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There has been limited research on the association between elder abuse and depression, as well as elder abuse and suicidal ideation concurrently. Therefore, the present study aimed to investigate this association using the dataset from a nationally representative elderly sample in Korea. This study analyzed the dataset from the 2020 National Survey of Older Koreans. Elderly participants (aged over 65 years, n=9920) were included. Multivariate regression analysis was utilized to explore the risk factors associated with depression and suicidal ideation in the context of elder abuse. In this study, 5.1% of the elderly reported having elder abuse in the past year, while 12.8% and 1.9% reported having depression and suicidal ideation, respectively. In addition, among the elderly with depression, 8.4% had experienced elder abuse, while among those reporting suicidal ideation, 17.6% had suffered from elder abuse. Multiple logistic regression revealed that elder abuse is independently associated with both depression [odds ratio (OR) for elder abuse=1.642] and suicidal ideation (OR for elder abuse=3.237). Besides elder abuse, poor subjective health status and poor social support were linked to higher risk of depression and suicidal ideation. Our findings revealed that elder abuse represented a substantial risk factor associated with both depression and suicidal ideation. Implementing preventive interventions to address these risk factors could have significant implications for public mental health., Competing Interests: The authors have no potential conflicts of interest to disclose., (© Copyright: Yonsei University College of Medicine 2024.)

Background: Few studies have longitudinally assessed the determinants of depressive symptoms among persons 80 years and older. The aim of this study was to estimate the determinants of depressive symptoms among persons 80 years and older based on 4-wave national longitudinal data from Thailand., Methods: Data from the Health, Aging, and Retirement in Thailand study from 2015, 2017, 2020 and 2022 were utilized. The sample was restricted to community-dwelling persons 80 years and older (analytic sample: n = 2763 observations). For the pooled sample, average age was 85.0 years (range 80-117 years). Established measurements were used to assess depressive symptoms. Linear fixed effects regression was applied to assess the time-variant determinants and outcomes., Results: Regressions found that higher functional disability and an increase in the number of chronic conditions worsened depressive symptoms. More favourable self-rated physical health, and higher exercise frequency improved depressive symptoms. In addition, among women higher subjective economic status decreased depressive symptoms., Conclusions: This longitudinal study enhances our understanding of the determinants of depressive symptoms among persons 80 years and older. Strategies to delay or decrease functional disability, chronic conditions, increase physical activity, and improve subjective economic status may help in reducing depressive symptoms., (© 2024. The Author(s).)

Background: Loneliness has been identified as a significant independent predictor of depression among older adults. Social support has been reported to play a protective role against both loneliness and depression in older adults. However, few studies to date have investigated the three constructs concurrently and the mediating role of Perceived Social Support (PSS) on the relationship between loneliness and depression in this age group. The current study aimed to assess the relationship between loneliness and depression among community-dwelling Nepalese older adults based on the mediating role of PSS., Methods: This descriptive cross-sectional research study included 367 community-dwelling older adults from a randomly selected ward in Kathmandu, Nepal. The University of California, Los Angeles Loneliness Scale, Geriatric Depression Scale, and Multidimensional Scale of Perceived Social Support were used. Correlation analysis, regression analysis, and the PROCESS 4.1 macro developed by Hayes with a bootstrapping procedure were used to test the mediating effect of the PSS on the relationship between loneliness and depression., Results: Loneliness was negatively associated with the PSS (β = -0.405; 95% CI: -0.473, -0.337; P < 0.001), and the PSS was positively associated with depression (β = 0.057; 95% CI: 0.014, 0.099; P = 0.009). The direct effect of loneliness on depression was positive and significant (β = 0.151; 95% CI: 0.117, 0.184; P < 0.001), whereas the indirect effect of loneliness on depression through the PSS was negative (path c; β = -0.023, 95% CI: -0.041, -0.005). The results indicated that the PSS partially mediated the relationship between loneliness and depression., Conclusion: These findings suggest that interventions focusing on reducing loneliness and fostering social support may be able to lessen depressive symptoms in older adults. By addressing these factors, healthcare providers and carers can promote the mental health of older adults., (© 2024. The Author(s).)

Introduction: This study examined the effects of the coronavirus disease 2019 (COVID-19) pandemic on depression and suicidal ideation in community-dwelling elderly in Korea., Methods: Data were employed from a survey on elderly mental health in Jeollanam-do (southwest province in Korea), conducted by the Jeollanam-do Provincial Mental Health and Welfare Center. A total of 2423 people were recruited from all 22 cities in Jeollanam-do from April to October, 2021. We used self-reported questionnaires including sociodemographic factors, COVID-19-related stress, the Geriatric Depression Scale-Short Form Korean Version, the Multidimensional Scale of Perceived Social Support, the Satisfaction With Life Scale and the Brief Resilience Scale. Logistic regression was performed to examine the factors of depression and suicidal ideation., Results: Of the 2423 subjects, 622 (25.7%) reported depressive symptoms and 518 (21.4%) reported suicidal ideation. The multivariate logistic regression analysis revealed that living alone, poor perceived health status, worry of COVID-19 infection, and restriction of daily activities due to COVID-19 pandemic are significantly associated with depression. Female gender, poor perceived health status, inability to perform household chores, and depressive symptom are risk factors of suicidal ideation., Conclusion: These findings show that old age, negative perception of health, and restriction of daily activities due to COVID-19 are risk factors of depression in community-dwelling elderly in the context of the COVID-19 pandemic. Female gender, poor self-perceived health status, and depression increase the risk of suicidal ideation among the elderly. Social support and life satisfaction are protecting factors of both depression and suicidal ideation. Resilience decreased risk of depression but not in suicidal ideation., (© 2024 John Wiley & Sons Ltd.)

Background: The fear of falling is a common issue among older adults that negatively affects physical and psychological aspects of health-related quality of life, regardless of actual fall events. Interventions aimed at reducing fear of falling, independent of falls, may improve older adults' quality of life. This study examined the moderated mediation effect of physical activity in how fear of falling affects health-related quality of life through depression in community-dwelling older adults., Methods: This study used secondary data from the Korea Centers for Disease Control and Prevention's 2019 Community Health Survey. The study included 73,738 adults aged 65 years or older. The researchers used the fear of falling scale, International Physical Activity Questionnaire, Patient Health Questionnaire-9, and EuroQol 5 Dimension as research tools, and performed descriptive statistics, Pearson's correlation coefficient, and SPSS PROCESS macro analysis. The study used the bootstrapping method to assess the adjusted mediating effect by resampling 5,000 times, and determined statistical significance with a 95% confidence interval., Results: In the model in which fear of falling affects health-related quality of life by mediating depression, the moderated mediation effect of physical activity was statistically significant, as the bootstrapping result did not include 0 in the 95% confidence interval (Index of moderated mediation [95% CI] = 0.006 [0.004-0.007], 0.008 [0.006-0.009]). Depression and health-related quality of life impairment decreased as the level of physical activity increased through inactivity, minimal activity, and health promotion activities, as the negative mediating effects decreased., Conclusion: Physical activity reduces depression and improves health-related quality of life by influencing older adults' fear of falling. Community-based programs are needed to encourage and support older adults in maintaining moderate physical activity to manage the depression caused by fear of falling, which is common among older adults, and to improve their health-related quality of life., (© 2024. The Author(s).)

Background: Elder abuse (EA), depressive symptoms, and loneliness represent a growing risk to the health, well-being, and premature mortality of older adults. However, the role of loneliness in the relationship between EA and depressive symptoms has not yet been examined., Aims: To investigate the associations between these constructs and to explore the possible mediating role of loneliness in the relationship between EA and depressive symptoms in a representative sample of older Mexican people., Methods: A representative community-dwelling survey of older adults aged 60 and older was conducted in two cities in Mexico (Mexico City and Xalapa) in 2018-2019. Measurements of EA, loneliness, depressive symptoms, health, and sociodemographic data were collected. Regression and mediation models were tested to analyze the associations between these variables., Results: The prevalence of EA was 16.3%, loneliness was 50%, and depressive symptoms were 25.5%. The odds ratio (OR) for the occurrence of depressive symptoms was 2.7 when the combined effects of EA and loneliness were considered. The proportion of the effect that could explain the mediating role of loneliness was 31%., Conclusion: To effectively reduce depressive symptoms in older individuals affected by emotional or psychological abuse and neglect, it is crucial to address both the mediating influence of loneliness and EA itself in therapeutic and preventive interventions., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: With the trend of digitalization, social activities among the older population are becoming more diverse as they increasingly adopt technology-based alternatives. To gain a comprehensive understanding of social activities, this study aimed to identify the patterns of digital and in-person social activities among community-dwelling older adults in South Korea, examine the associated factors, and explore the difference in depressive symptoms by the identified latent social activity patterns., Methods: Data were extracted from a nationwide survey conducted with 1,016 community-dwelling older adults (mean age 68.0 ± 6.5 years, 47.8% male). The main variables assessed were digital social activities (eight items), in-person social activities (six items), and depressive symptoms (20 items). Data were analyzed using latent class analysis, multinomial logistic regression, and multiple linear regression., Results: We identified four distinct social activity patterns: "minimal in both digital and in-person" (22.0%), "moderate in both digital and in-person" (46.7%), "moderate in digital & very high in in-person" (14.5%), and "high in both digital and in-person" (16.8%). Younger age, living in multi-generational households, and higher digital literacy were associated with a higher likelihood of being in the "moderate in both digital and in-person" than the "minimal in both digital and in-person" group. Younger age, male, living in multi-generational households, residing in metropolitan areas, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the "moderate in digital & very high in in-person" than the "minimal in both digital and in-person" group. Younger age, living in multi-generational households, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the "high in both digital and in-person" than the "minimal in both digital and in-person" group. Depressive symptoms were significantly higher in the group with minimal engagement in both digital and in-person activities, compared to other three groups., Conclusions: This study highlights distinct patterns of social activities among Korean community-dwelling older adults. Since older adults with minimal social activity engagement can be more vulnerable to depressive symptoms, interventions that address modifiable attributes, such as supporting digital literacy and facilitating physical activity of older adults, could serve as potential strategies to enhance their social activity engagement and, consequently, their mental well-being., (© 2024. The Author(s).)

Background: Although significant and disabling consequences are presented due to geriatric population-related depression, an insufficient comprehension of various biological, psychological, and social factors affecting this issue has been observed. Notably, these factors can contribute to geriatric population-related depression with low social support. This study aimed to identify factors associated with depression among the community-dwelling geriatric population with low social support in Malaysia., Methods: This study used secondary data from a population-based health survey in Malaysia, namely the National Health Morbidity Survey (NHMS) 2018: Elderly Health. The analysis included 926 community-dwelling geriatric population aged 60 and above with low social support. The primary data collection was from August to October 2018, using face-to-face interviews. This paper reported the analysis of depression as the dependent variable, while various biological, psychological and social factors, guided by established biopsychosocial models, were the independent variables. Multiple logistic regression was applied to identify the factors. Analysis was performed using the complex sampling module in the IBM SPSS version 29., Results: The weighted prevalence of depression among the community-dwelling geriatric population aged 60 and above with low social support was 22.5% (95% CI: 17.3-28.7). This was significantly higher than depression among the general geriatric Malaysian population. The factors associated with depression were being single, as compared to those married (aOR 2.010, 95% CI: 1.063-3.803, p: 0.031), having dementia, as opposed to the absence of the disease (aOR 3.717, 95% CI: 1.544-8.888, p: 0.003), and having a visual disability, as compared to regular visions (aOR 3.462, 95% CI: 1.504-7.972, p: 0.004). The analysis also revealed that a one-unit increase in control in life and self-realisation scores were associated with a 32.6% (aOR: 0.674, 95% CI: 0.599-0.759, p < 0.001) and 24.7% (aOR: 0.753, 95% CI: 0.671-0.846, p < 0.001) decrease in the likelihood of developing depression, respectively., Conclusion: This study suggested that conducting depression screenings for the geriatric population with low social support could potentially prevent or improve the management of depression. The outcome could be achieved by considering the identified risk factors while implementing social activities, which enhanced control and self-fulfilment., (© 2024. The Author(s).)

Background: Previous research examining the relationship between loneliness and depressive symptoms often treated these constructs as static traits rather than dynamic states. The current study focused on the short-term, prospective link between loneliness and depressive symptoms, while also analyzing potential gender differences., Methods: We modeled panel data from seven bi-weekly assessments gathered in the FRequent health Assessment In Later life (FRAIL70+) study. At baseline, the sample size amounted to N = 426 community-dwelling older adults aged 70 years or older in Austria. The relationship between loneliness and depressive symptoms was analyzed using a latent change score modeling framework., Results: As regards depressive symptoms, women showed higher initial levels and more change across the three months than men. Loneliness did not considerably change across time for both sexes. Moreover, greater levels of loneliness at a given point in time were associated with an accelerated increase in depressive symptoms two weeks later in women but not in men., Conclusion: Loneliness appeared to be a potential determinant of future increases in depressive symptoms. The varying effects observed between men and women suggest potential gender differences in short-term fluctuations of depressive symptoms and their underlying mechanisms., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Background: Prior research has identified the mediating effect of physical activity in the relationship between self-perceptions of aging and physical health. However, this impact on mental health is unknown, and the influence of environmental contexts proposed by ecological models in this regard remains largely unexplored. Therefore, this study aimed to investigate the role of physical activity in the relationship between self-perceptions of aging and depressive symptoms in older adults, and compare the impact across four levels of neighborhood walkability., Methods: A sample of 1,055 community-dwelling older adults aged 65 or above was obtained through random-digit-dialing computer-assisted telephone interviewing. The individual's neighborhood walkability was calculated using Walk Score®, and categorized into four levels: car-dependent, somewhat walkable, very walkable, and walker's paradise. Partial least squares structural equation modelling was employed., Results: We found that more positive self-perceptions of aging were associated with fewer depressive symptoms and a mediation effect of physical activity in this relationship. Among the four levels of neighborhood walkability, the mediation effect of physical activity was only statistically significant in the lowest level (car-dependent). The findings supported our hypotheses regarding the mediating effect of self-perceptions of aging on depressive symptoms via physical activity. Neighborhood walkability might potentially influence the mediating role of physical activity., Conclusions: This study emphasizes key areas on intervention programs and policy formulation to promote mental health in older adults., (© 2024. The Author(s).)

With the increasing number of older adults, research on cognitive function has expanded. However, studies examining the mediating effect of depression on the association between complex factors and cognitive function in older adults are still insufficient. Additionally, there is a lack of studies that have investigated these relationships by integrating multiple factors related to the cognitive function of older adults. Therefore, our study investigated the association between the number of family members, self-rated health, depression, and cognitive function in community-dwelling older adults and highlighted the mediating role of depression in these relationships. We used data from 218 older adults aged over 65 collected in a previous study. The independent variables were the number of family members and self-rated health, and the dependent variable was cognitive function measured by the cognitive impairment screening test (CIST). The mediation variable was depression measured by the Patient Health Questionnaire-9 (PHQ-9). Structural equation modeling was used to examine the association between the independent, dependent, and mediation variable. The mean ages of the participants were 81.71 (standard deviation [SD] = 6.00) years, with 198 females (90.83%) and 20 males (9.17%). The structural equation model demonstrated a good model fit (chi-square value = 33.375; degrees of freedom = 24; p-value = 0.0964; RMSEA = 0.042; CFI = 0.970; TLI = 0.956; SRMR = 0.042). Self-rated health and the number of family members were not directly associated with cognitive function; however, depression had significant indirect effects (self-rated health to cognitive function: coefficient = -0.023, p-value = 0.017; number of family members and cognitive function: coefficient = 0.012, p-value = 0.030). Our findings indicated that depression plays a crucial mediating role between self-rated health, number of family members, and cognitive function. The results highlight the need for comprehensive strategies for mental health care to support cognitive health in older adults., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bae et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Network analysis provides an innovative approach to examining symptom-to-symptom interactions in mental health, and adverse external conditions may change the network structures. This study compared the networks of common risk factors and mental health problems (loneliness, depressive symptoms, and anxiety symptoms) in community-dwelling older people before and during COVID-19. Older adults (aged ≥ 60) at risk for depression were recruited through non-governmental organizations. Loneliness, depressive symptoms and anxiety symptoms were measured using the three-item Loneliness Scale (UCLA-3), nine-item Patient Health Questionnaire (PHQ-9), and seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Data from 2549 (before) and 3506 (during COVID-19) respondents were included using propensity score matching. Being restless (GAD-7-item5) was most central, indicated by Expected Influence, in both pre and during COVID-19 networks despite low severity (mean score). The network during COVID-19 had higher global strength and edge variability than the pre-pandemic network, suggesting easier symptom spread and potentially more complex symptom presentation. In addition, feeling isolated from others (UCLA-3-item3) had stronger connections with feeling worthless/guilty (PHQ-9-item6) and anticipatory anxiety (GAD-7-item7) during COVID-19 than before. These findings may enhance our knowledge of the symptom structure of common mental health problems and the impacts of the pandemic. Targeting central symptoms may offer novel preventive strategies for older people., (© 2024. The Author(s).)

Objective: This study aimed to examine the mediation role of perceived social support in the relationship between functional limitations, depressive symptoms and quality of life among older people in Malaysia., Setting: The Malaysian National Health Morbidity Survey 2018: Elderly Health was a cross-sectional health community survey among adults aged 50 and above., Participants: 3977 community-dwelling older Malaysians aged 60 and above., Outcome Measures: Functional limitations were defined as personal activities of daily living (PADL) and instrumental activities of daily living (IADL), tested in separate paths in all analyses. PADL was measured using the Barthel Index, while IADL was measured using the Lawton and Brody scale. Perceived social support, depressive symptoms and quality of life were measured using the Duke Social Support Index, Geriatric Depression Scale-14 and Control, Autonomy, Self-Realisation and Pleasure-19 tools. We used mediation analysis through structural equation modelling to explore the role of perceived social support., Results: Perceived social support mediated the relationship between PADL and IADL with depressive symptoms, with the indirect effects at -0.079 and -0.103, respectively (p<0.001). Similarly, perceived social support mediated the relationship between PADL and IADL with quality of life, with the indirect effects at 0.238 and 0.301, respectively (p<0.001). We performed serial multiple mediation analysis and found that perceived social support and depressive symptoms mediated the path between PADL and IADL with quality of life, with the indirect effects at 0.598 and 0.747, respectively (p<0.001). The relationship between functional limitations and all outcomes remained significant in all mediation analyses., Conclusion: The present study provides evidence that perceived social support relieves the influence of functional limitations on depressive symptoms and declining quality of life among older people. Therefore, it is imperative to establish a social support system to improve the overall well-being of older people., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Social support (SS) has been widely recognized to have a protective effect influencing older adults' emotional and psychological well-being. This study aimed to determine the relationships of structural SS and functional SS on depression and quality of life among the community-dwelling older adults in the rural and Asian context. A cross-sectional study was conducted among 2324 community older adults aged 60 years and above in Kuala Pilah, Malaysia. Participants were recruited via multistage sampling and interviewed face-to-face. The relationships were analyzed using structural equation modeling. Structural SS was associated with functional SS (β = 0.05). Only functional SS (having a role, knowing what is going on, and having a confidant) was found to be significantly associated with depression (β = -0.07) and quality of life (physical component [β = 0.08], mental component [β = 0.31]). In summary, functional SS and familial SS should be addressed to reduce depression and improve quality of life among older adults. Community initiatives to increase awareness in optimizing social support should be conducted for quality of life among community older adults., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Escalating street violence and criminal homicides have an adverse impact on psychological well-being. However, these consequences have been difficult to evaluate. Using a recently validated scale, we aimed to assess the impact of fear of crime on the psychological status of middle-aged and older adults living in a rural setting afflicted by endemic violence., Methods: Participants were selected from Atahualpa residents included in previous studies targeting psychological distress in the population. A validated scale was used to objectively quantify fear of crime in participants. Differences in symptoms of depression and anxiety between baseline and follow-up were used as distinct dependent variables and the continuous score of the fear of crime scale was used as the independent variable. Linear regression models were fitted to assess the association between the exposure and the outcomes, after adjusting for relevant confounders., Results: A total of 653 participants (mean age = 53.2 ± 11.5 years; 57% women) completed the requested tests. We found a 13% increase in symptoms of depression and anxiety during the peak of violence in the village compared with previous years. Linear regression models showed a significant association between the total score on the fear of crime questionnaire and worsening symptoms of depression (β = .24; 95% CI = 0.14-0.35) and anxiety (β = .31; 95% CI = 0.24-0.37), after adjustment for relevant confounders., Conclusions: This study shows a significant aggravating effect of fear of crime on pre-existing symptoms of depression and anxiety and a deleterious effect of these conditions on overall well-being., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Aging societies are a public health concern worldwide. It is critical to develop strategies that harness technology to enhance older adults' mastery, achievement motives, self-esteem, isolation and depression effectively., Methods: This study aimed to explore the effects of a combination of three-dimensional virtual reality (VR) and hands-on horticultural activities on the psychological well-being of community-dwelling older adults. We used a quasi-experimental design. A total of 62 community-dwelling older adults were recruited and assigned to the experimental (n = 32) and comparison groups (n = 30). The members of the experimental group participated in an 8-week intervention program. Participants of both groups completed before-and-after intervention measurements for outcome variables that included perceived self-esteem, depression, isolation, and mastery and achievement motives, which were analyzed using the generalized estimating equation (GEE). A baseline score of depression was used as an adjustment for the GEE analyses to eliminate the effects of depression on outcomes., Results: After controlling age and gender as confounders, GEE analyses indicated that the experimental group showed significant post-intervention improvements in scores for self-esteem (β = 2.18, P = .005) and mastery (β = 1.23, P = .039), compared to the control group., Conclusions: This study supported a combination of three-dimensional VR and hands-on horticultural activities on community-dwelling older adults to improve self-esteem and mastery. The findings suggest that the future implementation of a similar program would be feasible and beneficial to community-dwelling older adults., Trial Registration: The study was posted on www., Clinicaltrials: gov (NCT05087654) on 21/10/2021. It was approved by the Institutional Review Board of En Chu Kong Hospital and performed in accordance with the Declaration of Helsinki., (© 2022. The Author(s).)

Aim: This study aimed to examine the relationship between oral health and social activity, and explore the mediating effect of depressive symptoms on the relationship between oral health and social activity among community-dwelling older adults in Korea., Methods: A total of 5033 community-dwelling older adults aged ≥65 years were included in the analysis. Data were obtained from the seventh wave (2018) of the Korean Longitudinal Study of Aging. Descriptive statistics, Pearson's correlation analysis and path analysis for mediation analysis were used., Results: Path analysis showed that older adults with better oral health had more social activities (β = 0.177, P < 0.001) and fewer depressive symptoms (β = -0.174, P < 0.001). Depressive symptoms had a mediating role partially in the relationship between oral health and social activity (β = 0.014, P < 0.001). The results of in-depth exploration using oral health subdomains showed that physical oral function and oral pain or discomfort were directly related to the social activity (β = 0.083 and β = 0.149, respectively) and indirectly mediated by depressive symptoms (β = 0.006 and β = 0.004, respectively). However, psychosocial oral function only had an indirect effect on social activity mediated by depressive symptoms (β = 0.006, P = 0.005)., Conclusions: Better oral health had a significant association with higher levels of social activities, which was partially mediated by decreased depressive symptoms. It is necessary to pay more attention to oral health promotion for older adults to decrease depressive symptoms and increase participation in social activities. Geriatr Gerontol Int 2022; 22: 766-772., (© 2022 Japan Geriatrics Society.)

Aims: This study aims to explore the relationship between regular exercise, social support and depression in community-dwelling older people and find out the predictors of depression., Methods: Cross-sectional and correlation designs were used. The participants were recruited from August to October in 2020. The STROBE was used as a checklist for this study., Results: The study found that female gender, older age, poor sleep quality, irregular exercise and low social support were the main predictors of depression among the community-dwelling older people., Conclusion: It is suggested that healthcare professionals motivate the older people to exercise regularly in the community using individualized exercise routines designed according to their physical conditions such as different types, frequencies and intensity of exercise. Providing social support to each other at the community care site should be encouraged, and regular assessment of the mental health of community-dwelling older people should be done. It is also recommended to organize a timely depression-related education course for older people in the community., (© 2021 John Wiley & Sons Australia, Ltd.)

Objectives: Neighborhood built environments (BEs) are increasingly recognized as being associated with late-life depression. However, their pathways are still understudied. This study investigates the mediating effects of physical and social activities (PA and SA) and functional ability (FA) in the relationships between BEs and late-life depression., Methods: We conducted a cross-sectional analysis with data from 2,081 community-dwellers aged 65 years and older in Hong Kong in 2014. Two road-network-based service area buffers (200- and 500-m buffers) adjusted by terrain and slope from participants' residences were created to define the scope of neighborhoods. BEs comprised population density in District Council Constituency Areas, urban greenness, land-use diversity, and neighborhood facilities within 200- and 500-m buffers. Multilevel path analysis models were used., Results: More urban greenness within both buffers and more commercial facilities within a 500-m buffer were directly associated with fewer depressive symptoms. SA mediated the relationship between the number of community facilities and depressive symptoms within a 200-m buffer. Neighborhood urban greenness and the number of commercial facilities had indirect associations on depressive symptoms within a 500-m buffer, which were mediated by FA., Discussion: Our findings have implications for the ecological model of aging. The mediating effects of SA and FA underscore the importance of promoting active social lifestyles and maintaining FA for older adults' mental health in high-density cities. Policy implications on how to build age-friendly communities are discussed., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: We examined the association between living alone and mental health and the moderating effects of face-to-face and non-face-to-face social contacts, among community-dwelling older adults., Study Design: Cross-sectional study., Methods: This cross-sectional study recruited Japanese adults older than 60 years, who attended health check-ups held in a suburban town hall in July and August of 2018 and 2019. As mental health outcomes, depression was assessed using the Geriatric Depression Scale 15-items, loneliness was assessed using the University of California, Los Angeles Loneliness Scale 3-items, and happiness was self-rated on a 10-point scale. Face-to-face social contacts were evaluated by participants' frequency of meetings with relatives or friends, whereas non-face-to-face contacts were measured by the frequency of interactions via letter, telephone or e-mail. Multivariable linear regression analysis was conducted to examine the association between living alone with each mental health outcome and the effect modifications of having face-to-face and non-face-to-face social contacts., Results: Data from 300 older adults were analysed. The participants' mean age was 73.0 years, 51.3% were female, and 16.0% lived alone. Living alone was significantly associated with poorer mental health. Regarding loneliness and low happiness, having face-to-face and non-face-to-face contacts more than once a week alleviated the adverse association of living alone (loneliness: face-to-face contacts, P = 0.020; non-face-to-face contacts, P = 0.028; happiness: face-to-face contacts, P = 0.020; non-face-to-face contacts, P = 0.001)., Conclusions: Our findings suggest that non-face-to-face, as well as face-to-face social contacts have a moderating effect on the adverse association of living alone with loneliness and happiness., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Frailty is considered to be a complex concept based mainly on physical vulnerability, but also vulnerabilities in mental/psychological and social aspects. Frailty can be reversible with appropriate intervention; however, factors that are important in recovering from frailty have not been clarified. The aim of the present study was to identify factors that help an individual reverse frailty progression and characteristics of individuals that have recovered from frailty. Community-dwelling people aged ≥75 years who responded to the Kihon Checklist (KCL) were enrolled in the study. The KCL consists of 25 yes/no questions in 7 areas: daily-life related activities, motor functions, nutritional status, oral functions, homebound, cognitive functions, and depressed mood. The number of social activities, degree of trust in the community, degree of interaction with neighbors, and subjective age were also evaluated. Frailty was assessed based on the number of checked items: 0-3 for robust, 4-7 for pre-frailty, and ≥8 for frailty. A total of 5050 participants were included for statistical analysis. At the time of the baseline survey in 2016, 18.7% (n = 942) of respondents had frailty, and the follow-up survey showed that the recovery rate from frailty within 2 years (median 24 months) was 31.8% (n = 300). Multiple logistic regression analysis showed that exercise-based social participation (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.2-3.4; P<0.01) and self-rated health (OR 1.2, CI 1.0-1.5; P = 0.02) were related to reversing frailty progression. Principal component analysis indicated that the main factors constituting the first principal component (contribution rate, 18.3%) included items related to social capital, such as interaction with neighbors, trust in the community, and number of social participation activities. Our results demonstrate that exercise-based social participation and high self-rated health have associations with reversing frailty progression. Individuals that recovered from frailty are characterized by high individual-level social capital components (i.e., trust in community, interaction with neighbors, and social participation)., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Investigate the cross-sectional association between hearing loss (HL), hearing aid use, and depressive symptoms in community-dwelling older adults., Method: The analytic sample consisted of 3,188 participants (age range 71-94 years) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). Multivariable logistic regression was used to evaluate the association of audiometric hearing status and self-reported hearing aid use with depressive symptoms (11-item Center for Epidemiologic Studies Depression scale)., Results: 4.6% of participants had depressive symptoms. Forty percent had mild HL and 27% had moderate or greater HL. In multivariable-adjusted models, mild HL was associated with 1.90 times higher odds (95% confidence interval [CI] 1.20-3.01) and moderate or greater HL with 2.42 times higher odds (95% CI 1.44-4.07) of depressive symptoms compared to normal hearing. Each 10dB increase in HL was associated with 1.30 higher odds of depressive symptoms (95% CI 1.14-1.49). Hearing aid use was not associated with depressive symptoms among those with mild (odds ratio [OR] 0.94, 95% CI 0.35-2.54) or moderate or greater (OR 1.12, 95% CI 0.60-2.11) HL., Discussion: Older adults with HL have higher odds of depressive symptoms compared to adults with normal hearing. Future studies are needed to assess whether hearing care is protective against depressive symptoms in older adults., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Depressive symptoms are common in people with dementia., Purpose: This study examined the discrepancies in the ratings of depressive symptoms between people with dementia and their family caregivers, and the extent to which these discrepancies varied according to the functional status of people with dementia., Participants and Methods: This study is a cross-sectional secondary analysis. Twenty-five people living with dementia ("participants") and their family caregivers ("proxies") participated as pairs in the study (participant mean age = 71.36, SD = 8.63; proxy mean age = 67.54, SD = 11.46). Data were collected in Victoria, Australia between May 2018 and May 2019. Participants were administered a semi-structured interview comprising the Cornell Scale for Depression in Dementia (CSDD). Proxies independently completed the CSDD and the Functional Activities Questionnaire (FAQ). A paired sample t -test was used to investigate differences in CSDD scores between participants and proxies. Kendall's tau-b correlation was used to examine the relationship between FAQ scores and discrepancy scores of CSDD. Participants were then classified into either low or high functional impairment. Mann-Whitney U -test was used to examine whether the discrepancy scores of CSDD were similar between these two groups. Intraclass correlation coefficients were calculated to indicate the level of agreement between participants and proxies in each group., Results: The CSDD scores of participants were significantly lower than proxies. The size of the discrepancy in CSDD scores was positively correlated with FAQ scores. The "high functional impairment" group had larger discrepancy scores and a lower level of agreement than the "low functional impairment" group., Conclusion: The findings highlighted that relying on proxy CSDD scores may not reflect estimates of depressive symptoms by people with dementia. Hence, both perspectives need to be taken into account, particularly when the level of functional impairment in dementia is advanced., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Leung et al.)

Background/objectives: Exposure to air pollution may contribute to both increasing depressive symptoms and decreasing episodic memory in older adulthood, but few studies have examined this hypothesis in a longitudinal context. Accordingly, we examined the association between air pollution and changes in depressive symptoms (DS) and episodic memory (EM) and their interrelationship in oldest-old (aged 80 and older) women., Design: Prospective cohort data from the Women's Health Initiative Memory Study-Epidemiology of Cognitive Health Outcomes., Setting: Geographically diverse community-dwelling population., Participants: A total of 1,583 dementia-free women aged 80 and older., Measurements: Women completed up to six annual memory assessments (latent composite of East Boston Memory Test and Telephone Interview for Cognitive Status) and the 15-item Geriatric Depression Scale (GDS-15). We estimated 3-year average exposures to regional particulate matter with aerodynamic diameter below 2.5 μm (PM 2.5 ) (interquartile range [IQR] = 3.35 μg/m 3 ) and gaseous nitrogen dioxide (NO 2 ) (IQR = 9.55 ppb) at baseline and during a remote period 10 years earlier, using regionalized national universal kriging., Results: Latent change structural equation models examined whether residing in areas with higher pollutant levels was associated with annual changes in standardized EM and DS while adjusting for potential confounders. Remote NO 2 (β = .287 per IQR; P = .002) and PM 2.5 (β = .170 per IQR; P = .019) exposure was significantly associated with larger increases in standardized DS, although the magnitude of the difference, less than 1 point on the GDS-15, is of questionable clinical significance. Higher DS were associated with accelerated EM declines (β = -.372; P = .001), with a significant indirect effect of remote NO 2 and PM 2.5 exposure on EM declines mediated by DS. There were no other significant indirect exposure effects., Conclusion: These findings in oldest-old women point to potential adverse effects of late-life exposure to air pollution on subsequent interplay between DS and EM, highlighting air pollution as an environmental health risk factor for older women., (© 2020 The American Geriatrics Society.)

Aim: This study aimed to assess the relationship between functional limitations and depression among community-dwelling older adults in Malaysia., Methods: Data from a nation-wide community-based cross-sectional study were analyzed. This study was conducted using a two-stage stratified random sampling design. In total, 3772 older adults aged ≥60 years responded to the survey. Depression was identified using a validated Malay version of the Geriatric Depression Scale (M-GDS-14), with those scored ≥6 categorized as having depression. Functional limitations were assessed using both Barthel's Activities of Daily Living (ADL) and Lawton's Instrumental Activities of Daily Living (IADL). The relationship was determined by multivariate logistic regression, adjusted for other variables., Results: The prevalence of depression was 11.5% (95% confidence interval [CI] 9.4, 13.4). Multiple logistic regression analysis found that older adults with limitations in ADL were 2.6 times more likely of having depression (adjusted odds ratio [aOR] 2.58, 95% CI 2.01, 3.32), while those with limitations in IADL the risk of having depression was almost doubled (aOR 1.68, 95% CI: 1.32, 2.14). Other significant factors were incontinence (aOR 3.33, 95% CI: 2.33, 4.74), chronic medical illness (aOR 1.44, 95% CI: 1.15, 1.81), current smoker (aOR 4.19, 95% CI: 1.69, 10.39), poor social support (aOR 4.30, 95% CI: 2.98, 6.20), do not have partner, ethnic minorities and low individual monthly income., Conclusions: Older adults with functional limitation in both basic ADL and complex IADL are independently at higher risk of having depression. Geriatr Gerontol Int 2020; 20: 21-25., (© 2020 Japan Geriatrics Society.)

Objectives: To investigate the association between depressive symptoms and several medical morbidities, and their combination, in a large older population., Design: Cross-sectional study of baseline data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial., Setting: Multicentric study conducted in Australia and the United States., Participants: A total of 19,110 older adults (mean age = 75 years [standard deviation = ±4.5])., Measurements: Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D 10) scale. Medical morbidities were defined according to condition-specific methods. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to test associations before and after accounting for possible confounders., Results: Depressive symptoms were significantly associated with obesity (OR = 1.19; 95% CI = 1.07-1.32), diabetes (OR = 1.22; 95% CI = 1.05-1.42), gastroesophageal reflux disease (GERD) (OR = 1.41; 95% CI = 1.28-1.57), metabolic syndrome (OR = 1.16; 95% CI = 1.03-1.29), osteoarthritis (OR = 1.41; 95% CI = 1.27-1.57), respiratory conditions (OR = 1.25; 95% CI = 1.10-1.42), history of cancer (OR = 1.19; 95% CI = 1.05-1.34), Parkinson's disease (OR = 2.56; 95% CI = 1.83-3.56), polypharmacy (OR = 1.60; 95% CI = 1.44-1.79), and multimorbidity (OR = 1.29; 95% CI = 1.12-1.49). No significant association was observed between depressive symptoms and hypertension, chronic kidney disease, dyslipidemia, and gout (P > .05). A significant dose-response relationship was evident between the number of medical comorbidities and the prevalence of depression (OR = 1.18; 95% CI = 1.13-1.22)., Conclusion: Late-life depressive symptoms are significantly associated with several medical morbidities, and there appears to be a cumulative effect of the number of somatic diseases on the prevalence of depression. These findings augment the evidence for a complex relationship between mental and physical health in an otherwise healthy older population and might guide clinicians toward early recognition of high-risk individuals. J Am Geriatr Soc 68:1834-1841, 2020., (© 2020 The American Geriatrics Society.)

Because depression has high prevalence and cause enduring disability, it is important to predict onset of depression among community dwelling adults. In this study, we aimed to build a machine learning-based predictive model for future onset of depression. We used nationwide survey data to construct training and hold-out test set. The class imbalance was dealt with the Synthetic Minority Over-sampling Technique. A tree-based ensemble method, random forest, was used to build a predictive model. Depression was defined by 9 or more on the Center for Epidemiologic Studies - Depression Scale 11 items version. Hyperparameters were tuned throughout the 10-fold cross-validation. A total of 6,588 (6,067 of non-depression and 521 of depression) participants were included in the study. The area under receiver operating characteristics curve was 0.870. The overall accuracy, sensitivity, and specificity were 0.862, 0.730, and 0.866, respectively. Satisfactions for leisure, familial relationship, general, social relationship, and familial income had importance in building predictive model for the onset of future depression. Our study demonstrated that predicting future onset of depression by using survey data could be possible. This predictive model is expected to be used for early identification of individuals at risk for depression and secure time to intervention., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: The current study aimed to elucidate the associations between cognitive leisure activities and cognitive function in an older population stratified by having or not having depressive symptoms., Design: A retrospective cross-sectional study based on a self-report questionnaire., Setting: Annual health check-ups in a rural community in Japan., Participants: A total of 11 010 community-dwelling older adults aged ≥65 years (mean age: 74.0±5.4 years) was examined. Participants with missing data for the main outcome (n=1630) were excluded., Outcome Measures: Cognitive impairment was defined as at least 1.5 SD below the reference threshold (age-adjusted and education-adjusted score) on two of more of the tests in the National Center for Geriatrics and Gerontology-Functional Assessment Tool. Depressive symptoms were defined by a 15-item Geriatric Depression Scale score ≥6. We assessed the frequency of participation in cognitive leisure activities using the validated scale (score: 0-42). A score of ≥8 points was defined as frequent participation in cognitive leisure activities., Results: A total of 12.6% (n=1186) of the participants had depressive symptoms. There was a significant association between cognitive leisure activities and cognitive impairment in older adults (adjusted OR=0.77, 95% CI=0.65 to 0.94). In older adults with depressive symptoms, a higher frequency of cognitive leisure activities was negatively associated with cognitive impairment (adjusted OR=0.45, 95% CI=0.28 to 0.70). In contrast, there was no significant association in older adults without depressive symptoms (adjusted OR=0.85, 95% CI=0.70 to 1.02)., Conclusions: Engaging in cognitive leisure activities in late life is associated with better cognitive function in older adults with depressive symptoms., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Sedentary behavior (SB) may be a risk factor for depression in middle- and old age adults. The aim of this study was to examine cross-sectional and longitudinal relationships between SB and depression in a large national sample of Irish people aged 50 and older taking into account a wide range of previously identified influential factors., Methods: Data from the Irish Longitudinal Study on Ageing survey were analyzed (wave 1: 2009-2011, wave 2: 2012-2013). Depression was assessed with the Center for Epidemiologic Studies Depression scale. Total weekday SB and control variables were self-reported. Multivariable logistic regression and mediation analysis were conducted to assess the associations., Results: The final sample consisted of 6903 individuals aged ≥50 years (63.6 ± 9.2years; 52.1% female). After full adjustment for age, gender, social class, current smoking, physical activity, mobility, pain, cognition, chronic physical conditions, disability, anxiety, loneliness, and social network, the association between SB and depression was not statistically significant (OR=1.06; 95%CI=0.60-1.89). Mediation analysis showed that the association is explained by social network (mediated percentage 23.1%), physical activity (20.3%), loneliness (13.2%), chronic physical conditions (11.1%), and disability (7.9%). Cross-sectional analysis showed that SB is significantly associated with depression even after full adjustment., Limitations: SB was self-reported., Conclusions: Factors closely linked with SB such as social isolation, loneliness, physical inactivity, chronic physical conditions, and disability may play a major role in depression among middle-aged and older people. Lifestyle interventions focusing on reductions in depression in this population need to consider these factors., (Copyright © 2019. Published by Elsevier B.V.)

An association between fatigue and depression was reported for older adults. We examined the association between fatigue, sleep and depression from interRAI-HC assessments of community dwelling older people (65+ years). Interview data from 5,950 participants who completed their first interRAI-HC assessment was analysed (mean age, 81.3 ± 7.1 years; 60.2% female). Only 873 (15%) reported "severe" fatigue. Nearly half reported minor sleep problems. Depression was diagnosed in 693 participants (11.6%). Depression explained only 0.2% of fatigue. This calls for further studies that may help in understanding the relationship between fatigue and depression across the life-cycle., Competing Interests: Declaration of Competing Interest None, (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: This study aimed to examine the bidirectional relationship between depressive symptoms and homebound status among older adults., Method: The study sample included 7,603 community-dwelling older adults from the National Health and Aging Trends Study. A bivariate latent state-trait model of depressive symptoms and homebound status was estimated via structural equation modeling., Results: The model fit the data well (Root Mean Square Error of Approximation = .02, Comparative Fit Index = .97, Standardized Root Mean Square Residual = .06). The relationship between homebound status and depressive symptoms can be decomposed into three parts: a moderate correlation between the stable trait components (r = .56, p <.001); a contemporary association of the state components (b = .17, p <.001); and bidirectional lagged effects between the state components. Change in homebound status was as a stronger predictor of depressive symptoms (b = .19, p < .001) than change in depressive symptoms was of homebound status (b = .06, p < .001; test of difference: Δ scaled χ2(1) = 24.2, p < .001)., Discussion: Homebound status and depressive symptoms form a feedback loop to influence each other. Improving the outdoor mobility of older adults may have immediate benefits for reducing depressive symptoms., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Instrumental Activities of Daily Living (IADL) is an indicator of whether a community-dwelling elderly can live independently. IADL decline was reported to be associated with aging and depression. The present study aimed to investigate whether the association between IADL decline and depressive symptoms differs with aging, using two age groups of community-dwelling Japanese elderly in their 70s and 80s., Methods: We conducted longitudinal analysis among participants in their 70s and 80s at the baseline from Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. IADL was assessed by The Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence. As a main predictor, depressive symptoms were measured by the five-item version of the Geriatrics Depression Scale (GDS-5). As possible confounders, we considered cognitive function, body mass index, solitary living, education, economic status, medical history of stroke and heart disease, hypertension, dyslipidemia, diabetes, and sex. We obtained odds ratios (ORs) of IADL decline for having depressive symptoms in each age group (70s/80s) and tested interactions between depressive symptoms and age groups in relation to IADL decline in 3 years by logistic regression. Additionally, to confirm age group differences, we conducted multiple group analysis., Results: There were 559 participants in their 70s and 519 in their 80s. Compared to participants without depressive symptoms, those with depressive symptoms had higher OR of IADL decline in 70s (OR [95% CI] = 2.33 [1.13, 4.78]), but not in 80s (OR [95% CI] = 0.85 [0.46, 1.53]). There were significant interactions between depressive symptoms and age groups in relation to IADL decline (p-value = 0.03). Multiple group analyses showed differences between the age groups by Akaike information criterion (AIC), and ORs (95%CI) decline for depressive symptoms was 2.33 (1.14, 4.77) in 70s and 0.85 (0.47, 1.54) in 80s., Conclusion: The association of depressive symptoms and IADL decline during the 3 years was significantly different between the 70s and 80s age groups, and significant association was found only in people in their 70s. Detecting depressive symptoms may be a key for preventing IADL decline in people in their 70s and not for those in their 80s.

Older adults with schizophrenia have some of the highest rates of both medical and psychiatric comorbidities. Despite this, little is known about comorbid pain and depressive symptoms in schizophrenia research. This study aimed to examine the associations between levels of pain intensity and depressive symptoms among community-dwelling adults aged 50 years and older with schizophrenia spectrum disorders. Recruited from U.S. community mental health centers, participants reported on pain and depressive symptoms at the onset of the Helping Older People Experience Success (HOPES) study. Unadjusted and adjusted regression analyses were conducted. Higher pain intensity was associated with elevated depressive symptoms in all analyses, which is consistent with other studies in the general population. Given the widespread efforts to manage pain and related mental health complications in older adults without serious mental illnesses, it is likewise important that community-based mental health professionals monitor and address intense pain and related depressive symptoms among older adults with schizophrenia.

Obstructive sleep apnea (OSA) is highly related to mental health problems, such as depression and anxiety. However, previous studies on OSA and depression and anxiety have mostly been conducted in the adult population. We aimed to (1) screen for risk of OSA in a sample of adolescents from the general population using self-report questionnaires and (2) examine whether there are differences between the high- and low-risk groups for OSA in depressive and anxiety symptoms, self-esteem, and sleep-related variables. The data of 793 students (age range: 12-17 years old) were analyzed. The participants were assigned to the high-risk (n = 202, 25.5%) or the low-risk group (n = 591, 74.5%) of OSA. The participants in the high-risk group had more severe anxiety symptoms, lower self-esteem, insomnia, excessive daytime sleepiness, and higher BMI compared those in the low-risk group. This study shows that it is possible to efficiently screen for risks of various problems associated with OSA in adolescents using an easy and simple screening tool., (Copyright © 2019 Elsevier B.V. All rights reserved.)

This study investigated the relationship between numerical accuracy (i.e, number comprehension and mental calculation) and self-reported depression in late adulthood. Whether social context (i.e., marital status) and very early cognitive decline symptoms impacted numerical performance was also examined. Ninety-four community-dwelling elderly participants were recruited in Sardinia, an Italian island characterized by increased longevity. All participants were presented a battery of tests and questionnaires assessing general cognitive efficiency, lifestyle, perceived physical health, numeracy, metacognitive and depressive responses. Number comprehension skills, time spent for gardening, metacognitive performance, and physical health predicted 26% of variance in CES-D index. Furthermore, married participants outperformed single/widowed ones in both number comprehension and mental calculation tasks. The same pattern of results was replicated when cognitively healthy controls were contrasted with participants with some signs of cognitive decline. The assessment of numeracy skills can be very informative in order to promote mental health and life quality in late adult span.

Objectives: American Indians experience disproportionately high rates of poor mental health and type 2 diabetes mellitus (T2DM). We examined the association between depressive symptoms and all-cause mortality in older American Indians with T2DM., Design: We used the Native Elder Care Study survey data from community-dwelling American Indians aged 55 years or older, linked to data extracted from participants' electronic health records. We focused on those who had an International Classification of Diseases-Ninth Revision diagnosis of T2DM in their electronic health records., Setting: The study was conducted with a federally-recognized tribe with approximately 16,000 enrolled members, most of whom reside on or near tribally-owned lands that span several rural counties., Participants: Participants were among the Native Elder Care Study participants with a final analytic sample of 222., Measurements: We measured depressive symptoms with the Centers for Epidemiologic Studies-Depression (CES-D) scale. We used Cox proportional hazard models to examine the association between depressive symptoms and all-cause mortality in the final analytic sample of 222 subjects., Results: Survival curves revealed that individuals in the third and fourth CES-D scale categories had higher mortality than those in the first and second categories. Mortality risk was significantly higher for participants with CES-D scale scores in the third highest compared with the lowest category (hazard ratio = 2.07; 95% confidence interval = 1.07-4.04), after adjustment for demographic characteristics, health behaviors, obesity, and prevalent T2DM complications. Analyses with the CES-D scale as a continuous variable also showed a positive association with mortality., Conclusion: The impact of mental health on older American Indians with T2DM is often overlooked, yet it is vital to clinical and public health practice. Our findings underscore the importance of addressing the mental health needs of this population, particularly because depression in older patients is often undetected or inadequately treated. J Am Geriatr Soc 67:1940-1945, 2019., (© 2019 The American Geriatrics Society.)

Objectives: Depressive symptoms can be both a cause and a consequence of functional limitations and medical conditions. Our objectives were to determine the association of depressive symptoms with subsequent total healthcare costs in older women after accounting for functional limitations and multimorbidity., Design: Prospective cohort study (Study of Osteoporotic Fractures [SOF])., Setting: Four US sites., Participants: A total of 2508 community-dwelling women (mean age = 79.4 years) participating in the SOF year 10 (Y10) examination linked with their Medicare claims data., Measurements: At Y10, depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS) and functional limitations were assessed by number (range = 0-5) of impairments in performing instrumental activities of daily living. Multimorbidity was ascertained by the Elixhauser method using claims data for the 12 months preceding the Y10 examination. Total direct healthcare costs, outpatient costs, acute hospital stays, and skilled nursing facility during the 12 months following the Y10 examination were ascertained from claims data., Results: Annualized mean (SD) total healthcare costs were $4654 ($9075) in those with little or no depressive symptoms (GDS score = 0-1), $7871 ($14 534) in those with mild depressive symptoms (GDS score = 2-5), and $9010 ($15 578) in those with moderate to severe depressive symptoms (GDS score = 6 or more). After adjustment for age, site, self-reported functional limitations, and multimorbidity, the magnitudes of these incremental costs were partially attenuated (cost ratio = 1.34 [95% confidence interval {CI} = 1.14-1.59] for those with mild depressive symptoms, and cost ratio = 1.29 [95% CI = 0.99-1.69] for those with moderate to severe depressive symptoms vs women with little or no depressive symptoms)., Conclusion: Depressive symptoms were associated with higher subsequent healthcare costs attributable, in part, to greater functional limitations and multimorbidity among those with symptoms. Importantly, even mild depressive symptoms were associated with higher healthcare costs. J Am Geriatr Soc 67:1596-1603, 2019., (© 2019 The American Geriatrics Society.)

Background: Depressive symptoms have been found to be associated with decreased hand-grip strength (HGS) and low socioeconomic status (SES) in older adults. We aimed to investigate the potential moderating effect of SES on the association between HGS and depressive symptoms and the potential mediating effect of HGS on the association between SES and depressive symptoms using a nationally representative sample of older adults., Method: Data from 3169 community-dwelling adults aged 60 years or older were acquired from the Korea National Health and Nutrition Examination Survey conducted in 2014 and 2016. HGS was measured using a digital hand-grip dynamometer. Depressive symptoms were evaluated using the 9-item version of the Patient Health Questionnaire-9 (PHQ-9). SES was assessed using equivalent monthly household income and education level., Results: Older adults in the lowest tertile of HGS measures were more likely to have experienced depressive symptoms compared to those in the highest tertile (odds ratio = 1.95, 95% confidence interval = 1.25-2.74). A significant moderating effect of household income level was observed on the association between HGS and PHQ-9 score (P = 0.014). Older adults with a low income had a stronger inverse correlation between HGS and PHQ-9 score compared to those with a high income (low income: beta =  -0.162, P < 0.001; high income: beta = -0.119, P = 0.036). HGS partially mediated the association between low income and depressive symptoms., Conclusion: Our findings indicate that there may be a stronger relationship between low HGS and depressive symptoms in socioeconomically deprived older people. Further research on muscle strength and income level in older adults is required regarding depression risk assessment., (Copyright © 2019. Published by Elsevier B.V.)

Background: Data from the World Health Organization Study on global AGEing and adult health (SAGE) were used to estimate the prevalence of depression in older adults in six low- and middle-income countries (LMICs), namely China, Ghana, India, Mexico, the Russian Federation, and South Africa, and to examine the relationship between demographic and lifestyle characteristics and depression., Method: A total of 33,421 participants aged ≥ 50 years were included. A set of diagnostic questions from the World Mental Health Survey was used within SAGE to define depression., Results: The crude population prevalence of depression was 7.4% [95%CI: 6.5%-8.3%] ranging from 1.5% in China to 15.2% in India. It was higher in females 8.6% [7.6%-9.6%] compared to males 6.1% [5.0%-7.2%]. The age-standardized prevalence of depression was 7.8% [6.3%-9.6%] in pooled data, 8.9% [6.9%-11.1%] in females and 6.6% [4.6%-9.0%] in males. Greater fruit (0.89[0.84-0.93]) and vegetable intake (0.94 [0.89-1.00]) was associated with a lower prevalence of depression. Furthermore, those who were older, female, underweight, and with lower education and lower wealth, had higher prevalence of depression., Limitations: The cross-sectional design of this study precluded conclusions on causality., Conclusion: In nationally-representative samples of older adults in six LMICs, an average of one in every 13 participants suffered from depression. The prevalence of depression varied considerably between countries, sexes, and with wealth and educational disadvantage. Increased fruit and vegetable intake appeared to co-occur with significantly lower rates of depression, suggesting diet as a modifiable factor for addressing depression burden., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The older adults with chronic disease usually show poor mental health and experience low quality of life (QOL). This study aimed to examine the mediating role of social support in the relationship between depression and QOL in community-dwelling older adults with chronic disease. A total of 387 Chinese older adults aged 60 or above with chronic disease were included in this cross-sectional study. Social support was negatively associated with depression and positively associated with physical component scale (PCS) and mental component scale (MCS). Depression and social support were all predictors of PCS and MCS. Mediation analysis suggested that social support partially mediated the impact of depression on PCS and MCS. Understanding the mediating role of social support might be beneficial in reducing the adverse impact of depression on QOL in community-dwelling older adults with chronic disease., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: This population-based study aimed to determine 5-year change in multidimensional QoL among community-dwelling older people, and to identify predictors of QoL change among demographic, socioeconomic, and health characteristics., Methods: Data of the 2011 and 2016 annual assessments of 1845 older men and women (age range 68-77 years) from the Lc65 + cohort study were used. QoL was assessed using a 28-item instrument yielding a QoL overall score and seven domain-specific QoL subscores. Additional ratings of QoL included a single item (excellent; very good; good; fair; poor), expected QoL in 1 year (better; worse; same as today), and retrospective assessment of QoL 5-year change (better; worse; same as 5 years ago). The predictors of 5-year change in the QoL score were assessed using linear regression, controlling for baseline QoL score., Results: All prospective and retrospective indicators of QoL converged towards a slight deterioration over 5 years. QoL subscores significantly decreased in domains "Close entourage" (P = 0.004), "Social and cultural life" (P < 0.001), "Esteem and recognition" (P = 0.001), "Health and mobility" (P < 0.001), and "Autonomy" (P < 0.001), whereas "Material resources" (P = 0.345) and "Feeling of safety" (P = 0.380) remained stable. A stronger decrease in QoL was observed in the most vulnerable profiles at baseline in terms of demographic, socioeconomic, and health characteristics. Changes in depressive symptoms and in disability-either worsening or improving-predicted QoL change in the expected direction., Conclusions: Age-related decline in QoL may be limited through the prevention of disability and depressive symptoms, and more generally by devoting special attention to vulnerable profiles.

Purpose: Many major studies of depression in Australia are under-representative of rural and remote residents, limiting the generalizability of their findings. This study explores the contributions of a range of individual, social, and community factors to the trajectory of depressive symptoms among a cohort of rural and remote residents., Methods: Data from four waves of the Australian Rural Mental Health Study (baseline n = 2639), a 5 year longitudinal study of rural community residents, were examined within generalized linear mixed models to predict depressive symptoms. Depression was measured using the PHQ-9, with key correlates including social support, employment status, financial wellbeing, neuroticism, and rural community factors., Results: Moderate-to-severe depression was reported by 6.3% of the baseline sample. Being permanently unable to work resulted in over a threefold increase in the odds of depression at the following survey wave. Self-rated financial hardship was associated with a fourfold increase in the odds of future depression, as was a high level of community concerns. Neuroticism and tobacco use also made a significant independent contribution to future depressive symptoms. Interpersonal support was a protective factor, reducing the odds of next-wave depression by 64%., Conclusion: Financial and employment-related difficulties appear to be important risk factors for depression, and targeting individuals experiencing such difficulties may be an effective means of reducing depression among certain sub-groups. Strategies to prevent depression in rural and remote Australia may benefit from a focus on interpersonal and community-level support, as the effects of this support are lasting and contribute to a reduced likelihood of depressive episodes in future years.

Background: Perceived stress may be a modifiable risk factor for mild cognitive impairment (MCI) and ultimately dementia, but studies on this topic from low- and middle-income countries (LMICs) are lacking., Objective: We assessed the association between perceived stress and MCI in six LMICs (China, Ghana, India, Mexico, Russia, and South Africa) using nationally representative data., Methods: Cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. A perceived stress score (range 0 [lowest stress] to 10 [highest stress]) was computed based on two questions from the Perceived Stress Scale. Multivariable logistic regression analysis was conducted to assess the as-sociation between perceived stress and MCI., Results: The mean (SD) age of the 32,715 participants was 62.1 (15.6) years and 51.7% were females. After adjustment for potential confounders including depression, in the overall sample, a one-unit increase in the perceived stress score was associated with a 1.14 (95% CI = 1.11-1.18) times higher odds for MCI. The association was similar among those aged 50-64 and ≥65 years. Countrywise analysis showed that there was a moderate level of between-country heterogeneity in this association (I2 = 59.4%), with the strongest association observed in Russia (OR = 1.33, 95% CI = 1.15-1.55)., Conclusion: If our study results are confirmed in prospective studies, addressing perceived stress may have an impact in reducing the risk for MCI and subsequent dementia in LMICs., (© 2018 S. Karger AG, Basel.)

Self-efficacy has been consistently found to be a protective factor against psychological distress and disorders in the literature. However, little research is done on the moderating effect of self-efficacy on depressive symptoms in the context of chronic pain. This cross-sectional study aimed to examine if pain self-efficacy attenuated the direct relationship between pain intensity and depressive symptoms, as well as their indirect relationship through reducing the extent of catastrophizing when feeling pain (moderated mediation). 664 community-dwelling Chinese older adults aged 60-95 years who reported chronic pain for at least three months were recruited from social centers. They completed a battery of questionnaires on chronic pain, pain self-efficacy, catastrophizing, and depressive symptoms in individual face-to-face interviews. Controlling for age, gender, education, self-rated health, number of chronic diseases, pain disability, and pain self-efficacy, pain catastrophizing was found to partially mediate the connection between pain intensity and depressive symptoms. Furthermore, the relationship between pain intensity and depressive symptoms was moderated by pain self-efficacy. Self-efficacy was also found to moderate the relationship between pain intensity and catastrophizing and the moderated mediation effect was confirmed using bootstrap analysis. The results suggested that with increasing levels of self-efficacy, pain intensity's direct effect on depressive symptoms and its indirect effect on depressive symptoms via catastrophizing were both reduced in a dose-dependent manner. Our findings suggest that pain self-efficacy is a significant protective factor that contributes to psychological resilience in chronic pain patients by attenuating the relationship of pain intensity to both catastrophizing and depressive symptoms., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To examine the cross-sectional and longitudinal relationships between elder abuse and neglect (EAN) and chronic pain in rural older Malaysians., Design: Two-year prospective cohort study., Setting: Kuala Pilah, a district in Negeri Sembilan approximately 100 km from the capital city, Kuala Lumpur., Participants: Community-dwelling older adults aged 60 and older. Using a multistage cluster sampling strategy, 1,927 respondents were recruited and assessed at baseline, of whom 1,189 were re-assessed 2 years later., Measures: EAN was determined using the modified Conflict Tactic Scale, and chronic pain was assessed through self-report using validated questions., Results: The prevalence of chronic pain was 20.4%. Cross-sectional results revealed 8 variables significantly associated with chronic pain-age, education, income, comorbidities, self-rated health, depression, gait speed, and EAN. Abused elderly adults were 1.52 times as likely to have chronic pain (odds ratio=1.52, 95% confidence interval (CI)=1.03-2.27), although longitudinal analyses showed no relationship between EAN and risk of chronic pain (risk ratio=1.14, 95% CI=0.81-1.60). This lack of causal link was consistent when comparing analysis with complete cases with that of imputed data., Conclusion: Our findings indicate no temporal relationship between EAN and chronic pain but indicated cross-sectional associations between the two. This might indicate that, although EAN does not lead to chronic pain, individuals with greater physical limitations are more vulnerable to abuse. Our study also shows the importance of cohort design in determining causal relationships between EAN and potentially linked health outcomes., (© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.)

Background: Evidence for the health benefits of a physically active lifestyle among older adults is strong, yet only a small proportion of older people meet physical activity recommendations. A synthesis of evidence identified "best bet" approaches, and this study sought guidance from end-user representatives and stakeholders to refine one of these, a peer-volunteering active aging intervention., Methods: Focus groups with 28 older adults and four professional volunteer managers were conducted. Semi-structured interviews were conducted with 9 older volunteers. Framework analysis was used to gauge participants' views on the ACE intervention., Results: Motives for engaging in community groups and activities were almost entirely social. Barriers to participation were lack of someone to attend with, lack of confidence, fear of exclusion or "cliquiness" in established groups, bad weather, transport issues, inaccessibility of activities, ambivalence, and older adults being "set in their ways". Motives for volunteering included "something to do," avoiding loneliness, the need to feel needed, enjoyment, and altruism. Challenges included negative events between volunteer and recipient of volunteering support, childcare commitments, and high volunteering workload., Conclusion: Peer-volunteering approaches have great potential for promotion of active aging. The systematic multistakeholder approach adopted in this study led to important refinements of the original ACE intervention. The findings provide guidance for active aging community initiatives highlighting the importance of effective recruitment strategies and of tackling major barriers including lack of motivation, confidence, and readiness to change; transport issues; security concerns and cost; activity availability; and lack of social support.

Purpose of the Study: This study investigated the mechanisms of change underlying an activity-based lifestyle intervention, an occupational therapy program aimed at promoting healthy habits, and routines in older adults. We examined two activity-relevant factors as potential mediators linking the intervention to reduced symptoms of depression: activity frequency and global perceptions of activity significance. Social connections and perceived control were assessed to understand how activity-related factors relate to reduced symptoms of depression., Design and Methods: The sample consisted of 460 multiethnic community-dwelling older adults aged 60-95 years. Participants were randomly assigned to a 6-month lifestyle redesign intervention (n = 232) or a no-treatment control (n = 228) condition. After the 6-month period, 360 individuals completed post-testing. Latent change score models were used to represent changes from baseline over the experimental interval. Structural equation models were applied to examine the indirect effects of the intervention on reduced depressive symptoms., Results: The results demonstrated significant indirect effects from intervention receipt to decreased depressive symptoms via increased activity frequency and activity significance. Higher activity frequency was linked to fewer depressive symptoms via heightened social connections, whereas increased activity significance was associated with fewer depressive symptoms via enhanced perceived control., Implications: The results support basic principles of occupational therapy by highlighting important mediating roles of activity frequency and activity significance in reducing depressive symptoms. Understanding of these change mechanisms can help optimize activity-centered interventions to reduce depressive symptoms.