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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The impact of coronary heart disease (CHD) on elderly patients' functional abilities is of growing interest because of the increasing number of people that survive the disease. The aim of our study was, firstly, to describe functional abilities among elderly CHD patients and, secondly, to analyze the relationships between physical disability and the severity of chest pain or dyspnea. The third aim was to assess whether there is an independent association between physical disability and CHD. The study was carried out at the health center of the municipality of Lieto, southwestern Finland. From a population of 1196 community-dwelling persons aged > or = 64 years, 89 men and 73 women with CHD (angina pectoris and/or a past myocardial infarction) were selected along with 178 male and 146 female sex- and age-matched controls without CHD. Physical functioning was assessed by means of interviewer-based questionnaires, compared between patients and controls and described in relation to the severity of chest pain and dyspnea among patients. The associations between dependence or difficulties in mobility, ADL (activities of daily living) and IADL (instrumental activities of daily living) and CHD, age, smoking, comorbidities, drug therapy and clinical characteristics were assessed by logistic regression analyses. On items representing mobility and managing in IADL, patients reported more difficulties or dependence than controls. Among female patients, more severe chest pain was associated with poor managing in IADL and tended to be associated with poor mobility. More severe dyspnea was associated with poor mobility among both male and female patients, and with poor managing in IADL among male patients. Logistic regression analyses failed to show that CHD was associated independently with physical disability among the elderly. However, physical disability was associated with the use of cardiovascular drugs in the models among both genders, which probably indirectly indicated an association between physical disability and CHD. Several confounding factors, such as higher age, depression, cancer and the use of psychotropic drugs, contributed to the decline in functional abilities even among persons with CHD. In conclusion, elderly CHD patients have greater limitations in their functional ability than matched controls, which may depend on the severity of the disease. Especially male patients' limitations in physical abilities may be influenced by the fact that men with CHD are more likely to be depressed. Although an independent association between physical disability and CHD was not found, the associations found between physical disability and the use of cardiovascular drugs probably indicate a causal relationship between CHD and physical disability.
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PMID:Functional abilities of elderly coronary heart disease patients. 966 93

This study examined (1) the direct effect of the duration of caregiving on caregiver psychological distress, and (2) two- or three-way interactions between duration, stressors (elderly's physical and cognitive impairments), and personal (caregiver's economic or work status) or social (informal or formal supports) resources. We interviewed 833 primary family caregivers of non-institutionalized frail elderly who had been selected through a screening process of all residents aged 65 and over (21,567 persons) in a suburban area of Tokyo. Caregiver psychological distress was evaluated by "Caregiving Burden Scale" as a caregiving-specific psychological measurement, and "Center for Epidemiologic Studies Depression Scale (CES-D)" as a general psychological measurement. The results were as follows. 1. For Caregiving Burden, duration showed a direct effect, as those who had been providing care for a longer duration of time reported higher burden. We found no interactions between duration, stressors, and resources on caregiving burden. 2. For CES-D, duration had interactions, but no direct effect. (1) Two-way interactions were observed between duration and caregiver's economic or work status, as caregivers with a low economic status or who were unemployed showed a stronger negative impact from duration of caregiving. (2) Three-way interactions were observed between duration, the elderly's ADL impairment, and informal support. Informal support, such as a secondary caregiver, buffered the negative impact of the elderly's ADL impairment in cases with a shorter duration of caregiving, but not for those with longer duration. (3) Three-way interactions were observed between duration, the elderly's cognitive impairment, and formal emotional support. Formal emotional support buffered the negative impact of the elderly's cognitive impairment for those with a longer duration of caregiving, but not for those with a shorter duration. These findings suggest that stress-buffering resources differ according to duration of caregiving.
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PMID:[Impact of duration of caregiving on stress among primary caregivers of elderly]. 969 62

The aim of the study was to evaluate which characteristics of geriatric patients account for readmission to hospital, 6 months after discharge. All patients (203 females, 176 males) consecutively admitted over a two-month period to four acute geriatric care units, located in the cities of Chieti, Perugia, Pescara and Prato, participated in the study. Data that could potentially explain early and late readmissions were collected for each patient. Prevalence of diseases and comorbidity were assessed with the Cumulative Illness Rating Scale (CIRS); physical function by self-report (ADL, IADL) and objective (Stand and Walking Speed) measures; cognitive level by MMSE; and depressive symptoms by the Geriatric Depression Scale (GDS). Information on family and social support were also obtained. After discharge, data on hospital readmissions were collected for six months. For each readmitted patient (cases), medical records were reviewed, and supplementary information was obtained from families and general practitioners. Readmissions were classified as "early" (within the first three months), "late" (within the third and sixth month), and "multiple" (2 or more readmissions irrespective of the period). Patients not readmitted (alive at home) were considered as controls. Systematic differences between centers and between periods of readmissions were evaluated using one-way analyses of variance, and Pearson's chi 2 test. Factors related to early, late, and multiple readmission were identified in multivariate logistic regression models. On univariate analysis, patients readmitted over the first three-month period were sicker than controls (CIRS classes 3-4: 52.1% vs 34.1%), had more social problems or behavioral symptoms, and were more functionally impaired (ADL dependencies 3.3 +/- 0.4 vs 2.1 +/- 0.2). Patients who were readmitted between the third and the sixth month after discharge had a significantly higher CIRS total score (p = 0.006). Patients with multiple readmissions had more severe diseases, and more social problems. On multivariate analysis, early readmission was associated with unsatisfactory social conditions, living alone, severity of diseases and cognitive impairment, while late readmission was associated with comorbidity only. Multiple readmissions were related only to social factors, and to hospital admission before the baseline evaluation. The findings of this study suggest that interventions aimed at improving unfavorable social conditions may reduce the rate of rehospitalization in geriatric patients.
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PMID:Characteristics of geriatric patients related to early and late readmissions to hospital. 982 26

This study charted changes in patient satisfaction with their rehabilitative progress over time, and examined the relative contributions of several factors to satisfaction. Participants were assessed on admission to and discharge from rehabilitation, and six and 12 months after discharge. The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia. Participants were 60 12-month stroke survivors who had undergone an inpatient rehabilitation programme. Satisfaction with progress in five areas of function was assessed using a five point rating scale. Functional outcome was assessed with the Australian ADL Index (competence and performance), lifestyle activities with the Frenchay Activities Index, knowledge of stroke with the Stroke Care Information Test, depression with the Zung Self-Rating Depression Scale, family functioning with the McMaster Family Assessment Device, and patients' expectations of rehabilitation by a qualitative assessment. Satisfaction with progress improved with time, particularly for dressing and washing, but for mobility declined after discharge. Satisfaction with progress was consistently influenced by the return to previous lifestyle activities, depression, family functioning, understanding of stroke, and clarity of expectations on admission to rehabilitation. It is important that the concept of successful rehabilitation acknowledges the perspective of the patient.
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PMID:Factors contributing to patient satisfaction with rehabilitation following stroke. 992 77

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity in old age. It leads to reduced quality of life (QoL), but the factors that contribute to this are less understood. There is no consensus on measurement of QoL in elderly COPD patients. We assessed (a) factors predicting QoL in elderly COPD out-patients and (b) specificity (SP), sensitivity (SEN), positive and negative predictive values (PPV and NPV) and repeatability of two disease-specific QoL instruments, the Chronic Respiratory Disease Questionnaire (CRQ) and the Breathing Problems Questionnaire (BPQ) in elderly people. All subjects also completed an ADL measure [Nottingham Extended ADL (NEADL)] and a measure of psychological well-being [Brief Assessment of Depression Cards (BASDEC)] as well as a 6-min walk test. Subjects comprised 96 (56 men) elderly out-patients with irreversible COPD aged 70-93 years (mean 78) who were clinically stable for > or = 6 weeks. Controls were 55 (23 men) aged 71-90 years (mean 78) with normal lung function. All were cognitively intact. Mean FEV1/FVC in COPD subjects was 45.5 (SE = 1.4)% and for controls was 71.4 (SE = 1.3)%. Repeatability was good for both BPQ and CRQ with no significant difference. There were no significant differences in specificity and positive predictive values between the two questionnaires but BPQ performed better than CRQ with regard to sensitivity (P = 0.02) and NPV (P < 0.001). A multiple regression analysis was used to identify variables that best predicted BPQ and CRQ in COPD subjects. For BPQ predictive values were NEADL (P < 0.0001); BASDEC (P < 0.0001); age (P < 0.0001); 6-min walk distance (P = 0.001); body mass index (P < 0.05); resting oxygen saturation (P < 0.05); and household composition (living alone or with relatives, P = 0.05). In contrast only the following predicted CRQ: NEADL, BASDEC and resting oxygen saturation. Sixteen per cent of the variance in BPQ was accounted for by NEADL score, 9% by BASDEC, 4% by age and 3% by 6-min walk distance (total r2 = 0.70). It was concluded that: (1) BPQ provides more valid assessment than CRQ of QoL in elderly COPD subjects; (2) severity of disease in terms of its impact on QoL is not predicted by lung function tests; (3) the most important determinants of QoL are ADL score and emotional status.
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PMID:Quality of life in elderly patients with COPD: measurement and predictive factors. 992 54

This study evaluated weight change and caregiver stress in 200 informal caregivers to elderly patients discharged from a rehabilitation hospital. Previous laboratory and epidemiologic studies have shown that stress predisposes to weight change. Nineteen percent of the caregivers had gained or lost at least 10 pounds since becoming caregivers. Weight change was significantly associated with higher scores on standardized measures of burden and stress (e.g., Burden Interview, Perceived Stress Scale, Geriatric Depression Scale) and with lower education, poorer self-rated health, more psychotropic medication use, and caring for patients with more ADL limitations who had been hospitalized for stroke or a frail elderly condition. Caregivers to patients with a stroke or frail elderly condition reported 2.8 times more weight change than caregivers to patients with a rehabilitation problem. These results suggest that weight change is a valid indicator of stress in caregivers, and they have public health, clinical, and research applications.
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PMID:Weight change: an indicator of caregiver stress. 1018 10

We investigated the degree of burden on care-givers and their subjective sense of well being, and studied the factors affecting them. Twenty people who were responsible for at least a year for constant care of elderly or bed-ridden patients under visitation care and nursing supervision of this hospital were registered. Regarding the care-givers, we investigated age, sex, duration of care, the relations between the care-givers and the cared-for, assistant care-givers, profession and hobbies, if any, of the care-givers, the depression scores; the social support, the degree of burden imposed by care, and the subjective sense of well being. As for the cared-for, we investigated their age, disease and degree of ADL. The burden felt by the care-giver became greater if the care-giver was a woman (p < 0.05), if the relationship with the cared or the health status of the care-giver was poor (p < 0.05, respectively), and if the scores for functional and emotional support networks were poor (p < 0.005 and p < 0.05, respectively). As for the cared-for, the burden was greater if they were older (p < 0.05) and if it was difficult for them to leave bed (p < 0.05). The sense of subjective well being of the care-giver was greater if there was an assistant care-giver (p < 0.005); if the scores for the functional and the emotional support networks were higher (p < 0.05, respectively): and if understanding of information in terms of ADL was not adequate (p < 0.05). The present study suggested the importance of improving the emotional and functional support networks for the care-giver in helping them continue care by alleviating the burden and not suffering a loss in the subjective sense of well being.
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PMID:[A study of the degree of burden and subjective sense of well being in care-givers involved in home care]. 1033 92

To investigate the feasibility of early assessment of preventable disabilities in primary care, we developed a geriatric preventive screening examination with various indicators of physical, emotional, and social functions as well as laboratory exams. Cognitive impairment was measured by the modified MMSE. Severe cases of dementia, who would deserve home visits were excluded. Results of the assessment procedure in 446 patients aged 70 and over (71.5% females) were compared to ratings of general practitioners (n = 67). In these patients we found 4250 medical, 374 psychiatric, and 528 social problems. 45.4% of medical, 61.8% of psychiatric, and 56.8% of social problems where hitherto unknown to the GPs. The prevalence of cognitive impairment was 4.6% according to GPs diagnosis and 21% according to the MMSE. The sensitivity of GPs diagnosis was 14%, the specificity 98%, and the overall agreement measured by kappa was 0.17. There were significant (p < 0.05) associations of cognitive impairment with poor health, vascular disease, syncope, weight loss, previous hospitalization, depression, and ADL and IADL-items. Hypertension, or pathological thyroid function, occurred more frequently in the cognitively impaired (p > 0.05). Only 19.5% of dementia cases had severe functional loss, which substantiates our hypothesis that mild dementia was studied. Of all cases with newly identified cognitive impairment (n = 83 of 446 patients), three (3.6%) had reversible disorder such as depression (n = 1), drug toxicity (n = 2) 3 (3.6%) received counseling, and 5 (6%) further diagnostic assessment or treatment. One (1.2%) patient did not accept any treatment. In the remainder of 71 patients (85.5%), the GPs adopted a wait and see strategy with no intervention. In conclusion, memory deficits seem to be underdiagnosed in general practice despite much treatable comorbidity or social problems, and some reversible conditions such as depression and drug adverse effects.
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PMID:[Early diagnosis and early treatment of cognitive disorders: a study of geriatric screening of an unselected patient population in general practice]. 1043 97

Electroconvulsive therapy (ECT) is among the most commonly performed medical procedures requiring general anesthesia in the United States. Nevertheless, very little is known about the characteristics of depressed patients who receive ECT and how they differ from depressed patients receiving psychotropic medication. We conducted a detailed examination of demographic, clinical, and quality-of-life (QOL) measurements in a group of 90 depressed inpatients, and we then used these measurements to contrast the 31 patients who received ECT with the 59 who received alternative therapies. The ECT group did not differ from the non-ECT group in gender composition, marital status, race, education, employment status, overall severity of depression, chronicity of depression, adequacy of prehospitalization antidepressant treatment, extent of physical illness, or extent of social support. The ECT group was older. Furthermore, the ECT group had greater weight loss, worse functioning in activities of daily living (ADLs), and worse functioning in instrumental activities of daily living (IADLs). The differences in weight loss, ADL, and IADL scores disappeared after age adjustment. However, statistical adjustment for age revealed that the ECT group reported worse capacity in their daily living and role functioning than did the non-ECT group. We conclude that the decision to pursue ECT is based in part on the perceived effect of the depression on QOL, as well as the severity of specific symptoms such as weight loss. The elderly seem particularly vulnerable to depression-related functional deficits and weight loss, and this may explain why prior studies showed a differential use of ECT in the elderly.
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PMID:Pretreatment differences in specific symptoms and quality of life among depressed inpatients who do and do not receive electroconvulsive therapy: a hypothesis regarding why the elderly are more likely to receive ECT. 1049 57

In order to maintain and improve the mental health of elderly people living in the community, a cross-sectional survey was conducted to elucidate their depressive state and its background factors. Subjects were elderly persons living in the community who were able to fill in the questionnaire themselves. The study used the self-recording questionnaire sheets used in the Kahoku Longitudinal Aging Study by Matsubayashi et al and the Zung Self-rating Depression Scale (SDS). Out of 2,379 elderly persons who were able to fill in the questionnaire by themselves in the community, 2,361 (99.2%) returned the questionnaire sheets. After removing inadequate responses, analysis was possible for 1,181 (49.6%) (542 males (average age 72.3 +/- 5.5) and 639 females (average age 73.0 +/- 6.3). Degree of depressive state as evaluated by SDS was normal for 731 persons (61.9%); mild, 240 (20.3%); moderate, 181 (15.3%); and severe, 29 (2.5%). The average age became higher as the SDS became high, of being indicating the seriousness of the depressive state (p = 0.0155), with the ratio women significantly higher (p = 0.0077). Among those with severe SDS, the ratio of single persons was high (p < 0.001) as well as those who were non-drinkers (p = 0.0015), without regular habit of walking (p < 0.001), or without work (p < 0.001). The ratio of those receiving medication regularly was also significantly high (p = 0.0022). As for the relation of SDS with various of the scores, the higher the SDS score became, the scores for ADL, information-related function, functional and emotional support network, family relationship, friendship, economic condition became significantly lower (p < 0.001, respectively). In logistic regression analysis using the background factors for SDS as explanatory variables, factors such as being women (odds ratio, 1.73; 95% confidence interval, 1.10-2.72). ADL (0.80; 0.69-0.93), emotional support network (0.88; 0.81-0.96), friendship (0.98; 0.96-0.99) were significant independent contributing factors. As for the relation between SDS and subjective senses, the more serious the SDS score became, the scores for feelings of healthiness and satisfaction became significantly smaller (both p < 0.001). For prevention and amelioration of the depressive state of elderly persons living in the community, attempts should be made to improve the background factors which were clarified by the present study by efficiently utilizing health, medical and welfare services and following the future course with a positive attitude.
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PMID:[A study of depressive state and background factors in community-dwelling older persons]. 1061 24


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