Depressive Symptoms In Older Patients Research Articles

Association between cognitive functioning and health-related quality of life and its mediation by depressive symptoms in older patients with kidney failure

BackgroundImpaired cognition, poor health-related quality of life (HRQoL) and depressive symptoms are common in older patients with kidney failure. Understanding what influences HRQoL is important, as older patients regard HRQoL as a health priority. This study examines whether cognitive functioning is associated with HRQoL and whether depressive symptoms mediate this effect in older patients with kidney failure.MethodsOutpatients aged ≥ 65 years from 35 Dutch and Belgian hospitals with eGFR 20–10 mL/min/1.73 m2 were included from the ongoing DIALOGICA study. Cognitive functioning was assessed using the Montreal Cognitive Assessment. Depressive symptoms were screened with 2 Whooley Questions and thereafter assessed with the 15-item Geriatric Depression Scale. HRQoL was assessed using the 12-item Short-Form Health Survey. To assess whether cognitive functioning is associated with HRQoL, cross-sectional multivariable linear regression analyses were performed. Subsequent mediation analyses were performed with PROCESS using the product method.ResultsIn total, 403 patients were included, with a mean age of 76.5 years (SD 5.8) and estimated glomerular filtration rate (eGFR) of 14.5 mL/min/1.73 m2 (SD 3.0). Cognitive functioning was associated with mental HRQoL (adjusted β 0.30, 95% CI 0.05;0.55) but not physical HRQoL (adjusted β 0.18, 95% CI -0.09;0.44). This effect is mediated by depressive symptoms (adjusted β 0.14, 95% CI 0.04;0.25).ConclusionLower cognitive functioning was negatively associated with mental HRQoL, which was mediated by depressive symptoms in older patients with kidney failure. Future research should explore whether cognitive interventions and treatment of depression improve HRQoL in this vulnerable patient population.Graphical

The Efficacy of Bibliotherapy in Depression Management: A Systematic Review of Randomized Clinical Trials

<p> Aim: This systematic review critically evaluates the efficacy of bibliotherapy in addressing mental health concerns across various populations and intervention modalities. </p> <p> Methods: A comprehensive bibliographic search was conducted, identifying 20 articles from databases PubMed, Scopus, and Google Scholar, representing studies published in English between 1990 and 2022. The selected randomized clinical trials were subjected to rigorous evaluation using Cochrane's Risk of Bias tool to assess methodological quality. Inclusion criteria focused on RCTs examining bibliotherapy programs for depression treatment. The selected studies were analyzed based on their comparison of bibliotherapy outcomes with standard treatments or no intervention. Follow-up periods ranging from 2 weeks to 3 years were considered. </p> <p> Results: Out of 413 retrieved results, 20 articles were included, reporting 3354 subjects. The methodological quality of the studies, assessed using Cochrane's Risk of Bias tool, was found to be sound. Bibliotherapy demonstrated significant improvements in depressive symptoms in older patients as studied in 3 long-term bibliotherapy RCTs and 7 shortterm bibliotherapy RCTs. In young patients, 3 long-term bibliotherapy RCTs have shown significant improvement in depressive symptoms over 6 months to 2 years, whereas 7 short-term bibliotherapy RCTs also showed significant improvement within a brief timeframe. The review explores bibliotherapy's efficacy in managing occupational stress and its potential as a therapy for depression in populations with chronic physical illnesses. </p> <p> Conclusion: The findings imply that bibliotherapy could serve as an affordable and prompt intervention, potentially reducing the need for additional medications. However, the study emphasizes the importance of further research to strengthen the evidence base, particularly in diverse populations and settings.</p>

Effects of a video-viewing intervention with positive word stimulation on the depressive symptoms of older patients with cardiac disease and subthreshold depression: a pilot randomized controlled trial protocol

BackgroundIntervention for older patients with cardiac disease and subthreshold depression (StD) may be an effective strategy to prevent the development of major depressive disorder. The subliminal priming with supraliminal reward stimulation (SPSRS) website developed by us is an advanced intervention that can improve depressive symptoms in individuals with StD by presenting positive word stimuli in videos. However, its efficacy for treating depressive symptoms in older patients with cardiac disease and StD has not been investigated. Here, we present a pilot randomized controlled trial protocol to investigate the preliminary efficacy of an intervention for older patients with cardiac disease with StD.MethodsThe study was designed as a single-center, open-label, pilot, randomized, parallel-group trial. The participants will include 30 older patients with cardiac disease and StD who are hospitalized in acute wards. The Experimental group received the SPSRS intervention (video viewing with positive word stimuli; n = 15) and the Control group will receive the YouTube intervention (video viewing without positive word stimuli; n = 15). In both groups, the intervention will be administered for 10 min per day, five times per week for 1 week. The primary outcome will be the change in the scores on the Japanese version of the Beck Depression Inventory-II at 1 week after the baseline assessment. The secondary outcomes will be the changes in the Specific Activity Scale, New York Heart Association functional classification, as well as grip strength at 1 week after the baseline assessment.DiscussionThis pilot randomized controlled trial will be the first to evaluate the SPSRS intervention for depressive symptoms in older patients with cardiac disease and StD who are admitted to acute wards. The results will provide tentative indications regarding the impact of the intervention on depressive symptoms among older patients with cardiac disease and StD who are admitted to acute wards, and will contribute to the planning of a full-scale study.Trial registrationUMIN, UMIN000052155. Registered September 8, 2023, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000059526. This study was registered with the University Hospital Medical Information Network (UMIN) (UMIN000052155) in Japan.

Depressive symptoms and associated factors among older patients with arthritis: evidence from a community-based study in eastern China.

Depressive symptoms are often experienced by patients with arthritis and are correlated with poor health outcomes. However, the association between depressive symptoms and multidimensional factors (sociodemographic characteristics, health conditions, health behaviors, and social support) among older patients with arthritis in China remains poorly understood. This study aimed to explore the prevalence of depressive symptoms in older patients with arthritis in eastern China and identify the associated factors. We analyzed data of 1,081 older patients with arthritis using secondary data from 2014 to 2020 from a community-based ongoing study initiated in 2014 in eastern China. The prevalence of depressive symptoms was calculated, and univariate and multilevel logistic regression analyses were used to identify the associated factors. The mean age of older patients with arthritis was 69.16 ± 7.13 years; 42.92% were men and 57.08% were women. The prevalence of depressive symptoms in older patients with arthritis was 14.99% (95% confidence interval: 12.91-17.26%), about 1.8 times higher than that in older adults without arthritis (8.49%, p < 0.001). Multilevel logistic regression identified perception of poor economic status (odds ratio [OR] = 5.52, p < 0.001), multimorbidity (OR = 1.96, p = 0.001), limitations in activities of daily living (OR = 2.36, p = 0.004), and living alone (OR = 3.13, p = 0.026) as factors positively associated with depressive symptoms. Patients diagnosed with arthritis at an older age had lower odds of experiencing depressive symptoms (OR = 0.67, p = 0.046). Screening for depressive symptoms is essential among older patients with arthritis, especially those who perceive themselves as having a poor economic status, are diagnosed at an earlier age, have multimorbidity, have limitations in activities of daily living, and live alone. The associations of age at arthritis diagnosis and dietary behaviors with depressive symptoms require further research.

Trajectories of Postoperative Depressive Symptoms in Older Patients Undergoing Major Surgery

This cohort study examines the trajectories of postoperative depressive symptoms in older patients undergoing major surgery and the differences in patient characteristics between the trajectory groups.

Efficacy of vitamin D supplementation on depressive symptoms in older patients: a meta-analysis of randomized controlled trials.

The relationship between vitamin D and depression has garnered significant attention in recent years. However, the efficacy of vitamin D in ameliorating depression among specific subgroups of older patients remains controversial. This study aimed to assess the impact of vitamin D supplementation on depressive symptoms and the prevalence of depression in older adults. Additionally, the study sought to examine potential moderating factors, including differences among population subgroups and various supplementation strategies. A systematic literature search was conducted in the databases PubMed, EMBASE, Web of Science, and the Cochrane Library up to March 2024. The RevMan 5.3 software was utilized to calculate the standardized mean difference (SMD) and to evaluate the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The objective was to determine the efficacy of vitamin D supplementation in alleviating depressive symptoms or treating depression in older adults. This meta-analysis encompassed eleven studies, comprising a total of 21,561 participants. The findings did not indicate a statistically significant therapeutic benefit of vitamin D supplementation for depression in older patients [SMD: -0.10; 95% CI: (-1.19, 0.00); p = 0.05]. Subgroup analyses revealed that the efficacy of vitamin D intervention in geriatric depression correlated with several factors, including baseline serum 25(OH)D levels, the dosage of the intervention, gender, and the initial presence of depressive symptoms or a diagnosis of depression. The current evidence is insufficient to conclusively establish the significant efficacy of vitamin D supplementation in alleviating depressive symptoms among older patients. Consequently, additional randomized controlled trials are warranted to further validate the relationship between vitamin D supplementation and depression in the older adults.

Association between depressive symptoms and heart rate variability in older patients admitted for rehabilitation: a cross-sectional study

Heart rate variability (HRV) is associated with depressive symptoms, but this relationship in older inpatients undergoing rehabilitation remains unclear. This study investigated the relationship between HRV and depressive symptoms in older inpatients undergoing rehabilitation. Fifty patients aged ≥65 years were assessed for depressive symptoms using the Geriatric Depression Scale. HRV was assessed by frequency analysis. The relationship between depressive symptoms and HRV indices, age, sex, Short Physical Performance Battery (SPPB) score, Mini-Mental State Examination score was examined using simple linear regression. Next, the predictors from the simple linear regression analysis significant at the 0.15 level were inputted in a multiple regression model. Multiple regression analysis revealed that very low frequency HRV [β = −2.13, 95% confidence interval (CI) −3.15 to −1.11, P &lt; 0.05] and SPPB score (β = −0.30, 95% CI −0.52 to −0.08, P &lt; 0.05) were negatively associated with depressive symptoms: the lower the HRV and the more severe the mobility impairment, the higher the severity of the depressive symptoms. Very low frequency (VLF) HRV and physical performance, as measured by the SPPB score, were associated with depressive symptoms in older patients undergoing rehabilitation. VLF HRV may serve as a useful biomarker for detecting depressive symptoms in this population.

Ninjinyoeito Prevents Onset of Depression-Like Behavior and Reduces Hippocampal iNOS Expression in Senescence-Accelerated Mouse Prone 8 Mice.

Late-life depression is a globally prevalent disorder. Ninjinyoeito (NYT), a traditional Japanese herbal medicine, attenuates depressive symptoms in older patients. However, the mechanisms underlying the antidepressive effect of NYT are unknown. In this study, we investigated the mechanism of the action of NYT using senescence-accelerated mouse prone 8 (SAMP8) mice, which exhibit accelerated aging. SAMP8 mice were treated with NYT starting at 12 weeks of age. Twelve-week-old SAMP8 mice did not show prolonged immobility time in the tail suspension test compared with age-matched SAMR1 mice (normal aging control). At 34 weeks of age, vehicle-treated SAMP8 mice displayed prolonged immobility time compared with SAMR1 mice. NYT-treated SAMP8 mice showed a shorter immobility time than that of vehicle-treated SAMP8 mice. Notably, NYT decreased hippocampal inducible nitric oxide synthase (iNOS) expression in SAMP8 mice. There was no difference in iNOS expression between SAMR1 and vehicle-treated SAMP8 mice. Subchronic (5 days) administration of an iNOS inhibitor, 1400 W, shortened the immobility time in SAMP8 mice. These results suggest that NYT prevents an increase in immobility time of SAMP8 mice by decreasing iNOS levels in the hippocampus. Therefore, the antidepressive effect of NYT in older patients might be mediated, at least in part, by the downregulation of iNOS in the brain. Our data suggest that NYT is useful to prevent the onset of depression with aging.

Changes in Subjective Measures of Cognitive Function in Older Adults From the Initiation Through 12 Months After the Receipt of Chemotherapy.

Cognitive impairment has a negative impact on older patients with cancer. The aim of this study was to evaluate for interindividual differences in 2 subjective measures of cognitive function in older patients (n = 112), as well as determine which demographic, clinical, and symptom characteristics, and levels of physical function, were associated with initial levels and with the trajectory of each of these 2 measures. Cognitive function was assessed using the cognitive function scale from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and the Attentional Function Index at the initiation of chemotherapy and at 1, 3, 6, 9, and 12 months after its initiation. Hierarchical linear modeling was used to assess for interindividual differences in and characteristics associated with initial levels and changes in cognitive function. Characteristics associated with decreases in Quality of Life Questionnaire Core 30 scores at the initiation of chemotherapy were longer time since the cancer diagnosis and higher depression scores. Characteristics associated with poorer Attentional Function Index scores at enrollment were lower levels of education and higher depression scores. No characteristics were associated with worse trajectories of either cognitive function measure. Some older patients undergoing chemotherapy experience decrements in cognitive function. Our findings suggest that clinicians need to assess for depressive symptoms in older patients before the initiation of chemotherapy. Evidence-based interventions (eg, cognitive stimulation, increased physical activity) can be recommended to maintain and increase cognitive function in older oncology patients.

Abstract 14997: Computerized Cognitive Training and 24-Month Mortality in Heart Failure

Introduction: Long-term efficacy has not been widely evaluated for computerized cognitive training (CCT) to improve cognition and reduce mortality. The purpose of this study was to evaluate long-term efficacy of CCT to reduce risk of death and test additional predictors of long-term mortality among patients with heart failure (HF). Methods: In this prospective study, a subset of 142 patients with HF were included from the parent 3-arm RCT testing CCT using BrainHQ to improve memory. Mortality data were collected from electronic health records, family caregivers, physicians or nurses during 24 months after the randomization between Mar 2017 and Dec 2020. Multiple logistic regressions were performed with 2 predictor variables (group and an additional predictor) given the small number of death cases. Predictors tested were age, baseline global cognition, memory, working memory, depressive symptoms, and health-related quality of life (HRQL). Results: The sample was 52% women/48% men; mean age 65 (SD=13) years; and race 13% Black, 1% more than one race, 1% Native Hawaiian/Pacific Islander, and 85% White. Mean left ventricular ejection fraction was 46% (SD=14). Of 142 patients, 16 (11.3%) died; 4 (8.3% of 48) in CCT group and 12 (12.8% of 94) in control groups (p=.429). The patients who died were older by 9 years (p=.002), had more depressive symptoms (p=.022), and poorer global cognition (p=.009), memory (p=.069), and HRQL (p=.080) at baseline. In logistic regression models, CCT group was not a statistically significant predictor of 24-month mortality (OR=0.65, 95% CI=0.28-1.15). Patients with better global cognition and memory were less likely to die over 24 months by 27% (OR=0.73, 95% CI=0.58-0.90) and 19% (OR=0.81, 95% CI=0.67-0.99), respectively. Patients with more depressive symptoms (OR=1.10, 95% CI=1.00-1.21) and older age (OR=1.08, 95% CI=1.01-1.14) were more likely to die over 24 months. Working memory and HRQL did not predict mortality. Conclusions: CCT using BrainHQ did not show long-term efficacy on reducing 24-month mortality in HF. Efficacious interventions are needed that are targeted at underlying etiologies of cognitive dysfunction and depressive symptoms in older patients with HF.

Recognition of cognitive impairment and depressive symptoms in older patients with heart failure.

IntroductionCognitive impairment and depression in patients with heart failure (HF) are common comorbidities and are associated with increased morbidity, readmissions and mortality. Timely recognition of cognitive impairment and depression is important for providing optimal care. The aim of our study was to determine if these disorders were recognised by clinicians and, secondly, if they were associated with hospital admissions and mortality within 6 months’ follow-up.MethodsPatients (aged ≥65 years) diagnosed with HF were included from the cardiology outpatient clinic of Gelre Hospitals. Cognitive status was evaluated with the Montreal Cognitive Assessment test (score ≤22). Depressive symptoms were assessed with the Geriatric Depression Scale (score >5). Patient characteristics were collected from electronic patient files. The clinician was blinded to the tests and asked to assess cognitive status and mood.ResultsWe included 157 patients. Their median age was 79 years (65–92); 98 (62%) were male. The majority had New York Heart Association functional class II. Cognitive impairment was present in 56 (36%) patients. Depressive symptoms were present in 21 (13%) patients. In 27 of 56 patients (48%) cognitive impairment was not recognised by clinicians. Depressive symptoms were not recognised in 11 of 21 patients (52%). During 6 months’ follow-up 24 (15%) patients were readmitted for HF-related reasons and 18 (11%) patients died. There was no difference in readmission and mortality rate between patients with or without cognitive impairment and patients with or without depressive symptoms.ConclusionCognitive impairment and depressive symptoms were infrequently recognised during outpatient clinic visits.

The effects of elective aortic repair, colorectal cancer surgery and subsequent postoperative delirium on long-term quality of life, cognitive functioning and depressive symptoms in older patients

Objectives: This study aimed to demonstrate the impact of elective major abdominal surgery and subsequent postoperative delirium on quality of life (QOL; primary outcome), cognitive functioning and depressive symptoms (secondary outcomes) in older surgical patients.Method: A single-centre, longitudinal prospective cohort study was conducted between November 2015 and June 2018, including patients ≥70 years old who underwent surgery for colorectal cancer or an abdominal aortic aneurysm. They were followed-up at discharge and at 6 and 12 months postoperatively until June 2019. QOL was assessed with the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). Cognitive functioning was measured with the Mini-Mental State Examination and depressive symptoms with the CES-D 16.Results: In all patients (n = 265), physical and psychological health were significantly lower at discharge compared to baseline (p < 0.001 for both domains). Physical health restored after 6 months, but psychological health remained decreased for the complete study period. Psychological, social and environmental QOL were significantly worse in patients with delirium compared to patients without (p = 0.001, p = 0.006 and p = 0.001 respectively). The cognitive functioning score was significantly lower at baseline in patients with delirium compared to those without (p = 0.006). Patients with delirium had a significantly higher CES-D 16 score compared to those without after 12 months (p = 0.027).Conclusion: Physical and psychological QOL were decreased in the early postoperative period. While physical health was restored after 6 and 12 months, psychological health remained decreased. After 12 months, postoperative delirium resulted in worse psychological, social and environmental QOL and more depressive symptoms. Decreased cognitive functioning may be a risk factor for delirium.

HOspitals and patients WoRking in Unity (HOW R U?): protocol for a prospective feasibility study of telephone peer support to improve older patients' quality of life after emergency department discharge

IntroductionOlder people presenting to an emergency department (ED) have a higher likelihood of social isolation, loneliness and depression; which are all associated with negative health outcomes and increased health service...

Older patients’ depressive symptoms 6 months after prolonged hospitalization: Course and interrelationships with major associated factors

The aim of this study was to examine the course of depressive symptoms in older patients 6 months following a prolonged, acute hospitalization, especially the interrelationships among depressive symptoms and its major associated factors. For this study, we conducted a secondary analysis of data from a prospective cohort study of 351 patients aged 65 years and older. Participants were recruited from five surgical and medical wards at a tertiary medical center in northern Taiwan and assessed at three time points: within 48h of admission, before discharge, and 6 months post-discharge. The course of depressive symptoms was dynamic with symptoms increased spontaneously and substantially during hospitalization and subsided at 6 months after discharge, but still remained higher than at admission. Overall, 26.7% of older patients at hospital discharge met established criteria for minor depression (15-item Geriatric Depressive Scale (GDS-15) scores 5–9) and 21.2% for major depression (GDS-15 scores >10). As the strongest associated factors, functional dependence and nutritional status influenced depressive symptoms following hospitalization. Depressive symptoms at discharge showed significant cross-lagged effects on functional dependence and nutritional status at 6 months after discharge, suggesting a reciprocal, triadic relationship. Thus, treating one condition might improve the other. Targeting the triad of depressive symptoms, functional dependence, and nutritional status, therefore, is essential for treating depressive symptoms and improving the overall health of older adults hospitalized for acute illness.

Depression and Cognition: How Do They Interrelate in Old Age?

To disentangle the reciprocal effects between depressive symptoms and cognitive functioning over time and to study the association between changes in their trajectories using 13 years of follow-up. Data were used from five waves of the population-based Longitudinal Aging Study Amsterdam. Subjects were included if data was present on depressive symptoms and cognitive performance on at least two occasions, which resulted in a study sample of N= 2,299. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale. Cognitive functioning was assessed using the Mini-Mental State Examination (general cognitive functioning) and timed coding task (speed of information processing). Cross-domain latent change analyses showed that depression at baseline predicted both decline of general cognitive functioning and information processing speed, independent of relevant covariates. Conversely, information processing speed at baseline, but not general cognitive functioning was related to the course of depressive symptoms. The course of cognitive functioning was not significantly associated with the course of depressive symptoms. Depressive symptoms in older patients flag an increased likelihood of cognitive decline. This effect is considerable and may be due to several underlying mechanisms. The likelihood of the relationship reflecting either a causal effect of depression on cognitive decline, or a common cause, or both, should be estimated. Likewise, older persons with more limitations in information processing speed specifically are more vulnerable to increases in depression.

Heterogeneity in symptom profiles among older adults diagnosed with major depression

Late-life depression may be undiagnosed due to symptom expression. These analyses explore the structure of depressive symptoms in older patients diagnosed with major depression by identifying clusters of patients based on their symptom profiles. The sample comprised 366 patients enrolled in a naturalistic treatment study. Symptom profiles were defined using responses to the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HAM-D) and the depression section of the Diagnostic Interview Schedule (DIS) administered at enrollment. Latent class analysis (LCA) was used to place patients into homogeneous clusters. As a final step, we identified a risk profile from representative items across instruments selected through variable reduction techniques. A model with four discrete clusters provided the best fit to the data for the CES-D and the DIS depression module, while three clusters best fit the HAM-D. Using LCA to identify clusters of patients based on their endorsement of seventeen representative symptoms, we found three clusters of patients differing in ways other than severity. Age, sex, education, marital status, age of onset, functional limitations, level of perceived stress and subjective social support were differentially distributed across clusters. We found considerable heterogeneity in symptom profiles among older adults with an index episode of major depression. Clinical indicators such as depression history may play less of a role differentiating clusters of patients than variables such as stress, social support, and functional limitations. These findings can help conceptualize depression and potentially reduce misdiagnosis for this age group.

Efficacy and safety of adjunctive aripiprazole in major depressive disorder in older patients: a pooled subpopulation analysis

To evaluate the efficacy and safety of adjunctive aripiprazole compared with standard antidepressant therapy (ADT) for older patients with major depressive disorder (MDD) who demonstrated an incomplete response to standard antidepressant monotherapy. Data from three similar 14-week studies (an 8-week prospective ADT treatment phase and a 6-week randomized, double-blind phase) of aripiprazole augmentation were pooled for this post hoc analysis. Two age groups were defined: younger patients (aged 18-49 years) and older patients (aged 50-67 years). The older patient group was further divided into three subgroups: 50-55, 56-60, and 61-67 years. The efficacy endpoint was the mean change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score from end of the prospective phase (Week 8) to endpoint (Week 14, last observation carried forward (LOCF)). Remission was defined as MADRS total score ≤10 at endpoint. Four hundred and nine older patients (placebo, n = 198; aripiprazole, n = 211) and 679 younger patients (placebo, n = 341; aripiprazole, n = 338) were included in this analysis. Older patients receiving aripiprazole demonstrated significantly greater improvement in MADRS total score versus placebo at Week 14 (-10.0 vs. -6.4; p < 0.001; LOCF), similar to the improvement seen in younger patients. Remission rates were significantly higher with aripiprazole versus placebo in older (32.5% vs. 17.1%; p < 0.001) and younger (26.9% vs. 16.4%; p < 0.001) patients. Akathisia was the most common adverse event in both the older (17.1%) and younger (26.0%) patient groups. Adjunctive aripiprazole was effective in improving depressive symptoms in older patients, 50-67 years, with MDD who have had an inadequate response to standard antidepressant medication.

Dietary factors and depression in older people

Depression is one of the most prevalent mental health conditions and can affect people of all ages, but it is becoming more common among the older population with increasing life expectancy. Observational studies have found poor micronutrient status (particularly folate and vitamin B12) to be associated with an increased risk of depression in older people. Supplementation with folic acid has been shown to enhance anti-depressant drug treatment and there is preliminary evidence that supplementation with certain micronutrients may help improve depressive symptoms in older patients. There has also been a lot of interest in the role of long-chain omega-3 fatty acids in depression. However, the evidence from randomized controlled trials is limited and difficult to evaluate owing to considerable variability between studies. The research highlights the importance of a healthy diet and lifestyle to help maintain good mental health into old age and health professionals should try to support older people in trying to achieve this.

The relationship between pain intensity and severity and depression in older people: exploratory study

BackgroundPain and depression are known to be associated in later life, and both have a negative effect on physical performance both separately and in combination. The nature of the relationships between pain intensity and depression in elderly persons experiencing pain is less clear. The objectives of this study were to explore which factors are associated with depressed mood in older people experiencing pain, and to test the hypothesis that older people experiencing pain are at risk of depressed mood according to the severity or frequency of their pain. In addition we explored whether other potentially modifiable factors might increase the risk of depressed mood in these persons.MethodsThe study is a secondary analysis of baseline data for four hundred and six community-dwelling non-disabled people aged 65 and over registered with three group practices in suburban London who had experienced pain in the past 4 weeks. Intensity and frequency of pain was measured using 24 item Geriatric Pain Measure (GPM) and the presence of depressive symptoms using the 5 item Mental Health Inventory. Risk for social isolation was measured using the 6 item Lubben Social Network scale and instrumental activities of daily living (IADL) were also measured.ResultsOverall 76 (19%) had depressed mood. Pain frequency and severity were not statistically significantly associated with depressed mood in this population. In multivariate analyses, significant predictors of the presence of depressive symptoms were difficulties with basic ADLs (OR 2.8, 95% CI 1.1.7.8), risk for social isolation (OR 4.1, 95% CI 1.8–9.3), and basic education only (OR 2.2, 95% CI 1.1–4.4).ConclusionOlder people experiencing pain are also likely to experience depression. Among those experiencing pain, social network and functional status seem to be more important predictors of depressive symptoms than the severity of pain. Further studies should evaluate whether improvement of social network and functional status might reduce depressive symptoms in older patients.

Is Preoperative Anxiety and Depression Associated with Onset of Delirium After Cardiac Surgery in Older Patients? A Prospective Cohort Study

To investigate the prevalence of preoperative anxiety and depressive symptoms and their relationship with the occurrence of postcardiac delirium and to describe the evolution of these symptoms from preoperative admission until discharge. Descriptive, prospective, longitudinal study. The intensive care unit and two cardiac surgery units in a university hospital setting. One hundred four patients (median age 71; 78.8% men) admitted for elective cardiac surgery. Anxiety measured preoperatively using the State-Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS); depression using the HADS; cognitive functioning using the Mini-Mental State Examination (MMSE); delirium using the Confusion Assessment Method (CAM), the CAM for the Intensive Care Unit (CAMICU), and the Delirium Index (DI); and activities of daily living using the Katz index of activities of daily living (Katz ADL scale). MMSE, CAM/CAM-ICU, and DI were obtained on postoperative Days 1, 3, and 7. On Day 7 and at discharge, the STAI, HADS, and Katz ADL scale were repeated. Postoperative delirium occurred in 26%; 55.8% reported preoperative state anxiety, 25.2% generalized anxiety, and 15.5% depressive symptoms, but no association was found with delirium occurrence. Based on multivariable analysis, prolonged intubation time (odds ratio (OR)51.10, CI: 1.05-1.15, P5.001) and a low intraoperative lowest body temperature (OR50.86, CI: 0.74-0.99, P5.03) were independent predictors of delirium onset. At discharge, 35.7% and 12.2% of patients reported state anxiety and generalized, and 15.3% reported depressive symptoms. Despite the high prevalence of preoperative anxiety and depressive symptoms in older patients with cardiac surgery, no association was found with postoperative delirium.