Examining functional and social determinants of depression in community-dwelling older adults: Implications for practice

doi:10.1016/j.gerinurse.2014.04.006

Geriatric Nursing

Volume 35, Issue 3, May–June 2014, Pages 236-240

https://doi.org/10.1016/j.gerinurse.2014.04.006 Get rights and content

Abstract

Coping with declining health, physical illnesses and complex medical regimens, which are all too common among many older adults, requires significant lifestyle changes and causes increasing self-management demands. Depression occurs in community-dwelling older adults as both demands and losses increase, but this problem is drastically underestimated and under-recognized. Depressive symptoms are often attributed to physical illnesses and thus overlooked, resulting in lack of appropriate treatment and diminished quality of life. The purpose of this study is to assess prevalence of depressive symptoms in community-dwelling older adults with high levels of co-morbidity and to identify correlates of depression. In this sample of 533 homebound older adults screened (76.1% female, 71.8% white, mean age 78.5 years) who were screened using the Geriatric Depression Scale (SF), 35.9% scored greater than 5. Decreased satisfaction with family support (p << 0.001) and functional status (p ≤ 0.001) and increased loneliness (p < 0.001) were significant independent predictors of depression status in this sample; thus, these factors should be considered when planning care.

Section snippets

Introduction and background

Depression is a serious problem facing older adults living in the community, a problem that is compounded by the fact that it is drastically underestimated and under recognized. The prevalence rate for major depressive disorder (MDD) is lower in older adults than in younger adults,1, 2 suggesting that this older population is at significant less risk for developing the depression. There is a discrepancy in the literature regarding rates of depressive symptoms in the older population. While many

Participants and procedure

Participants in this study included 533 homebound, community-dwelling older adults living in rural areas in the southern U.S. After obtaining permission, representative members of a community coalition from local Area Agencies on Aging (AAA) referred homebound clients 60 years and over who were determined by these AAA case managers to benefit from health screenings in the home. Clients were selected on the basis of reported health conditions, including complex and/or unstable health problems,

Characteristics of the sample

The sample in this study of 533 homebound older adults, was 76.1% (n = 406) female and 71.8% (n = 383) white. The mean age was 78.5 years (SD = 8.8; range = 60–100), and 48% were 80 or older. The mean level of education (measured by reports of last grade of school completed) was 7.9 years (SD = 3.6; range: 0–20 years), with 55.4% completing eight grades or less. Forty-three percent received Supplemental Security Income (SSI). Only 18.5% received some form of retirement income in addition to

Discussion

Previous studies examining depression in older adults have shown that a score greater than five on the GDS-SF is useful in screening for depression.¹⁹ Using this parameter, the prevalence of depressive symptoms was significantly high in homebound older adults screened in this study. Results indicate that satisfaction with family support, functional dependence for activities of daily living, and feelings of loneliness are useful predictors of depression in this sample of community-dwelling,

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The association between intergenerational relationships and depression among older adults: A comprehensive systematic literature review
2024, Archives of Gerontology and Geriatrics
This systematic review aims to comprehensively examine the relationship between intergenerational relationships and depression among older adults in Eastern Asian countries.
For this research, a systematic search was conducted on several electronic databases including PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar search engine up until June 2023.
Out of 953 articles initially identified, 33 met the inclusion criteria. Emotional support and financial support emerged as crucial factors that can significantly reduce depressive symptoms among older individuals. However, there are diverse and sometimes contradictory results regarding the impact of intergenerational instrumental support on depression in older adults.
Promoting positive intergenerational relationships and enhancing support systems can greatly benefit the mental health of older adults by addressing depression within this population. This review enhances our understanding of the complex relationship between intergenerational relationships and depression among older adults. The diverse findings on intergenerational instrumental support and depression in older adults suggest the need for further research to clarify this relationship and its nuances. This research may have practical implications for policies and interventions aimed at improving the mental well-being of older adults in Eastern Asian countries.
Loneliness in Community-Dwelling, Older Adults: An Integrative Review
2023, Journal for Nurse Practitioners
Citation Excerpt :
Abedini et al38 noted the significance of screening for, preventing, and mitigating loneliness during the end-of-life period. Integrating loneliness screening tools may help target interventions and identify health disparities contributing to loneliness.22,31,39 An increase in the identification of loneliness in community-dwelling older adults through the use of a loneliness screening tool will support continued implementation of the screening intervention while also supporting further research on the implementation of curricula to educate and train health care professionals on loneliness.
Loneliness is a major public health concern impacting the well-being of older adults. Loneliness increases older adults’ risk of adverse health outcomes. Approximately 35% of adults over age 65 report frequent feelings of loneliness. A comprehensive search was performed of the literature published from 2011 to 2021. Primary studies that examined or described loneliness in the community-dwelling, older adult US population were included. The evidence was synthesized, and common themes were identified. Twenty-two studies were included. The University of California Los Angeles Loneliness Scale was the most frequently used measurement tool. Older adults experienced physical and psychological changes associated with loneliness. Common approaches to reduce loneliness included community-based, person-centered, and socialization approaches. Loneliness increases older adults’ risk of adverse health outcomes. Future studies should consider the impact of loneliness on older adults across diverse backgrounds. The integration of loneliness screening tools may help promote targeted interventions and improve quality of care.
Mental health of homebound older adults in China
2022, Geriatric Nursing
Citation Excerpt :
Thirdly, mental health problems require an interdisciplinary and community-based approach. Social workers, who provide care management, stress reduction, and depression education, along with existing aging network services, have exhibited positive results in addressing depression among homebound older adults.34 Community-integrated home-based interventions and non-pharmacological interventions, such as psychological therapy, were found to be not only useful but also cost-effective.35,36
The mental health status of the homebound population in China is relatively overlooked. A sample of 1,301 older adults from Shandong Province was used to compare the mental health status among homebound, semi-homebound, and non-homebound older adults in China, and examine the moderation effects of loneliness and gender. This study found that, controlling for demographic and physical health status, the homebound population was more likely to have worse mental health status than non-homebound older adults. Experiencing loneliness intensified the adverse effects of being homebound on older adults’ mental health. The negative effects of being semi-homebound on mental health were more pronounced among older males than females. Findings from this study suggested that homebound older adults in China experienced psychological challenges. Social programs and interventions may be designed to improve this population's mental health.
Cognitive Issues: Decline, Delirium, Depression, Dementia
2017, Nursing Clinics of North America
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Sensory deficits, especially in older persons who are hard of hearing, are risk factors for depression. Loneliness and functional decline also place older persons at risk.32 Valid tools for older persons should be used to screen for depression (Table 2).
Homebound older adults: Prevalence, characteristics, health care utilization and quality of care
2015, Geriatric Nursing
Citation Excerpt :
This prevalence rate of homebound older adults is similar to the rates characterized by Cohen-Mansfield et al. (17.7%–19.5%; 2012)16 among Israeli older adults (75 years and older) and in line with the 23.5% with ambulatory disabilities reported by the US Census Bureau in the US (65 years and older).14 Similar to other research studies, our homebound older adult population reported high levels of depression (28.8%), chronic conditions (33.4% with 2 or more conditions), prescription drug use (47.9% using 5 or more medications) and hospitalizations (31.6% with at least one hospitalization in the past year).4,13,15,16,18,19 The strongest predictor of homebound status was cognitive impairment (self-reported memory loss).
The purpose of this study was to estimate prevalence rates of homebound older adults, their characteristics and the impact of homebound status on health care utilization, expenditures and quality of medical care measures. Surveys were sent to new enrollees (n = 25,725) in AARP^® Medicare Supplement plans (insured through UnitedHealthcare) to screen for serious chronic conditions, ambulatory disabilities and eligibility for care coordination programs. Health care utilization and expenditures were determined from paid claims. Member-level quality measures considered compliance with medication adherence and care patterns. Among survey respondents, 19.6% were classified as being homebound. The strongest predictors of being homebound included serious memory loss, being older, having more chronic conditions, taking more prescription medications and having multiple hospitalizations. Homebound had significantly higher health care utilization and expenditures. Homebound were more likely to be noncompliant with medication adherence and care pattern rules. Ongoing screening and subsequent interventions for new enrollees classified as homebound may be warranted.
The importance of social activity to risk of major depression in older adults
2023, Psychological Medicine

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NGNA SectionExamining functional and social determinants of depression in community-dwelling older adults: Implications for practice

Abstract

Section snippets

Introduction and background

Participants and procedure

Characteristics of the sample

Discussion

J Affect Disord

J Affect Disord

Am J Geriatr Psychiatry

J Psychiatr Res

Am J Prev Med

Depression in older adults

BMJ

High occurrence of mood and anxiety disorders among older adults. The National Comorbidity Survey Replication

Arch Gen Psychiatry

U.S. Department of Health and Human Services

The trajectory of depressive symptoms across the adult life span

JAMA Psychiatry