Depressive Disorders In Old Age Research Articles

Positive aging-How does it work? : Contribution of resilience to the prevention of depressive disorders in old age

Although the prevalence of depressive disorders in old age is high, many older people succeed in staying healthy despite age-related stressors. The individual resilience or mental power of resistance can explain these differences. It is shown how resilience factors or strategies of healthy aging can be used for the primary prevention of depressive disorders in old age. The article summarizes the practically relevant age-specific aspects of resilience obtained through anarrative literature search and evaluates the relevant state of knowledge, also with respect to the consecutive development of primary preventive measures to avoid depressive disorders. Individual psychological strategies for promoting resilience include "stay active", and "mindfulness towards positive things", social strategies "remain socially connected" and "acceptance of support options". In addition to this individual level, which aims at every single person, the social dimension of resilience also includes strategies that start at the social level. Above all, this includes the esteem of older people in society as well as improved opportunities for participation. Age-specific aspects of resilience can be specifically used for the prevention of depressive disorders in old age. They enable aframework to establish resource-promoting and activating interventions, to counteract the deficit perspective on ageing. At the same time, there are clear limits to individual prevention and resilience. The responsibility cannot be seen solely for each individual but above all social structures and framework conditions must enable successful implementation in old age.

Types of Utilization and Types of Treatment Response in a Collaborative Care Approach for Depressive Disorders in Old Age in Primary Care.

Background: Treatment of depressive disorders in old age is hindered by several barriers. Most common are time pressure in primary care and latency for specialized therapeutic care. To improve treatment, the collaborative care approach GermanIMPACT was evaluated in a cluster-randomized controlled trial. Care managers offered a complex stepped-care intervention of monitoring, psychoeducation, and behavioral activation techniques. Twenty-six percent of the intervention group responds with a remission of depressive symptoms compared with 11% who received treatment as usual (TAU). The low-threshold intervention was more successful than TAU. Nevertheless, three-quarters did not respond with a remission. The aim of this study is to identify and describe the different types of utilization and of treatment response to understand what constitutes an effective intervention.Methods: Of 64 patients from the intervention group, we carried out problem-centered interviews with 26 patients from the intervention group. We analyzed the interviews using a qualitative type-building content analysis. For type construction, we performed a contrasting case comparison, regarding inductive and deductive categories of the intervention utilization and the symptom development.Results: The 26 participants' ages ranged from 62 to 87 years (mean = 72 years). Three participants were male. We identified five types of utilization, which differ primarily in the realization of pleasant activations, depending on own activity at the beginning and during the therapy: “activatable relief seekers,” “active relief seekers,” “active relaxation seekers,” “passive problem-solving seekers,” and “passive relief seekers.” In the second typology, we analyzed four deductively determined types of treatment response responders, slight improvers, constant moderates, and non-responders. Patient-specific characteristics are a recent history of depression, an affinity for activities, supportive contacts, and limited comorbidity. In contrast, non-responders report contrary characteristics.Conclusion: Our two typologies emphasize that an effective intervention requires a match between intervention components and patient characteristics. We saw no intersections between utilization and treatment response. GermanIMPACT is an effective low-threshold intervention for moderately burdened patients, who are still capable of self-activation. An expansion of the intervention, especially for depression with a long history and comorbidities impairing mobility, could increase the effectiveness and improve the care situation of older people suffering from depression.

Depression in the nursing home: a cluster-randomized stepped-wedge study to probe the effectiveness of a novel case management approach to improve treatment (the DAVOS project)

BackgroundDepression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents have minor or major depression. Although depressive disorders in old age can be improved and even cured with adequate therapy, they often go unnoticed in nursing home residents and remain untreated. This highlights a striking deficit in health care and might result not only in lower quality of life among those concerned but also in poor physical functioning, premature mortality, and increased hospitalization rates.MethodsThe aims of the interdisciplinary research project DAVOS are to implement an innovative and stepped structural case management program to improve depression treatment for nursing home residents by a modularized intervention and to assess it in terms of its effectiveness. Intervention modules are in line with recommendations given by the German national treatment guidelines for depression (S3 guidelines). Ten nursing homes in Frankfurt, Germany, will participate in the project, which aims to recruit a study population of 380. The recruitment will continue throughout the trial (open cohort). Persons (>60 years) who live in a nursing home, have no medical diagnosis of dementia, and can provide their informed consent to participate are eligible for inclusion in the study. Residents with a clinical diagnosis of dementia, alcohol or substance-related disorders, or other serious psychiatric illnesses will be excluded. DAVOS is a controlled cluster-randomized study that employs a stepped-wedge design.DiscussionOur main hypothesis is that the implementation of the intervention will lead to a decline in the prevalence of depression and a reduction in depression symptoms among the home residents. In addition, we expect the intervention to have a positive impact on secondary outcomes such as level of functioning, quality of life, and social participation. The project’s results can make an important contribution toward improving the health care of nursing home residents who have late-life depression.Trial registrationDRKS, DRKS00015686, Oct. 10, 2018.

The Elderly and the City: Lack of Knowledge on Violence Perception and Consequences on Daily Life.

Introduction:Two main demographic phenomena have substantially changed the condition of elderly: the growth of the urban population and the increase in longevity.Objective:The aim of the present review is to investigate how the elderly living in the cities perceive the sense of insecurity compared to those who reside in rural areas, and their Quality of Life (QoL).Method:Studies published from January 2011 to August 2017 were identified on Google and PubMed combining the following terms: “elderly urban/rural QoL” or “old age urban/rural QoL”.Results:We found 18 different papers published. However, there was only one study on how the elderly perceive the violence in the city. Studies on quality of life were not univocal. Studies on depressive disorders in old age were most homogeneous showing a condition worsening in the cities. A study on the perception of violence in US showed in residents of cities and neighborhoods with the entertainment arena and casinos an increase of criminality perception. In contrast, the crime decreased in both above-mentioned neighborhoods.Conclusion:The condition of elderly in the cities is changed considerably in the recent years. It is estimated that this trend will increase in the coming years. We do not know how older people are experiencing these changes and how they perceive the persistence of violence in the cities. Future researches must satisfy this need by addressing the issue with appropriate methodological tools. This is a public health priority.

Depression in Old Age--Challenge of an Ageing Society

Besides dementia, depressive disorders belong to the most common mental disorders in the elderly. Along with the demographic change and the associated increasing proportion of older people aged 65 and more they become a central and urgent challenge. Depressive disorders in old age are treatable, although they involve special features when compared to younger adults. Guidelines are considered to be of great importance in the optimization of treatments. But how will the treatment of depressive disorders in the elderly displayed in the current guidelines? A systematic search for treatment recommendations in current evidence- and consensus-based guidelines regarding psychotherapeutic and psychosocial treatment approaches indicates that this highly relevant patient group has been strongly neglected so far.

Collaborative and home based treatment for older adults with depression: a review of the literature

Due to the demographic development depressive disorders in old age are becoming a central and urgent healthcare challenge. The article reviews effective approaches towards treatment of depression in the elderly. A literature review of complex interventions improving depression care was carried out. Robust evidence exists for the use of collaborative care models which incorporate collaboration between mental health and medical providers in the primary care setting (e.g. general practitioners and specialists), regular monitoring, case management, and evidence-based treatment. Staged treatment approaches seem to be appropriate by which initially use treatment strategies of low intensity. For patients with limited mobility, home-based approaches have proven to be particularly practical and effective. Multidisciplinary and multimodal treatment approaches represent an effective and efficient way of healthcare provision for late life depression. In Germany, only few initiatives inspired by successful international models have so far been identified.

Age- and gender-specific prevalence and risk factors for depressive symptoms in the elderly: a population-based study

Information on the prevalence and risk factors for depressive disorders in old age is of considerable interest for the assessment of future needs of the health care system. The aim of the study is to determine age- and gender-specific prevalence of major depression (MD), minor depression (MiD), and depressive symptoms, and to analyze risk factors associated with depressive symptoms. A representative sample of the German population of 1,659 individuals aged 60 to 85 years were visited at home and answered self-rating questionnaires. Depressive symptoms and syndromes (MD, MiD) were assessed using the Patient Health Questionnaire (PHQ-9). Factors associated with depressive symptoms were determined with linear regression models for the total sample and for men and women separately. Depressive symptoms were found in 28.7% of the participants, while 6.6% were affected by MD or MiD. The highest prevalence of MD and depressive symptoms was found in the oldest age groups. MiD showed an unsteady course across age groups in both sexes. In the total sample as well as in the male subsample, depressive symptoms were significantly associated with increasing age, lower household income, an increasing number of medical conditions, and lower social support. In women only, the number of medical conditions and lacking social support were significantly associated with depressive symptoms. Depressive symptoms are common in old age and occur on a spectrum ranging from very mild forms to MD. The potential modifiability of a number of risk factors for depressive symptoms opens possibilities of secondary prevention such as treatment of chronic diseases as well as support in requirements of daily living.

Adjustment disorders, posttraumatic stress disorder, and depressive disorders in old age: findings from a community survey

Based on a new psychopathological model of adjustment disorders (AJD), we propose that AJDs are particular forms of stress response syndromes, in which intrusions, avoidance of reminders, and failure to adapt are core symptoms. We aim to demonstrate that these AJD symptom groups constitute a disorder that is distinct from posttraumatic stress disorder (PTSD), complicated grief disorder, major depressive disorder, and subsyndromal depression, by estimating their prevalence and comorbidities. A representative sample of elderly persons from Zurich, aged 65 to 96 years, was assessed by standardized interviews or self-report questionnaires. Index events for AJD were indicated by 52% of the sample set, with a 2.3% current prevalence of AJD. Prevalence rates for other disorders were 0.7% PTSD, 4.2% subsyndromal PTSD, 4.2% complicated grief disorder, 2.3% major depressive disorder, and 9.3% subsyndromal depression. The comorbidity rate for AJD and other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders is 46%, and that between AJD and subsyndromal disorders is 38%. Use of mental health care for AJD is low. This article concludes that the new concept of AJD constitutes a meaningful psychopathological model and thus warrants a place in standardized psychiatric taxonomies. Although this study was restricted to a sample of the elderly, it provides evidence regarding AJD prevalence, comorbidity, and associated health care use, all of which indicate its utility.

Treatment of depressive disorders in old age

Results indicate that major depressive disorders among the aged can be effectively treated by administration of sertraline, fluoxetine, reboxetine, nortriptyline, imipramine, and buproprion sustained release. When secondary outcome measures have been utilized, sertraline has been determined to be superior to nortriptyline and fluoxetine in improving cognitive functioning. Sertraline may have fewer side effects than nortriptyline. Sertraline, citalopram, and mianserin are effective in reducing depressive symptoms among aged patients with mild or moderate dementia. Imipramine, reboxetine and paroxetine have been proven in double-blind studies to reduce depressive symptoms among dysthymic patients or patients with minor depression, and sertraline has been proven to reduce symptoms in an open trial. The results suggest that maintenance therapy with antidepressants in old age may be safe and effective in preventing recurrences of depression, but further studies are needed. Unfortunately, fewer studies have been conducted regarding the effects of psychological treatment of depression in old age.