Prevalence Of Late-life Depression Research Articles

Can Low Level of Life Satisfaction and Poor Living Arrangements Increase the Risk for Late Life Depression among Elderly?

Background: The elderly are less vulnerable to depressive symptoms compared to younger populations. However, there is a likelihood of a greater risk for late-life depression among the elderly due to perceptions of low life satisfaction and poor living arrangements. Despite numerous studies examining various risk factors for late-life depression, the impact of a poor perception of life satisfaction and living alone on the health of the elderly remains unclear. Methods: To investigate this, we examined late-life depressive symptoms among 30,389 Indian adults aged 60 and above. Using data from the recent round of the Longitudinal Aging Survey of India, we employed multivariable logistic regression to predict the likelihood of these factors, along with other associated risk factors. Discussion: Our findings confirm a significant correlation between both life satisfaction and living arrangements and late-life depressive symptoms. These factors have an impact on the mental health of older adults in later life, leading to stress, anxiety, trauma, and various co-morbid complications. Conclusion: This study thoroughly explores the theoretical implications and presents empirical results on the prevalence of late-life depression among the elderly, despite their lower risk profile. It highlights the importance of shaping policies in India to cater to the needs of the elderly, thereby reducing late-life depressive symptoms and minimizing the effects of risk factors. Additionally, focusing on coping strategies is essential to enhance social capital, making it crucial to implement social policies that provide support for the elderly and effectively address the mental health challenges associated with aging.

Explaining the Urban-Rural Difference in Late-Life Depression in India: Evidence from a Multivariate Decomposition Analysis Based on Longitudinal Aging Study in India, Wave 2017-18

ABSTRACT Objectives The study explored the associated factors of depression among older Indian adults and the influences of individual and socio-environmental factors in explaining the rural-urban difference in the prevalence of late-life depression. Methods Data come from the Longitudinal Aging Study in India, with a sample of 30,637 older adults aged 60 and above. Multivariable logistic regression and nonlinear multivariate decomposition analyses were conducted to fulfill the objectives. Results About 6.2% older adults in urban areas and 9.5% in rural areas were depressed. Older adults in rural areas had significantly higher likelihood to be depressed than those in urban areas. Poor self-rated health, multiple chronic conditions, functional difficulty, low life satisfaction, social inactivity, low satisfaction with living arrangement, ill-treatment and being widowed increased the risk of depression. Additionally, work status similar to urban older adults, physical activity, living arrangement satisfaction, self-rated health and ill-treatment would decrease the urban-rural difference in depression. Conclusions The study showed significant rural-urban difference in late-life depression, with a rural disadvantage. Clinical implications The findings suggest the need for identifying at-risk populations and developing a framework of targeted policy interventions for mitigating the increased risk of late-life depression among older Indians and in rural areas in particular.

Late-Onset Depression but not Early-Onset Depression may Increase the Risk of All-Cause Mortality in Older Age: 8-Year Follow-Up of the Salus in Apulia Study.

Individuals with late-life depression (LLD) may have shorter survival, but there is a lack of findings in population-based settings about health-related outcomes of LLD and its subtypes: early-onset depression (EOD) and late-onset depression (LOD). We aimed to evaluate the risk of all-cause mortality of individuals with LLD and its subtypes in an older population-based cohort. Moreover, we investigated whether inflammatory, cognitive, genetic features and multimorbidity could modify the effect of this association. Longitudinal population-based study with 8-year follow-up. We analyzed data on a sample of 1479 participants, all aged >65years, in the Salus in Apulia Study. LLD was diagnosed through DSM-IV-TR criteria and LOD and EOD according to the age of onset. Multimorbidity status was defined as the copresence of 2 or more chronic diseases. The overall prevalence of LLD in this older sample from Southern Italy was 10.2%, subdivided into 3.4% EOD and 6.8% LOD. In multivariable Cox models adjusted for age, gender, education, global cognition, apolipoprotein E ε4 allele, physical frailty, interleukin-6, and multimorbidity, LLD showed a greater risk of all-cause mortality. LOD differed from EOD regarding gender, education, cognitive dysfunctions, and diabetes mellitus. There was a significantly increased risk of all-cause mortality for participants with LOD (hazard ratio:1.99; 95% CI 1.33-2.97) in the time of observation between enrollment date and death date (7.31 ± 2.17months). In older age, individuals with LOD but not with EOD had a significantly decreased survival, probably related to increased inflammation, multimorbidity, and cognitive impairments.

Older Adults and Late-Life Depression.

As the U.S. population ages, the prevalence of late-life depression (LLD) increases. The general assumption that depression is part of normal aging and lack of diagnostic criteria specific to older adults resulted in this condition being underdiagnosed and untreated, leading to serious public health concerns, including high rates of suicide. Because of its complex etiologies, LLD requires careful assessment, especially in older adults from diverse ethnic/racial backgrounds. Suicide risk should be thoroughly assessed, including regular follow ups. Modifiable risks, such as cardiovascular conditions, should be addressed in middle-age populations to prevent LLD. Evidence-based treatment modalities include pharmacological (less effective) and more effective nonpharmacological (i.e., neuromodulation, psychotherapy) approaches. LLD has policy and research implications. Evidence exists of a new impetus to invest federal, state, and local funding for public health programs dedicated to improving the overall health of older adults. Research is needed to measure outcomes of these programs. [Journal of Psychosocial Nursing and Mental Health Services, 61(4), 8-11.].

Age, period and cohort effects in depression prevalence among Canadians 65+, 1994 to 2018: A multi-level analysis.

The nature of the Canadian population 65+ has changed considerably over the past several decades. They comprise a larger proportion of the population, are better educated, and are wealthier than previous generations. We estimate the contributions of chronological aging, temporal periods, and birth cohort effects on the trends in the major depressive episode (MDE) prevalence among Canadian seniors from 1994/1995 to 2017/2018. Using data from two sets of national health surveys, the National Population Health Survey (NPHS) and the Canadian Community Health Survey (CCHS). Pooled data on 150,246 survey respondents aged 65+ from 16 repeated cross-sectional surveys are included. Hierarchical regression age-period-cohort models were used to visualize the linear and non-linear effects of age, period, and cohort trends in late-life depression. We found that: the prevalence of MDE in later life fluctuated non-significantly during the study time period; the probability of developing MDE declined with increasing age from 65 to 80+ (β = -.32, p = .027). The significant quadratic birth cohort predictor showed a non-linear increasing association with the prevalence of MDE from the earlier to later-born cohorts (β = .01, p = .049). We also found that females 65+ were consistently more likely to be depressed than males 65+ (β = .47, p = .007). The significantly negative "age × female" interaction shows that age exerts a greater effect on females' probability of developing MDE than males (β = -.09, p = .011). There were no consistent significant period effects but there were peaks in prevalence around 2001, 2008, and 2012 which corresponded to some recent historical events. Our moderation analysis documents that lower levels of education significantly contributed to the higher rates of depression among cohorts born earlier in the 20th century. Our findings show the presence of strong chronological age and cohort effects and weaker period effects on the prevalence of late-life depression in Canadian seniors.

The Aging Brain and Benefits of Exercise versus Increased Prevalence of Sedentary Lifestyle: Lessons Learned from Behavioral Economics on Irrational Decision Making

<h3>Introduction</h3> Thereis growing evidence for the benefits of exercise to the aging brain. Exercise promotes brain function, improves brain metabolism, cerebrovascular flow, and neuroplasticity. All these contribute to cognitive reserve and prevention of late life cognitive decline. Conversely, a sedentary lifestyle has been shown to increase all causes of mortality, double the risk of cardiovascular and metabolic diseases which are significant risk factors to stroke and vascular cognitive decline. Inactivity also increases the risk for late life depression and anxiety. Despite the known benefits of exercise and long existing recommendations to promote physical activity, 60-85% of the world's population lead an inactive lifestyle. Sedentary lifestyle carries high risk for late life cognitive decline and reduced brain health amongst additional vascular and metabolic consequences. Inactivity has become one of the most difficult to treat health risk factors. Efficient promotion of physical activity is of high importance to the elderly population. Nevertheless, high prevalence of sedentary lifestyle indicates that the implementation of exercise recommendations is unsuccessful. The field of Behavioral Economics (B/E) studies motivation and decision-making and may be able to shed light on common behaviors such as inactivity. Given the known risks of sedentary lifestyle, physical inactivity would be defined by Behavioral Economists as an "irrational behavior". This approach may suggest a new and valuable method in mitigating inactivity. This review aims to present concepts of B/E related to health behavior and establish the vital need for collaboration. Efficient promotion of physical activity is crucial in prevention and treatment of late life cognitive decline and depression. <h3>Methods</h3> We searched MEDLINE, MEDLINE RCTs, PsycINFO, EMBASE without a date filter. Studies that explore the impact of exercise on the brain, including neurophysiology and neurocognitive function were reviewed and evaluated. Additionally, studies exploring human motivation and decision making from the field of B/E were evaluated in the context of healthcare management. Epidemiological data for the prevalence of late life depression, aging, cognitive decline, and the prevalence of sedentary lifestyles is appraised. <h3>Results</h3> Studiesacross various domains of healthcare and behavioral economics have been reviewed. There is well studied scientific evidence for benefits of exercise in improving brain health, such as increased cerebrovascular flow, improved neuroplasticity, increase in neurotrophic factors, neurotransmitters, and more. Moreover, exercise is already a longstanding healthcare recommendation for prevention of late life cognitive decline and depression. High prevalence of sedentary lifestyle suggests that healthcare recommendations for physical activity are ineffective and should be more efficiently implemented. Review of B/E literature supports a novel approach: the definition of certain health behaviors as "predictably irrational", meaning that the individual's decision is not necessarily benefitting the person. For example, one of the principles in behavioral economics is "optimism bias": the assurance that our present behavior will probably not have a negative result in the future. As a result of optimism bias, people underestimate the future health consequences of sedentary behavior at present. Another concept is "loss aversion": the discomfort of loss is more dominant than the comfort of the chance to benefit. Loss aversion may explain why a person would not choose to exercise: it is perceived as an immediate loss, with no benefit. Exercise is effortful and involves discomfort, while the future health benefit is perceived as a non-existent at present. The present loss (discomfort of exercise) combined with no immediate health benefit may explain the common choice of staying inactive. These examples illustrate some of the difficulties in implementing an active lifestyle. <h3>Conclusions</h3> Exercise is highly beneficial in maintaining brain health, including prevention of late life cognitive decline and late life depression. Motivation to exercise is expected to be high given these benefits, though most of the population does not meet the physical activity recommendations criteria. Effective promotion of exercise is substantial for the aging population in prevention of late life cognitive decline and depression. High prevalence of sedentary lifestyle suggests ineffectiveness in current promotion of physical activity. Further research is required to adapt Behavioral Economics concepts in healthcare and develop novel and more efficient strategies in promotion of physical activity. <h3>This research was funded by</h3> There was no funding of any kind and no financial support to this research project.

The diagnostic accuracy of late-life depression is influenced by subjective memory complaints and educational level in an older population in Southern Italy

The prevalence of late-life depression (LLD) depends on the study sample, measurements, and diagnostic approaches. We estimated the 30 item-Geriatric Depression Scale (GDS-30) accuracy against the gold standard LLD diagnosis made with the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders, focusing on the prevalence of a late-life major depressive disorder (MDD), in a population-based sample of 843 subjects aged>65 years, subdivided into three groups: normal cognition, subjective memory complaints, and mild cognitive impairment. At the optimal cut-off score (≥4), the GDS-30 showed 65.1% sensitivity and 68.4% specificity for LLD (63% and 66% for late-life MDD, respectively). Using the standard cut-off score (≥10), the GDS-30 specificity reached 91.2%, while sensitivity dropped to 37.7%, indicating a lower screening accuracy [area under the curve(AUC):0.728, 95% confidence interval(CI):0.67–0–78]. The GDS-30 performance was associated with educational level, but not with age, gender, cognition, apathy, and somatic/psychiatric multimorbidity. For subjective memory complaints subjects, at the optimal cut-off score (≥7), the GDS-30 showed better discrimination performances (AUC=0.792,95%CI:0.60–0.98), but again the educational level affected the diagnostic performance. In subjective memory complaints subjects, symptom-based scales like the GDS-30 may feature a better performance for diagnosing depression in older age, but the GDS-30 seems to require adjustment to the patient's educational level.

Themes of Gerotranscendence in Narrative Identity Within Structured Life Review

Abstract. Narrative identity is a person’s internalized and evolving life story. It provides a person with some degree of unity and purpose over the life course. It is shaped by the themes, plots, and images available within an individual’s culture. Research in narrative gerontology finds that positive themes within narrative identity in late life are sparse because of a pervading “narrative of decline,” which may contribute to prevalence of late life depression. Structured Life Review (SLR) is an effective intervention to manage depressive symptoms in older adults. It relies on clinician-guided storytelling and themes drawn from Erikson’s developmental stages to foster positive narrative identity. In this theoretical review, the authors explore gerotranscendence-related themes to inform narrative identity through SLR, the goal being to advance the argument that gerotranscendence can adaptively navigate negative narrative themes. It should be considered within clinical narrative practice to improve psychological well-being for older adults.

Depression in the Elderly–Epidemiology, Diagnosis, Special Aspects, and Treatment Options

The prevalence of Late-life Depression (LLD) is estimated between 10 and 15 % and therefore LLD is a considerable world-wide problem. The psychopathology is not substantially different from that of depressive episodes in young adults, but somatic complaints in combination of end-of-life perspective leave an imprint on emotional experience. Frequent suicide ideation, especially in old unmated men, remains a particular challenge. It is important to combine psychiatric and somatic diagnostics including modern methods such as cMRT (magnetic resonance tomography) or extensive clinical laboratory to exclude organic underlying diseases. The treatment is a multidisziplinary approach including biological, psychotherapeutic and physiotherapeutic or sociotherapeutic methods. Modern antidepressants and augmentation strategies allow to treat the old-aged population with sufficient safety, tolerability and therapeutic efficiency.

Abstract P014: Aortic Stiffness and Late-life Depression: the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)

Introduction: Late-life depression, which occurs at the age of 65 years or older, is a heterogeneous syndrome associated with cognitive decline and dementia. Aortic stiffness increases pulsatility, which damages microvascular circulation, resulting in poor vasoreactivity and cerebral hypoperfusion that is related to late-life depression. However, only few studies that relate aortic stiffness to late-life depression. Hypothesis: Higher aortic stiffness is associated with greater depressive symptoms and a higher prevalence of late-life depression. Methods: A total of 4,392 ARIC-NCS participants (mean age: 75.2±5.0 years; 40% male; 21% Black) with measurements of aortic stiffness and depressive symptoms in 2011-2013 were included in this cross-sectional analysis. Aortic stiffness was assessed as carotid-femoral pulse wave velocity (cfPWV) using the VP-1000 plus system (Omron Co., Ltd., Japan). cfPWV was dichotomized based on the upper 25th percentile. The 11-item short form of the Center for Epidemiological Studies Depression Scale (CES-D) was used to assess depressive symptoms. Depressive symptoms were calculated as the sum of scores obtained from the 11 items addressing appetite, depressed feelings, sense of effort, restless sleep, feeling happy, sad, or lonely, perceiving others as unfriendly, enjoying life, feeling disliked, and not able to get going (score range:0 to 22). The CES-D score was quantified as both a binary and a continuous variable. Individuals were categorized as depressed if CES-D score≥8. The total CES-D was log-transformed due to right skewed distribution (mean: 3.1; median: 2.0). Multivariable linear regression was used to estimate the association between high cfPWV and CES-D score, and multivariable logistic regression was used to estimate the association between high cfPWV and odds of depression. All models were adjusted for age, sex, race-center, education, self-reported financial situation, smoking, alcohol use, body mass index, LDL cholesterol, prevalent hypertension, diabetes and coronary heart disease. Race and sex were tested as potential effect measure modifiers. Results: A total of 412 (9.4%) participants were depressed. Compared to participants with less stiff aortas (cfPWV&lt;13.11 m/s), those with stiffer aortas (cfPWV≥13.11m/s) had higher average CES-D scores (3.5 vs. 2.9, respectively) and a higher prevalence of depression (12.9% vs 8.2%, respectively). High cfPWV was associated with 6% higher depressive symptoms (beta (β): 0.06, 95% confidence interval (CI): 0.002, 0.13), and greater odds of depression (odds ratio (OR): 1.32, 95% CI: 1.03, 1.69). No significant interactions were found by race or sex. Conclusion: Aortic stiffness is associated with late-life depression. These results suggest a role for age-related hemodynamic properties as targets for the study of late-life depression and the mitigation of its burden.

Prevalence of late-life depression and gap in mental health service use across European regions

Background We aimed to determine the prevalence and gap in use of mental health services for late-life depression in four European regions (Western Europe, Scandinavia, Southern Europe and Central and Eastern Europe) and explore socio-demographic, social and health-related factors associated with it.Methods We conducted a cross-sectional study based on data from the Survey on Health, Ageing and Retirement in Europe. Participants were a population-based sample of 28 796 persons (53% women, mean age 74 years old) residing in Europe. Mental health service use was estimated using information about the diagnosis or treatment for depression.Results The prevalence of late-life depression was 29% in the whole sample and was highest in Southern Europe (35%), followed by Central and Eastern Europe (32%), Western Europe (26%) and lowest in Scandinavia (17%). Factors that had the strongest association with depression were total number of chronic diseases, pain, limitations in instrumental activities of daily living, grip strength and cognitive impairment. The gap in mental health service use was 79%.Conclusions We suggest that interventions to decrease the burden of late-life depression should be targeted at individuals that are affected by chronic somatic comorbidities and are limited in mental and physical functioning. Promotion of help-seeking of older adults, de-stigmatization of mental illness and education of general practitioners could help decrease the gap in mental health service utilization.

The prevalence of late-life depression in a Portuguese community sample: A 10/66 Dementia Research Group study

Late life depression is associated with a significant burden of disease. Estimating depression in older adults can be difficult and requires different methodological approaches from those fitting younger adults. As community prevalence data is scarce in Portugal, we estimated the prevalence of depression in a sample of older Portuguese adults. Moreover, we investigated the association between depression and disability. A cross-sectional comprehensive one-phase survey was conducted of all residents aged 65 and over of one urban and one rural catchment area in Southern Portugal. Standardized 10/66 assessments include a comprehensive cognitive module and the Geriatric Mental State (GMS)-AGECAT. Information on demographics, non-communicable disease risk factors and disability/functioning (WHODAS 2.0) was also recorded. Depression was assessed using both ICD-10 and EURO-D criteria. We interviewed 1405 older people (mean age 74.9, SD = 6.7 years; 55.5% women) after 313 (18.2%) refusals to participate. The prevalence rate for ICD-10 depression was 4.4 (95% CI 3.5-5.6) and 18.0 (95% CI 16.0-20.1) using the EURO-D case definition. As compared with having no depression, ICD-10 depression was associated with a higher level of disability, even after adjusting for confounders (4.8, 95% CI 2.8-8.1). The same happened with subsyndromal depression ('EURO-D only') cases (2.2, 95% CI 1.4-3.5). Non-generalisability of findings outside of catchment areas. In this sample of older Portuguese people, the prevalence of depression was high and so were the associated levels of disability. EURO-D diagnoses may provide a better picture of clinically significant old age depression as a basis for health and social service planning.

The Effect of Employment and Occupational Factors on Late-Life Depression in Korea.

The present study investigated the prevalence of depression using Patient Health Questionnaire (PHQ-9) across general and occupational characteristics in older Koreans and identified associations between depression and occupational factors. This cross-sectional study used Korean National Health and Nutrition Examination Survey and analyzed 2426 participants (more than 50 years older). Complex sample logistic regression analysis was performed after adjusting general characteristics. Using Korean National Health and Nutrition Examination Survey data we identified the employment status and occupational factors (working hours per week, working status, occupation type, working schedule) are associated with the prevalence of late-life depression after adjusting general characteristics among older Korean men. The occupational environment associated with mental health is an important social issue for increasingly aging workers. There is a need for appropriate occupational environments and high-quality occupations enabling older people to work with public interest and collaborative effort of social and governmental institutions.

Prevalence of late-life depression and its correlates in a community-dwelling low-educated population aged 75+ years: The Pietà study

BackgroundThe number of individuals with advanced age is growing worldwide, especially in developing countries. Depression is the most common mental disorder in the elderly. The aim of this study was to evaluate the prevalence rates and the correlates of late-life depression (LLD) and clinically significant depressive symptoms (CSDS) in a population aged 75+ years. MethodsWe evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil, and used the MINI to diagnose LLD according to DSM-IV criteria and the GDS-15 to identify CSDS. Quality of life was assessed by the WHOQOL-OLD scale. ResultsOverall, 639 individuals (64% female, with a mean age of 81.1 ± 5.2 and 2.6 ± 2.8 years of schooling) were evaluated; 70 (11.1%) were diagnosed with LLD and 146 (25.6%) with CSDS. Depressed subjects (both with LLD and CSDS) had poorer measures of quality of life. Logistic regression analyses showed that LLD was independently associated to a history of falls/fracture, a diagnosis of cognitive impairment-no dementia, the number of regular drugs used, lack of reading habit and, inversely, to systolic blood pressure. LimitationsThe use of MINI which has not been validated in the elderly. No information was available on the number of previous depressive episodes or on the age of first episode. ConclusionBoth dimensional and categorical diagnoses of depression were prevalent among community-dwelling oldest-old individuals. Different clinical and personal variables were associated with depression, which negatively influenced the quality of life of the affected individuals.

A comparative cross-cultural study of the prevalence of late life depression in low and middle income countries

BackgroundCurrent estimates of the prevalence of depression in later life mostly arise from studies carried out in Europe, North America and Asia. In this study we aimed to measure the prevalence of depression using a standardised method in a number of low and middle income countries (LMIC). MethodsA one-phase cross-sectional survey involving over 17,000 participants aged 65 years and over living in urban and rural catchment areas in 13 sites from 9 countries (Cuba, Dominican Republic, Puerto Rico, Mexico, Venezuela, Peru, China, India and Nigeria). Depression was assessed and compared using ICD-10 and EURO-D criteria. ResultsDepression prevalence varied across sites according to diagnostic criteria. The lowest prevalence was observed for ICD-10 depressive episode (0.3 to 13.8%). When using the EURO-D depression scale, the prevalence was higher and ranged from 1.0% to 38.6%. The crude prevalence was particularly high in the Dominican Republic and in rural India. ICD-10 depression was also associated with increased age and being female. LimitationsGeneralisability of findings outside of catchment areas is difficult to assess. ConclusionsLate life depression is burdensome, and common in LMIC. However its prevalence varies from culture to culture; its diagnosis poses a significant challenge and requires proper recognition of its expression.

Natural outcome and risk-prediction model of late-life depression

To investigate the prevalence and natural outcome of late-life depression in the community and to analyze the risk-prediction models. A community in Hang Zhou was selected as a trial. A total of 1 275 persons aged 60 or more in this community were screened by PHQ-9 questionnaire; SCID was used for interviewer to diagnostic interview the people whose PHQ-9 was more than 10 points, 50 % of those whose PHQ-9 was from 5 to 9 points and 5 % of those whose PHQ-9 was less than 5 points, then all those who accepted diagnostically interview were interviewed by PHQ-9 every 3 months in one year, and were diagnostic interviewed by SCID in the last month. Logistic regression analysis was used to explore depressive risk factors in 12 months. There were 141 (11.1%) persons whose PHQ-9 score was more than 10 points, 298 (23.4%) whose PHQ-9 score were 5-9 points, and 836 (65.5%) whose PHQ-9 score were 0 to 4 points in the preliminary survey, 93 were major depressive disorder (MDD). The prevalence of late-life depression was 7.3%. Compared with the PHQ-9 score in one year, 17.6% of those with no depressive symptoms emerged depression; 50% of those who had depressive symptoms declined, 9% developed to significant depressive symptoms, and 41% did not change; 12% of those with significant depressive symptoms were found no depression, 24% reduced, and 64% still had depression. The significant predictors were the accumulation of disease, social support, educational level, daily capacity and baseline of depression. The prevalence of late-life depression was high. The rates of recognition, diagnosis and treatment were low. The natural outcome after a year did not relieve apparently. Specialist-community health partnership management model is one of the important ways to prevent and treat late-life depression.

Which Version of the Geriatric Depression Scale is Most Useful in Medical Settings and Nursing Homes? Diagnostic Validity Meta-Analysis

The Geriatric Depression Scale (GDS) has been evaluated in individual studies, but its validity and added value in medical settings and nursing homes is uncertain. Therefore, the authors conducted a meta-analysis, analyzing the diagnostic accuracy of long, short, and ultrashort versions of the GDS and stratified this into those with and without cognitive impairment. A comprehensive search identified 69 studies that measured the diagnostic validity of the GDS against a semistructured psychiatric interview, and of these, 43 analyses (in 36 publications) took place inmedical settings. Twenty-one studies examined the GDS₃₀, 12 studies examined the GDS₁₅, and 3 examined the GDS₄(/)₅. For comparison, the authors also summarized studies examining unassisted clinical judgment. Heterogeneity was moderate to high; therefore, random effects meta-analysis was used. Across all studies, the prevalence of late-life depression was 29.2% (95% confidence interval [CI] = 24.7%–33.9%), with no difference between inpatients, outpatients, and nursing homes. Diagnostic accuracy of the GDS₃₀ aftermeta-analytic weighting was given by a sensitivity of 81.9% (95% CI = 76.4%–86.9%) and a specificity of 77.7% (95% CI = 73.0%–82.1%). For the GDS₁₅, sensitivity was 84.3% (95% CI = 79.7%–88.4%) and specificity was 73.8% (95% CI = 68.0%–79.2%). For the GDS₄(/)₅, the sensitivity and specificity were 92.5% (95% CI = 85.5%–97.4%) and 77.2% (95% CI = 66.6%–86.3%), respectively. Results were not significantly influenced by the presence of dementia. Concerning added value, when identification using the GDS was compared with routine clinicians’ ability to diagnose late-life depressions, at a prevalence of 30%, of every 100 attendees, the GDS₃₀ would help correctly identify an additional 22 people as depressed but at a cost of 13 additional false positives. The GDS₁₅ performed the same as GDS₃₀ but with 15 false positives. The ultrashort form would help identify an additional 25 true positives with only 10 false positives. Thus, the best option when choosing between versions of the GDS seems to be the GDS₄(/)₅. All versions of the GDS yield potential added value in medical settings, but the GDS₄(/)₅ is the most efficient. In nursing homes, given an absence of data on the GDS₄(/)₅, the GDS₁₅ may be preferred until more studies are reported.

The Prevalence of Late-Lifedepression and Physicians’ Attitude Toward it in Primary Care Settings of China

Late-life depression is associated with physical and psychological comorbidity, functional and cognitive impairment, and increased mortality due to suicide and other causes. However, studies in the west show that the identification of depression in older people is problematic and consequently the illness is underdiagnosed and undertreated. We investigated the prevalence of late-life depression and physicians’ attitude toward it in primary care settings of China.The survey was performed in urban primary care settings of Hangzhou, China. 1000 patients aged ≥ 55 years and 300 primary care physicians were recruited, of which 689 patients and 247 physicians provided complete data. The Geriatric Depression Scale (GDS-30) was used for investigating the prevalence of late-life depression in patients, and the Depression Attitude Questionnaire (DAQ) for investigating physicians’ attitudes and knowledge about depression.Of the 689 patients, 23.4% (n=161) scored ≥ 11 on the GDS-30, including 3% (n=21) who scored ≥ 21. Among the physicians, 72% (n=178) endorsed that “Becoming depressed is a natural part of being old”, and 70% (n=173) of them thought “Working with depressed patients is heavy going”; in their clinical practice. Only 6.6% of physicians prescribed anti-depressants.Primary care physicians in China are ill prepared to diagnose and treat depression in older adults, which presents at high rates in primary care clinics. How to improve their attitudes and clinical practice is crucial to the well-being of older people in China.

Late life depression.

Depression has an overall prevalence of 5-8%. The prevalence of late life depression is estimated among people 65 years of age to be 15%. There is a great under-diagnosis and under-treatment of late life depression with the most serious consequence being premature death. Depression is also an important and independent risk factor for mortality following myocardial infarction, while patients with stroke associated with depression also have a higher death rate. The suicide rate is increased in elderly especially elderly men with depression. The aetiology of depression is more heterogeneous than depression in younger adults. Obviously age-related changes in the brain increase the risk for depression. Patients with neurodegenerative disorders also run a higher risk for being depressed. In Alzheimer's disease the frequency is around 50%. Deficiency of essential nutrients like folic acid and vitamin B12 is an obvious risk factor for both disorders with cognitive impairment and depression. Treatment of depression in the elderly follows the same lines as treatment of depression in younger patients. Many different drugs may be prescribed; however, the risk of adverse events is greater in the elderly. The drugs of choice are the selective serotonin re-uptake inhibitors (SSRIs), which have a response rate of around 65%. Of interest is that emotional disturbances like irritability, aggressiveness and anxiety also respond to treatment with SSRIs. A comprehensive treatment of late life depression, which includes social and psychological support, has a response rate of 80-90%.

Research directions for treatment of depression.

Late-life depression is an immense public health problem for which research on treatment interventions is very much needed. Between 1950 and 1990, average longevity worldwide increased from 46.6 years to 64.7 years (United Nations, 1993). With this surge in the elderly population has come an increased prevalence of late-life depression and its sometimes severe consequences. Older people with depressive symptoms have a threefold increase in mortality (Ashby et al., 1991). As many as 15% to 25% of nursing home residents in the United States have major depression (NIH Consensus Development Panel, 1992), and between 50% and 80% of elderly people who commit suicide have major depression (Clark, 1991; Conwell et al., 1991; Finkel &amp; Rosman, 1995).