Depressive symptoms in relation to physical health and functioning in the elderly
TL;DR: The authors conclude that physical disabilities among the elderly do not appear to be a major threat to the validity of the CES-D scale and that the strong associations between physical and mental health should be rigorously investigated.
Abstract: The associations between depressive symptoms and functional disability and chronic conditions are examined in an elderly cohort of 2,806 noninstitutionalized men and women living in New Haven, Connecticut who were interviewed in 1982 as a part of the Yale Health and Aging Project. The aim is to explore several potential sources of invalidity in using the Center for Epidemiologic Studies-Depression scale (CES-D) to measure depressive symptoms in elderly populations. In particular, the authors are concerned with the possibility that prevalent physical illnesses and disabilities may cause the older person to report many somatic complaints, a major component of most measures of depressive symptomatology, and thereby inflate his or her CES-D score. Mean CES-D scores are 4.86 for those without any disabilities and range to 13.51 for those with major functional disabilities. However, physical disability is significantly associated with virtually every item on the CES-D scale not just those somatically-oriented items. The addition of functional disability to a multivariate model including age subfactor analysis of responses from this elderly sample produces results almost identical to those reported by earlier investigators who studied younger and middle-aged adults. The authors conclude that physical disabilities among the elderly do not appear to be a major threat to the validity of the CES-D scale and that the strong associations between physical and mental health should be rigorously investigated.
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TL;DR: It is concluded that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.
Abstract: To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.
6,197 citations
TL;DR: Performance tests of lower extremity function accurately predict disability across diverse populations and Equations derived from models using both the summary score and the gait speed alone allow for the estimation of risk of disability in community-dwelling populations and provide valuable information for estimating sample size for clinical trials of disability prevention.
Abstract: Background. Although it has been demonstrated that physical performance measures predict incident disability in previously nondisabled older persons, the available data have not been fully developed to create usable methods for determining risk profiles in community-dwelling populations. Using several populations and different follow-up periods, this study replicates previous findings by using the Established Populations for the Epidemiologic Study of the Elderly (EPESE) performance battery and provides equations for the prediction of disability risk according to age, sex, and level of performance. Methods. Tests of balance, time to walk 8 ft, and time to rise from a chair 5 times were administered to 4,588 initially nondisabled persons in the four sites of the EPESE and to 1,946 initially nondisabled persons in the Hispanic EPESE. Follow-up assessment for activity of daily living (ADL) and mobility-related disability occurred from 1 to 6 years later. Results. In the EPESE, compared with those with the best performance (EPESE summary performance score of 10‐ 12), the relative risks of mobility-related disability for those with scores of 4‐6 ranged from 2.9 to 4.9 and the relative risk of disability for those with scores of 7‐9 ranged from 1.5 to 2.1, with similar consistent results for ADL disability. The observed rates of incident disability according to performance level in the Hispanic EPESE agreed closely with rates predicted from models developed from the EPESE sites. Receiver operating characteristic curves showed that gait speed alone performed almost as well as the full battery in predicting incident disability. Conclusions. Performance tests of lower extremity function accurately predict disability across diverse populations. Equations derived from models using both the summary score and the gait speed alone allow for the estimation of risk of disability in community-dwelling populations and provide valuable information for estimating sample size for clinical trials of disability prevention.
2,513 citations
Cites methods from "Depressive symptoms in relation to ..."
...Disability Status at Follow-up Disability status at follow-up, based on self-report or proxy report, used a three-level hierarchical scale (9,17) that contains a subset of questions from a scale originally developed by Berkman and colleagues (18)....
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TL;DR: The extant evidence regarding the etiology of depression in late life from a biopsychosocial perspective is presented and the current therapies prescribed for depressed elders, ranging from medications to group therapy are presented.
Abstract: Depression is perhaps the most frequent cause of emotional suffering in later life and significantly decreases quality of life in older adults. In recent years, the literature on late-life depression has exploded. Many gaps in our understanding of the outcome of late-life depression have been filled. Intriguing findings have emerged regarding the etiology of late-onset depression. The number of studies documenting the evidence base for therapy has increased dramatically. Here, I first address case definition, and then I review the current community- and clinic-based epidemiological studies. Next I address the outcome of late-life depression, including morbidity and mortality studies. Then I present the extant evidence regarding the etiology of depression in late life from a biopsychosocial perspective. Finally, I present evidence for the current therapies prescribed for depressed elders, ranging from medications to group therapy.
2,034 citations
Cites background from "Depressive symptoms in relation to ..."
...’’ When the factor structure for the range of depressive symptoms is examined across the life cycle, there are no major differences between Caucasians and African Americans (23), between men and women (4,23), or between older and younger adults (4,24)....
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...In studies of samples of mixed Caucasians and African Americans, rates are similar (2,4)....
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...Reports of the prevalence of clinically significant depressive symptoms among community-dwelling older adults range from approximately 8% to 16% (2,4,9,62,65)....
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...(4) Community sample of adults 651 y of...
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TL;DR: In this paper, a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index was conducted in a multisite survey of persons 65 and older.
Abstract: Brief measurement devices can alleviate respondent burden and lower refusal rates in surveys. This article reports on a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index in a multisite survey of persons 65 and older. Factor analyses demonstrate that the briefer forms tap the same symptoms dimensions as does the original CES-D, and reliability statistics indicate that they sacrifice little precision. Simple transformations are presented to how scores from the briefer forms can be compared to those of the original.
1,949 citations
TL;DR: Treatment of depression in patients with CVD improves their dysphoria and other signs and symptoms of depression, improves quality of life, and perhaps even increases longevity.
Abstract: This article reviews the burgeoning literature on the relationship of mood disorders and heart disease. Major depression and depressive symptoms, although commonly encountered in medical populations, are frequently underdiagnosed and undertreated in patients with cardiovascular disease (CVD). This is of particular importance because several studies have shown depression and its associated symptoms to be a major risk factor for both the development of CVD and death after an index myocardial infarction. This review of the extant literature is derived from MEDLINE searches (1966-1997) using the search terms "major depression," "psychiatry," "cardiovascular disease," and "pathophysiology." Studies investigating pathophysiological alterations related to CVD in depressed patients are reviewed. The few studies on treatment of depression in patients with CVD are also described. Treatment of depression in patients with CVD improves their dysphoria and other signs and symptoms of depression, improves quality of life, and perhaps even increases longevity. Recommendations for future research are proposed.
1,567 citations
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TL;DR: The CES-D scale as discussed by the authors is a short self-report scale designed to measure depressive symptomatology in the general population, which has been used in household interview surveys and in psychiatric settings.
Abstract: The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
48,339 citations
TL;DR: The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out and a wide variety of psychiatric rating scales have been developed.
Abstract: The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations." Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15These have been well summarized in a review article by Lorr11on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
35,176 citations
TL;DR: The general depression scales used were felt to be insufficient for the purpose of this research project and the more specific scales were also inadequate.
Abstract: The fact that there is a need for assessing depression, whether as an affect, a symptom, or a disorder is obvious by the numerous scales and inventories available and in use today. The need to assess depression simply and specifically as a psychiatric disorder has not been met by most scales available today. We became acutely aware of this situation in a research project where we needed to correlate both the presence and severity of a depressive disorder in patients with other parameters such as arousal response during sleep and changes with treatment of the depressive disorder. It was felt that the general depression scales used were insufficient for our purpose and that the more specific scales were also inadequate. These inadequacies related to factors such as the length of a scale or inventory being too long and too time consuming, especially for a patient
8,413 citations
7,863 citations
TL;DR: Results show that the CES-D scale is a sensitive tool for detecting depressive symptoms and change in symptoms over time in psychiatric populations, and that it agrees quite well with more lengthy self-report scales used in clinical studies and with clinician interview ratings.
Abstract: Data from five psychiatric populations and a community sample are presented on the CES-D, 20-item self-report depression symptom scale developed by the Center for Epidemiologic Studies. Results show that the scale is a sensitive tool for detecting depressive symptoms and change in symptoms over time in psychiatric populations, and that it agrees quite well with more lengthy self-report scales used in clinical studies and with clinician interview ratings. Although a symptom scale cannot differentiate between diagnositc groups, the CES-D has demonstrated its validity as a screening tool for detecting depressive symptoms in psychiatric populations.
2,118 citations