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Dementia, depression and delirium in the very old: prevalences and associated factors
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Emotional suffering in old age is largely caused by a variety of psychiatric disorders which are often, however, undertreated and underrecognized. This leads to reduced quality of life and functional status and increased morbidity and mortality. Dementia, delirium and depression are common disorders in the very old, and are similar in several ways. All have multiple causes and are diagnosed by means of symptomatic criteria, are challenging to diagnose and difficult to differentiate from each other in the very old. They often coexist in the same individual, and may have common risk factors.

The overall aim of this thesis was to add to our knowledge about threats to successful aging, by investigating the prevalences of dementia, depression and delirium, and factors associated with these three disorders. Further aims were to measure change over time in the prevalence of dementia and depression, respectively, and to investigate the risk factors for incident depression. This thesis uses the population-based Umeå85+/GErontological Regional DAtabase (GERDA) material.

In 2000-2002, every other 85-year-old, all 90-year-olds and all people ≥95 years living in six municipalities in Västerbotten, Sweden were invited to participate, and in 2005-2007 the process was repeated, with the additional inclusion of the corresponding populations of two municipalities in Österbotten, Finland. A third data collection was carried out in 2010-2012. Trained assessors carried out assessments in the form of structured interviews during one or more home visits, recorded current medication and reviewed medical records obtained from general practitioners and hospitals. In 2000-2002 the prevalence of dementia was 17% among 85-year-olds, 24% among 90-year-olds and 46% among those aged ≥95 years. In 2005-2007 dementia prevalence reached 28% among 85-year-olds, 40% among 90-yearolds and 45% among those aged ≥95 years. The prevalence of dementia in the total sample was 27% in 2000-2002 and 37% in 2005-2007 (p=0.001). In 2000-2002 the prevalence of depressive disorders was 24% among 85-yearolds, 34% among 90-year-olds and 31% among those aged ≥95 years. In 2005-2007 the prevalence of depressive disorders was 33% among 85-year-olds, 39% among 90-year-olds and 38% among those aged ≥95 years. The prevalence of depressive disorders in the total sample was 29% in 2000-2002 and 37% in 2005-2007 (p=0.025). Among participants not depressed at baseline, 26% had developed depression after five years. Factors independently associated with new cases of depression at follow-up were hypertension, a history of stroke and a higher score on the 15-item Geriatric Depression Scale at baseline. The thirtyday prevalence of delirium in 2005-2007 was 17% among 85-year-olds, 21% among 90-year-olds and 39% among participants aged ≥95 years. Delirium prevalence among individuals with dementia was higher than among those without dementia (52% vs. 5%, p<.001). Factors independently associated with delirium superimposed on dementia in a multivariate logistic regression model were depression, heart failure, living in an institution and prescribed antipsychotics.

There was a high prevalence of dementia, depression and delirium in the papers comprising this thesis, and 55% had at least one of the three disorders. The prevalence of dementia and depression also increased between 2000-2002 and 2005-2007, after controlling for age and sex. Dementia and depression were important associated factors for delirium and half of those with dementia were depressed. The increasing age-specific prevalence of depression seems to be associated with the increasing age-specific prevalence of dementia. The papers presented are among the first to report a significantly increasing age-specific prevalence of dementia and depression among very old people. More knowledge about associated factors and risk factors concerning these disorders may be helpful for carers and decision-makers, as well as providing reference values for studies in other regions. Further efforts are needed in both care and research to better prevent, screen for, diagnose and treat dementia, depression and delirium, especially considering the growing number of very old people.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2013. , 101 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1595
Keyword [en]
dementia, depression, depressive disorders, delirium, aged, 80 and over, epidemiology, cross-sectional study, prevalence, risk factors, GDS-15, stroke, hypertension
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:umu:diva-79984ISBN: 978-91-7459-718-9 (print)OAI: oai:DiVA.org:umu-79984DiVA: diva2:645685
Public defence
2013-09-28, Vårdvetarhuset, aulan, Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Projects
Umeå85+/GERDA
Available from: 2013-09-06 Created: 2013-09-05 Last updated: 2013-10-15Bibliographically approved
List of papers
1. Increasing prevalence of dementia among very old people
Open this publication in new window or tab >>Increasing prevalence of dementia among very old people
2011 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 40, no 2, 243-249 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: it is unknown whether the age-specific prevalence of dementia among the very old changes over time.

METHODS: this study compares the prevalence of dementia in two population-based cross-sectional samples of very old people in northern Sweden in 2000-02 and in 2005-07. In total, 430 individuals aged 85 and older (mean age 89.5 years, 71.4% women) were evaluated for dementia in the first cross-section and 465 individuals (mean age 90.2 years, 70.9% women) in the second. Trained assessors performed assessments and interviews during home visits and collected information from carers, relatives and medical records. Dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria.

RESULTS: the prevalence of dementia in the total sample was 26.5% in 2000-02 and 37.2% in 2005-07 (P = 0.001). There was also an increase in the prescription of different antihypertensive agents, antilipemic agents and choline esterase inhibitors, and more people had had heart surgery in the later sample.

CONCLUSIONS: in this sample of very old people, an increase in the age-specific prevalence of dementia was detected over 5 years. Possible reasons for this may be extended survival among individuals with risk factors for dementia and among individuals with established dementia.

Place, publisher, year, edition, pages
Oxford Journals, 2011
Keyword
dementia, aged, 80 and over, cross-sectional study, prevalence, epidemiology, elderly
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-47976 (URN)10.1093/ageing/afq173 (DOI)21258087 (PubMedID)
Available from: 2011-10-05 Created: 2011-10-05 Last updated: 2017-12-08Bibliographically approved
2. Prevalence of depressive disorders among very old people in 2000-2002 and 2005-2007: the Umeå 85+/GERDA study
Open this publication in new window or tab >>Prevalence of depressive disorders among very old people in 2000-2002 and 2005-2007: the Umeå 85+/GERDA study
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-79961 (URN)
Available from: 2013-09-04 Created: 2013-09-04 Last updated: 2015-04-22Bibliographically approved
3. Risk factors for depressive disorders in very old age: a population-based cohort study with a five-year follow-up
Open this publication in new window or tab >>Risk factors for depressive disorders in very old age: a population-based cohort study with a five-year follow-up
Show others...
2014 (English)In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 49, no 5, 831-839 p.Article in journal (Refereed) Published
Abstract [en]

Depressive disorders are common among the very old, but insufficiently studied. The present study aims to identify risk factors for depressive disorders in very old age.

The present study is based on the GERDA project, a population-based cohort study of people aged a parts per thousand yen85 years (n = 567), with 5 years between baseline and follow-up. Factors associated with the development of depressive disorders according to DSM-IV criteria at follow-up were analysed by means of a multivariate logistic regression.

At baseline, depressive disorders were present in 32.3 % of the participants. At follow-up, 69 % of those with baseline depressive disorders had died. Of the 49 survivors, 38 still had depressive disorders. Of the participants without depressive disorders at baseline, 25.5 % had developed depressive disorders at follow-up. Baseline factors independently associated with new cases of depressive disorders after 5 years were hypertension, a history of stroke and 15-item Geriatric Depression Scale score at baseline.

The present study supports the earlier findings that depressive disorders among the very old are common, chronic and malignant. Mild depressive symptoms as indicated by GDS-15 score and history of stroke or hypertension seem to be important risk factors for incident depressive disorders in very old age.

Place, publisher, year, edition, pages
Springer, 2014
Keyword
Depression, Depressive disorder, Very old, Risk factors, GDS-a5, Stroke, Hypertension
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-79981 (URN)10.1007/s00127-013-0771-2 (DOI)000336286100015 ()24100915 (PubMedID)
Available from: 2013-09-05 Created: 2013-09-05 Last updated: 2017-12-06Bibliographically approved
4. Thirty-day prevalence of delirium among very old people: a population-based study of very old people living at home and in institutions
Open this publication in new window or tab >>Thirty-day prevalence of delirium among very old people: a population-based study of very old people living at home and in institutions
2013 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 57, no 3, 298-304 p.Article in journal (Refereed) Published
Abstract [en]

Delirium has mainly been studied in various patient samples and in people living in institutions. The present study investigates the 30-day prevalence of delirium in a population-based sample of very old people in northern Sweden and Finland. Seven hundred and eight persons aged 85 years and older from the GErontological Regional DAtabase (GERDA) were assessed. Information was also collected from relatives, carers and medical records. Assessments performed were among others the Organic Brain Syndrome (OBS) scale, the Mini Mental State Examination (MMSE), and the Geriatric Depression Scale-15 (GDS-15). Delirium, depression and dementia diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. The prevalence of delirium was 17% among 85 year-olds, 21% among 90 year-olds and 39% among participants aged 95 years and older (p < 0.001). Delirium prevalence among individuals without dementia was lower than among those with dementia (5% vs. 52%, p < 0.001). Factors independently associated with delirium superimposed on dementia in a multivariate logistic regression model were depression (Odds Ratio (OR) = 2.0, 95% Confidence Interval (CI) = 1.2–3.3), heart failure (OR = 2.1, 95% CI = 1.2–3.7), institutional living (OR 4.4, 95% CI = 2.4–8.2) and prescribed antipsychotics (OR = 3.0, 95% CI = 1.5–6.0).

Delirium is highly prevalent among very old people with dementia. Depression, heart failure, institutional living and prescribed antipsychotic medication seem to be associated with delirium.

Keyword
Delirium, Dementia, Aged, 80 and over, Cross-sectional study, Prevalence, Epidemiology
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-79960 (URN)10.1016/j.archger.2013.04.012 (DOI)
Available from: 2013-09-04 Created: 2013-09-04 Last updated: 2017-12-06Bibliographically approved

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