Sarah T. Stahl

Coaching in Healthy Dietary Practices in At-Risk Older Adults: A Case of Indicated Depression Prevention

Prevention of major depressive disorder is important because current treatments are only partially adequate in reducing symptom burden and promoting health-related quality of life. Lifestyle interventions may be a desirable prevention strategy for reasons of patient preference, particularly among older patients from minority groups. Using evidence from a randomized depression prevention trial for older adults, the authors found that coaching in healthy dietary practices was potentially effective in protecting at-risk older adults from developing incident episodes of major depression. The authors describe the dietary coaching program (highlighted in a case example) as well as the feasibility and potential efficacy of the program within the context of evidence-based interventions for preventing episodes of major depression and mitigating symptoms of depression. Older adults receiving dietary coaching experienced a low incidence of major depressive episodes and exhibited a 40%-50% decrease in depressive symptoms, as well as enhanced well-being, during the initial 6-week intervention; these gains were sustained over 2 years. The authors also describe why lifestyle interventions like coaching in healthy dietary practices may hold promise as effective, practical, nonstigmatizing interventions for preventing episodes of major depressive disorder in older adults with subsyndromal depressive symptoms.

Changes in Routine Health Behaviors Following Late-life Bereavement: A Systematic Review

This systematic review examines the relationship between late-life spousal bereavement and changes in routine health behaviors. We review six behavioral domains/modifiable risk factors that are important for maintaining health among elderly populations: physical activity, nutrition, sleep quality, alcohol consumption, tobacco use, and body weight status. Thirty-four articles were identified, derived from 32 studies. We found strong evidence for a relationship between bereavement and nutritional risk and involuntary weight loss, and moderate evidence for impaired sleep quality and increased alcohol consumption. There was mixed evidence for a relationship between bereavement and physical activity. We identify several methodological shortcomings, and describe the clinical implications of this review for the development of preventive intervention strategies.

Gender differences in physical activity patterns among older adults who fall.

OBJECTIVE This study describes gender differences in the level and pattern of physical activity in groups of older adults who were frequent fallers, intermittent fallers, or non-fallers. METHODS Interviews were conducted with adults aged 50 years and older (N=1834) at senior centers across Pennsylvania from 2010 to 2011. Self-reported falls and validated measures of physical activity were collected at baseline and at 6- and 12-month follow-up assessments. RESULTS Complete follow-up data were available for 1487 participants. Men who fell frequently decreased in recreational/leisure activity and household/yard work compared to the intermittent fallers and non-fallers. This association remained even when controlling for baseline health status. All women-regardless of fall group-engaged in similar levels of recreational/leisure activity and household/yard work over time. For both men and women, frequent fallers also showed a greater decrease in walking activities compared to intermittent fallers and non-fallers. DISCUSSION Frequent falling among older adults is associated with declines in common leisure, household, and walking activities. The effect of falling frequency on physical activity appears to affect men and women differently, generating the hypothesis that interventions to promote physical activity among fallers need to be gender specific.

Caloric Expenditure Assessment among Older Adults: Criterion Validity of a Novel Accelerometry Device

Criterion validity of a novel accelerometry device that measures caloric expenditure (Fitbit) was evaluated against a self-report estimation of caloric expenditure (Community Healthy Activities Model Program for Seniors) in older adults. Community Health Activities Model Program for Seniors and Fitbit estimates of total caloric expenditure per day were significantly correlated (r = .61, p < .05). Bland–Altman plots indicated that 70 percent of participants’ data were within 1 standard deviation of the mean difference between measures. These preliminary findings suggest that the Fitbit may be considered a viable instrument for measuring daily caloric expenditure among older adults. However, further work is required to determine the optimal measurement technique for caloric expenditure among older adults.

Living alone and depression: the modifying role of the perceived neighborhood environment

ABSTRACT Objective: Older adults who live alone are more likely to report feelings of depression than those who live with a spouse or other family members. This study examines the effects of residential status and perceived neighborhood characteristics on depression in middle-aged and older adults. Methods: This study is based on a probability sample of 1049 adults aged 55–98 years (M = 69 years) residing in Allegheny County, Pittsburgh, PA, USA in 2014. Thirty percent of participants reported living alone. We tested a multivariate model using living alone (vs. living with a family member or others) and perceived neighborhood physical and social quality as predictors of depressive symptomatology while controlling for age, sex, race, education, and disability. Results: Living alone (compared to living with a family member) was associated with elevated levels of depressive symptomatology. However, perceptions of neighborhood social quality moderated this association. Living alone was more highly associated with depression when the perceived social quality of the neighborhood was low. Neighborhood social quality was not associated with depression among older adults who lived with a family member. Perceptions of neighborhood physical quality were not significantly associated with depression. Conclusions: Perceptions of good neighborhood social quality is important for adults who live alone, in terms of fewer symptoms of depression.

Mortality After Bereavement: The Role of Cardiovascular Disease and Depression.

Objectives Late-life bereavement is associated with an increased risk of mortality. This study assesses the associations among bereavement, cardiovascular disease (CVD), and depressive symptoms on mortality in older men and women. Methods We examined data from the Cardiovascular Health Study, a prospective population-based cohort study of older adults. We compared mortality in those who became bereaved from 1989 to 1999 (n = 593) to an age- and sex-matched sample of individuals who remained married (n = 593). Cox regression was used to examine the association between bereavement and 3-year all-cause mortality and whether or not the association differed by sex, presence of CVD, or postbereavement depressive symptoms. Results One hundred ninety-nine (16.8%) individuals died. There was no association of bereavement with mortality (hazard ratio [HR] = 0.98 [0.74–1.30]). However, there were significant interaction effects of bereavement with participant sex (p < .001) and CVD (p = .010). Bereavement decreased the risk of mortality in women (HR = 0.67 [0.46–0.97]) and increased the risk of mortality in men (HR = 1.77 [1.14–2.75]). Within sex, the association of bereavement with mortality differed according to CVD status. The reduced risk of mortality associated with bereavement in women was only observed in women with CVD, and the increased risk in men was only observed in men without CVD. High levels of depressive symptoms attenuated the relation between bereavement and mortality in men without CVD. Conclusions The relation between bereavement and mortality was different in men and women and varied by CVD status. Bereavement decreased mortality in women with CVD and increased mortality in men without CVD.

Husbands’ and Wives’ Physical Activity and Depressive Symptoms: Longitudinal Findings from the Cardiovascular Health Study

BackgroundWhen examining older adults’ health behaviors and psychological health, it is important to consider the social context.PurposeThe purpose of this study was to examine in older adult marriages whether each spouse’s physical activity predicted changes in their own (actor effects) and their partner’s (partner effects) depressive symptoms. Gender differences were also examined.MethodEach spouse within 1260 married couples (at baseline) in the Cardiovascular Health Study completed self-report measures at wave 1 (1989–1990), wave 3 (1992–1993), and wave 7 (1996–1997). Dyadic path analyses were performed.ResultsHusbands’ physical activity significantly predicted own decreased depressive symptoms (actor effect). For both spouses, own physical activity did not significantly predict the spouse’s depressive symptoms (partner effects). However, husbands’ physical activity and depressive symptoms predicted wives’ physical activity and depressive symptoms (partner effects), respectively. Depressive symptoms did not predict physical activity.ConclusionFindings suggest that husbands’ physical activity is particularly influential for older married couples’ psychological health.

Self-reported obstructive sleep apnea is associated with nonresponse to antidepressant pharmacotherapy in late-life depression.

Obstructive sleep apnea (OSA) is frequently comorbid with late‐life depression. The purpose of this project was to determine, using a sample of older adults with major depressive disorder, whether patient‐reported diagnosis of OSA was associated with rate of response to venlafaxine.

Psychiatric Diagnoses Among Older Recipients of Publicly Funded Mental Health Services

To compare the prevalence of psychiatric diagnoses among older recipients of publicly funded mental health services (county safety‐net base services and Medicaid) to psychiatric diagnoses in an insured population of older adults from the same county.

Grief Reactions in the Elderly

Learning Objectives 1. To recognize the nature of bereavement in old age as it differs from bereavement in other stages of life, including unique social and cultural constructs. 2. To understand the relationship between grief in older adults and comorbid medical and neurologic conditions, especially psychiatric and health-related quality of life. 3. To differentiate diagnostic criteria for bereavement-related diagnoses, address the current controversy around the “over-medicalization” of grief, and review the current evidence-based practices for clinical assessment, including the Inventory for Complicated Grief (ICG) [1]. 4. To discuss the current evidence-informed treatment of bereavement-related depression and complicated grief, highlighting treatment response prediction as an area of interest and in need of further research. 5. To summarize recent research findings in neuroimaging and neurobiology that contribute to our understanding of grief reactions in older adults. 6. To address the importance of continued research into risk factors, prevention strategies for adverse grief reactions, and strategies for the facilitation of healthy adaptation to loss. 7. To briefly present what is known about other unique grief circumstances that require further bereavement research, including grief in older LGBTQ adults, suicide bereavement, and grief in the setting of palliative care and hospice medicine, and grief reactions following catastrophic natural disasters.