Chih-Jung Yeh

Leisure activity, mobility limitation and stress as modifiable risk factors for depressive symptoms in the elderly: results of a national longitudinal study.

Few national longitudinal studies have investigated the modifiable risk factors for depression in the elderly. This study investigated the risk factors and health-related behaviors associated with depressive symptoms using a national survey of Taiwanese elderly with a 4-year follow-up period. In this prospective cohort study, 1481 non-demented population-based elderly were interviewed at baseline in 2003 and at follow-up in 2007. The independent variables included demographics, chronic medical diseases and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms assessed at follow-up. Reduced rank regression was applied to characterize independent factors related to depressive symptoms. The prevalence of depressive symptoms at follow-up was 21.1%. The results of multivariate analyses revealed three independent risk factors for depressive symptoms: fewer leisure activities (odds ratio, OR=0.56, 95% confidence interval, CI=0.38-0.83, p=0.0034), more mobility limitations (OR=1.93, 95% CI=1.30-2.86, p=0.0011) and higher stress levels (OR=2.43, 95% CI=1.68-3.50, p<0.0001). The leisure activities least associated with depression were reading newspapers/books and doing outdoor building projects; the two mobility limitations most associated with depression were difficulty in lifting things and in climbing stairs. The two stresses most associated with depression were perceived health stress and financial stress. These results indicated that interventions to prevent or reduce depression in older adults should include practical strategies aimed at these modifiable risk factors.

Social support and mobility limitation as modifiable predictors of improvement in depressive symptoms in the elderly: Results of a national longitudinal study

Few national longitudinal studies have investigated the predictors of a better depression outcome in geriatric depression. This study examined the predictors of improvement in case-level depressive symptoms in the elderly. In this prospective cohort and population-based study in Taiwan, 206 non-demented and case-level depressed subjects aged 65 and older were interviewed at baseline in 2003 and follow-up in 2007. The independent variables included demographics, chronic medical diseases, and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms, assessed using the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CESD-10) assessed at follow-up. Multivariate analyses were used to identify the predictors of improvement in depression. The independent predictors of improvement in depression over a 4-year follow-up period are more social support and fewer mobility limitations at baseline. With regards to practical health-related behaviors, the 2 items of social support most associated with improvement in depression were willingness of significant others to talk with you and satisfaction with dependence upon significant others; the 2 items of mobility limitations most associated with non-improvement of depression were difficulty in carrying things and squatting. These findings suggested that health-related behaviors were important to the depression outcome in the elderly; moreover, interventions to improve depression should include practical health-related behaviors aimed at these modifiable risk factors.

Change in depressive status and mortality in elderly persons: results of a national longitudinal study.

The authors aimed to investigate whether a change in depressive status was associated with a change in the risk of mortality in the elderly during a four-year follow-up period. Data came from the Survey of Health and Living Status of the Elderly in Taiwan. A cohort of 1784 men and women in Taiwan aged 65 or older who were assessed on two occasions in 1999 and 2003, and subsequently followed up until 2007. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). The mortality risk of different depressive statuses was computed after adjustment for a variety of covariates. The data were further analyzed by gender and cause of death. Overall, chronic depression was associated with all-cause mortality (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.18-2.32) after 4 years of follow-up and controlling for covariates. When analyzing by gender, incident depression was associated with mortality in males only (HR=1.54; 95% CI=1.04-2.27). In females, only chronic depression was associated with a higher risk of mortality (HR=1.77; 95% CI=1.08-2.88). The increased risk of mortality with incident depression in males and chronic depression in females was attributed to non-cardiovascular disease (non-CVD) causes more than to CVD causes. In males, chronic depression predicted a higher incidence of CVD deaths. While chronic depression confers a greater risk of mortality in older women, incident depression predicts increased mortality in older men. The link between changing depressive status, gender, ethnicity and mortality warrants further investigation.

Depressive symptoms as an independent risk factor for mortality in elderly persons: Results of a national longitudinal study

Objective: Depressive symptoms have been associated with increased mortality risk in previous cohort studies, but there is a paucity of research on Asian elderly in recent years. The authors investigated the depression–mortality link using data from a representative national cohort. Methods: Data came from the Survey of Health and Living Status of the Elderly in Taiwan. A cohort of 2416 men and women in Taiwan aged 65 or older were followed up for eight years from 1999 to 2007. Depressive symptoms were assessed by the 10-item Center for Epidemiologic Studies Depression Scale. The mortality risk of depression was computed after adjustment for a variety of covariates. Data on the presence or absence of chronic diseases were further analyzed. Results: Overall, depressive symptoms were associated with all-cause mortality (hazard ratio (HR), 1.21; 95% confidence interval (CI), 1.03–1.42) after eight years follow-up, but this mortality risk was detected in men only (HR, 1.27; 95% CI, 1.03–1.56), not in women (HR, 1.1; 95% CI, 0.86–1.4). Further analyses showed that in the group without chronic diseases (without diabetes mellitus, stroke, lung disease, cancer, or cognitive impairment), depressive symptoms were associated with mortality (HR, 1.40; 95% CI, 1.12–1.76) after eight years follow-up; however, there was no association between depressive symptoms and mortality in participants with chronic diseases (HR, 1.02; 95% CI, 0.82–1.26). Conclusion: Depressive symptoms are an independent risk factor for mortality in the elderly. Elderly depressive men and elderly without chronic diseases seemed to have a greater mortality risk.

Hierarchy of higher-level physical functions: a longitudinal investigation on a nationally representative population of community-dwelling middle-aged and elderly persons

Purpose: Understanding the hierarchy of higher-level physical functions to infer disability level (mild, moderate or severe) is essential for the precise targeting of preventive interventions and has been examined previously in a cross-sectional study. Based on longitudinal data, this study evaluated the hierarchy of higher-level physical functions. Methods: Data from a cohort of 2729 community-dwelling persons aged over 50 with no initial disability were drawn from the “Survey of Health and Living Status of the Elderly in Taiwan” from 1996 through 2007. The three-level hierarchy of eight chosen activities was examined by the median ages to disability onset with survival analyses and by Cox regressions, which examined the effects of sex and age on the development of this hierarchy. Results: The progression of incident disability was as follows: mild level-running, carrying weight, and squatting; moderate level-climbing stairs, walking, and standing; and severe level-grasping and raising arms up. Women and older persons were at greater risk of developing more severe levels of disability. Another Cox regression with one index activity from each hierarchical level revealed similar results. Conclusions: The three-level hierarchy of higher-level physical functions has been validated longitudinally, suggesting rich research and clinical implications. Implications for Rehabilitation Higher-level physical functions demand greater challenges than the activities of daily living. This longitudinal study, based on nationally representative data, has validated a three-level hierarchy of higher-level physical functions. This three-level hierarchy forms a basis of rapidscreening of high-risk people eligible for preventive interventions, which may help to reverse disability status or to prevent progression of disability. Future work could investigate the effects of focused targeting of people with different levels of disability to administer preventive interventions.

Social support and mortality among the aged people with major diseases or ADL disabilities in Taiwan: A national study

OBJECTIVE To determine the effects of social support on mortality among the aged people with major diseases or ADL disabilities. METHOD In this prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging from 1996 to 2007. Data for 1297 males and 1666 females aged ≥65 years were collected. The participants were divided into having major diseases or ADL disability or none. Subjects received financial, instrumental, and emotional support, and they actively provided instrumental and emotional support to others. The effect of the association between providing and receiving social support on mortality was examined using Cox regression analysis after adjusting several covariates. RESULTS Results showed a significant finding that providing instrumental support can lower mortality rates in the aged people [Hazard ratio (HR)=0.77; 95% confidence interval (CI)=0.66-0.90; p=0.0009] and those with major diseases or impairment of activities of daily living [Hazard ratio (HR)=0.62; 95% confidence interval (CI)=0.50-0.78; p≤0.0001] after adjusting for several covariates. Providing instrumental social support to others may prolong life expectancy in the aged people and even those with major diseases or those facing difficulties performing ADL. CONCLUSION Based on the finding, we should encourage older adults who have major diseases or ADL disabilities to be supporting providers especially in providing instrumental social support.