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Depression is perhaps the most frequent cause of emotional suffering in later life and significantly decreases quality of life in older adults. In recent years, the literature on late-life depression has exploded. Many gaps in our understanding of the outcome of late-life depression have been filled. Intriguing findings have emerged regarding the etiology of late-onset depression. The number of studies documenting the evidence base for therapy has increased dramatically. Here, I first address case definition, and then I review the current community- and clinic-based epidemiological studies. Next I address the outcome of late-life depression, including morbidity and mortality studies. Then I present the extant evidence regarding the etiology of depression in late life from a biopsychosocial perspective. Finally, I present evidence for the current therapies prescribed for depressed elders, ranging from medications to group therapy.

Objectives: Work in occupations with higher levels of occupational stress can bring mental health costs. Many older adults worldwide are continuing to work past traditional retirement age, raising the question whether older adults experience depression, anxiety, or burnout at the same or greater levels as younger workers, and whether there are differences by age in these levels over time.Design/setting/participants: Longitudinal survey of 1161 currently employed US clergy followed every 6-12 months for up to 66 months.Measurements: Depression was measured with the 8-item Patient Health Questionnaire (PHQ-8). Anxiety was measured using the anxiety component of the Hospital Anxiety and Depression Scale (HADS). Burnout symptoms were assessed using the three components of the Maslach Burnout Inventory: emotional exhaustion (EE), depersonalization (DP), and sense of personal accomplishment (PA).Results: Older participants had lower scores of depression, anxiety, EE, and DP and higher levels of PA over time compared to younger adults. Levels of EE decreased for older working adults, while not significantly changing over time for those younger. DP symptoms decreased over time among those 55 years or older but increased among those 25-54 years.Conclusions: Older working adults may have higher levels of resilience and be able to balance personal life with their occupation as well as may engage in certain behaviors that increase social support and, for clergy, spiritual well-being that may decrease stress in a way that allows these older adults to appear to tolerate working longer without poorer mental health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Current standard of care for most intermediate and high‐grade soft‐tissue sarcomas (STS) includes limb‐preserving surgical resection with either neoadjuvant radiation therapy (NRT) or adjuvant radiation therapy. To date, there have been a few studies that attempt to correlate histopathologic response to NRT with oncologic outcomes in patients with STS. Methods: Using our institutional database, we identified 58 patients who received NRT followed by surgical resection for primary intermediate or high‐grade STS and 34 patients who received surgical resection without NRT but did receive adjuvant radiation therapy or did not receive any radiation therapy. We analyzed four histologic parameters of response to therapy: residual viable tumor, fibrosis/hyalinization, necrosis, and infarction (each ratiometrically determined). Data were stratified into two binary groups. Unadjusted, 5‐ and 10‐year overall survival, and relapsed‐free survival (RFS) were calculated using the Kaplan–Meier method. Results: Analysis of pathologic characteristics showed that patients treated with NRT demonstrate significantly higher tumor infarction, higher tumor fibrosis/hyalinization, and a lower percent viable tumor compared with patients not treated with NRT (p < 0.0001). Based on Kaplan–Meier curve analysis and multivariate cox proportional hazard model for OS and RFS, patients treated with NRT and showing >12.5% tumor fibrosis/hyalinization have significantly higher overall survival and recurrence‐free survival at 5 and 10 years. Discussion and Conclusion: We have identified three histopathologic characteristics—fibrosis, hyalinization, and infarction—that may serve as predictive biomarkers of response to NRT for STS patients. Future prospective studies will be needed to confirm this association. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to determine whether the [epsilon]4 allele of apolipoprotein E is predictive of mortality in a community-based sample. Design and Methods: Of the stratified random household sample of 4,162 participants age 65 years and older enrolled in the Duke site of the Established Populations for Epidemiologic Studies of the Elderly, those included in the present study were the 1,998 who were genotyped for apolipoprotein E (alleles [epsilon]2, [epsilon]3, and [epsilon]4) six years after baseline, and for whom survival status eight years later was known by search of the National Death Index. Information on demographic characteristics, physical and mental health status, functional status, and health services use was determined by structured questionnaires administered in person in the home. Results: The [epsilon]4 allele did not predict mortality for the group as a whole, or for those who were cognitively impaired. It did predict mortality for those who reported having had a heart attack or stroke. Implications: The apolipoprotein [epsilon]4 allele--although a risk factor for Alzheimer's disease, heart disease, and stroke--was only found to be a risk factor for mortality for those community residents who had had a heart attack or stroke. Otherwise, for this community-based sample, 71 years of age and older, it did not predict time to death and was not a risk factor for mortality. Key Words: Apolipoprotein E, Mortality, Race, African American, White

Background. Given previous findings of adverse health outcomes associated with the EA allele, data from a biracial community sample of older adults were used to determine whether functional decline is associated with the apolipoprotein E (APOE) E4 allele. Methods. In 1986, a stratified random household sample of community residents 65 years of age and older (n = 4162) formed the Duke Established Populations for Epidemiologic Studies of the Elderly. Of those available 6 years later, 78.4% (n = 1999) were genotyped, providing 'baseline' data at this time. The available survivors (n = 1529) provided longitudinal data 4 years later. Using longitudinal data from this sample, a combination of measures assessing self-care capability, instrumental activities of daily living (IADL), and mobility was obtained at baseline and 4 years later (n = 1529) to determine the extent to which the EA allele affected change in functional status. Functional status was assessed using items from a modified Katz Activities of Daily Living (ADL) Scale, the Older American Resources and Services IADL scale, and the Rosow-Breslau physical health scale. Control measures included demographic characteristics, depression, health status, arthritis, and cognitive status. APOE was coded as E4 present versus absent. Results. APOE E4 was not associated with decline in functional status in either bivariate or multivariate analyses as a main effect. There were, however, statistically significant interactions of the E4 allele with gender and baseline functional status, with greater functional decline in women with the E4 allele, whereas those with poorer baseline functioning who had the E4 allele were less likely to decline. No significant racial differences were found. Conclusions. Despite the documented association of the E4 allele of APOE with adverse health outcomes, the E4 allele was not associated with a decline in functional status as a main effect. Interactions of E4 with gender (being female) and baseline functional status, however, did predict functional decline.

Recent research has shown the beneficial effects of religious activity for individual health and well-being among older adults. The purpose of this article is to determine whether breaking the norms of the religious group can have deleterious consequences for individual mental health and whether this effect is exacerbated by frequent service attendance. To test these ideas, the authors used two waves of data collected from a sample of older adults (age 65 and over) living in central North Carolina. Using only sample members who reported an affiliation with a Baptist denomination, the authors tested whether attending services more often and living in rural areas were associated with a smaller likelihood of alcohol use. The authors further tested whether the use of alcohol in this sample was associated with higher counts of depressive symptoms. The results indicate that older Baptists who lived in rural areas and who attended services more often were less likely to use alcohol. It was also found that alcohol use had no effect on depressive symptoms. One exception to this latter finding was that among rural Baptists who rarely attended religious services, using alcohol was associated with more depressive symptoms.

Background. The purpose of the study was to examine religious attendance as a predictor of survival in older adults. Methods. A probability sample of 3,968 community-dwelling adults aged 64-101 years residing in the Piedmont of North Carolina was surveyed in 1986 as part of the Established Populations for the Epidemiologic Studies of the Elderly (EPESE) program of the National Institutes of Health. Attendance at religious services and a wide variety of sociodemographic and health variables were assessed at baseline. Vital status of members was then determined prospectively over the next 6 years (1986-1992). Time (days) to death or censoring in days was analyzed using a Cox proportional hazards regression model. Results. During a median 6.3-year follow-up period, 1,777 subjects (29.7%) died. Of the subjects who attended religious services once a week or more in 1986 (frequent attenders), 22.9% died compared to 37.4% of those attending services less than once a week (infrequent attenders). The relative hazard (RH) of dying for frequent attenders was 46% less than for infrequent attenders (RH: 0.54, 95% CI 0.48-.0.61), an effect that was strongest in women (RH 0.51, CI 0.43-0.59) but also present in men (RH 0.63, 95% CI 0.52-0.75). When demographics, health conditions, social connections, and health practices were controlled, this effect remained significant for the entire sample (RH 0.72, 95% CI 0.64-.81), and for both women (RH 0.65, 95% CI 0.55-0.76, p < .0001) and men (RH 0.83, 95% CI 0.69-1.00, p = .05). Conclusions. Older adults, particularly women, who attend religious services at least once a week appear to have a survival advantage over those attending services less frequently.