Anxiety and Depression in Medically Ill Older Adults

Anxiety and depression are extremely common in the elderly with medical problems. They can manifest not only as symptoms of a primary psychiatric illness, but also as physiologic sequelae of medical illnesses and medical treatments. Recognition and treatment of depression and anxiety in the medically ill is especially difficult. If these states go untreated, they result in higher morbidity and mortality, higher health care costs and utilization, and poorer functional status and outcomes. Three of the most common medical illnesses that afflict geriatric patients, cardiovascular disease, pulmonary disease, and rheumatoid arthritis, will be presented to illustrate the difficulty in recognizing depression and anxiety and the impact of treating these symptoms in the medically ill elderly. Multidisciplinary approaches combining optimal medication regimens and psychosocial interventions can be effective for treatment of anxiety and depression in the medically ill elderly.     

Treatment of Depression and Suicide in Older Adults

This article describes a cognitive behavior therapy (CBT) intervention for suicide prevention in older adults. Although many studies have found that CBT interventions are efficacious for reducing depressive symptoms in the elderly, researchers have yet to evaluate the efficacy of such interventions for preventing suicide or reducing suicide risk in older adults. In this article we describe a 12-session CBT protocol for reducing depression, suicide ideation, and other risk factors of late-life suicide. The following aspects of the treatment are described: assessing suicide risk, conceptualizing the problem through a cognitive behavioral framework, developing a safety plan, increasing hope and reasons for living, improving social resources, improving problem-solving skills and efficacy, improving adherence to medical regimen, and relapse prevention. In addition, we review other behavioral and cognitive strategies such as activity scheduling and cognitive restructuring that are commonly associated with CBT interventions for depression. We illustrate the application of these strategies through the use of case examples.     

Performance in Autobiographical Memory of Older Adults with Depression Symptoms

The aim of this study was to compare the performance in the Autobiographical Memory Test in older adults with high scores on depression symptoms (HDS) compared with a matched group with low scores on depression symptoms (LDS) according to the clinical cut‐off of the Centre for Epidemiological Studies Depression Scale. Participants were asked to generate specific autobiographical memories in response to a series of positive and negative cue words. Latencies of responses for each item were also scored. LDS participants showed a higher proportion of specific memories than HDS participants. Latencies of responses to positive and negative cues were greater for HDS than LDS. Specific autobiographical memory was positively associated with Life Satisfaction. Cognitive emotional changes in the function of memory with age are suggested as a possible explanation for the findings. Copyright © 2012 John Wiley & Sons, Ltd.     

老年抑郁症的症状、诊断及测量

对老年抑郁症的症状、诊断和测量的探讨有利于寻找更有效的治疗方法。文章在简要讨论老年抑郁症主要症状以及诊断特点的基础上,重点介绍老年抑郁症的测量工具。文章指出,开展老年抑郁症研究的多学科研究,运用认知神经科学方法深入研究老年抑郁症,制订相对独立的老年抑郁症的分类标准,结合老年抑郁症患者身心特点开发更简便可靠的老年抑郁症量表,将有利于老年抑郁症的进一步研究。     

Depression Among Transgender Older Adults: General and Minority Stress

This study aims to (a) examine the direct and indirect effects internalized heterosexism, disclosure of gender identity, and perceived general stress in association with depression among transgender older adults; and (b) to assess the relative contribution of each relationship. Secondary analyses of data from a large community‐based study of older sexual and gender minorities were conducted utilizing structural equation modeling with a subsample (n = 174) of transgender adults aged 50 to 86‐years old. Disclosure of gender identity had no significant direct or indirect effects on either perceived general stress or depression. Internalized heterosexism did not have a direct effect on depression, but did have a significant indirect effect through perceived general stress. Finally, perceived general stress had an additional significant direct effect on depression, over and above internalized heterosexism. Total effect sizes appear to be considerable with standardized betas greater than 5.0. Perceived general stress and internalized heterosexism independently and cumulatively have significant direct and indirect effects on depression among transgender older adults. Implications for depression among transgender older adults and the role of community psychology are discussed.     

Differential Diagnosis in Older Adults: Dementia,Depression, and Delirium

Research shows that misdiagnosis can have particularly damaging consequences in older adults. It is frequently difficult, however, to determine whether observed symptoms are due to aging or to a medical condition. The author examines three common disorders that can be particularly challenging to diagnose in older adults: dementia, depression, and delirium. Three general questions are discussed for each: What are the age-related differences in the disorder's presentation? What medical issues need to be ruled out? What assessment methods are particularly useful in the diagnostic process?     

Depression in Homebound Older Adults: Problem-Solving Therapy and Personal and Social Resourcefulness

The goal of problem-solving therapy is to teach patients systematic coping skills. For many homebound older adults, coping skills must also include both personal and social (help-seeking) resourcefulness. This study aimed to examine the relationship between perceived resourcefulness and depressive symptoms at postintervention and potential mediating effect of the resourcefulness among 121 low-income homebound older adults who participated in a pilot randomized controlled trial testing feasibility and preliminary efficacy of telehealth-PST. Resourcefulness Scale for Older Adults was used to measure personal and social resourcefulness. Only personal resourcefulness scores were significantly associated with depression outcomes at postintervention, and neither resourcefulness scores were significantly associated with group assignment. Analysis found no mediation effect of resourcefulness. The findings call for further research on potential mediators for the potentially effective depression treatment that could be sustained in the real world for low-income homebound older adults who have limited access to psychotherapy as a treatment modality.     

Depression and Anxiety in Older and Middle‐aged Adults With Diabetes

This study aims to compare rates of depressive and anxious symptoms among older adults with and without diabetes. The study also examines differences in depression, anxiety, and diabetes‐related emotional distress between middle‐aged and older adults with diabetes. A total of 224 participants completed a range of questionnaires measuring depression, anxiety, and diabetes‐related emotional distress (if applicable). One hundred and three adults with diabetes (55 middle‐aged, mean age = 47 years, range 40–59 years and 48 older, mean age = 69 years, range 60–81 years) were recruited from a tertiary diabetes clinic. One hundred and twenty‐one adults without diabetes (72 middle‐aged, mean age = 52 years, range 40–59 years and 49 older, mean age = 65 years, range 60–76 years) were recruited from either a university student pool or a registry of adults aged 50 and above. Older adults with diabetes had significantly higher levels of depression and comparable levels of anxiety with older adults without diabetes. Older adults with diabetes had significantly lower levels of depression, anxiety, and diabetes‐related distress than middle‐aged adults with diabetes. Diabetes is associated with high rates of depression and anxiety, with middle‐aged adults more adversely affected than older adults.     

The Influence of Religiosity,Family-of-Origin,and Self-Efficacy on Depression in Older Adults

ABSTRACT

In this study, the influence of religiosity, self-efficacy, and family-of-origin on depression was examined. In addition, the associations of race, gender, and age on these variables were analyzed. A total of 81 older persons, 56% white and 44% black, and approximately the same number of males and females, were recruited from public housing, a senior citizens organization, and a private community dwelling. Results indicated that a number of associations were significant between race, gender, religion, and age. No gender or race differences were associated with self-efficacy or depression. Multiple regression analysis was utilized to examine the role of self-efficacy, family-of-origin, and religiosity on depression of older adults. Significant causal effects were found for the influence of religiosity and family-of-origin on self-efficacy and the influence of self-efficacy on depression.     

老年人自尊、希望和抑郁关系的纵向研究

为考察老年人自尊、希望与抑郁间的关系,本研究对281名老年人进行为期一年的追踪调查。相关分析及纵向中介分析结果表明:(1)自尊和希望与老年人的抑郁显著负相关,老年人自尊和希望显著正相关。(2)自尊正向预测老年人的希望,老年人的希望负向预测抑郁。(3)希望在自尊对老年人抑郁的影响中起中介作用。本研究结果揭示了希望是自尊对老年人抑郁产生效应的重要机制变量。这些结果对于减缓老年人抑郁,促进老年心理健康具有一定的实践价值。     

The Interrelations of Agency,Depression, and Suicidal Ideation Among Older Adults

The high rates of suicide among older men are cause for concern, and have prompted the investigation of factors that might explain these elevated rates. The current research examined whether the gender role construct agency was associated with depression and suicidal ideation among older adults. The results, based on self‐report data from a sample of older Australian men (n = 69) and women (n = 90), indicated that depression mediated the relation between agency and suicidal ideation. In addition, for older men only, agency moderated the depression‐suicidal ideation relation. The results suggest that older adults, and particularly men, with low levels of agency should be the targets for interventions aimed at increasing levels of agency and improving mental health.     

Behavioral Activation Treatment for Depression in Older Adults Delivered via Videoconferencing: A Pilot Study

Depression affects up to 25% of older adults. Underdetection and subsequent undertreatment of depression in older adults has been attributed in part to difficulties in older adults being able to access treatment. This uncontrolled pilot study, N = 3, explored the acceptability and efficacy of a brief behavioral activation treatment delivered via videoconferencing to 3 participants, aged 64 to 73 years, diagnosed with major depressive disorder. The results indicate that a 5-session behavioral activation treatment delivered via videoconferencing produced clinically significant and reliable decreases in depression. The results also showed clinically significant and reliable decreases in negative affect and clinically significant and reliable increases in positive affect. Treatment gains were maintained at 1-month follow-up. Videoconferencing can be a valuable and effective tool in increasing accessibility to psychological treatment for older adults.     

老年人的朋友参照效应

采用自我参照效应范式探讨老年人朋友参照效应的特点。城市老年人和农村老年人各36人参加实验1, 结果表明：(1)城乡老年人都表现出朋友参照效应; (2)与农村老年人相比, 城市老年人朋友参照效应指标显著高于自我参照效应指标。城市教育程度较高与教育程度较低老年人各36人参加实验2, 结果发现, 与城市教育程度较低的老年人相比, 城市教育程度较高的老年人朋友参照效应指标高于自我参照效应指标, 表明教育程度对朋友参照效应有显著影响。由此推断, 老年人会将朋友包含于自我图式之内, 并且教育程度会影响朋友在自我图式中的地位。     

Depression, Psychological Resources, and Health-Related Quality of Life in Older Adults 75 and Above

The purposes of this study were (1) to compare psychological resources and health-related quality of life between two groups of community-dwelling elders, 75 years of age and older, with similar chronic illnesses, but with varying levels of depression, and (2) to examine the relationships among depression, psychological resources, and health-related quality of life. Fifty-two elders (14 men and 38 women) were divided into mildly (n = 18) and severely (n = 34) depressed groups based on their depression scores. There were no significant differences between the two groups for demographic and illness characteristics. There were significant differences for number of medications, mastery, health perceptions, mental health functioning, and well-being. Severely depressed elders had poorer health perceptions, and decreased mastery, functioning, and well-being as compared with mildly depressed elders. An explanatory model was developed using factor analysis that fit the data well. Health perceptions and mastery had direct influences on depression, and depression directly impacted well-being.     

Pragmatic Screening of Anxiety,Depression, Suicidal Ideation,and Substance Misuse in Older Adults

Older adults’ mental health needs are often unmet across care settings (e.g., primary or residential care) for a variety of reasons, such as mental health stigma and mental health care professionals’ lack of awareness of age-related changes in mental disorders. Screening, when coupled with access to evidence-based interventions, is effective at identifying and reducing anxiety, depression, suicidal ideation, and substance misuse in older adults across care settings. Unfortunately, due to lack of training many mental health care professionals may be unsure about what or how to screen, as well as which screening measures are available for use with older adults. Following professional guidelines recommended for older adults, we provide an overview of screening measures for anxiety, depression, suicidal ideation, and substance misuse that are evidence-based and meet pragmatic criteria identified by stakeholder research. Specific pragmatic criteria include screening measures developed with older adults (unless unavailable) as well as brief in length (items ≤30), time for administration (≤15 minutes), scoring (<5 minutes), and interpretation (<5 minutes). Other pragmatic criteria include screening measures readily available on the internet at no cost and usable across diverse settings (e.g., community, primary care, and/or residential care). For each measure, we also review relevant psychometric properties (e.g., reliability, cut-scores, sensitivity, specificity, and construct validity). Lastly, we discuss strategies to facilitate screening with older adults and direct mental health care providers to internet resources that can be used to learn more about assessment with older adults.     

Internal Consistency and Test-Retest Stability of the Geriatric Depression Scale-Short Form in African American Older Adults

The Geriatric Depression Scale (GDS) is one of the most widely used self-rated mood questionnaires for older adults. It is highly correlated with clinical diagnoses of depression and has demonstrated validity across different patient populations. However, the reliability of the GDS among African American older adults remains to be firmly established. In a baseline sample of 401 African American adults age 51 and over, the GDS-15 item short form demonstrates good internal consistency (KR20 = .71). Stability over a 15-month interval in a retest sample of 51 adults is deemed adequate (r = .68). These findings support the use of the GDS-15 item short form as a reliable mood questionnaire among African American older adults.     

Psychophysiological Identification of Depression Subtypes in Older Adults: Problematic Diagnostic Heterogeneity in the DSM-III-R and DSM-IV

The DSM-IV does not subclassify patients with depression on the basis of anxiety level. Hence a significant confound may exist in all outcome studies that employ DSM definitions of depression. To establish that objectively identifiable anxious and nonanxious subtypes of depression do indeed exist, a psychophysiological assessment battery was used with 114 treatment-seeking older adults. Dichotomous criterion categorization as either Nonanxious Depressed or Anxious Depressed was based on (a) DSM-III-R/DSM-IV diagnosis, and (b) standardized questionnaires of psychopathology. Multivariate analyses revealed no differences between groups when DSM criteria were used to classify participants. However, identical analyses using phenomenological diagnostic criteria indicated that anxious and nonanxious depressed participants differed in their psychophysiological response to negative imagery. Although anxious and nonanxious depressed participants evince different psychophysiological response patterns, these differences unfortunately are obscured by the DSM. Consequently, a phenomenological classification system may be more appropriate with affective disorders.     

Self-Reported Cognitive Inconsistency in Older Adults

ABSTRACT

Insight into one's own cognitive abilities, or metacognition, has been widely studied in developmental psychology. Relevance to the clinician is high, as memory complaints in older adults show an association with impending dementia, even after controlling for likely confounds. Another candidate marker of impending dementia under study is inconsistency in cognitive performance over short time intervals. Although there has been a recent proliferation of studies of cognitive inconsistency in older adults, to date, no one has examined adults' self-perceptions of cognitive inconsistency. Ninety-four community-dwelling older adults (aged 70–91) were randomly selected from a parent longitudinal study of short-term inconsistency and long-term cognitive change in aging. Participants completed a novel 40-item self-report measure of everyday cognitive inconsistency, including parallel scales indexing perceived inconsistency 5 years ago and at present, yielding measures of past, present, and 5-year change in inconsistency. The questionnaire showed acceptable psychometric characteristics. The sample reported an increase in perceived inconsistency over time. Higher reported present inconsistency and greater 5-year increase in inconsistency were associated with noncognitive (e.g., older age, poorer ADLs, poorer health, higher depression), metacognitive (e.g., poorer self-rated memory) and neuropsychological (e.g., poorer performance and greater 5-year decline in global cognitive status, vocabulary, and memory) measures. Correlations between self-reported inconsistency and neuropsychological performance were attenuated, but largely persisted when self-rated memory and age were controlled. Observed relationships between self-reported inconsistency and measures of neuropsychological (including memory) status and decline suggest that self-perceived inconsistency may be an area of relevance in evaluating older adults for memory disorders.     

Spiritual Wellness and Depression: Testing a Theoretical Model With Older Adolescents and Midlife Adults

Overall spiritual wellness, as well as 4 individual components of spiritual wellness, has been theoretically and empirically linked with depression. Prior to this investigation, no study has examined the relationship between spiritual wellness and depression by using a 4‐component measurement model of spiritual wellness. In this study of older adolescents and midlife adults, negative correlations between 4 components of spiritual wellness and depression were found for both groups. Results of multiple regression analyses showed that for both older adolescents and midlife adults, the only significant contributing factor of spiritual wellness to depression was meaning and purpose in life.