GDS Score Research Articles

Moving Out of Shadows: Depression among the Elderly in Dehradun District of Uttarakhand, India.

BackgroundDepression, a stigma swept under the rug, has morphed to be tabbed as the theme of World Health Day 2017 by the World Health Organization (WHO). Depression in old age is stereotypically tethered to the ageing process but it is a medical problem that has been under-researched. This study was conducted to estimate the point prevalence of depression among the elderly in Dehradun district of Uttarakhand and to identify its predictor variables.MethodsIt was a cross-sectional study conducted in Dehradun district of Uttarakhand (India) among 660 elderlies (≥60 years) from three strata (rural, urban and special groups). The Hindi version of long form of Geriatric Depression Scale (GDS-H) was used to identify mild and severe depression. All statistical analyses were carried out by SPSS software (version 22) at 5% level of significance.ResultsThe arithmetic mean (±SD) of GDS scores was 10.62 (±6.1). 55% elderly were found to be suffering from depression (46.8% mild and 8.2% severe depression). Bivariate analysis showed significant association of depression with increasing age, female gender, place of residence, type of family, living without spouse, financial dependency, involvement in any kind of substance abuse and suffering from some chronic morbidities like osteoarthritis, chronic respiratory illness, skin diseases, visual impairment or hearing impairment. These predictor variables were further subjected to multivariate analysis.ConclusionThe high prevalence of depression in old age and its multifactorial association tags it as a public health problem in this age group which should be recognized and managed before it becomes a health menace.

Senam Jantung Sehat Seri-I Improves Physical Fitness, Decreases the GDS Scores and the Level of NF-kB Plasma Elderly Depression

Senam Jantung Sehat Seri-I Improves Physical Fitness, Decreases the GDS Scores and the Level of NF-kB Plasma Elderly Depression

Late contributions of repetitive head impacts and TBI to depression symptoms and cognition.

To test the hypothesis that repetitive head impacts (RHIs), like those from contact sport play and traumatic brain injury (TBI) have long-term neuropsychiatric and cognitive consequences, we compared middle-age and older adult participants who reported a history of RHI and/or TBI with those without this history on measures of depression and cognition. This cross-sectional study included 13,323 individuals (mean age, 61.95; 72.5% female) from the Brain Health Registry who completed online assessments, including the Ohio State University TBI Identification Method, the Geriatric Depression Scale (GDS-15), and the CogState Brief Battery and Lumos Labs NeuroCognitive Performance Tests. Inverse propensity-weighted linear regressions accounting for age, sex, race/ethnicity, and education tested the effects of RHI and TBI compared to a non-RHI/TBI group. A total of 725 participants reported RHI exposure (mostly contact sport play and abuse) and 7,277 reported TBI (n = 2,604 with loss of consciousness [LOC]). RHI (β, 1.24; 95% CI, 0.36-2.12), TBI without LOC (β, 0.43; 95% CI, 0.31-0.54), and TBI with LOC (β, 0.75; 95% CI, 0.59-0.91) corresponded to higher GDS-15 scores. While TBI with LOC had the most neuropsychological associations, TBI without LOC had a negative effect on CogState Identification (β, 0.004; 95% CI, 0.001-0.01) and CogState One Back Test (β, 0.004; 95% CI, 0.0002-0.01). RHI predicted worse CogState One Back Test scores (β, 0.02; 95% CI, -0.01 to 0.05). There were RHI × TBI interaction effects on several neuropsychological subtests, and participants who had a history of both RHI and TBI with LOC had the greatest depression symptoms and worse cognition. RHI and TBI independently contributed to worse mid- to later-life neuropsychiatric and cognitive functioning.

Type 2 Diabetes, Change in Depressive Symptoms Over Time, and Cerebral Small Vessel Disease: Longitudinal Data of the AGES-Reykjavik Study.

Type 2 diabetes has been associated with depression. However, the underlying pathophysiological mechanisms remain unknown. Cerebral small vessel disease, a consequence of diabetes, may lead to depression. Therefore, we evaluated whether cerebral small vessel disease mediates the association between type 2 diabetes and higher depressive symptoms. We used longitudinal data from the population-based Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, with examinations from 2002 to 2006 and 5 years later. Type 2 diabetes was defined as self-reported history of type 2 diabetes, use of blood glucose-lowering drugs, or fasting blood glucose level ≥7.0 mmol/L. Cerebral small vessel disease load was quantified in a composite score based on MRI-defined presence of high white matter hyperintensity volume, low total brain parenchyma volume, and subcortical infarcts, cerebral microbleeds, and large perivascular spaces. The 5-year change in the 15-item Geriatric Depression Scale score (GDS-15) was measured between baseline and follow-up. Included were 2,135 individuals without dementia and baseline depression (baseline age 74.5 [SD 4.6] years, 1,245 women [58.3%], and 197 [9.2%] with diabetes). The GDS-15 score increased 0.4 (SD 1.6) points over time. Baseline diabetes was associated with a greater increase in the GDS-15 score (β = 0.337; 95% CI 0.094; 0.579), adjusted for age, sex, education, and cardiovascular risk factors. Baseline cerebral small vessel disease and change of cerebral small vessel disease statistically significantly mediated a part of this association. Type 2 diabetes is associated with a greater increase in depressive symptoms score over 5 years, and cerebral small vessel disease partly explains this association.

Depressive symptoms and use of health services among older adults in Israel

ObjectivesDepressive symptoms are often undetected, particularly among older adults. The purpose of this study is to provide information on the prevalence, characteristics, and patterns of depressive symptoms among older adults residing in the community in Israel, and their health-care utilization.MethodsA cross-sectional survey was conducted among a random sample of 2502 members of one HMO in Israel, aged 65+. They were interviewed by telephone with the GDS-15 scale, which serves as the gold standard for depressive symptoms. Data from the computerized medical records of the HMO were added to the interview file, including the diagnosis of depression, purchase of antidepressant medication and use of services.ResultsThe average age of respondents was 73; 54% were women. They tended to be older, living alone, suffering from falls and from sleep disorders, and to have poor subjective health status. 24% scored 6+ on the GDS scale. A significant association was found between a GDS score of 6+ and increased hospitalizations, visits to the emergency room and/or to family physicians and specialists.ConclusionWe found a high prevalence of depression. Its negative effects on the individual and increased costs to the health system, supports the screening and treatment of the disease in the older population. This problem should be a national priority, with screening and treatment becoming part of the national quality of care indicators which would then be implemented by the HMOs as part of an integrated disease management program for the elderly.

67Atrial fibrillation and depressive symptoms in the elderly: an association with age, CHA2DS2-VASc score and physical performance

Abstract Background. Atrial fibrillation (AF) is the most frequent sustained arrhythmia found in clinical practice. Its prevalence significantly grows with age. The proportion of elderly individuals with depression varies between 4.2 and 10.6% according to the different criteria used for diagnosis. Interestingly, AF and depression synergistically act to increase mortality. Purpose. Aim of this study was to identify the clinical variables associated with depressive symptoms in elderly individuals with persistent AF. Methods. All patients consecutively admitted in a Day-Hospital setting to undergo electrical cardioversion of AF were enrolled in the study. No exclusion criteria were specified. Population was studied with instruments exploring neurocognitive performance (Mini-Mental State Examination - MMSE; range: 0-30; abnormal values <27) and functional status (Short Physical Performance Battery; range: 0-12; abnormal values <10). With these tools, a better condition is expressed by higher scores. The presence of depressive symptoms was assessed with the Geriatric Depression Scale (GDS; 15-item form; abnormal values >5). In this case, lower scores identified a healthier emotional profile. Results. Between January 2018 and August 2019, 111 patients were evaluated (age: 77 ± 9 years; women: 39.6%; weight: 78 ± 15 Kg; height: 171 ± 11 cm). Lone AF and brady- tachy- syndrome were diagnosed in 12.6% of cases. Hypertension and structural heart disease (coronary artery disease, heart failure, valvular heart disease) were responsible of the arrhythmia in 30.6% and 56.8% of patients, respectively. Left ventricular ejection fraction was 60 ± 12%, with a heart rate equal to 78 ± 17 bpm. MMSE and SPPB score were 28 ± 3 and 8.7 ± 2.9. An abnormal GDS score was observed in 19.8% of cases (mean: 3.0 ± 2.7). Interestingly, in univariate analysis, depressive symptoms increased with age (p = 0.002) and the CHA2DS2-VASc score (< =2: 1.3 ± 1.7; 3: 1.9 ± 2.3; 4: 3.9 ± 3.2; 5: 4.0 ± 2.4; > =6: 4.4 ± 2.8; p < 0.001), and were inversely related to MMSE (p = 0.004) and SPPB (p < 0.001). The type of oral anticoagulation (NOACs: 64.0%) did not exert any effect on GDS score (VKA: 3.2 ± 2.2 vs. NOACs: 3.0 ± 3.0; p = 0.717). In multivariate analysis (R = 0.711; p < 0.001), depressive symptoms were higher in those who lived alone (+1.35 ± 0.48; p = 0.007) and were taking a renin-angiotensin system blocker (+0.93 ± 0.43; p = 0.032). Age (-0.07 ± 0.03 per year; p = 0.026), height (-0.09 ± 0.03 per cm; p = 0.001), glomerular filtration rate (-0.03 ± 0.01 per mL/min; p = 0.013) and SPPB (-0.39 ± 0.09 per each point; p < 0.001) were inversely associated with GDS. Conclusions. In a population of elderly patients with persistent AF, the prevalence of depression is not negligible. Importantly, depressive symptoms are significantly associated with the CHA2DS2-VASs score, and, at multivariate analysis, with renal function, to live alone and physical performance. Paradoxically, after adjustment for these factors, GDS score decreases with age per se.

Assessment of Geriatric Depression Scale's Applicability in Longevous Persons based on Classical Test and Item Response Theory

BackgroundThe 15-item short form Geriatric Depression Scale (GDS-15) has been widely used for depression screening in multiple settings. However, few studies have specifically investigated the applicability of GDS-15 in longevous population. The aim of this study is to evaluate the psychometric property and item characteristic of the scale in Chinese community-dwelling longevous persons. Materials and methodsA total of 838 longevous people participated in this study. The reliability and validity of GDS-15 were analyzed with classical test theory, and the characteristics of each item were analyzed with item response theory using a three-parameters logistic model. ResultsThe Cronbach's α coefficient of the scale was 0.776. Spearman correlation coefficients between the GDS-15 score and each item were between 0.274 and 0.667 (P<0.01); the summed GDS-15 score was negatively associated with physical function, self-report health status and subjective well-being. Factors extracted using exploratory factor analysis accounted for 52.63% of the variance and the item loadings were between 0.513 and 0.828. The discrimination of each item ranged from 1.045 to 3.777; the difficulty ranged from -0.972 to 2.006, and the guessing parameter ranged from 0.000 to 0.499. The total information of GDS-15 was 13.645 when the subject's latent trait located at 1.131. LimitationThe sample used is representative of the longevous in rural communities, thus extrapolation to other populations requires further validation. ConclusionThe GDS-15 has good applicability in depression detecting among Chinese longevous persons, especially for the individuals with moderate symptoms. Suggestions were provided on further improving its measurement precision.

Genome Wide Association Study (GWAS) of cognitive impairment after blood or marrow transplantation (BMT) for hematologic malignancy.

1536 Background: Cognitive impairment is prevalent in hematologic malignancy patients treated with BMT (autologous: 18.7%; allogeneic: 35.7%; Sharafeldin JCO; 2018). Given the inter-individual variability in risk of cognitive impairment in this population, we investigated the role of genetic susceptibility using a genome-wide single nucleotide polymorphism (SNP) array platform to identify novel genetic associations. Methods: Discovery: Cognitive function was assessed objectively in 239 adult BMT recipients at pre-specified timepoints: pre-BMT and at 6 mo, 1y, 2y, and 3y post-BMT. A global deficit score (GDS - a summary score of 14 standardized neuropsychological tests) was computed for each patient; a higher score indicated greater cognitive impairment. SNPs passing standard quality control filters ( &gt; 1.4M) were used for analysis. Linear mixed effects models used GDS as the outcome, adjusted for age, sex, BMT type, baseline cognitive reserve, and the first four principal components. We used additive, codominant, and genotype models and an adjusted genome-wide significance threshold of 1.25 x 10−8. Replication: An independent cohort of 544 BMT survivors (192 cases with self-endorsed cognitive problems and 352 controls without) was used for replication. Results: Discovery: Median age at BMT was 51.3y; primary diagnoses: 47% leukemia, 32% lymphoma, 21% multiple myeloma; 57% males; 69% non-Hispanic whites: 50% allogeneic BMT, median GDS score = 0.22 (range 0-2). Forty-four SNPs were significantly associated with increased GDS (additive model: 3 SNPs; codominant model: 20 SNPs; genotype model: 21 SNPs). Estimates ranged from increase in GDS score by 0.28 points for each additional copy of risk allele, p = 1.07 x 10−8 to increase in GDS score by 1.82 points for two copies of risk allele, p = 2.3 x 10−11. Replication: Median age at BMT was 44y; primary diagnoses: 32% leukemia, 49% lymphoma, 19% multiple myeloma; 54% males; 80% non-Hispanic whites: 34% allogeneic BMT. Three SNPs were successfully replicated: rs116334183 resides within lncRNA-SEMA6D-2, which facilitates neuronal migration; rs13286152 86kb downstream of TLE-1, which promotes neuronal survival; and rs12486041 0.36Mb downstream from lncRNA-SPTSSB-1, which regulates sphingolipid production in neuronal axons and 0.36Mb upstream from TOMM22P6 linked to neural repair. Conclusions: In this first GWAS of cognitive impairment post-BMT, we identify 3 SNPs with plausible links to genes implicated in neuronal integrity. Functional studies are currently underway.

Multi-ethnic validation of 15-item Geriatric Depression Scale in Chile

BackgroundThere has been scant research published regarding the assessment of depression in ethnic groups, and few studies have addressed the validation of scales for standardized assessment of depressive symptoms among indigenous minorities.ObjectiveThe aim of this study was to analyze the psychometric properties of the 15-item Geriatric Depression Scale (GDS-15) for a multi-ethnic sample of older Chilean adults.MethodsCross-sectional study with a sample of 800 older people, 71% of whom were self-declared indigenous (Aymara/Mapuche).ResultsThe non-indigenous group had a higher total GDS-15 score and lower quality of life and wellbeing scores than the indigenous groups (p < 0.001). The GDS-15 had a KR-20 coefficient of 0.90 for the non-indigenous group, 0.80 for Aymara, and 0.85 for Mapuche. The homogeneity index was 0.38 for non-indigenous, 0.24 for Aymara, and 0.29 for Mapuche.DiscussionThe GDS-15 showed satisfactory psychometric characteristics for the samples studied. However, the better results observed for the non-indigenous group suggest that some characteristics and content of the rating scale are not fully appropriate for the indigenous older population.ConclusionsThere is a need to develop the transcultural validation of scales such as GDS-15, which are applied in a standardized manner in geriatric evaluations as part of primary healthcare.

The Impact of Geriatric Assessment on Patient Outcomes in Radiation Oncology: A Pilot Study

Introduction: The objective of this pilot study was to obtain preliminary data on the efficacy and feasibility of incorporating geriatric assessment (GA) into radiation oncology (RO) with regard to patient outcomes and treatment decisions. Materials and Methods: Feasibility was assessed via the percentage of patients able to complete certain aspects of the assessment on their own, or with the assistance of a carer before appointments, was recorded. Consultation times and referrals were also documented. All participants (n=30) underwent GA at baseline, before randomisation to the intervention/control arm and commencement of radiotherapy treatment planning procedures. The results of GA were relayed to the Radiation Oncologist (RO) for the intervention arm only. GA was repeated for each participant three months after the completion of radiotherapy. Results: There was some evidence of increasing dependence, at three month follow-up, in ADLs and IADLs, less mobility (TUG score), higher GDS scores and increased vulnerability. However, these were not statistically significant. All patients underwent their predefined radiotherapy treatment plan, without modification. A number of deficits on GA were identified that may be considered significant for older patients. Conclusion: The impact on decision making may reflect a lack of experience and familiarity with GA and how to interpret it, as well as an obvious gap in the literature as to how it affects radiotherapy patient outcomes.

Associations between Depressive Symptoms and Satisfaction with Meaningful Activities in Community-Dwelling Japanese Older Adults.

The aim of this cross-sectional study was to investigate relationships between individuals’ ratings of satisfaction and performance of activities that they found meaningful and depressive symptoms. Data was obtained from 806 older adults (mean age 74.9 ± 6.3 years, women = 63.0%) who participated in a community-based health check survey (Tarumizu Study 2018). Participants selected meaningful activities from 95 activities using the Aid for Decision-Making in Occupation Choice and evaluated their satisfaction and performance. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15) and defined by a GDS-15 score of ≥5. Non-linear logistic regression analyses were used separately by gender to examine the association between satisfaction and performance of meaningful activities and depressive symptoms. The prevalence of depressive symptoms was 15.8%. We found no significant difference between meaningful activity choice between older adults with depressive symptoms and those without, in both men and women. After adjusting for potential covariates, satisfaction was associated with depressive symptoms in both men (OR 0.52, 95% CI 0.35–0.77) and women (OR 0.67, 95% CI 0.49–0.91), but performance was limited in women (OR 0.87, 95% CI 0.77–0.99). Our findings suggest that depressive symptoms are associated with satisfaction in meaningful activities regardless of activity categories.

Personalized prediction of depression in patients with newly diagnosed Parkinson's disease: A prospective cohort study

BackgroundDepressive disturbances in Parkinson's disease (dPD) have been identified as the most important determinant of quality of life in patients with Parkinson's disease (PD). Prediction models to triage patients at risk of depression early in the disease course are needed for prognosis and stratification of participants in clinical trials. MethodsOne machine learning algorithm called extreme gradient boosting (XGBoost) and the logistic regression technique were applied for the prediction of clinically significant depression (defined as The 15-item Geriatric Depression Scale [GDS-15] ≥ 5) using a prospective cohort study of 312 drug-naïve patients with newly diagnosed PD during 2-year follow-up from the Parkinson's Progression Markers Initiative (PPMI) database. Established models were assessed with out-of-sample validation and the whole sample was divided into training and testing samples by the ratio of 7:3. ResultsBoth XGBoost model and logistic regression model achieved good discrimination and calibration. 2 PD-specific factors (age at onset, duration) and 4 nonspecific factors (baseline GDS-15 score, State Trait Anxiety Inventory [STAI] score, Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire [RBDSQ] score, and history of depression) were identified as important predictors by two models. LimitationsAccess to several variables was limited by database. ConclusionsIn this longitudinal study, we developed promising tools to provide personalized estimates of depression in early PD and studied the relative contribution of PD-specific and nonspecific predictors, constituting a substantial addition to the current understanding of dPD.

Mobile device use and the cognitive function and depressive symptoms of older adults living in residential care homes

BackgroundWith the fast-paced aging and increasing digitalization of society, there has been a growing interest in the effect of mobile device use on cognitive function and depression in older adults. However, research examining this issue among older adults in residential care homes (RCHs) is scant. Therefore, this study aimed to examine the impact of mobile device use on the cognitive function and depressive symptoms of older adults living in RCHs.MethodsA cross-sectional survey was conducted using a sociodemographic questionnaire, the Montreal Cognitive Assessment (MoCA) and the 15-item Geriatric Depression Scale (GDS-15).ResultsA total of 235 senior residents (aged 82.58 ± 5.54) in four RCHs were surveyed. Users of mobile devices had a significantly higher total MoCA score (25.02 ± 4.14) and a significantly lower GDS-15 score (3.28 ± 2.74) than non-users (MoCA: 19.34 ± 5.21, GDS-15: 4.69 ± 2.90). Multivariate linear regression indicate that mobile device use is significantly associated with total MoCA score, six of the seven sub-scores (visuospatial abilities and execution functions, attention, language, abstraction, delayed recall, and orientation)(P < 0.05). Logistic regression showed that mobile device use was significantly associated with the level of depressive symptoms (OR = 0.458, 95%CI = 0.249–0.845).ConclusionsUse of mobile devices has a significant association with the cognitive function and depressive symptoms of older adults living in RCHs, and thus should be encouraged as a measure to maintain and improve cognition and prevent depression.

Effect of Frequency of Exercise on Cognitive Function in Older Adults: Serial Mediation of Depression and Quality of Sleep.

Background: Sleep quality and depression are two reciprocal causation socioemotional factors and their roles in the relationship between physical exercise and cognition are still unclear. Methods: A face-to-face survey of 3230 older adults aged 60+ was conducted in Xiamen, China, in 2016. Frequency of exercise (FOE) referred to the number of days of exercise per week. Quality of sleep (QOS) was categorized into five levels: very poor/poor/fair/good/excellent. The 15-item Geriatric Depression Scale (GDS-15) and the Montreal Cognitive Assessment (MoCA) were used to measure depression (DEP) and cognitive function (CF), respectively. Serial multiple mediator models were used. All mediation analyses were analyzed using the SPSS PROCESS macro. Results: 2469 respondents had valid data with mean scores for GDS-15 and MoCA being 1.87 and 21.61, respectively. The direct path from FOE to CF was significant (c’= 0.20, p < 0.001). A higher FOE was associated with better QOS (B = 0.04, p < 0.01), which in turn was associated with fewer symptoms of DEP (B = −0.40, p < 0.001), and further contributed to better CF (B = −0.24, p < 0.001). Similarly, a higher FOE was associated with lower GDS-15 scores (B = −0.17, p < 0.001) which then resulted in higher MoCA scores (B = −0.24, p < 0.001). However, QOS alone did not alter the relationship between FOE and CF. Conclusions: FOE is a protective factor of CF in older adults. Moreover, CF is influenced by QOS through DEP, without which the working path may disappear.

Comparison of depression among the elderly in a selected semiurban and rural community of Haryana, North India: A cross-sectional survey

Background: Depression in the elderly is one of the most common rising mental health problems worldwide. The prevalence of geriatric depression is relatively sparse as per the epidemiological studies conducted in the Indian setting. Aim: The present study compares the depression among the elderly in a selected semiurban and rural community of North India. Materials and Methods: The present study was conducted among 400 elderly in a selected semiurban and rural community setting of North India. The participants were included as per the predetermined criteria using a convenient sampling method. Geriatric depression scale 15 Hindi version (GDS-15) was used for the assessment of depression. Results: The overall prevalence of geriatric depression (GDS-15 score >5) was found to be 10.5% (95% confidence interval [CI]: 7.8–13.8). Of the 400 individuals, the proportion of the elderly who were at risk of developing depression was higher in the rural area (46.19%; 95% CI: 39.5–52.9) as compared to the semiurban area (22.1%; 95% CI: 16.79–28.53). The presence of chronic illness had an independent association with depression in the elderly residing in the rural setup (adjusted OR: 3.584; 95% CI: 1.399–9.178). Conclusion: The study showed a significantly higher burden of depression in rural geriatric population as compared to the semiurban setting. Considering the rapidly increasing population of older aged people in India, epidemiological data regarding the prevalence of depression form the mainstay for proper health planning.

COGNITIVE IMPAIRMENT AND DEPRESSION ARE THE MOST IMPORTANT RISK FACTORS FOR FRAILTY

Background : Frailty is a condition that causes a decline or failure in homeostasis mechanism on older people resulting in increased susceptibility to stressor. The risk factors of frailty include: cognitive impairment and depression. Objective : To prove the relation between cognitive impairment and depression with frailty. Methods : This study is using cross-sectional approach. Samples are collected from 222 citizens from the elderly population of Malang using accidental sampling method. Variables measured in this study are frailty that is determined by Fried Criteria, cognitive impairment that is determined by MMSE score and depression status that is determined by GDS score. Results: The analysis result of relation between cognitive impairment and depression and frailty using the Spearman correlation test produces the value of p = 0,000 and the correlation coefficients for rare 0,500 and 0,508 respectively. Different levels of cognitive impairment and depression in the frail group compared to pre-frail and robust groups resulted in p = 0,000, whereas the level of cognitive impairment and depression in the pre-frail group compared to robust group yielding p values of 0.735 and 0.944 respectively. Conclusion: There is a relation between cognitive impairment and depression on frailty. There was a significant difference in the levels of cognitive impairment and depression in the frail group compared to the pre-frail and robust groups, whereas in the pre-frail group compared to robust group the levels of cognitive impairment and depression did not have a significant difference.

Prevalence and determinants of geriatric depression in North India: A cross-sectional study.

Context:“Aging India” has become a phenomenon of public health importance. Old age is beset with physical, mental, and social challenges. Among these, mental health concerns are least prioritized in most of the developing countries with depression being the most common and easy to screen.Aims:To assess the burden of geriatric depression and determine its association with sociodemographic factors such as religion, age, gender, education, marital status, and family type.Settings and Design:A cross-sectional study was conducted in July-August 2018 in village Kirpind in north India.Methodology:162 subjects aged 60 years or more, both males and females participated in the study. Depression was assessed using the 15-item Geriatric Depression Scale and those with a GDS score >=5 were categorized as depressed.Statistical Analysis Used:Pearson's Chi-square test and binary logistic regression were used for analysis.Results:Nearly 59.3% of subjects had no depression, 33.9% were suffering from mild to moderate depression whereas 6.8% were severely depressed. The mean age of subjects was 69 (±7.4) years. Chi-square test was used to study the association of various factors with depression and only female gender showed a positive statistical association. On using binary logistic regression analysis, being female again emerged to be a significant predictor of depression while no other factor was significantly associated with the outcome.Conclusions:There is a need to sensitize primary care workers and physicians to identify and manage geriatric depression early. It also points towards the need for multicentric, longitudinal studies evaluating various aspects of geriatric depression.

The Burden of Frailty on Mood, Cognition, Quality of Life, and Level of Independence in Patients on Hemodialysis: Regina Hemodialysis Frailty Study.

Background:The prevalence of frailty is disproportionately increased in patients with chronic kidney disease (CKD) in comparison with non-CKD counterparts and is the highest in patients on hemodialysis (HD). While the cross-sectional measurement of frailty on HD has been associated with adverse clinical events, there is a paucity of data on longitudinal assessment of frailty and its relationship to outcomes.Objective:The objectives were to (1) evaluate changes in frailty status, level of independence, mood, cognition, and quality of life (QoL) over a 12-month period and (2) explore the relationship between frailty status and level of independence, mood, cognition, and QoL at 2 different time points (at baseline and at 1 year).Design:This is a prospective cohort study involving 100 prevalent HD patients.Setting:Regina General Hospital and Wascana Dialysis Unit in Regina, Saskatchewan, Canada, between January 2015 and January 2017.Patients:One hundred prevalent HD patients underwent frailty assessments using the Fried criteria at baseline and 1 year later.Measurements:Frailty was assessed using the Fried criteria, which included assessments of unintentional weight loss, weakness (handgrip strength), slowness (walking speed), and questionnaires for physical activity and self-perceived exhaustion. Cognition, mood, and QoL were measured using questionnaires (Montreal Cognitive Assessment [MoCA], Geriatric Depression Scale [GDS], and EuroQol [EQ-5D] utility scores and visual analog scale [VAS], respectively).Methods:Frailty status was reported as a binary variable: frail vs. nonfrail (prefrail and robust). Differences across baseline and 1-year groups were assessed using McNemar’s test or Wilcoxon signed-rank test, as appropriate. We assessed the differences between frail and nonfrail groups using the Mann–Whitney U test or chi-square test/Fisher’s exact test where appropriate.Results:Ninety-seven of the 100 patients had complete initial assessments. The median (interquartile range [IQR]) duration of dialysis at baseline was 35.5 (13.75-71.75 months). One year later, 22 had died, 10 refused assessments, and 3 had relocated. In comparison with baseline vs 1 year, the number of frail patients was 68.1% vs. 67.7%; prefrail 26.8% vs. 26.1%; robust 5.1% vs. 6.2%; MoCA ≥24, 69% vs. 64.5%; GDS score ≥ 2, 52.8% vs. 47.7%; median EQ-5D utility score 0.81 vs. 0.77; and median EQ-VAS 60 vs. 50. Similarly, in comparison with baseline vs. 1 year, the number of independent patients was 82% vs. 63%, independent with support 17% vs. 31%, and long-term care home 0% vs. 3.1%. Eighteen of the 22 patients (82%) who died were frail. At 1 year, the median (IQR) MoCA was 24 (19-25) vs. 25 (21-26; P = .039) and median (IQR) GDS was 2 (1-3) vs. 1(0-2; P = .034). Likewise, median (IQR) EQ-5D utility score was 0.78 (0.6-0.82) vs. 0.81 (0.78-0.85; P = .023). There were significant changes in self-care (27% vs. 0%), P = 0.006, and daily activities (68.2% vs. 38.1%), P = 0.021.Limitations:This is a single-center study, so direct inferences must be interpreted in the context of the demographics of the study population. Patients were undergoing dialysis for a median of 36 months before undergoing initial assessment.Conclusions:Frailty and prefrailty in our dialysis patients is near-ubiquitous and will need to be proactively addressed to improve subsequent health care outcomes.

Screening for elder abuse in geriatric outpatients: reliability and validity of the Iranian version Hwalek–Sengstock Elder Abuse Screening Test (H-S/EAST)

ABSTRACTThe present research seeks the notion of the appropriateness of “Hwalek-Sengstock Elder Abuse Screening Test (H-S/East)”, and psychometric properties to analyses cultural aspects of elder abuse in the Iranian community dwellers referred to clinics. In this cross-sectional validation study 364 participants, 60 years and over were selected from outpatient’ clinics. The SF-36, GDS-15, and AMT scores were used for concurrent validity. The Brief Abuse Screen for the Elderly (BASE) scale was examined to determine the sensitivity and specificity of the Iranian version H-S/East. The elder abuse rate in participants was 29.4% based on cutoff ≥4, while a significant correlation was found in Iranian version H-S/EAST with depression and SF-36 subscale MCS at P < .01, and four factors observed. Optimal cutoff ≥4 obtained with 82.8% sensitivity and 84.5% specificity. It seems the Iranian version of H-S/East demonstrates concurrent validity and fair reliability in elderly outpatients, while construct validity should be carried out in the Iranian elder illiterate population and other languages/cultures.

37 Postural Instability in Parkinson’s Disease: The Association of Cognitive Impairment and Non-Motor Symptoms

Abstract Introduction Parkinson’s disease (PD) is the second most common neurodegenerative condition after Alzheimer’s. Historically considered as a movement disorder, the multitude of non-motor symptoms (NMS) are now a recognised cause of significant disease burden. This study aimed to explore the relationship between postural instability and NMS in PD. Methodology We recruited individuals (n=100) in South East Queensland with a pre-existing diagnosis of idiopathic PD into this prospective observational study. Motor assessment was performed via the Movement Disorders Society-revised Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Assessment of postural instability was based on the Hoehn &amp; Yahr Scale (H&amp;Y) with a score of ≥3 considered indicative of postural instability. NMS were assessed via the Non-Motor Symptoms Scale (NMSS). Further neuropsychiatric and affective assessment was evaluated with the Geriatric Depression Scale (GDS-15), Geriatric Anxiety Inventory (GAI), Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI) and Montreal Cognitive Assessment (MoCA). Results Cohort demographics comprised of 62% male and 38% female with a mean age of 69.1 years (SD 7.35) and mean H&amp;Y 2.34 (SD 0.59). Sixty four participants were H&amp;Y 1 &amp; 2 whilst 36 participants were H&amp;Y ≥3. Participants with postural instability were significantly older (p = 0.033) and had lower MoCA scores (p=0.039). Among the MoCA domains, only the Visuospatial / Executive domain was associated with postural instability (p= 0.005). Among the NMSS domains, only the sexual function domain was significantly associated with the latter group (p=0.029). GDS scores tended to be higher in the postural instability group (p=0.054) but there was no significance in major depressive disorder (p=0.436). Conclusion Postural instability in PD is significantly associated with age and cognitive impairment, in-particular frontal lobe function. The association of sexual dysfunction is supportive of the notion that disorders in dopaminergic and non-dopaminergic systems underpin the pathophysiology substrate of postural instability.