Health Profiles, Health Services Use, and Transition to Dementia in Inpatients With Late-Life Depression and Other Mental Illnesses

Objectives: Depression has been reported as a risk factor for dementia. We compared health and health service use profiles in older people hospitalized with late-life depression and older people hospitalized with other mental illnesses and examined the transition to dementia. Design: A retrospective population-based study using linked administrative health data over 11 years. Setting and Participants: The sample includes 55,717 inpatients age 65+ years with depression and 104,068 inpatients age 65+ years with other mental illnesses in New South Wales, Australia. Methods: The risk of subsequent dementia under consideration of sociodemographics, comorbidities, and health service use was analyzed with logistic regression. Results: The most prominent differences were the rates of delirium and self-harm with a 6 times lower rate of delirium and an 8 times higher rate of self-harm in people with late-life depression compared with those with other mental illness. Inpatients with late-life depression had an increased risk of subsequent dementia by 12% and received a dementia diagnosis at a younger age compared with inpatients with other mental illnesses. Besides depression only 3 other conditions, delirium, diabetes, and cerebrovascular accidents, were associated with an increased dementia risk. Other factors associated with an increased dementia risk were longer hospital stays, low socioeconomic status, male sex, and older age. Conclusions and Implications: Results from this study lead to a better understanding of the risk for dementia and of differences in health profiles and health services use in older people with depression compared with those with other mental illnesses. Our findings highlight the importance of the clinical management and prevention of self-harm and delirium in older people

Factors associated with acute care service use after epilepsy hospitalisation in people with intellectual disability

Background: This study aimed to identify factors associated with unplanned acute hospital readmission and emergency department (ED) presentation after hospitalisation for epilepsy in people with intellectual disability (ID). Methods: This study is a retrospective cohort study using linked administrative datasets. We identified 3293 people with ID aged 5–64 years with a hospitalisation for epilepsy between 2005 and 2014 in New South Wales, Australia. We examined unplanned readmission and ED presentation within 30 or 365 days and associations with demographic, socio-economic and health status variables. Modified Poisson regression with robust estimation was used to model outcomes within 30 days. Negative binomial regression was used to account for the overdispersion of the data and to model 365-day outcome rates. Results: Around half of the cohort had an unplanned readmission and ED presentation within 365 days of the index hospitalisation. In fully adjusted models, being female, being a young adult and having a longer or acute care index admission, mental and physical comorbidities and a history of incarceration were associated with an elevated risk of readmission or ED presentation. The strongest association was observed between history of self-harm and 365-day readmission (incidence rate ratio 2.15, 95% confidence interval 1.41–3.29). Conclusions: Socio-demographic, justice and health factors are associated with unplanned readmission and ED presentation risk after hospitalisation for epilepsy in people with ID. Interventions targeting improving continuity of care should be tailored for individuals and their support workers. The findings also emphasise the importance of person-centred multidisciplinary care across different health sectors

Instrumental Activities of Daily Living by Subjective and Objective Measures: The Impact of Depression and Personality

Objective: Previous research shows that depression and personality are independently associated with self- and informant-reports of the ability to perform instrumental activities of daily living (IADLs). However, less is known about the association between depression and personality and performance-based measures of IADLs. We aimed to determine how depression and personality predict self-and informant-reports of IADL compared to performance-based measures of IADLs in a sample of older adults with normal cognition (NC) and Mild Cognitive Impairment (MCI). Methods: Participants consisted of 385 older adults with NC (n = 235), or a diagnosis of MCI (n = 150), aged between 76 and 99-years from the Sydney Memory and Ageing Study. Participants underwent comprehensive neuropsychological and clinical assessments to determine global cognition and clinical diagnoses. Personality traits were measured by the NEO Five-Factor Inventory (NEO-FFI) and depression by the Geriatric Depression Scale (GDS). Subjective IADLs were self- and informant-reported Bayer Activities of Daily Living (B-ADL) scales and objective IADL was the Sydney Test of Activities of Daily Living in Memory Disorders (STAM). Linear regressions examined the relationship between depression and personality and the three types of IADL measures, controlling for all covariates and global cognition. Results: Participant-reported IADL, although associated with global cognition, was more strongly associated with GDS and NEO-FFI scores (conscientiousness and neuroticism). Informant-reported IADL was strongly associated with both global cognition and participants’ GDS scores. STAM scores were not associated with participants’ GDS or NEO-FFI scores; instead, they were predicted by demographics and global cognition. Conclusion: These results suggest that performance-based measures of IADL may provide more objective and reliable insight into an individual’s underlying functional ability and are less impacted by the participants’ mood and personality compared to subjectively reported IADL. We argue that performance-based IADL measures are preferable when trying to accurately assess everyday functional ability and its relationship to cognitive status. Where performance-based measures are not available (e.g., in some clinical settings), informant ratings should be sought as they are less influenced by the participant’s personality and mood compared to self-reports

Instrumental Activities of Daily Living by Subjective and Objective Measures: The Impact of Depression and Personality

ObjectivePrevious research shows that depression and personality are independently associated with self- and informant-reports of the ability to perform instrumental activities of daily living (IADLs). However, less is known about the association between depression and personality and performance-based measures of IADLs. We aimed to determine how depression and personality predict self-and informant-reports of IADL compared to performance-based measures of IADLs in a sample of older adults with normal cognition (NC) and Mild Cognitive Impairment (MCI).MethodsParticipants consisted of 385 older adults with NC (n = 235), or a diagnosis of MCI (n = 150), aged between 76 and 99-years from the Sydney Memory and Ageing Study. Participants underwent comprehensive neuropsychological and clinical assessments to determine global cognition and clinical diagnoses. Personality traits were measured by the NEO Five-Factor Inventory (NEO-FFI) and depression by the Geriatric Depression Scale (GDS). Subjective IADLs were self- and informant-reported Bayer Activities of Daily Living (B-ADL) scales and objective IADL was the Sydney Test of Activities of Daily Living in Memory Disorders (STAM). Linear regressions examined the relationship between depression and personality and the three types of IADL measures, controlling for all covariates and global cognition.ResultsParticipant-reported IADL, although associated with global cognition, was more strongly associated with GDS and NEO-FFI scores (conscientiousness and neuroticism). Informant-reported IADL was strongly associated with both global cognition and participants’ GDS scores. STAM scores were not associated with participants’ GDS or NEO-FFI scores; instead, they were predicted by demographics and global cognition.ConclusionThese results suggest that performance-based measures of IADL may provide more objective and reliable insight into an individual’s underlying functional ability and are less impacted by the participants’ mood and personality compared to subjectively reported IADL. We argue that performance-based IADL measures are preferable when trying to accurately assess everyday functional ability and its relationship to cognitive status. Where performance-based measures are not available (e.g., in some clinical settings), informant ratings should be sought as they are less influenced by the participant’s personality and mood compared to self-reports

Risk factors for dementia and self-harm: A linkage study

Introduction: People living with dementia experience poor mental health and high rates of self-harm. We investigated risk factors for self-harm in people aged > 40 years living with dementia and risk factors for dementia after self-harm. Methods: Using linked hospital data from New South Wales, Australia, we defined a dementia cohort (n = 154,811) and a self-harm cohort (n = 28,972). Using survival analyses, we investigated predictors of self-harm for the dementia cohort, and predictors of dementia for the self-harm cohort. Results: We found self-harm or dementia diagnoses occurred most often within 24 months of a dementia diagnosis or initial self-harm presentation, respectively. Men living with dementia, and people with complex psychiatric profiles, had the greatest risk of self-harm. Men who had self-harmed had the greatest risk of dementia diagnoses. Discussion: Men and people with complex psychiatric profiles and dementia may particularly benefit from post-diagnosis mental and behavioral support to reduce risk of self-harm

Intraindividual Stepping Reaction Time Variability Predicts Falls in Older Adults With Mild Cognitive Impairment

Background: Reaction time measures have considerable potential to aid neuropsychological assessment in a variety of health care settings. One such measure, the intraindividual reaction time variability (IIV), is of particular interest as it is thought to reflect neurobiological disturbance. IIV is associated with a variety of age-related neurological disorders, as well as gait impairment and future falls in older adults. However, although persons diagnosed with Mild Cognitive Impairment (MCI) are at high risk of falling, the association between IIV and prospective falls is unknown. Methods: We conducted a longitudinal cohort study in cognitively intact (n = 271) and MCI (n = 154) community-dwelling adults aged 70–90 years. IIV was assessed through a variety of measures including simple and choice hand reaction time and choice stepping reaction time tasks (CSRT), the latter administered as a single task and also with a secondary working memory task. Results: Logistic regression did not show an association between IIV on the hand-held tasks and falls. Greater IIV in both CSRT tasks, however, did significantly increase the risk of future falls. This effect was specific to the MCI group, with a stronger effect in persons exhibiting gait, posture, or physiological impairment. Conclusions: The findings suggest that increased stepping IIV may indicate compromised neural circuitry involved in executive function, gait, and posture in persons with MCI increasing their risk of falling. IIV measures have potential to assess neurobiological disturbance underlying physical and cognitive dysfunction in old age, and aid fall risk assessment and routine care in community and health care settings

Nature Versus Nurture – Studying the Relationships Between Diet and Depression in Older Adults

Abstract Objectives Prior work suggests that higher fruit and vegetable consumption may protect against depression in older adults. By better understanding the influence of genetic and environmental factors on fruit and vegetable intakes, more effective interventions could be designed to increase intakes in older adults to reduce and/or assist with the treatment of depression in older adults. The aim of this heritability study is to estimate the genetic and environmental influences on the consumption of fruit and vegetables in older adults and to investigate if there are shared influences between fruit and vegetable intakes and depression. Methods Participants (n = 374 twins, 67.1% female; 208 identical; 166 non-identical, ≥ 65-years) were drawn from the Older Australian Twins Study. Data on diet (validated food frequency questionnaire) and depressive symptoms (15-item Geriatric Depression Scale) were collected. The contribution of genetic and environmental influences on fruit and vegetable intake were estimated by comparing identical and non-identical twin intakes using structural equation modelling. A trivariate model was used to estimate the genetic and environmental correlation between total fruit and vegetable intakes and depression. Results In this study, vegetable intake was moderately influenced by genetics (heritability = 36%) with the remaining 64% due to the unique environment. Heritability was highest for brassica vegetables (40%), while intake of starchy vegetables was not heritable. Genetics did not significantly influence the intake of fruit. No significant genetic or environmental correlations were detected between fruit or vegetable intakes and depression. The number of participants meeting Australian Dietary Guidelines for fruit and vegetable intake was low (fruit 46.5%; vegetables 2.9%). Conclusions Consumption of vegetables, particularly bitter tasting brassica vegetables, was significantly influenced by genetics. These findings provide novel insights into the drivers of fruit and vegetable consumption in older adults and may help shape interventions to increase intakes, with the view of reducing the burden of depression. Funding Sources The Older Australian Twins Study was funded by the National Health & Medical Research Council and Australian Research Council

Genetic and environmental influences on fruit and vegetable consumption and depression in older adults

Background: Prior work suggests that higher fruit and vegetable consumption may protect against depression in older adults. Better understanding of the influence of genetic and environmental factors on fruit and vegetable intakes may lead to the design of more effective dietary strategies to increase intakes. In turn this may reduce the occurrence of depression in older adults. Objectives: The primary aim of this study is to estimate the genetic and environmental influences on the consumption of fruit and vegetables in older adults. The secondary aim is an exploratory analysis into possible shared genetic influences on fruit and vegetable intakes and depression. Methods: Analysis of observational data from 374 twins (67.1% female; 208 monozygotic (MZ); 166 dizygotic (DZ)) aged ≥ 65 years drawn from the Older Australian Twins Study. Dietary data were obtained using a validated food frequency questionnaire and depressive symptoms were measured using the 15-item short form Geriatric Depression Scale. The contribution of genetic and environmental influences on fruit and vegetable intake were estimated by comparing MZ and DZ twin intakes using structural equation modelling. A tri-variate twin model was used to estimate the genetic and environmental correlation between total fruit and vegetable intakes and depression. Results: In this study, vegetable intake was moderately influenced by genetics (0.39 95%CI 0.22, 0.54). Heritability was highest for brassica vegetables (0.40 95%CI 0.24, 0.54). Overall fruit intake was not significantly heritable. No significant genetic correlations were detected between fruit and vegetable intake and depressive symptoms. Conclusions: Vegetable consumption, particularly bitter tasting brassica vegetables, was significantly influenced by genetics, although environmental influences were also apparent. Consumption of fruit was only influenced by the environment, with no genetic influence detected, suggesting strategies targeting the food environment may be particularly effective for encouraging fruit consumption