Aisling Denihan

Loneliness, social support networks, mood and wellbeing in community‐dwelling elderly

Both loneliness and social networks have been linked with mood and wellbeing. However, few studies have examined these factors simultaneously in community‐dwelling participants. The aim of this study was to examine the relationship between social network, loneliness, depression, anxiety and quality of life in community dwelling older people living in Dublin.

Benzodiazepine use among the elderly in the community

Benzodiazepines are the most commonly prescribed psychotropic drug in the elderly. Benzodiazepines with a long duration of action can produce marked sedation and psychomotor impairment in older people, and are associated with an increased risk of hip fracture and of motor vehicle crash. One thousand seven hundred and one individuals of 65 years and over, identified from General Practitioner lists, were interviewed using the Geriatric Mental State‐AGECAT package and current psychotropic drug use was recorded. Benzodiazepines were classified as having a short or long elimination half‐life. Two hundred and ninety‐five (17.3%) individuals were taking a benzodiazepine, with use in females being twice that in males. Of the 295, 152 (51.5%) were taking a long acting benzodiazepine and the use of long acting anxiolytic type benzodiazepines was particularly common. Fifty‐two (17.6%) benzodiazepine users were taking one or more other psychotropic drugs. A benzodiazepine was used by eight of 18 (44.4%) subjects with an anxiety disorder, 62 of 180 (34.4%) individuals with depression, and seven of 71 (9.9%) people with dementia. Four‐fifths of older people on a psychotropic drug were taking a benzodiazepine, highlighting the importance of this class of drug in the elderly population. The choice of a benzodiazepine with a long duration of action, which have been shown to be associated with serious adverse events in the elderly in over one half of benzodiazepine users, is of concern. The potential for adverse effects was further accentuated by polypharmacy practices. The choice of benzodiazepine for an older person has important consequences and should be addressed in greater detail with primary care. Copyright

Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults

It has been reported that late onset depression is more frequently associated with acquired organic pathology and that patients are less likely to report a family history of depression. Differences in phenomenology according to age of onset have been described although these have not been consistently replicated. The majority of these studies have been in hospital populations. The aim of this study is to address this question in a sample of community dwelling older adults.

The spectrum of worry in the community-dwelling elderly

Objectives: In this study, we examine the prevalence and distribution of worry, its content, and its associations with quality of life and depression, based on a large sample of community-dwelling elderly. We will attempt to distinguish between pathological and non-pathological worry based on these associations. Design: Community survey. Setting: Inner-city population. Participants: A total of 2136 people aged between 65 and 96, of whom 66% were women, were recruited through general practitioners and interviewed in their own homes. Measurements: The GMS-AGECAT structured psychiatric interview was used to rate symptoms which were classified into five levels of severity of worry ranging from simple, non-excessive to generalised anxiety disorder (GAD). Results: In this study, 79% of the participants reported worrying, 37% worrying excessively, while 20% reported excessive, uncontrollable worry and 6.3% met criteria for GAD. Prevalence of all types of worry declined with age and was lower in men. The prevalence of depressed mood was similar in those without worry and those with non-severe worry (Wald post hoc test, p = 0.06) but rose significantly with each level of severe worry (Wald post hoc tests, all p < 0.05). Major depressive disorder was absent in those who did not worry, and had a prevalence of only 0.2% in those with non-severe worry (p = 0.552, Fishers exact test). It has a significantly elevated prevalence at all levels of excessive worry, and a significantly higher prevalence in those with GAD. All levels of excessive worry were associated with reduced quality of life. Conclusion: Severe worry is highly prevalent in the elderly; most severe worriers do not meet criteria for GAD, but have a reduced quality of life and an increased prevalence of depression.

Psychiatric morbidity in cohabitants of community‐dwelling elderly depressives

Objective. To determine the effect of living with a depressed elderly individual on the mental health of the cohabitant carer.

The pattern of support networks among the community dwelling elderly in urban Ireland: variations with mental disorder

Objectives : The changing family and social patterns in modern society are likely to influence the availability of informal support for older people. The aims of this study were to determine the support network distribution of a community dwelling elderly population in Dublin, and of those with mental disorders (dementia, depression and anxiety). Methods : Interviews with 1,001 community dwelling older people using GMS-AGECAT. In addition, a support network assessment instrument was administered, which identifies five different support network types. The local integrated and wider community focused networks are characterised by extensive community involvement, family dependent networks by close family support, and the local self contained and private restricted networks by low levels of family and community involvement. Results : Of the elderly population, 83% had support networks characterised by close community and/or family involvement. Subjects with cognitive impairment had lower levels of informal support from the community, as indicated by a lower proportion of local integrated (44% v 63%) and a higher proportion of private restricted (6% v 12%) networks. Late life depression was also associated with decreased levels of community integration. Conclusions : The elderly in Dublin appear to have high levels of informal support. The extensive support may be a factor in the lower rates of depression found in Dublin than in London and New York. While the overall level of informal support available to older people with mental disorders in the community remains high, a proportion have low levels of family and community involvement and consequently their mental health problems may go unrecognised.