Celia F. Hybels

Abbreviating the Duke Social Support Index for Use in Chronically Ill Elderly Individuals

The 35-item Duke Social Support Index (DSSI) measures multiple dimensions of social support and has been used extensively in cross-sectional and longitudinal studies of aging. Epidemiological studies of chronically ill, frail elderly individuals often wish to include a measure of social support. However, most multidimensional measures (including the DSSI) are long and may exhaust the patient, especially when included in an often already congested interview schedule. The authors have developed two abbreviated versions of the DSSI (23-item and 11-item) that capture the essential components of social support related to mental health outcomes and use of health services in treating elderly individuals with nonpsychiatric medical illness.

Origins of depression in later life

BACKGROUND Despite the burden of depression in late life, its origins present a paradox to investigators and clinicians alike. METHOD We review biological (genetics and heredity factors, neurotransmitter dysfunction, endocrine changes, vascular disorders, and medical co-morbidities), psychological (personality attributes, neuroticism, cognitive distortions, and the lack of emotional control and self-efficacy) and social (stressful life events, bereavement, chronic stress or strain, socio-economic disadvantage and impaired social support) origins of late-life depression based upon an extensive though not exhaustive review of the extant literature. In addition, modifying psychological and social factors are discussed. RESULTS Older adults appear to be at greater risk for major depression biologically, such as depression resulting from vascular changes, yet the frequency of depression is lower compared to younger adults. Older adults may be protected psychologically due to factors such as socio-emotional selectivity and wisdom, compared to younger adults, and perhaps relatively protected from social risks. CONCLUSIONS A biopsychosocial approach to evaluating the origins of late-life depression is heuristically valuable, a continual reminder of the many factors that contribute to the onset and persistence of clinically significant symptoms in late life.

Epidemiology of late-life mental disorders

This article reviews the prevalence and incidence of mental disorders in older adults. The authors outline the epidemiologic challenges in determining the frequency of mental disorders in late-life and discuss issues that are critical for understanding the prevalence of the disorders and for reviewing the evidence from epidemiologic studies of mental disorders in this population. The authors summarize the epidemiologic data for depression, anxiety, dementia, schizophrenia, and alcoholism. Also included is a discussion of risk factors and outcomes of these disorders and a discussion of the implications of these epidemiologic findings for geriatric medicine.

What Symptoms of Depression Predict Mortality in Community‐Dwelling Elders?

Objectives: To determine which symptoms of depression are most likely to increase the risk of mortality in a biracial sample of older adults.

Sedative, Hypnotic, and Antianxiety Medication Use in an Aging Cohort over Ten Years: A Racial Comparison

OBJECTIVES: Prescriptions of sedatives, hypnotics, and antianxiety medications have decreased over the past 15 years. However, racial differences have not been well investigated in controlled analyses.

The Complex Relationship Between Depressive Symptoms and Functional Limitations in Community Dwelling Older Adults: The Impact of Subthreshold Depression

BACKGROUND Depressive symptoms above screening thresholds have been shown to predict functional decline in older adults. Less is known about the impact of subthreshold depression, and whether more symptoms confer significantly greater risk compared to fewer symptoms. METHOD Using data from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) collected over 10 years, we used repeated-measures mixed models to predict functional change by depression status at the prior (index) in-person interview. Depressive symptoms were measured using a modified version of the Center for Epidemiologic Studies Depression Scale (CES-D). Subthreshold depression was operationalized as 6-8 symptoms and CES-D-defined depression as 9-20 symptoms in the previous week. Three domains of functional status were assessed at the subsequent in-person interview: limitations in basic activities of daily living (ADL), instrumental ADL (IADL) and mobility. RESULTS Controlling for race, sex, age, education, marital status, cognitive status, health status, self-perceived health, perceived social support and functional status at the index interview, having 6 depressive symptoms predicted an increase of 0.12 IADL limitations 3-4 years later (p=0.03). The incremental effect of CES-D-defined depression (9 symptoms compared to 6-8 symptoms) was not significant, suggesting that the effect of more symptomatic depression did not add to that of subthreshold depression. CES-D score modeled as a continuous variable predicted functional change for all domains, but the relationship was not linear, supporting a possible threshold effect. CONCLUSIONS The relationship between depressive symptoms and functional change is complex, not necessarily linear, and may vary by tasks assessed.

The Combined Effect of Visual Impairment and Cognitive Impairment on Disability in Older People

OBJECTIVES: To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity.

Perception of Unmet Basic Needs as a Predictor of Mortality Among Community-Dwelling Older Adults

OBJECTIVES We sought to determine whether, among older adults (>65 years), a perception that their basic needs are not being met increased mortality risk and whether this risk varied by race/ethnicity. METHODS We used Cox proportional hazards modeling to estimate the effect of perceived inadequacy in having ones basic needs (adequacy of income, quality of housing, and neighborhood safety) met on 10-year mortality rates. RESULTS After control for age, gender, race/ethnicity, marital status, education, income, and cognitive and functional status at baseline, perceived inadequacy in having ones basic needs met was shown to be a significant predictor of mortality (P<.0001), but no significant differences by race/ethnicity were observed. CONCLUSIONS Perceived inadequacy in having ones basic needs met predicted mortality during a 10-year follow-up among community-dwelling elderly persons.

Sociodemographic Characteristics of the Neighborhood and Depressive Symptoms in Older Adults: Using Multilevel Modeling in Geriatric Psychiatry

OBJECTIVE Neighborhood sociodemographic characteristics may be important to the mental health of older adults who have decreased mobility and fewer resources. Our objective was to examine the association between neighborhood context and level of depressive symptomatology in older adults in a diverse geographic region of central North Carolina. METHODS The sample included 2,998 adults 65 or older residing in 91 census tracts. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Neighborhoods were characterized by five census-based characteristics: socioeconomic disadvantage, socioeconomic advantage, racial/ethnic heterogeneity, residential stability, and age structure. RESULTS In ecologic level analyses, level of census tract socioeconomic disadvantage was associated with increased depressive symptoms. To determine whether neighborhood context was associated with depressive symptoms independently of individual characteristics, the authors used multilevel modeling. The authors examined the ability of each of five neighborhood (level 2) characteristics to predict a level 1 outcome (CES-D symptoms) controlling for the effects of individual (level 1) characteristics. Younger age, being widowed, lower income, and having some functional limitations were associated with increased depression symptoms conditional on census tract random effects. However, none of the neighborhood characteristics was significantly associated with depression symptoms, conditional on census tract random effects, either unadjusted or adjusted for individual characteristics. CONCLUSION Any observed association between neighborhood sociodemographic characteristics and individual depressive symptoms in our sample may reflect the characteristics of the individuals who reside in the neighborhood rather than the neighborhood characteristics themselves. The use of multilevel modeling is important to separate these effects.

Change in stress and social support as predictors of cognitive decline in older adults with and without depression.

The relationship between stress, social support, and cognition in geriatric depression is complex. In this study, we sought to examine whether an increase in stressful life events or a decrease in social support would lead to subsequent cognitive decline among older adults with and without depression.