Elderly Depressed Patients Research Articles

Parallel Mediating Roles of Social Support and Self-Efficacy in the Relationship Between Frailty and Depression in Elderly Patients After Percutaneous Coronary Intervention.

To examine chain mediating roles of social support and self-efficacy between quality of frailty and depression in elderly people after percutaneous coronary intervention (PCI). Frailty is a cause of depression among elderly patients after PCI. Although previous studies have shown that frailty, social support, self-efficacy and depression are significantly related, the interaction mechanism remains unclear. Employing a cross-sectional research design and convenience sampling methodology, data were collected at a tertiary hospital in China. Participants completed the FRAIL Scale, Social Support Rate Scale, General Self-Efficacy Scale and the Hospital Anxiety and Depression Scale. We utilised the PROCESS macro in SPSS to ascertain the mediating roles of social support and self-efficacy between frailty and depression. The study used the STROBE checklist for reporting. A total of 241 elderly patients were included in the study, with an average age of 68.05 (6.04) years. Among them, 63.1% of the participants had experienced depression. Elderly patients after PCI's frailty score was negatively correlated with social support and self-efficacy, and positively correlated with depression. Social support was significantly positively correlated with self-efficacy, significantly negatively correlated with depression. Finally, self-efficacy was significantly negatively correlated with depression. Social support and self-efficacy mediated 11.61% and 29.46% of the total depressive role in elderly after frailty and PCI, respectively. Frailty in elderly PCI patients is directly associated with depression and indirectly related through social support or self-efficacy. To enhance the quality of life for elderly patients following PCI, healthcare providers should address the impact of frailty on depression and develop intervention strategies based on the levels of social support and self-efficacy. Questionnaires filled out by patients were used to understand the relationship between frailty, social support, self-efficacy and depression.

Effects of adjunctive esketamine on depression in elderly patients undergoing hip fracture surgery: a randomized controlled trial

BackgroundDepression is a prevalent perioperative psychiatric complication among elderly hip fracture patients. Esketamine has rapid and robust antidepressant effects. However, it is unknown whether it can alleviate depressive symptoms in elderly patients who undergo hip fracture surgery. This study aimed to explore whether the adjunctive esketamine in patient-controlled intravenous analgesia (PCIA) could improve depressive symptoms in elderly patients undergoing hip fracture surgery.MethodsA single-center, prospective, double-blind and randomized controlled clinical trial was carried out from July 2022 to August 2023 at the Wenzhou People’s Hospital among 90 patients, aged ≥ 65 years with hip fracture undergoing elective surgery. Participants were randomly allocated to either the esketamine group (group S) or the control group (group C). In Group S, patients were administered 0.5 mg/kg of esketamine as a PCIA adjuvant for 48 h, while the control group received saline. The primary outcome was the assessment of depressive symptoms using the Geriatric Depression Scale-15 (GDS-15) on postoperative day 2. The secondary outcomes were assessments of depressive symptoms on postoperative day 7 and postoperative day 30, serum levels of brain-derived neurotrophic factor (BDNF) and 5-hydroxytryptamine (5-HT), postoperative pain intensity, the number of effective PCIA presses, sufentanil consumption, and adverse events.ResultsThe prevalence and GDS-15 scores of depression were significantly lower in group S on postoperative day 2 (28.6% vs. 53.5%; 3.5 ± 1.8 vs. 4.3 ± 1.7, P < 0.05). In group S, the number of effective PCIA presses was significantly lower on postoperative day 2 than that in group C [2(1–4) vs. 1(0–2), P<0.05]. Higher levels of BDNF (23.8 ± 1.7 ng/mL vs. 25.3 ± 2.0 ng/mL, P < 0.05) and 5-HT (219.5 ± 19.5 ng/mL vs. 217.0 ± 22.2 ng/mL, P < 0.05) in the blood were observed on postoperative day 2 in group S.ConclusionIn elderly patients aged ≥ 65 years undergoing hip fracture surgery, the administration of adjunctive esketamine in PCIA could improve depressive symptoms and increase levels of BDNF and 5-HT in the blood.Trial registrationChinese Clinical Trial Registry, ChiCTR2200061956 (Date: 13/07/2022).

Effect of a Nurse-Led Exercise Program on Depression in Elderly Patients with Diabetes: A Retrospective Study.

Patients with diabetes often face psychological challenges, particularly depression. The coexistence of these two conditions can significantly impact both the mental and physical health of individuals. This study aims to investigate the effects of nurse-led exercise training on elderly patients diagnosed with type 2 diabetes mellitus and comorbid depression through experimental research. By selecting appropriate exercise programs for patients, the study seeks to identify effective strategies for improving both their physical health and depressive symptoms. Additionally, it aims to offer tailored exercise recommendations to enhance the overall well-being of these patients. The observation group (n = 53) and the control group (n = 53) were selected based on the interventions documented in the patients' medical records, with eligible patients identified as research participants. The control group received standard medication, while the observation group engaged in intensive exercise training in addition to their standard treatment, dedicating 60-90 min per day to exercise. Prior to and following the intervention, blood glucose indices, levels of 5-hydroxytryptamine (5-HT) and norepinephrine (NE), self-rating depression scale (SDS), Self-Rating Anxiety Scale (SAS), Pittsburgh Sleep Quality Index (PSQI), and Generic Quality of Life Inventory (GQOLI-74) scores were assessed to evaluate the impact of the exercise training intervention. Following the intervention, levels of fasting blood glucose (FBG), 2-h postprandial blood glucose (PBG), and Hemoglobin A1c (HbA1c) were reduced compared to pre-intervention levels, with the exercise group exhibiting lower levels than the control group (p < 0.05). Additionally, post-intervention, patients' levels of 5-HT and NE increased, with the exercise group demonstrating higher levels than the control group (p < 0.05). Moreover, post-intervention, SDS and SAS scores decreased, with more significant improvements observed in the observation group (p < 0.05). Furthermore, the intervention improved sleep quality and quality of life among patients in the exercise group compared to those in the control group (p < 0.05). Nurse-guided exercise training demonstrates a significant capacity to ameliorate glycemic indexes among patients with diabetes mellitus comorbid with depression. It not only diminishes depression and anxiety levels but also enhances the expression of 5-HT and NE. Furthermore, it effectively elevates patients' sleep quality and quality of life. These findings underscore the potential of nurse-led exercise interventions for clinical promotion and widespread application.

Adherence to clinical practice guidelines for using electroconvulsive therapy in elderly depressive patients

ObjectivesElectroconvulsive therapy (ECT) is one of the most effective treatments in mood disorders, mainly in major depressive episode (MDE) in the context of either unipolar (MDD) or bipolar disorder (BD). However, ECT remains a neglected and underused treatment. Older people are at high risk patients for the development of adverse drug reactions. In this context, we sought to determine the duration of MDEs and the number of lines of treatment before the initiation of ECT in patients aged 65 years or over according to the presence or absence of first-line indications for using ECT from international guidelines.MethodsIn this multicenter, retrospective study including patients aged 65 years or over with MDEs in MDD or BD who have been treated with ECT for MDEs, data on the duration of MDEs and the number of lines of treatment received before ECT were collected. The reasons for using ECT, specifically first-line indications (suicidality, urgency, presence of catatonic and psychotic features, previous ECT response, patient preference) were recorded. Statistical comparisons between groups used standard statistical tests.ResultsWe identified 335 patients. The mean duration of MDEs before ECT was about 9 months. It was significantly shorter in BD than in MDD- about 7 and 10 months, respectively. The co-occurrence of chronic medical disease increased the duration before ECT in the MDD group. The presence of first-line indications for using ECT from guidelines did not reduce the duration of MDEs before ECT, except where there was a previous response to ECT. The first-line indications reduced the number of lines of treatment before starting ECT.ConclusionEven if ECT seems to be a key treatment in the elderly population due to its efficacity and safety for MDEs, the delay before this treatment is still too long.

Development and Validation of a Community-Based Prediction Model for Depression in Elderly Patients with Diabetes: A Cross-Sectional Study.

In elderly diabetic patients, depression is often overlooked because professional evaluation requires psychiatrists, but such specialists are lacking in the community. Therefore, we aimed to create a simple depression screening model that allows earlier detection of depressive disorders in elderly diabetic patients by community health workers. The prediction model was developed in a primary cohort that consisted of 210 patients with diabetes, and data were gathered from December 2022 to February 2023. The independent validation cohort included 99 consecutive patients from February 2023 to March 2023. Multivariable logistic regression analysis was used to develop the predictive model. We incorporated common demographic characteristics, diabetes-specific factors, family structure characteristics, the self-perceived burden scale (SPBS) score, and the family APGAR (adaptation, partnership, growth, affection, resolution) score. The performance of the nomogram was assessed with respect to its calibration (calibration curve, the Hosmer-Lemeshow test), discrimination (the area under the curve (AUC)), and clinical usefulness (Decision curve analysis (DCA)). The prediction nomogram incorporated 5 crucial factors such as glucose monitoring status, exercise status, monthly income, sleep disorder status, and the SPBS score. The model demonstrated strong discrimination in the primary cohort, with an AUC of 0.839 (95% CI, 0.781-0.897). This discriminative ability was further validated in the validation cohort, with an AUC of 0.857 (95% CI, 0.779-0.935). Moreover, the nomogram exhibited satisfactory calibration. DCA suggested that the prediction of depression in elderly patients with diabetes mellitus was of great clinical value. The prediction model provides precise and user-friendly guidance for community health workers in preliminary screenings for depression among elderly patients with diabetes.

The Assessment of Geriatric Depression Among Primary Healthcare Physicians in Buraidah City, Saudi Arabia.

The global geriatric population is increasing, leading to a higher prevalence of non-communicable diseases, including depression. This condition often remains underdiagnosed and untreated disease. A cross-sectional study was conducted among 130 primary healthcarephysicians (PCPs) in Buraidah to assess their practices in diagnosing geriatric depression from March 2023 to March 2024. After ethical committee approval, data were collected through a self-administered questionnaire, entered, cleaned, and analyzed with StatisticalPackage for the Social Sciences (IBMSPSSStatisticsforWindows,IBMCorp., Version 21.0, Armonk,NY). Informed consent was obtained and the confidentiality of the participant information was maintained.Statistical tests, including the Chi-square test, were used for inference. Out of 130 PCPs, 85.4% (n=111) were diagnosing depression during their clinical practice. The most common depression scale used in their regular practice was the patient health questionnaire (PHQ)-2(70%, n=91), followed by the Geriatric Depression Scale (53.8%, n=70). Nearly 26.2% (n=34) of physicians responded that there is no need for routine lab tests for the diagnosis of depression. Concerning the initial plan of depression management, nearly 76.2% (n=99) of physicians preferred non-pharmacological treatment. Regarding barriers to diagnosis of depression in elderly patients, nearly 76.2% (n=99) mentioned the need for more training about geriatric depression, followed by 70% for both short consultation time and the need for Ministry of Health guidelines. There was a statistically significant association observed between <35 years of age group and a preference for a high percentage of pharmacological therapy (P<0.05). Based on the findings of the study, there was a good number (85.4%) of PCPs diagnosing depression in their clinics, and also three-fourths of the physicians (76.2%) preferred non-pharmacological treatment. Only one-fourth (26.2%) of the PCPs mentioned no lab is required for the diagnosis of depression.

Association Between Sarcopenia, Insomnia, and Depression in Elderly Patients

Association Between Sarcopenia, Insomnia, and Depression in Elderly Patients

FATORES DE RISCO ASSOCIADOS AO DESENVOLVIMENTO DA DEPRESSÃO EM IDOSOS/AS ONCOLÓGICOS: Uma revisão integrativa da literatura

FATORES DE RISCO ASSOCIADOS AO DESENVOLVIMENTO DA DEPRESSÃO EM IDOSOS/AS ONCOLÓGICOS: Uma revisão integrativa da literatura

A differentiated approach to the choice of a neuroprotective drugs during complex antidepressant therapy of elderly depressive patients in a hospital setting

IntroductionThe complex antidepressant therapy in combination with neuroprotectors increases the overall effectiveness of the treatment of depression in the elderly due to the group of the most difficult patients for therapy with ≥2 predictors of a low therapeutic response (LTRP), as well as in patients with complex (anxious, senesto-hypochondriacal, delusional) and prolonged (≥6 months) depressions.ObjectivesDevelopment of a differentiated approach to the choice of types of neuroprotective drugs in the course of complex antidepressant therapy in depressive elderly patients.MethodsWe studied groups of hospitalized patients aged ≥60 years with mild, moderate and severe depression (according to ICD-10) who received antidepressant monotherapy (comparison group) for 28 days (43 people) or complex antidepressant therapy in combination with carnicetin (20), cerebrolysin (20), citicoline (20), ethylmethylhydroxypyridine succinate (EMHPS) (25) and actovegin (25). Complaints about memory impairment, lonely living, and the presence of leukoaraiosis on brain CT were considered as LTRP. Efficacy of therapy (change in total HAMD-17 scores in %) was compared in subgroups with neuroprotectors and in the comparison group in patients with ≥2 LTRPs, as well as in patients with complex and prolonged depressions. Statistical analysis was performed.ResultsBy the 28th day of treatment, all patients with ≥2 LTRPs in the subgroups with the addition of any neuroprotectors were responders (≥50% change) with a significantly higher efficacy of therapy than in the monotherapy group (36.0%, p&lt;0.05). The efficacy of therapy was significantly higher in the subgroup with the addition of actovegin than in the subgroups with cerebrolysin and citicoline (73.7% versus 55.6% and 52.0%, respectively, p&lt;0.05). In complex depression, the effectiveness of therapy in the subgroup with cerebrolysin did not statistically differ from the comparison group. In prolonged depression, no statistically significant difference in efficacy was found between the citicoline-supplemented subgroup and the monotherapy group. The highest efficacy in the treatment of complex and prolonged depression was observed in subgroups with the addition of actovegin and EMHPS (p&lt;0.01).ConclusionsIf there are indications for prescribing complex antidepressant therapy (≥2 LTRPs) in depressive patients of late age, all studied neuroprotective drugs demonstrated high efficiency compared to monotherapy. In complex depressions, the combination of antidepressants with cerebrolysin turned out to be less effective, in protracted depressions - with citicoline. Neuroprotectors actovegin and EMHPS can be considered universal drugs of choice for complex therapy of the most difficult categories of elderly depressive patients in a hospital setting.Disclosure of InterestNone Declared

The role of depression between sleep disorders and frailty among elderly patients with chronic kidney disease (CKD) in China: a cross-sectional study.

To investigate the correlation among sleep disorders, physical frailty, and depression in elderly patients with chronic kidney disease (CKD), and to explore the mediating role of depression. This was a cross-sectional study, simple sampling was used to investigate the elderly CKD patients from one tertiary hospital in Shanghai. Those CKD patients who were diagnosed as CKD1-5 phase and were admitted to the Renal Medicine Ward from January to June 2022 and provided formal consent were considered for inclusion in our study. They were investigated with frailty phenotype (FP), Pittsburgh sleep quality index (PSQI), Center for Epidemiological Studies Depression Scale (CES-D), and self-made general information questionnaire. Linear regression was used to assess the associations between the variables, before this, PROCESS v4.1 was used to transform PSQI, CES-D and FP score to improve its normality, and conduct intermediary analysis. A difference of p < 0.05 was statistically significant. A total of 504 elderly patients with CKD completed the questionnaire survey, aged 60-91. The incidence of sleep disorders among elderly patients with CKD was 60%, and the incidence of physical frailty was 18%. The depression was positively correlated with physical frailty (r = 0.418, p < 0.01) and sleep disorders (r = 0.541, p < 0.01). Physical frailty was positively correlated with sleep disorders (r = 0.320, p < 0.01). The depression plays a significant mediating role in the model, and the effect ratio of depression is 52%. Depression is a mediating variable between sleep disorders and frailty. Improving depression in elderly patients with CKD accompanied by sleep disorders can help delay the occurrence of frailty.

Efficacy observation of acupoint application combined with psychological intervention in elderly patients with mild liver-qi stagnation depression

Introduction/Objective. The objective was to propose a safer and more effective treatment method for mild liver-qi stagnation syndrome depression in elderly patients. Methods. A total of 70 elderly patients were recruited from the outpatient or inpatient departments of our hospital between July and December 2022 and were randomly divided into two groups, with 35 in each. The control group received sertraline, and the observation group received acupuncture point application combined with psychological intervention. The course of treatment was 10 days for four consecutive courses of treatment. Following courses 1, 2, and 4, the patients? Hamilton Depression Scale (HAMD-24) scores were compared. Statistical analysis was performed using the paired t-test and the ?2 test. Results. After the end of courses 1, 2, and 4, the traditional Chinese medicine syndrome scale and total HAMD-24 scores were lower in the observation group than in the control group (p &lt; 0.01, p &lt; 0.05). Conclusion. The acupoint application combined with psychological intervention has a rapid and significant effect and fewer adverse effects in liver-qi depression.

A comparative study of electroconvulsive therapy among the elderly and adult patients with depressive disorder

ABSTRACT Aim: The present study aimed to compare the clinical profile, indications for electroconvulsive therapy (ECT), effectiveness of ECT, and complications associated with the use of ECT among elderly and adult patients. Methodology: Using a retrospective study design, data from patients with a diagnosis of unipolar depression, who received ECT between January 2013 and March 2023 was extracted. Based on the age at the time of receiving ECT, the study sample was divided into adult (age &lt;60 years) and elderly (≥60 years) groups and compared. Results: The study included data from 1144 patients with depression. Of them, 371 (32.4%) patients were aged 60 years or above. Compared to the adult group, a significantly higher number of patients in the elderly group were diagnosed with recurrent depressive disorder (P &lt; 0.001), had psychotic symptoms (P &lt; 0.001), and had at least one medical comorbidity. Compared to adult patients, elderly depressed patients had longer total lifetime duration of illness (P &lt; 0.001) and longer duration of current symptoms (P = 0.012). In terms of indications for ECT, the elderly patients had a higher frequency of poor response to the pharmacological treatment (P = 0.003) and a lower frequency of suicidality and attempts at self-harm (P &lt; 0.001). Compared to adults, elderly patients received a higher number of effective ECTs (P = 0.04). There were no differences between the two groups in terms of the reason for stopping ECT and the extent of improvement. However, a higher proportion of the elderly experienced complications related to ECT and received repeat ECT courses (P = 0.003) and continuation ECT (P &lt; 0.001). Conclusion: The present study shows that there are some differences between the elderly and adult patients with depression in terms of indications for ECT, side effects related to ECT, need for multiple courses of ECT, and continuation ECT. However, the efficacy of ECT does not differ between the two groups.

P103: Middle Cerebral Artery Stenosis is Associated with Severity of Depression in Elderly Patients: Magnetic Resonance Angiography (MRA) Findings

Objective:Vascular abnormalities have been frequently reported in elderly adults as a potential risk factor of late-life depression. However, it is still unclear whether stenosis of cerebral arteries may increase risk of depression in the elderly.Methods:Study participants were 365 patients 65 years or older with depressive disorder who had undergone brain MRI and angiography (MRA) which were assessed by trained radiologists, and the 15-item Geriatric Depression Scale (GDS-15) and the Mini Mental State Examination (MMSE), and blood glucose and lipid profiles.Results:Of the 365 subjects, 108 had at least one location of cerebral artery stenosis (29.59%). Stenosis was associated with age, marital status, infarction, and atherosclerosis. In multivariable linear regression analysis of different locations of stenosis among the whole sample, only bilateral middle cerebral artery (MCA) stenosis was found to have a significant association with higher GDS-15 score (p= 0.0138), and more than 8 scores in the GDS-15 (p= 0.0045), but no significant associations with ACA (anterior cerebral artery), PCA (posterior cerebral artery) or ICA (internal carotid artery). In multivariable linear logistic analysis of different locations among patients with at least one cerebral artery stenosis, left MCA was found to be significantly related to higher GDS-15 scores but not with right MCA (p = 0.0202).Conclusion:MCA stenosis is significantly associated with severity of depression in elderly adults with cerebral artery stenosis, especially in those with left MCA stenosis.Key pointsPatients with cerebral artery stenosis found with brain magnetic resonance angiography (MRA) were associated with higher depression severity.Stenosis of both left and right middle cerebral artery (MCA) was associated with greater depression severity, with left MCA stenosis having a greater influence on depression severity than right MCA stenosis.Higher depression severity in patients with MCA stenosis suggests that depression in elderly patients is mediated at least in part by vascular pathology of MCA supplied regions and careful investigation and management of cerebral artery stenosis and their risk factors may help reduce the severity of depression in elderly patients who visit psychiatrists.

Relationship between serum Th1/Th2 imbalance and depression in elderly patients with COPD and its clinical implications.

Chronic obstructive pulmonary disease (COPD) causes organic damage as well as anxiety, depression, fear, and other psychological disorders, which seriously affect the quality of life and prognosis of patients and cause a huge economic burden to the family and society. The aim of this study was to investigate the correlation between an imbalance of serum Th1/Th2 indicators and psychiatric depression in elderly patients with COPD and analyze its implications for clinical management. From January 2018 to May 2022, 120 elderly patients with COPD treated at our hospital were categorized into two groups based on the self-rating depression scale (SDS): COPD with depression (SDS score ⩾ 50) and COPD alone (SDS score < 50). Blood gas analysis, pulmonary function, and serum Th1/Th2 index were determined. Receiver operating characteristic (ROC) curves were analyzed to explore the diagnostic value of serum Th1/Th2 ratios for COPD complicated by depression. Compared with the group without depression, the partial pressure of carbon dioxide and COPD assessment test scores were significantly higher, and the oxygenation index, forced expiratory volume in one second (FEV1), and percent predicted FEV1 were significantly lower in the COPD with depression group (P< 0.05). Interleukin (IL)-1β, IL-2, IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α) were significantly higher in the COPD with depression group than in the group without depression (P< 0.05). Logistic regression analysis indicated that the imbalance of serum IL-1β, IL-2, IL-6, IL-8, IL-10, and TNF-α was a risk factor for mental depression in elderly patients with COPD. When comparing prognostic indices, the interval before the first onset of clinically noticeable deterioration (CID-C) in the COPD with depression group was noticeably shorter than that in the COPD without depression group; the incidence of CID-C within 6months was noticeably higher in the COPD with depression group than in the group without depression. Elderly patients with COPD and depression had reduced pulmonary function and higher serum Th1/Th2 levels, and an imbalance in serum Th1/Th2 indicators was a potential risk factor for depression. Moreover, elderly patients with COPD and depression were at a higher risk of disease progression and had a worse prognosis. Thus, an imbalance in serum Th1/Th2 indicators is a potential prognostic factor for evaluating depression in patients with COPD.

Evidence-based cognitive retraining in elderly depressives

Background: Aging is a normal biological process, and its dynamic changes are beyond the control of human beings. The role of depression, fear, and anxiety in old age is preoccupied with unhappy thoughts, and loneliness leads to early deterioration in their cognitive performance which makes it difficult to perform daily activities and hence affects their quality of life. Aim: The present study was done to assess the effectiveness of cognitive retraining in elderly depressives and its effect on their quality of life. Materials and Methods: The study was done on a sample of 20 depressive elderly patients with an age range above 60 years diagnosed with ICD-10 criteria. The study was pre- and post-intervention, and the sampling method was purposive. Firstly to screen handedness, Annet's hand preference battery was used, to assess the depression in elderly, the geriatric depression scale was done, and for attention and memory, Digit Span Test (WAIS-R) and Wechsler Memory Scale (WMS) were administered, respectively. WHO-QOL BREF was done to know the quality of life of the patient. After preassessment, cognitive retraining tasks were introduced to the patients. A total of 15 sessions were taken within three months of follow-up and after that to evaluate the efficacy of an outcome of the cognitive retraining, post-assessment was done. Results: Improvement was noticed in elderly depressive patients in the area of cognitive domain, i.e., attention, recognition, shifting, fixedness, recall, and planning which showed improvement in quality of life and daily activities. Conclusion: In the remediation of cognitive deficits, cognitive retraining plays a very important role, and it helps the elderly population to live their life healthily and hence enhance their coping skills.

Type 2 diabetes mellitus is associated with manic morbidity in elderly patients with mood disorders.

The association between mood disorders, especially bipolar disorder (BD), and metabolic disorders, is long known. However, to which extent metabolic disorders affect the course of mood disorders in late life is still open to inquiring. To assess the impact of type 2 diabetes mellitus (T2DM) on late-life mood disorders a retrospective chart review was performed. Elderly depressive patients (≥ 65 years) diagnosed with Major Depressive Disorder (N = 57) or BD (N = 43) and followed up for at least 18 months were included and subdivided according to the presence of T2DM comorbidity. Vascular encephalopathy (39.1% vs. 15.6%, P = 0.021) and neurocognitive disorders (21.7% vs. 5.2%, P = 0.028), were more frequently reported in patients with T2DM than in those without. Patients with T2DM showed a greater percentage of follow-up time in manic episodes (r = -0.23, P = 0.020) and a higher rate of manic episode(s) during follow-up (21.7% vs. 5.2%, P = 0.028) than those without. When restricting longitudinal analyses to patients with bipolar spectrum disorders, results were confirmed. In line with the well-known connection between BD and metabolic disorders, our data support an association between T2DM and unfavorable course of illness in the elderly with BD.

Clinical picture and differential diagnosis of depression in old age

Depression in old age is often underdiagnosed, although it is the leading mental health problem at this age. The significance of assessment and adequate treatment of depression among elderly patients cannot be overstated, since it significantly impairs the quality of life, increases morbidity and mortality in many of the chronic disease groups. In addition, it is a primary risk factor in completed suicide, which occurs up to three times more often among elderly than in other age groups. In our non-systematic (narrative) summary study, we briefly review the clinical picture and differential diagnosis of depression in elderly patients, as well as the main aspects of screening and treatment. The clinical characteristics and the pathology of the disease at this age raise a number of methodological questions that could be the subject of further empirical studies. Orv Hetil. 2023; 164(39): 1537-1543.

Impact of depression in Elderly patients with low vision

OBJECTIVE: To determine the effects of depression in the elder patients suffering from low vision and correlate depression with low vision.&#x0D; METHOD: A cross-sectional study was performed on 91 subjects who visited Low Vision Center at Mayo Hospital Lahore. All the patients were asked to fill the questionnaire. Qualitative data was analyzed through frequency and percentage. This study was conducted from September to November 2020.&#x0D; RESULTS: Forty six out of ninety one (50.5%) patients had trouble in reading regular size print. Fifty three percent were having difficulty to sign documents. Forty percent were having difficulty in recognizing faces. Sixty three (69.2%) patients had difficulty in independent travelling. Reduced vision leading to unhappy feeling sometimes was experienced by 39.6% of the participants. Out of 91, 40 patients of low vision having depression get frustrated when they could not perform certain tasks. Poor daily routine work was found in 50.5%. Patient having mild, severe and very severe glare problem were 51.7%, 24.2% and 6.6% respectively. Severe problem while watching television is found in 39.6% patients. Depressive patients having thoughts of hurting themselves were 3.3%. Thirty eight percent felt that ignorance could develop stress.&#x0D; CONCLUSION: There were high chances in low vision patients to develop depression because of visual loss, functional impairment, and difficulty in daily life activities. Visual impairment restricted a person's independence, and worsened the quality of life. If a person is counseled properly, it is beneficial in increasing the functional performance and will also help him or her to avoid developing depression.&#x0D; KEYWORDS: Low vision, Depression.

Clinical characterization, physical frailty, and depression in elderly patients with psoriasis from a reference center in Brazil: a cross-sectional study

BackgroundThere are few studies dedicated to the characterization of the geriatric population with psoriasis, which has particularities in terms of clinical manifestations and therapeutic limitations. As psoriasis is a chronic disease, presenting a higher prevalence with age, the increase in life expectancy in Brazil demands knowledge about the behavior of the disease among the elderly. ObjectivesTo characterize elderly people with psoriasis from a tertiary service, from the clinical-epidemiological point of view, presence of comorbidities, physical frailty, and affective impact, and to compare these aspects with adults with psoriasis and elderly people without the disease. MethodsCross-sectional study of 64 elderly patients with psoriasis, 64 adults with psoriasis, and 64 elderly patients without the disease. Clinical-demographic aspects, the Beck depression scale, and Skindex-16 were evaluated. Indicators of physical frailty were evaluated in elderly patients: handgrip, sit-to-stand test, fatigue, and weight loss >5%. ResultsIn the elderly, the mean age (SD) of psoriasis onset was 44 (10) years, men represented 47% of the sample, the prevalence of arthritis was 22%, and ungual involvement occurred in 72%. Topical corticosteroids were used more often among elderly people with psoriasis (100%) than among adults with the disease (86%), with no difference among other systemic treatments. Diabetes mellitus occurred in 30% of the elderly. Hypertension (59%), dyslipidemia (52%), depression (34%), and fatigue (59%) were more prevalent among the elderly with psoriasis than among the healthy controls. Study limitationsThe study was carried out in a public reference service for patients with psoriasis, all of which were undergoing treatment. ConclusionsElderly people with psoriasis from a tertiary service showed greater affective impairment, metabolic comorbidities, and physical frailty than elderly controls.

Coexistence and clinical implications of anemia and depression in the elderly population.

Anemia and depression are common in the elderly and they are important medical, social and economic problems for the world. Both disorders are associated with a lower quality of life, multimorbidity and a higher risk of death. The connections between anemia and depression have been reported, but the mechanism and clinical consequences of their co-existence are not fully understood. Several links can be found between anemia and depression in the elderly: common etiological factors, low socioeconomic status of patients, poor education and less physical activity. Both conditions are associated with the occurrence of the same pathological changes: age-related (especially with the presence of inflammation, oxidative stress, degenerative changes in organs and tissues), nutritional deficiencies (iron, vitamin B12, folic acid) and hormonal disorders (especially thyroid gland disorders, sex hormone deficiencies). Anemia and depression are not sufficiently diagnosed in the elderly and, as a result, are often left untreated. The diagnosis and treatments of these conditions in the elderly differ from those in other age groups. The study provides an overview of the literature regarding the co-existence of anemia and depression in elderly patients and clinical recommendations.