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By Siegfried Weyerer

Depression in old age occurs frequently, places a severe burden on patients and relatives, and increases the utilization of medical services and health care costs. Although the association between age and depression has received considerable attention, very little is known about the incidence of depression among those 75 years of age and older. Studies that treat the group 65+ as one entity are often heavily weighted towards the age group 65-75. Therefore, the prediction of depression in the very old is uncertain, since many community-based studies lack adequate samples over the age of 75.

With the demographic change in the forthcoming decades, more emphasis should be put on epidemiological studies of the older old, since in many countries the increase in this age group will be particularly high. To study the older old is also important, since some crucial risk factors such as bereavement, social isolation, somatic diseases, and functional impairment become more common with increasing age. These factors may exert different effects in the younger old compared to the older old. Knowledge of risk factors is a prerequisite to designing tailored interventions, either to tackle the factors themselves or to define high-risk groups, since depression is treatable in most cases.

In our recent study, over 3,000 patients recruited by GPs in Germany were assessed by means of structured clinical interviews conducted by trained physicians and psychologists during visits to the participants’ homes. Inclusion criteria for GP patients were an age of 75 years and over, the absence of dementia in the GP’s view, and at least one contact with the GP within the last 12 months. The two follow-up examinations were done, on average, one and a half and then three years after the initial interview.

Depressive symptoms were ascertained using the 15-item version of the Geriatric Depression Scale (GDS). We found that the risk for incident depression was significantly higher for subjects

• 85 years and older
• with mobility impairment and vision impairment
• with mild cognitive impairment and subjective memory impairment
• who were current smokers.

It revealed that the incidence of late-life depression in Germany and other industrialized countries is substantial, and neither educational level, marital status, living situation nor presence of chronic diseases contributed to the incidence of depression. Impairments of mobility and vision are much more likely to cause incidents of depression than individual somatic illnesses such as diabetes mellitus and coronary heart disease. As such, it is vital that more attention is paid to the oldest old, functional impairment, cognitive impairment, and smoking, when designing depression prevention programs.

GP practices offers ample opportunity to treat mental health problems such as depression occurring in relation to physical disability. If functional impairment causes greater likelihood of depression, GPs should focus on encouraging older patients to maintain physical health, whether by changing in personal health habits, advocating exercise, correcting or compensating functional deficits by means of medical and surgical treatments, or encouraging use of walking aids. Additionally, cognitive and memory training could prevent the onset of depressive symptoms, as could smoking cessation. If these steps are taken, the burden of old age depression could be significantly reduced.

Siegfried Weyerer is professor of epidemiology at the Central Institute of Mental Health in Mannheim, Germany. He has conducted several national and international studies on the epidemiology of dementia, depression and substance use disorders at different care levels. He is also an expert in health/nursing services research. He is one of the authors of the paper ‘Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older: results from a 3-year follow-up study’, which appears in the journal Age and Ageing. You can read the paper in full here.

Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.

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Image credit: Grief. Photo by Anne de Haas, iStockPhoto.

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5 Stars Silly Frilly Grandma Tillie Laurie A, Jacobs Anne Jewett Flashlight Press 32 Pages Ages: 5 and up Inside Jacket:  Sophie and Chloe are lucky that their Grandma Tillie knows how to be royally silly. To their delight, whenever Grandma Tillie babysits she seems to disappear, only to be replaced by a parade of [...]

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By Edward Zelinsky

Receiving my AARP membership card was one of the truly traumatic events of my life. I had marched for civil rights. I had protested the war in Vietnam. I walked the streets for Gene McCarthy. I was a legitimate Baby Boomer. How could this have happened to me?

My wiser and more self-confident spouse took it in better stride. Doris quickly became adept at pulling out her AARP card and demanding old-age discounts, as I stood sheepishly aside.

My personal disquiet about my AARP card reinforced my deeply-seated, policy-based misgivings about the AARP. President Clinton and Speaker Gingrich could have emulated President Reagan and Speaker O’Neill by negotiating a reasonable, bi-partisan approach to Social Security. At that time, increasing the retirement ages for Baby Boomers and other similarly modest measures would have brought Social Security’s projected payments into line with its expected revenues, with only minor impacts on future retirees.

There were many reasons such a deal didn’t happen during the Clinton years, but the AARP’s strident opposition was chief among them.

As the financial problems of Social Security and Medicare became more acute, I became increasingly troubled by the AARP’s refusal to address them. The AARP’s effective opposition to reforming these entitlement programs has implemented perfectly the ethic of Baby Boomer narcissism.

I was accordingly surprised and reassured to learn that the AARP has at last acknowledged the need for us geezers, i.e., its members, to reform Social Security benefits for the financial sake of our children and grandchildren. As a mushy moderate, I am convinced that there is a balanced package of tax increases and benefit reductions which can allow the Baby Boomers to retire without bankrupting our offspring.

It is good news that the AARP has belatedly recognized this reality.

Medicare will be tougher to reform. It is now finally sinking in that the Independent Payment Advisory Board President Obama and Congress created as part of the health reform package will effectively ration medical care through its control of Medicare’s payments to health care providers. This should surprise no one: Rationing is how government outlays are controlled. Medicare’s outlays must be controlled.

The same is true of the consumer-driven approach to controlling Medicare expenses proposed by Rep. Paul Ryan. The Ryan plan would place greater responsibility on Medicare consumers to control costs. This approach is also going to be necessary to control Medicare outlays.

Determining the right mix of these two approaches is going to be a difficult task. Regrettably, neither Republicans nor Democrats are now prepared to undertake the serious enterprise of governing.

It would be good for the AARP to also raise its voice on behalf of the cause of Medicare cost reform.

However, for now, I’ll take what I can get. It is progress for the AARP, however gingerly, to acknowledge that Social Security entitlements for the elderly must be curbed in the interests of national solvency and the futures of our children and grandchildren.

But I will still step aside while Doris demands the elderly discount.

Edward A. Zelinsky is the Morris and Annie Trachman Professor of Law at the Benjamin N. Cardozo School of Law of Yeshiva University. He is the author of The Origins of the Ownership Society: How The Defined Contribution Paradigm Changed America

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NOTE TO SELF: THERE ARE GOOD PEOPLE WITH GOOD SOULS IN THIS WORLD


A retired couple living in Nova Scotia, Canada decided, as many of us do, to play the lottery. Up for grabs was an $11.2 million dollar jackpot and as many of us also do, they dreamed of a win. The couple, Alan, a former welder, and Violet Large, are senior citizens who live simple lives with Violet afflicted with cancer and undergoing chemotherapy.

Last July they hit the jackpot in the Lotto 6/49 winning $11,255,272 to be exact, which in itself is something given the odds against winning anything, especially a huge amount like this. It's what the couple did following their win, which makes this story one-in-a-million. They gave away almost $11.2 million of their winnings to family members, local churches, fire departments, cemetaries, Red Cross and hospitals who obviously meant a lot to Violet, given her health issues.

Once word got out about their generosity, a producer with ITV television in London called The Canadian Press on Thursday looking to connect with the Larges, and the story drew a flood of comments from readers on the Daily Mail's website in the United Kingdom. Not surprising since everyone wants to hear about good news and good people doing good things.

"As I say you can't buy your health and you can't buy happiness but if you can help someone out that's what you want to do," Violet said.

I've always believed that when you reach out and share your blessings, they return to you in kind. Now didn't this story make you smile?

I haven't updated my journal lately because things have just been so busy. I've been building a mailing list for my publisher to send out some additional ARCs, working on my secret school visit project, writing an article for our state SCBWI's newsletter The Prairie Wind (http://www.scbwi-illinois.org/PrairieWind/), and getting my teenager back to school. It's hard to believe he is a junior. And the most recent thing I did was celebrate my mother's 90th birthday!

I can only write this here because I know my mother will never see it. My mother never tells her age.

I can never understand why my mother has always been so secretive about disclosing her age. If I make it to 90, you had better believe that I am going to tell everyone how old I am and really celebrate it. 

My mother no way looks 90. My son didn't take a lot of shots at her party, but if you could see her whole face you would know it's true. Happy Birthday, Mom!




Trivia alert--My mother shares her September 4th birthday with another favorite subject of mine--Daniel Burnham.

In this episode, a very nice audio comment from illustrator Andy J. Smith, member of PictureBookArtists.org, and two Listener Submitted Reviews: Good Night - the long way to bed reviewed by Romanian illustrator Livia Coloji of the Creative Cup Illustrators Group One Potato, Two Potato reviewed by Jillian Curtis, author of The Little Prince and his Magic Wand Many thanks to Livia, Andy and Jillian for participating in JOMB and to those of you who have sent us feedback via email and have spread the JOMB word in your own circles. We really appreciate your support. Listeners who submit reviews before May 30, 2007 will be entered in a draw to win an autographed copy of The Call to Shakabaz. If you would like to share your thoughts on a favourite children’s book, please send your review (five-minutes or less) as an MP3 file in email to [email protected], phone it in to our listener feedback line (206-350-6487), leave a two-minute MyChingo, or send your text review in email. Tags:childrens books, giveaways, Good Night the long way to bed, one potato two potato, Podcastchildrens books, giveaways, Good Night the long way to bed, one potato two potato, Podcast