Depression in Japanese community-dwelling elderly—prevalence and association with ADL and QOL

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Abstract

This cross-sectional study examined the prevalence of screening-based depression and compared the scores of activities of daily living (ADL) and quality of life (QOL) between community-dwelling elderly subjects with and without depression in Japan. Elderly subjects aged 65 or older living in four rural towns participated in 2000 or 2001 (n=5363, female 58.3%, mean (S.D.) age 74.6 (7.0) years). Depressive symptoms were assessed using a 15-item Geriatric Depression Scale (GDS-15) and ADL, higher functions, and medical and social histories were assessed by self-report questionnaires. For assessing subjective QOL, a 100 mm visual analogue scale was used. One thousand seven hundred ninety-eight participants (33.5%, range, 32.3–34.6%) had suggestive depression using cutoff 5/6 of GDS-15. Subjects with depression revealed significantly lower scores for ADL and QOL than those without depression. Prevalence of screening-based depression was similar in the four different rural Japanese towns. However, the reported prevalence of depression varies enormously in different country. Primary physicians and caregivers should pay more attention to depression in the community-dwelling elderly population, especially below the threshold of major depression as minor depression or dysthymia.

Introduction

Depressive illness is a major threat not only to mental health and well-being in the elderly patients but also to primary physician and caregivers concerned. Depressive illness is projected to be the second leading cause of disability world wide in 2020 (Murray and Lopez, 1997). Thirty-four studies have reported a prevalence of depression in the community-dwelling elderly, but their rates vary enormously (0.4–35%) (Beekman et al., 1999). Methodological differences among studies preclude firm conclusions about cross-cultural and geographical variation of prevalence of depression. In the community, the point prevalence of major depression ranges from 1 to 2% among the elderly (Unutzer et al., 1997, Penninx et al., 1998), but other disabling depressive illnesses include dysthymia (a chronic low-grade depression) and minor depression (an episodic, less severe illness) are common in the elderly.

Nowadays, pursuit of the successful ageing is emphasized and comprehensive geriatric assessment is considered to be very important for its achievement (Rowe and Kahn, 1987). The health status of the elderly should be measured comprehensively not only for the physical condition, but also the emotional condition, social activity and quality of life (QOL). In the community-based settings, depression in the elderly is difficult to define clearly and the significance of depression screening for the comprehensive health status of the elderly has remained unclear. To our knowledge, there have been very few reports addressing depression related to both activities of daily Living (ADL) and QOL, especially, in the community-based settings. Xavier et al. (2002) reported subjects with minor depression were significantly associated with lower life satisfaction and worse indices of life quality in Brazil, but a random sample size was only 77 in their study. The purpose of this study was to examine a prevalence of depression defined as 15-item Geriatric Depression Scale (GDS-15) in 5363 people aged 65 years or older living in four different rural communities in Japan, and to clarify the relationship of depression with quantitative ADL and QOL scores in these individuals.

Section snippets

Subjects and methods

Five thousand three hundred sixty-three Japanese subjects aged 65 or older living in four different Japanese towns (U town in Hokkaido, Y town in Shiga, S town in Kyoto, and M town in Mie Prefectures) completed the survey between June 2000 and June 2001. The four communities had a population of 27,700 (2700, 4200, 16,700, and 4100, respectively), and the proportion of aged 65 years or older was 25.5% (29.0, 28.0, 20.0, and 37.4%, respectively). All the elderly living in those towns was given a

Results

The characteristics of the 5863 subjects from the four different populations are shown in Table 1. According to the certificate of residence, 7056 elderly lived in those four areas (U town = 783, Y town = 1100, S town = 3652, and M town = 1521, respectively), and 83.1% (95.1, 89.2, 76.2, and 89.1%, respectively) of eligible subjects participated in and completed this study.

In M town, subjects living alone reported the highest incidence of osteoarthropathies, which mainly involved knees and

Discussion

The results show that 33.5% (32.3–34.6%) of community-dwelling elderly subjects reported screening-based mild depression (GDS-15 scores of 6–15). The reported prevalence of screening-based depression using a cutoff of 5/6 of GDS-15 in foreign countries varies widely, 14% in a US study (Whooley et al., 2000), and 40.2% in an Estonian study (Kai et al., 2002). In this study, the prevalence of depression among the elderly in four different towns was very similar regardless of geographical

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