Deprescribing & Antidepressant Use in Older Adults

Research Paper Title

Long term antidepressant use in a cohort of older people.

Background

Depression is the most common mental health problem in older adults and untreated is associated with significant burden of illness for patients. This study aimed to examine longitudinal patterns of antidepressant use in older adults and determine which factors were associated with changes in use.

Methods

Adults aged 50 and over, from the Irish Longitudinal Study on Ageing, who participated at any one of the four TILDA waves (n = 8,175) were included in the analysis. Repeated measures latent class analysis (RMLCA) is the model-based approach we used to identify underlying subgroups in a population.

Results

The researchers found antidepressant use ranged from 6% to 10%, over a 6-year period. RMLCA identified three distinct classes of anti-depressant use. Notably, 6% of older adults were categorised in a ‘long-term antidepressant use’ class, with consistent use across all four waves, and 6% were categorised in an ‘Intermittent/ Developing Use’ class. We found long-term antidepressant use to be a characteristic of older adults with chronic conditions at baseline of study and striking low uptake of psychological and psychiatric services.

Conclusions

These findings provide evidence of the complex presentations of depression with comorbidities in long-term antidepressant users. While prolonged use of antidepressants in an older cohort is often rationalised due to recurrent depression and comorbidities, this study suggests little deprescribing of antidepressants and a need for greater access and provision of psychological services tailored to later life seem necessary to improve management of this condition.

Reference

O’Neill, A., McFarland, J. & Kelly, D. (2021) Long term antidepressant use in a cohort of older people. International Journal of Geriatric Psychiatry. doi: 10.1002/gps.5518. Online ahead of print.

Pre-Clinical Dementia & Depression

Research Paper Title

A cross-national study of depression in preclinical dementia: A COSMIC collaboration study.

Background

Depression commonly accompanies Alzheimer’s disease, but the nature of this association remains uncertain.

Methods

Longitudinal data from the COSMIC consortium were harmonized for eight population-based cohorts from four continents.

Incident dementia was diagnosed in 646 participants, with a median follow-up time of 5.6 years to diagnosis.

The association between years to dementia diagnosis and successive depressive states was assessed using a mixed effect logistic regression model.

A generic inverse variance method was used to group study results, construct forest plots, and generate heterogeneity statistics.

Results

A common trajectory was observed showing an increase in the incidence of depression as the time to dementia diagnosis decreased despite cross-national variability in depression rates.

Conclusions

The results support the hypothesis that depression occurring in the preclinical phases of dementia is more likely to be attributable to dementia-related brain changes than environment or reverse causality.

Reference

Carles, S., Carriere, I., Reppermund, S., Davin, A., Guaita, A. et al. (2020) A cross-national study of depression in preclinical dementia: A COSMIC collaboration study. Alzheimer’s & Dementia. doi: 10.1002/alz.12149. Online ahead of print.

Do Older Adults with Parent(s) Alive Experience Higher Psychological Pain and Suicidal Ideation?

Research Paper Title

Do Older Adults with Parent(s) Alive Experience Higher Psychological Pain and Suicidal Ideation? A Cross-Sectional Study in China.

Background

Elderly mental health promotion is an important task in the current “Healthy China Action”.

This study aims to:

  1. Clarify the psychological pain and suicidal ideation of the Chinese elderly with different parental states;
  2. Examine the associated factors of psychological pain and suicidal ideation; and
  3. Examine the relationship between psychological pain and suicidal ideation.

Methods

A sample of 4622 adults aged 60 years and older were included in this study, from the China’s Health-related Quality of Life Survey for Older Adults 2018.

Results

Participants with both parents alive demonstrated the heaviest psychological pain, and those with one parent alive observed significantly lowest psychological pain and suicidal ideation.

Participants who were single, divorced, or widowed, live in rural areas, had higher education level, had lower family income, suffered from two or more chronic diseases, and had no self-care ability were more likely to experience psychological pain and suicidal ideation.

In addition, higher psychological pain was significantly associated with the occurrence of suicidal ideation.

Conclusions

In China, much more attention should be paid to the mental health condition of the elderly, especially for those with both parents alive.

Moreover, the associated factors above should be considered to develop targeted health interventions.

Reference

Yang, Y., Wang, S., Hu, B., HAo, J., Hu, R., Zhou, Y. & Mao, Zongfu. (2020) Do Older Adults with Parent(s) Alive Experience Higher Psychological Pain and Suicidal Ideation? A Cross-Sectional Study in China. International Journal of Environmental Research and Public Health. 17(17), pp.E6399. doi: 10.3390/ijerph17176399.

Respect for the Aged Day

Introduction

Respect for the Aged Day (敬老の日, Keirō no Hi) is a Japanese designated public holiday celebrated annually to honour elderly citizens.

Annually, Japanese media take the opportunity to feature the elderly, reporting on the population and highlighting the oldest people in the country.

Brief History

  • This national holiday traces its origins to 1947, when Nomadani-mura (later Yachiyo-cho, currently Taka-cho), Hyōgo Prefecture, proclaimed 15 September Old Folks’ Day (Toshiyori no Hi).
  • Its popularity spread nationwide, and in 1966 it took its present name and status, becoming a national holiday and officially being held on every 15 September.
  • Since 2003, Respect for the Aged Day is held on the third Monday of September due to the Happy Monday System.

Commemorative Silver Sake Cups

  • Since 1963, the Japanese government has given a commemorative silver sake cup to Japanese who reach the age of 100.
  • In 1963 the number was 153, but with numbers increasing, in 2009, the government decided to reduce the size of the cup to cut costs.
  • In 2014, 29,357 received a cup.
  • The cost increase from this led to the government considering making the cups from a different material or simply sending a letter.

Celebration

On this holiday, people return home to visit and pay respect to the elders. Some people volunteer in neighbourhoods by making and distributing free lunch boxes to older citizens. Entertainments are sometimes provided by teenagers and children with various keirokai performances. Special television programmes are also featured by Japanese media on this holiday.

What is the Association with Several Physical, Mental, & Cognitive Health Outcomes with Gait Speed in Older Adults?

Research Paper Title

Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes.

Background

Although clinical gait speed may indicate health and wellbeing in older adults, there is a lack of studies comparing clinical tests with ambulatory gait speed with regard to several health outcomes.

The objective of this study was to examine the associations of clinical gait speed, measured by the 2.44 meter walk test and the ambulatory gait speed with several physical, mental, and cognitive health outcomes in older adults.

A cross-sectional design was used.

Methods

The study population comprised 432 high-functioning community-dwelling older adults (287 women) aged between 65 and 92.

Clinical and ambulatory gait speeds were measured using the 2.44 m walk test and a portable gait analysis device, respectively.

Multiple linear regressions were used to examine the association of clinical and ambulatory gait speeds with several health outcomes (BMI, waist circumference, systolic and diastolic blood pressure, chronic conditions, self-rated health, exhaustion, upper and lower body strength, physical and mental health status, cognitive status and self-rated cognitive status).

Results

The results showed that the average gait speed for clinical and ambulatory measures cannot be directly compared.

Clinical gait speed was associated with 7 health outcomes, while the ambulatory gait speed was associated with 6 health outcomes.

The significant associations between measures of gait speed and the health outcomes converged in 5 of the 13 health outcomes studied, however, the strength of associations were singly different between measures.

The short monitoring time, the inability to distinguish between the ambulatory gait speed inside the home and outdoor gait speed, and the under-representative sample are limitations of the study.

Conclusions

The results indicated differences in the number and strength of associations between clinical and ambulatory gait speed.

Both measures have construct validity because they have been associated with physical and health outcomes, however, they may have different predictive validity.

Further research should be done to compare their predictive validity in longitudinal designs.

Reference

De la Cámara, M.Á., Higueras-Fresnillo, S., Sadarangani, K.P., Esteban-Cornejo, I., Martinez-Gomez, D. & Veiga, Ó.L. (2020) Clinical and Ambulatory Gait Speed in Older Adults: Associations With Several Physical, Mental, and Cognitive Health Outcomes. Physical Therapy. pii: pzz186. doi: 10.1093/ptj/pzz186. [Epub ahead of print].

Suicide in Older Adults: A Critical Problem

Research Paper Title

Suicide in Older Adults.

Abstract

Suicide in older adults is a critical problem that nurses and other health professionals need to address. Evidence-based interventions for prevention of late-life suicide are urgently needed, as well as increased availability of health care professionals with knowledge and skills to recognise suicide risks and intervene to provide effective care for this vulnerable population.

Reference

Sorrell, J.M. (2020) Suicide in Older Adults. Journal of Psychosocial Nursing and Mental Health Services. 58(1), pp.17-20. doi: 10.3928/02793695-20191218-04.