Dorly J. H. Deeg

Major and minor depression in later life: a study of prevalence and risk factors

In this paper, the results of a community-based study into the prevalence and risk factors associated with depression in the older (55-85 years) population of The Netherlands are presented. The prevalence of major depression was 2.02%, that of minor depression 12.9%, while 14.9% had clinically relevant levels of depressive symptoms. Associations with a comprehensive set of risk factors were not affected dramatically by age or sex. However, comparing major to minor depression, risks were substantially differently distributed. It appears that major depression is more often an exacerbation of a chronic mood disturbance, with roots in long-standing vulnerability factors; while minor depression is more often a reaction to the stresses commonly experienced in later life.

Anxiety disorders in later life: a report from the longitudinal aging study Amsterdam

Objective. To study the prevalence and risk factors of anxiety disorders in the older (55–85) population of The Netherlands.

Depression Is Associated With Decreased 25-Hydroxyvitamin D and Increased Parathyroid Hormone Levels in Older Adults

CONTEXT Depression has incidentally been related to altered levels of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH), but this relation has never been studied systematically. OBJECTIVE To determine in a large population-based cohort whether there is an association between depression and altered 25(OH)D and PTH levels. DESIGN Population-based cohort study (Longitudinal Aging Study Amsterdam). PARTICIPANTS One thousand two hundred eighty-two community residents aged 65 to 95 years. SETTING The Netherlands. MAIN OUTCOME MEASURE Depression was measured using self-reports (Center for Epidemiologic Studies-Depression scale) and diagnostic interviews (Diagnostic Interview Schedule). Levels of 25(OH)D and PTH were assessed. Potentially confounding factors (ie, age, sex, smoking status, body mass index, number of chronic conditions, and serum creatinine concentration) and explanatory factors (ie, season of data acquisition, level of urbanization, and physical activity) were also measured. RESULTS Levels of 25(OH)D were 14% lower in 169 persons with minor depression and 14% lower in 26 persons with major depressive disorder compared with levels in 1087 control individuals (P < .001). Levels of PTH were 5% and 33% higher, respectively (P = .003). Depression severity (Center for Epidemiologic Studies Depression Scale) was significantly associated with decreased serum 25(OH)D levels (P = .03) and increased serum PTH levels (P = .008). CONCLUSION The results of this large population-based study show an association of depression status and severity with decreased serum 25(OH)D levels and increased serum PTH levels in older individuals.

Higher Inflammatory Marker Levels in Older Persons: Associations With 5-Year Change in Muscle Mass and Muscle Strength

BACKGROUND There is growing evidence that higher levels of inflammatory markers are associated with physical decline in older persons, possibly through the catabolic effects of inflammatory markers on muscle. The aim of this study was to investigate the association between serum levels of inflammatory markers and loss of muscle mass and strength in older persons. METHODS Using data on 2,177 men and women in the Health, Aging, and Body Composition Study, we examined 5-year change in thigh muscle area estimated by computed tomography and grip and knee extensor strength in relation to serum levels of interleukin-6 (IL-6), C-reactive protein, tumor necrosis factor-alpha (TNF-alpha), and soluble receptors (measured in a subsample) at baseline. RESULTS Higher levels of inflammatory markers were generally associated with greater 5-year decline in thigh muscle area. Most associations, with the exception of soluble receptors, were attenuated by adjustment for 5-year change in weight. Higher TNF-alpha and interleukin-6 soluble receptor levels remained associated with greater decline in grip strength in men. Analyses in a subgroup of weight-stable persons showed that higher levels of TNF-alpha and its soluble receptors were associated with 5-year decline in thigh muscle area and that higher levels of TNF-alpha were associated with decline in grip strength. CONCLUSIONS TNF-alpha and its soluble receptors showed the most consistent associations with decline in muscle mass and strength. The results suggest a weight-associated pathway for inflammation in sarcopenia.

Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam.

The objective of this study was to identify easily measurable predictors for falls, recurrent falls, and fractures using a population‐based prospective cohort study of 1469 elderly, born before 1931, in three regions of the Netherlands. The baseline at‐home interview was in 1992. In 1995, falls experienced in the preceding year and fractures over the preceding 38‐month period were registered. In a period of 1 year, 32% of the participants fell at least once, and 15% fell two or more times. The rate of recurrent falls was similar in men and women up until the age of 75 years. The total number of fractures was 85, including 23 wrist fractures, 12 hip fractures, and 9 humerus fractures. The incidence density per 1000 person‐years for any fracture was 25.1 (95% confidence interval [CI], 18.9–31.4) for women and 8.2 (95% CI, 4.5–12.0) for men, respectively. Multiple logistic regression identified urinary incontinence, impaired mobility, use of analgetics, and use of antiepileptic drugs as the predictors most strongly associated with recurrent falls. Female gender, living alone, past fractures, inactivity, body height, and use of analgetics proved to be the predictors most strongly associated with fractures. The probabilities of recurrent falls were 4.7% (95% CI, 2.9–7.5%) to 59.2% (95% CI, 24.1–86.9%) with zero to four predictors, respectively. The probability of fractures ranged from 0.0% (95% CI, 0.0–0.4%) without any of the identified predictors to 12.9% (95% CI, 4.4–32.2%) with all six predictors present. Our study shows that the risk of recurrent falls and of fractures can be predicted using up to, respectively, four and six easily measurable predictors. This study emphasizes the importance of impaired mobility and inactivity as predictors for falls and fractures.

Consequences of anxiety in older persons: its effect on disability, well-being and use of health services

BACKGROUND Although anxiety is quite prevalent in late life, its impact on disability, well-being, and health care utilization of older persons has not been studied. Older persons are a highly relevant age group for studying the consequences of anxiety, since their increasing numbers put an extra strain on already limited health care resources. METHODS Data of a large community-based random probability sample (N = 659) of older subjects (55-85 year) in the Netherlands were used to select three groups: subjects with a diagnosed anxiety disorder, subjects with merely anxiety symptoms and a reference group without anxiety. These groups were compared with regard to their functioning, subjective well-being, and use of health care services, while controlling for potentially confounding variables. RESULTS Anxiety was associated with increased disability and diminished well-being. Older persons with a diagnosed anxiety disorder were equally affected in their functioning as those with merely anxiety symptoms. Although use of health services was increased in anxiety sufferers, their use of appropriate care was generally low. CONCLUSIONS Anxiety has a clear negative impact on the functioning and well-being of older subjects. The similarity of participants with an anxiety disorder and those having merely anxiety symptoms regarding quality of life variables and health care use was quite striking. Finally, in spite of its grave consequences for the quality of life, appropriate care for anxiety is seldom received. Efforts to improve recognition, disseminate effective treatments in primary care, and referring to specialized care may have positive effects on the management of anxiety in late life.

Functioning, well-being, and health perception in late middle-aged and older people : Comparing the effects of depressive symptoms and chronic medical conditions

OBJECTIVES: To expand the landmark Medical Outcomes Study (MOS) and World Health Organization (WHO) findings on the unique association of symptoms of depression with multiple domains of functioning, health perception, and well‐being in consulting populations to the late middle‐aged and older community‐dwelling population and to contrast this unique association to that of specific chronic medical conditions and sensory and cognitive impairment (collectively denoted as medical conditions (MCs)).

Skeletal muscle mass and muscle strength in relation to lower-extremity performance in older men and women.

OBJECTIVE: Low muscle strength is associated with poorer physical function, but limited empirical evidence is available to prove the relationship between muscle mass and physical function. We tested the hypothesis that persons with lower muscle mass or muscle strength have poorer lower‐extremity performance (LEP).

The impact of depression on the well‐being, disability and use of services in older adults: a longitudinal perspective

Objective: To study the impact of depression on the wellbeing, disability and use of health services of older adults.

Sex differences in the risk of frailty for mortality independent of disability and chronic diseases

Objectives: To determine the effect of static and dynamic frailty on mortality in older men and women.