From: Systematic reviews on behavioural and psychological symptoms in the older or demented population
First author | Search date | BPS | Popu-lation | N reviewed | Summary of results | Meta-analysis | Recommendations future research | Reported limitations | Quality |
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Prevalence and co-occurrence | |||||||||
Seitz [23] See 1A | Mar 2009 | BPS Dep Anx | Care home | 35 | Prevalence dep symptoms in long term care: 29% (14 to 82%) | - | - Developing countries - Multinational studies - Collaboration across centres - Adoption of standard survey methods - Effective and safe interventions | Original studies - Small sample size - Conducted in developed countries - Included relatively few long term care facilities - Many studies conducted several years ago | 3 |
Luppa [28] | May 2010 | Dep | Older (60+) | 24 | Prevalence of dep disorders ranged from 4.5 to 37.4%. Pooled prevalence: 17.1% (95% CI 9.7 to 26.1) | Pooled prev major dep: 7.2% (95%CI 4.4 to 10.6) Dep disorders: 17.1 (9.7 to 26.1) | - Large scale - Population-based - Prospective studies - Also covering oldest age segments - Comorbidity, cognition and function - Suitable depression diagnostics | Original studies - Methodological differences in study design, sampling structure and study quality | 5 |
Chen [20] | Jun 1997 | Dep | Older (60+) | 10 | Prevalence dep mood: 14.8 (14.2 to 15.6%), higher in rural communities | Prev dep mood: 14.8% (14.2 to 15.6) | - Similar methodology - Culture-specific validated instruments - Risk factors and understanding dep | Original studies - Much variation - Cultural acceptability of instruments | 4 |
Beekman [29] | 1996 | Dep | Older, community dwelling (55+) | 34 | The reported prevalence rates vary enormously (0.4 to 35%). Minor dep: 9.8% (8.3 to 14.3) Clinical dep symptoms: 13.5% (2.8 to 35%) | - | - Focus on those most at risk and in adverse socio-economic conditions - Improving comparability of the data | Original studies - Methodological differences - Bias translating instruments Review - Formal meta-analysis was not considered justified | 3 |
Meeks [30] | Jan 2010 | Dep | Older (55+) | 153 | Dep was generally at least two to three times more prevalent than major dep. Prevalence lower in community settings (9.8%, 4.0 to 22.9) than primary care (15.1 to 35.9%) and LTC (4.0 to 30.5%). | - | - Incidence - Prevalence - Various clinical settings, - Diverse geographical areas - Cultural/socioeconomic groups - Neurobiology - Treatment - Terminology of depression - Associations with psychopathology | Review - Could not conduct a meta-analysis due to data heterogeneity - Review did not include data on early or mild adulthood subthreshold depression, limiting extrapolation of findings to other age groups | 2 |
Djernes [31] | Sep 2004 | Dep | Older (65+) | 122 | Prevalence clinical relevant depressive symptoms: 7.2 to 49% | - | - Target risk factors, improvement of prevention and treatment of chronic somatic and mental illnesses, adequate social support, prevention social isolation - Education and information dep in elderly - Comparability of methodology - Focus on nursing home residence | Original studies - Methodological differences - Rates of participation; depressed elderly may be particularly prone to refuse research invitations - Subjective variations in the assessment of the presence or absence of a diagnostic criterion - Differences between instruments | 2 |
Alwahhabi [32] | 2001 | Anx | Older (55+) | 119 | Â | - | See disease outcome | See disease outcome | 1 |
Course and progression | |||||||||
Huang [35] | Aug 2007 | Dep | Older (55+) | 17 | Non-dementia cognitive impairment vs without: incidence dep: OR = 1.5, 95% CI 0.9 to 2.5 prevalence dep: RR = 1.1, 95% CI 0.6 to 2.0. Dem vs. no dem: incidence OR = 1.8, 85% CI 1.2 to 2.9, prevalence RR = 3.9, 95% CI 1.9 to 8.0 | See summary of results | - Risk for cognitive impairment for depression | Review - No conclusion if dep was risk factor for dem - No hand-search of journals and no attempt to identify unpublished studies. English language only - Heterogeneity among included studies - Confounding comorbidity other psychiatric disorders - Data only gathered until august 2007 - Only four longitudinal studies included | 5 |
Meeks [30] | Jan 2010 | Dep | Older (55+) | 153 | 8 to 10% of subthreshold dep developed major dep per year. Median remission rate to non-dep status 27% after > 1 year. | - | - Longitudinal course | See prevalence | 2 |
End 2000 | Dep | Dem/Older | 11, 15, 2 | 1991: history of dep (late onset cases) associated with AD (late onset). 2000: Dep increased risk of dem in case control, 95% CI 1.2 to 3.5 and prospective studies, 95% CI 1.1 to 3.2.; 2001: Update 2000: case control studies: RR = 2.0, 95% CI 1.2 to 3.5, prospective studies 1.9, 95% CI 1.1 to 3.2 | Too many results | 1991: - Prospective studies - History of psychiatric disorders other than dep and psychiatric treatments 2000/2001: - Large sample size - Mechanisms association dep and dem | Review 1991 - The pooled analyses cover only a small number of exposures from the domain of psychiatric history | 0 | |
Ohayon [38] | 2003 | Sle | Adult ("healthy or normal") | 65 | Total sleep time, sleep efficiency, percentage of slow-wave sleep, percentage of REM sleep and REM latency all significantly decreased with age. Sleep latency, waking after sleep, waking after sleep duration and the percentage of stage 1 and 2 sleep increase with age, but only sleep efficiency continued to significantly decrease after 60 yr. | Age - sleep: TST: r = -0.76 P < 0.0001 Sleep efficiency: r = -0.82, %SWS: r = -0.56% REM: r = 0.16 Sleep latency: r = 0.16% stage 1 sleep: r = 0.16% stage 2 sleep: r = 0.34 WASO: r = 0.75 All P < 0.0001 | - Strict screening methods - Effect of race - Take into account subjects' habitual sleep schedules as well as whether PSG recording occurs on weekday or weekend night | Original studies - No information given in relation with the presence or absence of sex differences, no information about race composition - Several studies did not include middle-aged subjects Review - Limited to peer-reviewed studies | 3 |
Floyd [39] | 2002 | Sle | Adult ("healthy or normal") | 244 | Age and REM%: essentially linear, decreasing 0.6% per decade but ceased during mid-70s followed by small increase 75 to 85 | Age - REM%: r = -0.17 | - REM sleep in women - More data in old-old population | Review - Studies did not screen for psychoactive substance use, dep and sleep apnea, few studies of women - Univariate approach - Publication bias | 2 |
Floyd [40] | 1996 | Sle | Adult | 41 | Night-time sleep amount and the ability to initiate sleep decreased with age. Larger age-related changes when sleep variables were measured by polysomnography rather than self-report. | Age - sleep, effect size: Sleep latency: 0.19 (0.14 to 0.24) WASO frequency: 0.38 (0.34 to 0.42) WASO duration: 0.74 (0.71 to -0.77) Night time sleep amount: -0.33 (-0.37 to -0.28) | - Controlling for health moderators (carefully assessed for levels of depression, sleep apnea and use of psychoactive substances) - Study women | Original studies - Inclusion or exclusion of certain covariates may have influenced which predictors emerged as significant - Very few of the studies examined the effects of collinearity, moderation or mediation among critical predictor variables - Range of quality scores Review - Heterogeneity made the estimation of pooled effects impractical | 1 |
Biological | |||||||||
Huang [43] | Aug 2007 | Dep | Older (55+) | 28 | Significant OR and RR for increased dep in old age: stroke, loss of hearing, loss of vision, cardiac disease or chronic lung disease had a. Significant OR but un-significant RR: arthritis, hypertension and diabetes. Both OR and RR not significant: gastro-intestinal disease | Too many results | Â | Review - Not hand-search journals, not identify unpublished studies, three databases, only English language - Risk factors dep might be differently related to the onset, chronicity and recurrence but not differentiated - Recent life event not taken into account - Heterogeneity in results | 5 |
Huang [44] | Aug 2007 | Dep | Older (55+) | 31 | Chronic disease - dep: RR = 1.5, 95% CI 1.2 to 2.0. poor SRH - dep: RR = 2.4, 95% CI 1.9 to 3.0. | Chronic disease - dep: RR = 1.5 (1.2 to 2.0) SRH - dep: RR = 2.4 (1.9 to 3.0) | Â | Review - Not hand-search journals, no attempt to identify unpublished studies, three databases, only English - Heterogeneity in results | 5 |
Almeida [45] | Â | Dep | Older (70+) | 17 | High tHcy increased risk of dep: OR = 1.7, 95% CI 1.4 to 2..1 TT vs. CC carriers: OR = 1.2, 95% CI 1.0 to 1.5 | High tHcy - dep: OR = 1.7 (1.4 to 2.1) MTHFR C677T - dep: TT vs CC: OR = 1.2 (1.0 to 1.5) CT vs CC: OR = 1.1 (0.9 to 1.2) | - Sufficiently powered randomised trials | Original studies - Small sample size (trials) - Reverse causality (observation studies) - Inconsistent definition phenotype, misclassification bias (genetic studies) - Lack of reliable information on ethnicity Review - Meta-analysis lacked power | 4 |
Stetler [46] | May 2009 | Dep | Adult | 414 | Dep vs no dep: Cortisol d = 0.6 (95% CI 0.5 to 0.7) Adrenocorticotropic-releasing hormone d = 0.28 (95% CI 0.2 to 0.4) Corticotropin-releasing hormone d = 0.02 (95% CI -0.5 to 0.5) | Too many results | - Bioinformatic technologies - Larger sample size - Longitudinal | Original studies - High degree of heterogeneity - Publication bias possible - Based on cross-sectional studies - Arbitrary criteria for minimal methodological quality - Most of the included studies were underpowered | 3 |
Kuo [47] | Sep 2004 | Dep | Adult | 19 | High concentrations C-reactive protein predictive of cognitive decline and dem. Relations to dep cross and not consistent. | - | - Prospective study c-reactive protein-dep - Intervention studies to lower c-reactive protein and improved outcomes | NR | 3 |
Kuo [41] | Mar 2004 | Dep | Older (55+) | NR | Growing evidence of association hyper-homocysteinemia and cognitive impairment, dem and dep. Proposed mechanisms include angiotoxicity, neurotoxicity, and inhibition of collagen cross-linking | - | - Role of homocysteine in prevention - Prospective studies association with dep - Adequate adjustment for possible confounders | NR | 3 |
Camus [48] | Jun 2003 | Dep | Older | NR | Potential ways association dep - vascular disease: 1 direct influence vascular disease, 2 direct influence dep, 3 common causes | - | - Pathophysiological and genetic background of vascular depression | NR | 1 |
Vink [49] | Dec 2005 | Anx Dep | Older (50+) | 80 | Risk factors anx and dep showed many similarities but some differences were found. Biological factors may be more important in predicting dep, and a differential effect of social factors on dep and anx was found. | - | - Intervention (whether manipulation of risk factors reduces the onset of anx/dep) - Clearer understanding of etiological factors differentiating anx and dep | Review - Heterogeneity between studies, no meta-analysis - Only main effects of risk factors on anx and dep - Heterogeneity limits comparison across studies - Risk factors that have not yet been studied - No distinction made between different anx disorders | 1 |
Risk factors | |||||||||
Chen [20] | Jun 1997 | Dep | Older (60+) | 10 | The patterns of risk factors were similar to those in western countries | See prevalence | See prevalence | See prevalence | 4 |
Meeks [30] | Jan 2010 | Dep | Older (55+) | 153 | Risk factors: female, medical burden, disability and low social support; neurological illnesses (Parkinson's disease, stroke, AD) | - | - While some risk factors are well established, others remain to be identified. | See prevalence | 2 |
Djernes [31] | Sep 2004 | Dep | Older (65+) | 122 | Risk factors: female, somatic illness, cognitive and functional impairment, lack of social contacts, history of dep | - | See prevalence | See prevalence | 2 |
Cole [50] | 2001 | Dep | Older (50+) | 20 | Risk factors, Qualitative: disability, new medical illness, poor health status, prior depression, poor self-perceived health, and bereavement. Quantitative: bereavement, sleep disturbance, disability, prior depression, female gender | 13 risk factors investigated. OR ranged from 1.0 to 3.3, significant risk factors: bereavement, sleep disturbance, disability, prior dep, female gender | - Intervention | Original studies - Follow-up incomplete in most studies - Differences in the length of follow-up - Differences in definitions risk factors and adjustment - Many potential risk factors not studied adequately - Cumulative effect of multiple risk factors not studied - Heterogeneity in the results Review - Search by one author only - Only English or French literature - Did not assess publication bias - Abstracted by one author | 2 |
Vink [49] | Dec 2005 | Anx, Dep | Older (50+) | 80 | Risk factors both anx and dep: personality, coping strategies, previous psychopathology, social network, stressful life events, female. Dep: smaller network size, being unmarried. | - | See biological | See biological | 1 |
Disease outcome | |||||||||
Meeks [30] | Jan 2010 | Dep | Older (55+) | 153 | Consequences: disability, greater healthcare utilisation, increase suicide ideation | - | - More sophisticated health economic studies | See prevalence | 2 |
Alwahhabi [32] | 2001 | Anx | Older (55+) | 119 | Limitations: understanding expression anx, variable definitions elderly, diagnostic instruments. Anx in elderly potential for negative consequences independent of comorbidity major dep. | - | - Definition of elderly - Symptom definition and diagnostic instruments - Clinical trials | Original studies - No common definition of the lower limit of geriatric age | 1 |