Depressive symptoms and cognitive functioning among older adults with cancer

Depression is a common mental illness in elderly adults that is associated with substantial disability, medical comorbidity, and suicide risk. Factors associated with risk of depression in older adults are many, but the role of dietary and nutritional factors remains relatively unexplored. Accumulating evidence suggests that certain dietary patterns and micronutrients may have important protective effects.1-3 The present study used longitudinal data from 1,615 Chinese adults aged 55 to 93 from the Singapore Longitudinal Aging Study (SLAS)4, 5 to examine the association between amount of tea drinking and incident depressive symptoms from follow-up over an average period of 18 months. It was hypothesized that higher levels of tea consumption would be associated with lower risk of depressive symptoms at follow-up. The baseline recruitment and data collection in SLAS were completed from 2003 to 2005, and follow-up assessment of depressive symptoms was conducted from 2005 to 2007. The National University of Singapore institutional review board approved the study, and written informed consent was obtained from all participants. Trained research nurses administered the 15-item Geriatric Depression Scale (GDS-15)6 to measure depressive symptom severity. Depressive symptoms were defined as a GDS-15 total score of 5 or higher at follow-up assessment. Information on the consumption of green tea, Chinese oolong or black tea, and English black tea was collected at baseline (0 = never or rarely; 1 = <1 cup/wk; 2 = >1 cup/wk but < 1 cup/d; 3 = 1–2 cups/d; 4 = 3–5 cups/d; 5 = 6–9 cups/d; 6 = ≥10 cups/d). A participant was classified as a non-tea consumer if the sum of the scores of all three types of tea was 0. Low tea consumption was defined as a sum score from 1 to 2, medium consumption from 3 to 4, and high consumption 5 or more. Independent-sample t-tests and chi-square tests were used to compare differences in various characteristics of non-tea consumers and tea consumers and between participants with and without depression at follow-up. A variable was considered to be a potential confounder of the association between tea consumption and depressive symptoms if there was a statistically significant difference in both comparisons, and the variable was subsequently controlled for in multivariate analysis. Hierarchical multiple logistic regression was used to analyze the association between level of tea consumption and depressive symptoms at follow-up. All analyses were performed with SPSS version 19.0 (SPSS, Inc., Chicago, IL). Seventy-three participants had depressive symptoms at follow-up assessment. The proportion of participants with depression at follow-up decreased with increasing tea consumption (6.6%, 5.3%, 3.2%, and 1.8%, respectively). This linear association between tea consumption and depression was confirmed in multivariate analysis. In fully adjusted model (Table 1), the odds ratio of depressive symptoms at follow-up for participants with low, medium, and high tea consumption was 1.15, 0.55, and 0.37, respectively (P for linear trend = .01). The results remained essentially the same when all participants with cognitive impairment at baseline were excluded from the analysis. A similar linear trend of association between level of tea consumption and depressive symptoms at follow-up was observed in participants who were and were not depressed at baseline, although given small number of depression cases in each of the four categories of tea consumption, further multivariate analysis was not performed. This study provides the first evidence of a longitudinal association between tea consumption and clinically meaningful depressive symptoms in older adults. The results are consistent with an earlier report on the association between tea consumption and lower prevalence of depressive symptoms in community-living elderly adults3 and several studies that were conducted in study populations other than older adults.7, 8 These results support a cause-and-effect relationship between tea consumption and low risk of subsequent depressive symptoms. The underlying mechanisms may involve the antioxidant, anti-inflammatory, cerebrovascular protective, and antidepressant effects of bioactive compounds in tea leaves.9, 10 The role of tea consumption and tea bioactive compounds in the prevention of late-life depression deserves further study. SLAS was supported by research grants 03/1/21/17/214 and 08/1/21/19/567 from the Biomedical Research Council, Agency for Science, Technology and Research, Singapore. Conflicts of Interest: We have no financial support or relationships that may pose a conflict of interest. Author Contributions: Lei Feng formulated the hypothesis, reviewed the literature, performed the statistical analysis, and wrote the letter. Tze-Pin Ng designed the research as the principal investigator of the SLAS project. Tze-Pin Ng, Jialiang Li, Ee-Heok Kua, Tih-Shih Lee, Keng-Bee Yap, and A. John Rush reviewed the statistical analysis and revised the article. All authors read and commented on the final manuscript. Sponsor's Role: No commercial company sponsored or played any role in the design and methods of the study, participant recruitment, data collection and analysis, or preparation of this article.

BackgroundDepressive symptoms and cognitive impairment often interact, rendering their associations controversial. To date, their joint trajectories and associations with dementia and death remain underexplored.AimsTo explore the interactions between depressive symptoms...

ObjectiveSubjective (SH) and objective health (OH) measures are associated with depressive symptomatology in older adults. We explored whether the discrepancy between SH and OH (operationalised as ‘health asymmetry’ with four categories: ‘health optimistic’, ‘health pessimistic’ and ‘good health realistic’ and ‘poor health realistic’) may also relate to depressive symptomatology 1) cross-sectionally, and 2) longitudinally, among older European adults. MethodsAdults (n = 26,520), aged 50+, from 11 European countries, were assessed over six waves of data collection (2006–2020) in the SHARE study. A hierarchical multi-level growth curve model explored whether health asymmetry was associated with depressive symptomology at baseline, and with depressive symptom trajectories across time, accounting for country of origin. ResultsAt baseline, 11.8% of older adults were classified as health pessimistic, with 15.5% being health optimistic, 42.9% being poor health realistic and 29.8% being good health realistic. A positive linear trend in depressive symptomatology was noted across 14 years of SHARE data (β = 0.11, p < .001). Health pessimists displayed higher levels of depressive symptoms than both health realistic groups and health optimists. However, health pessimists experienced a less steep increase in depressive symptoms across time (β = −0.10, p < .001), relative to good health realists. ConclusionHealth pessimists experience elevated levels of depressive symptoms, but show less growth in depressive symptomatology than expected. Further research is required to understand the underlying causes of the varying depressive symptom trajectories among these groups.

IntroductionThe COVID-19 pandemic led to the implementation of physical–social distancing measures–including self-isolation, home confinement, and quarantine around the world, with psychological consequences such as depression. Older adults are especially likely to develop depressive symptomatology. This study aims to investigate the association between physical activity intensities and sedentary behavior with depression levels among previously active older adults during the COVID-19 lockdown.MethodsA total of 1,123 physically active older Brazilian adults (67.68 ± 5.91 years, 91.00% female) were interviewed by telephone in regard to sociodemographic, general health status, depression (GDS-15), and physical activity (IPAQ-SV) after being home-confined for 11.59 ± 2.42 weeks. Participants were also asked to self-report changes in their physical activity levels and time spent sitting. Descriptive statistics (mean, frequencies), between-groups comparisons (t-tests and chi-square), and hierarchical regression analysis were used.ResultsAbout 83.80% of older adults self-reported a decrease in daily physical activity levels and 73.90% increased sitting time. Overall, depressive symptoms were observed in 30.40, and 20.80% met physical activity recommendations. Daily moderate (β = −0.174; 95% CI = −0.026; -0.012) and moderate-to-vigorous (β = −0.183; 95% CI = −0.023; 0.011) physical activity intensities were negatively associated with depression score explaining 2.6 and 2.9% of depression variability, respectively, after adjusting for age, gender, education level, body mass index, and polypharmacy. Daily walking and sitting time were not associated with the depression score (p > 0.05).ConclusionThe results provide empiric suggestion supporting moderate to vigorous physical activity as a way to reduce depressive levels among older adults during COVID-19 confinement. Supervised home-based exercise programs, specifically designed for older adults, might be an important strategy to maintain and improve older adults’ mental health.

Background: Depressive and insomnia symptoms are common among older adults with chronic pain. We aimed to examine different chronic pain trajectories of older adults over an 8-year observation period and explore the network structures of depression and insomnia in each chronic pain group.Methods: The trajectories of pain in the USA-based Health and Retirement Study (HRS) data from 2010 to 2018 were examined using latent class growth analyses (LCGA) method. Depressive and insomnia symptoms were measured with the eight-item version of the Center for Epidemiological Studies Depression (CESD-8) Scale and the four-item Jenkins Sleep Scale (JSS-4), respectively. Network models were constructed using the Ising model. Central symptoms and bridge symptoms were identified via expectedInfluence (EI) and bridge EI, respectively.Results: A total of 11,132 older adults were included in the trajectory analysis, with three chronic pain trajectories identified, including “severe pain trajectory,” “moderate pain trajectory,” and “non or mild pain trajectory”. From these trajectories, “Lack of happiness” (CESD4), “Feeling depressed” (CESD1), and “Feeling sad” (CESD7) emerged as the most central symptoms, while “Feeling tired in the morning” (JSS4) was identified as the key bridge symptom. However, the findings may not be generalizable to other parts of the world outside the USA.Conclusion: Older adults with different chronic pain trajectories exhibited similar depression and insomnia network structure. Implementing timely interventions that target central and bridge symptoms might mitigate the co-occurrence of depression and insomnia in this population.

To examine the relationship between self-reported health status, prophylactic medication use, and healthcare service use in older adults with asthma. A prospective longitudinal cohort study was conducted over a 2-year postenrollment period in a population of asthmatic older adults enrolled in managed care. Patients completed a comprehensive health-risk screen at time of enrollment in the plan. A Medicare health maintenance organization (HMO) in the southeastern United States with prescription benefit. One hundred twenty-nine older adults with asthma using inhaled corticosteroid therapy as prophylaxis and enrolled in a Medicare HMO were available for complete follow-up. We measured self-reported health perception, falls, lifestyle, depressive symptomatology, and pre-enrollment healthcare service use using a comprehensive risk screen. We used the Med-Total index and total annual healthcare charges as measures of postenrollment inhaled corticosteroid and healthcare service use. After adjusting for the effects of other variables, we found that depressive symptomatology at baseline and increased comorbidity severity (using the Charlson comorbidity index) were associated with significant reductions in prophylactic medication possession (27% with depressive symptomatology and 6% with unit increase in Charlson's index, P <.05). Additionally, after adjusting for the effects of baseline health status, we found that a 10% increase in prophylactic medication possession was associated with a nearly 5% decrease in total annual healthcare charges in this population (P <.01). There are strong but not fully explained associations between depressive symptoms at time of enrollment, decreased postenrollment prophylactic medication use and increased postenrollment healthcare service use in older adults with asthma.

BackgroundUniversal HIV screening programs are costly, labor-intensive, and in practice unable to identify all individuals at risk of HIV infection. Automated risk assessment methods that leverage longitudinal electronic health records (EHRs) could catalyze targeted screening programs in Emergency Departments and across public health jurisdictions. While information on social and behavioral determinants of health are typically collected in unstructured fields, previous analyses have only considered structured EHR data. We sought to characterize whether clinical notes can improve predictive models of HIV diagnosis.Methods181 individuals who received care at an academic medical center in New York City prior to a confirmatory HIV diagnosis were included in the study cohort. 543 HIV- controls with similar utilization patterns were selected using propensity score matching. Demographics, laboratory tests, and diagnosis codes were extracted from longitudinal records. Clinical notes were preprocessed using both topic modeling and an n-grams approach. We fit 3 predictive models using Random Forests including a baseline model which included only structured EHR data, the baseline model plus topic modeling, and baseline model plus clinical keywords.ResultsPredictive models demonstrated a range of performance with F-measures of 0.59 for the baseline model, 0.63 for the baseline plus topic modeling and 0.74 for the baseline plus clinical keyword model. The baseline plus topic model displayed low precision but high recall while the baseline plus clinical keyword model displayed high precision but low recall. Clinical keywords including ‘msm’, ‘unprotected’, ‘hiv’, and ‘methamphetamine’ were indicative of elevated risk.ConclusionClinical notes improved the performance of predictive models for automated HIV risk assessment. Future studies should explore novel techniques for extracting social and behavioral determinants from unstructured text in longitudinal EHRs.DisclosuresAll authors: No reported disclosures.

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

To investigate whether self-efficacy moderates the association between self-rated memory and depressive symptoms in a large sample of older adults. The influence of self-efficacy and depressive symptoms on memory performance was also examined in a subsample of individuals who reported poor memory. Non-demented participants (n = 3766) were selected from the 2012 wave of the Health and Retirement Study. Depressive symptomatology was assessed with the 8-item Center for Epidemiologic Studies Depression Scale. A modified version of the Midlife Developmental Inventory Questionnaire was used as the measure of self-efficacy. Participants were asked to rate their memory presently on a five-point scale from Excellent (1) to Poor (5). Immediate memory and delayed memory (after a 5-min interval) were measured by the number of correct words recalled from a 10-item word list. Multiple regression analyses revealed that negative ratings of memory were significantly associated with greater levels of depressive symptoms, with this effect being greatest in those with low levels of self-efficacy. Additionally, greater self-efficacy was associated with optimal objective memory performances but only when depressive symptoms were low in individuals who reported poor memory function (n = 1196). Self-efficacy moderates the relationship between self-rated memory function and depressive symptoms. Higher self-efficacy may buffer against the impact of subjective memory difficulty on one's mood and thereby mitigating the effect of depressive symptoms on memory. Interventions should focus on increasing perceived self-efficacy in older adults reporting poor memory function to potentially minimize memory impairment.

Depression and depressive symptoms commonly co-occur with mild cognitive impairment (MCI) and dementia in older adults (Ismail et al., 2017; Panza et al., 2010), and may occur for various reasons, including as an emotional response to cognitive decline (Bennett &amp; Thomas, 2014; Richard et al., 2013). Emotional responses may be explained by a decline in sense of control, or the belief in one’s ability to influence their environment to achieve desired outcomes, which declines with age as cognitive and physical abilities change and limit independence (e.g., Lachman &amp; Weaver, 1998). Using data taken from years 2006 to 2018 of the Health and Retirement Study (HRS), a mixed model regression indicated that cognitive functioning on the Modified Telephone Interview for Cognitive Status (TICS-27) was significantly associated with depressive symptoms on the Center for Epidemiologic Studies Depression (CES-D-8), β = -.02, t (45,163) = -5.65, p &amp;lt; .001, R2 = .49. Further, TICS-27 in 2016 predicted CES-D-8 in 2018, and this relation was mediated by sense of control in 2018, measured using the subscale of the Midlife Development Inventory, while controlling for demographic variables, β = -.02, SE = .004, 95% CI [-.03, -.01], Δ R2 = .11. The findings of this study confirm that cognitive function predicts depressive symptoms and highlight the importance of sense of control in explaining this emotional reaction. These findings have critical implications for preventing and treating depressive symptoms in older adults, particularly those with signs of cognitive dysfunction.

ObjectiveDietary diversity has been found to be related to depressive symptoms. However, the relationship between the trajectory of dietary diversity score (DDS) and depressive symptoms in Chinese older adults remains unclear.MethodsThe longitudinal dataset of Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011 to 2018 was used to identify the DDS trajectory among older adults over 65 years old by latent class growth analysis. DDS and depressive symptoms were measured using the food frequency questionnaire and the Center for Epidemiologic Studies Depression Scale-10, respectively. The logistic regression model was used to explore the association between the DDS trajectory and depressive symptoms measured in 2018, and network analysis was used to explore the inter-relationships of depressive symptoms.ResultsA total of 1549 participants were included. This study identified two different DDS trajectories: “persistent high DDS trajectory” and “low but slowly rising DDS trajectory.” After adjusting the covariates, participants with a low but slowly rising DDS trajectory had a higher risk of having depressive symptoms (odds ratio [OR] [95% confidence interval [CI]]: 1.71 [1.34–2.18], p<0.001). Comparisons of network structures of depressive symptoms in different DDS trajectories showed that local difference was found in edge CESD2-CESD6 (difficulty with concentrating-feeling nervous/fearful), and the central symptom in both groups was CESD3 “feeling blue/depressed.”ConclusionMaintaining high dietary diversity is associated with a lower risk of depressive symptoms among Chinese older adults. Educational campaigns highlighting the importance of dietary diversity could be implemented for this population to lower depression risk and promote healthy aging.

Marital Status as a Moderator: Exploring the Relationship between Social Engagement and Depressive Symptoms in China's Older Adult Population

The emphasis on body image has increased over the past few decades, underscoring the importance of understanding factors associated with perceptions of body satisfaction and how body satisfaction is related to physical activity (PA) participation across all subgroups in the population. Little is known about satisfaction with body function and appearance in the older adult population. Purpose The purpose of this presentation is to examine sociodemographic, psychosocial and health-related correlates for body satisfaction in an adult population ages 50 and over from the Active for Life® (AFL) pilot year (n = 768). A secondary purpose is to explore relationships between body appearance satisfaction (BAS) and body function satisfaction (BFS) with PA while controlling for age, race, education, BMI, health rating and depressive symptoms. Methods AFL was established to learn how to deliver, sustain and evaluate evidence-based PA programs to mid-life and older adults through community organizations. Nine community grantees (in 12 geographical areas) implemented one of two evidence-based PA programs. Analyses for this presentation used baseline data from the AFL pilot year. Bivariate correlates for two dependent variables (BAS and BFS) were examined using correlation coefficients for continuous independent variables and ANOVAs for categorical independent variables; ANCOVAs were run to assess relationships between BAS and BFS with PA (MET-hrs/week of moderate-intensity PA from the CHAMPS) while controlling for sociodemographic, psychological and health-related correlates and geographical area. Results More positive BAS and BFS was associated with being female, younger age and better health ratings; lower BMI and depressive symptoms and higher levels of education and PA (all ps <0.05). In multivariate models, PA remained a significant correlate of BAS (p = 0.002) and BFS (p <0.0001) after adjusting for sex, age, race, education, BMI, health status, depressive symptoms and geographical area; the model explained 29.64% of the variance in BAS and 29.23% of the variance in BFS. Conclusions The results from this study demonstrate a significant relationship between PA and BAS and BFS in an older adult population even after adjusting for sociodemographic, psychological and demographic variables. These findings suggest the importance of PA in understanding older adults' perceptions of body satisfaction, both appearance and body function satisfaction. Programs aimed at increasing PA among older adults should consider the motivational impact of improved body appearance and physical function as desired outcomes. Funded by The Robert Wood Johnson Foundation.

An analysis and evaluation of the literature regarding traditional treatment methods for depression among older adults compared the effectiveness of the results to the benefits of a treatment plan that integrates the narrative practices of storytelling and reflexive writing. Priority was given to peer-reviewed journal articles from 2008 forward, though some earlier information was used for clarification and foundation building. The formation and implementation of individual patient treatment plans for depression and depressive symptoms are impacted by many variables such as: Confusion surrounding provider treatment guidelines, social organizational context, organizational climate and the differing definitions of depression that exist among providers and patients. Patients often struggle to self-identify or put words to depressive symptoms and the process of reflexive writing is transformative and increases narrative competency, which strengthens a patient’s ability to give an account of oneself, aiding in self-discovery and personal symptom awareness. An imbalance of power exists in the clinical encounter and the practices and principles of the discipline of Narrative Medicine can have a positive impact on strengthening the therapeutic alliance and treatment outcomes. Older adults with depression and depressive symptoms have a lower quality of life and often feel less productive in their communities. Traditional pharmacologically based depression treatment plans are one-dimensional and often fail to address personal patient context and preference. Older adults living with diagnosed depression and depressive symptoms can be better served with treatment plans that include narrative techniques that increase alliance, affiliation, self-awareness and self-discovery.

BackgroundGiven the unique socioeconomic structures, and the rural/urban differentials in the prevalence of mental illnesses in the country, this study aimed to explore the associations of childhood, adulthood and late-life rural/urban place of residence with mental health outcomes, namely depressive symptoms and cognitive impairment, among older adults in India. The study also examined the relationship between older individuals’ life-course rural/urban place of residence and late-life mental and cognitive health.MethodsUtilizing data from the Longitudinal Aging Study in India (n = 28,027 older adults age 60 years and above), the study employed multivariable logistic and linear regression models to examine the association between urban/rural residential status, life-course residence, depressive symptoms and cognitive impairment among older adults.ResultsChildhood and adulthood place of residence was not associated with depressive symptoms in older men and women. Current rural place of residence was positively associated with depressive symptoms in older women [adjusted odds ratio (aOR): 1.37, confidence interval (CI): 1.05–1.80] but not men. Childhood [aOR: 1.88, CI: 1.16–3.04], adulthood [aOR: 2.00, CI: 1.26–3.16] and current rural residence [aOR: 1.93, CI: 1.27–2.91] was positively associated with cognitive impairment in men. Only current rural residence [aOR: 1.71, CI: 1.29–2.27] was associated with cognitive impairment in women. There was no significant association between life-course place of residence and depressive symptoms except in case of lifetime rural residence Respondents with urban-urban-urban (childhood-adulthood-current) place of residence were less likely to have depressive symptoms [adjusted coefficient (aCoef.): -0.14, CI: -0.21- -0.07] compared to those with rural-rural-rural place of residence. There were significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants, showing an urban advantage in cognitive function among older adults.ConclusionsThis study showed significant associations between life-course residence and depressive symptoms among permanent rural/urban residents. The study also showed significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants. Considering the rural disadvantage in mental and cognitive health among older adults, the government should continue to support policies that can improve access to education and healthcare among people residing in rural areas and women, in particular. The findings also urge social scientists and gerontologists in particular, to consider the importance of lifetime historical context while evaluating mental and cognitive health of older persons.