female. The median EQ-5D index was 0.68 (range: −0.149–1), and the mean VAS and GDS-15 scores were 61.60 (range: 0–100), and 5.23 (range: 0–15), respectively. Centenarians with MnDD and MDD accounted for 38.12 and 9.98%, respectively. While those with poor health states accounted for 45.11%. For every 1-point increase in GDS-15, the risk of poor health state increased by 20% (P < 0.001) after an adjustment for age, gender, ethnicity, marital status, education, residence type, smoking, drinking, weekly exercise, body mass index category, serum albumin, 25-hydroxyvitamin D, C-reactive protein, and comorbidities. MnDD and MDD were independent risk factors for poor health state (MnDD, OR = 2.76, P < 0.001; MDD, OR = 3.14, P < 0.001). The association was more prominent in centenarians without comorbidity.Conclusions: This study demonstrated a negative association between depression and HRQoL in Chinese centenarians, especially in centenarians without comorbidity. Large-scale prospective studies are needed to corroborate our findings and provide more information about the causal inference and internal mechanisms of this association.
Highlights
Significant differences were found between the two groups in terms of sex, residence type, alcohol drinking, weekly exercise, Alb, 25(OH)D, C-reactive protein (CRP), and body mass index (BMI) categories
The risk of minor depressive disorder (MnDD) in male centenarians [Model 2, odds ratios (ORs) = 3.62, 95% confidence interval (CI):1.59–8.25, P = 0.002] was higher than in female centenarians (Model 2, OR = 2.61, 95% CI: 1.85–3.68, P < 0.001)
In centenarians with comorbidities, compared with normal group, participants with MnDD, and major depressive disorder (MDD) had a 1.88- and 0.56-fold increased risk of poor health state in the fully adjusted model, but this association was not statistically significant in MDD (MnDD: OR = 2.88, 95% CI: 1.61–5.14, P < 0.001; MDD: OR = 1.56, 95% CI: 0.63–3.86, P = 0.340)
Summary
The proportion of the population aged 60 years and older increased from 9.2% in 1990 to 11.7% in 2013, and will continue to increase and account for 21.1% of the world’s population by 2050 [1]. Due to dramatic changes in population structure, aging-related problems have significantly impacted social and economic development, health and disease prevalence patterns, and individuals’ lifestyles. There has been an increased emphasis on promoting healthy aging. Health-related quality of life (HRQoL) is a widely used instrument to evaluate individuals’ daily activities, physiological functions, and subjective satisfaction in their emotional and social life [2]. HRQoL comprehensively reflects the health-related factors of older adults, covering all aspects of the biopsychosocial model; it is considered an important indicator of healthy aging [3]. As evidence on depression and health-related quality of life (HRQoL) among the oldest-old is currently limited, this study aimed to re-examine the association between depression and HRQoL among centenarians
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