Depressive symptoms in institutionalized older adults

Santiago, Lívia Maria; Mattos, Inês Echenique

doi:10.1590/S0034-8910.2014048004965

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Sumário

Artigos Originais • Rev. Saúde Pública 48 (2) • Apr 2014 • https://doi.org/10.1590/S0034-8910.2014048004965 copy

Depressive symptoms in institutionalized older adults

Sintomas depressivos em idosos institucionalizados

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To estimate the prevalence of depressive symptoms among institutionalized elderly individuals and to analyze factors associated with this condition.

METHODS

This was a cross-sectional study involving 462 individuals aged 60 or older, residents in long stay institutions in four Brazilian municipalities. The dependent variable was assessed using the 15-item Geriatric Depression Scale. Poisson’s regression was used to evaluate associations with co-variables. We investigated which variables were most relevant in terms of presence of depressive symptoms within the studied context through factor analysis.

RESULTS

Prevalence of depressive symptoms was 48.7%. The variables associated with depressive symptoms were: regular/bad/very bad self-rated health; comorbidities; hospitalizations; and lack of friends in the institution. Five components accounted for 49.2% of total variance of the sample: functioning, social support, sensory deficiency, institutionalization and health conditions. In the factor analysis, functionality and social support were the components which explained a large part of observed variance.

CONCLUSIONS

A high prevalence of depressive symptoms, with significant variation in distribution, was observed. Such results emphasize the importance of health conditions and functioning for institutionalized older individuals developing depression. They also point to the importance of providing opportunities for interaction among institutionalized individuals.

Aged; Depression, epidemiology; Homes for the Aged; Risk Factors; Cross-Sectional Studies

Variable	n	Prevalence of depressive symptoms	%	Crude PR	95%CI
Gender
Male	291	137	47.1	1
Female	171	88	51.5	1.09	0.90;0.32
Age group
60 to 69	126	65	51.6	1
70 to 79	168	80	47.6	0.92	0.73;1.16
80 or older	156	71	45.5	0.88	0.69;1.12
Level of education
Over 5 years	121	55	45.5	1
Up to 5 years	198	95	48.0	1.06	0.83;1.35
Illiterate	116	62	53.4	1.18	0.91;1.52
Marital status
Married/Steady partner	62	25	40.3	1
Divorced/Separated	70	38	54.3	1.35	0.93;1.95
Widow(er)	114	61	53.5	1.33	0.94;1.88
Single	214	101	47.2	1.17	0.84;1.64
Having visitors
Yes	295	143	48.5	1
No	163	81	49.7	1.03	0.84;1.24
Religion and spirituality
Yes	428	207	48.4	1
No religion	29	15	51.7	1.07	0.74;1.54
Friends in the institution
Yes	341	152	44.6	1
No	118	72	61.0	1.37	1.14;1.65
Friends outside the institution
Yes	307	146	47.6	1
No	150	79	52.7	1.11	0.91;1.34
Leisure/Recreational activities in the last 12 months
Yes	109	57	52.3	1
No	346	166	48.0	0.92	0.74;1.13

Variable	n	Prevalence of depressive symptoms	%	Crude PR	95%CI
Self-rated health
Excellent/Good	197	64	32.5	1
Regular	166	87	52.4	1.61	1.26;2.07
Bad/Very bad	90	71	78.9	2.43	1.93;3.05
Presence of cognitive deficit (MEEM)
No	120	51	42.5	1
Yes	327	170	52.0	1.22	0.97;1.54
Report of 5 or more illnesses
No	438	205	46.8	1
Yes	21	18	85.7	1.83	1.50;2.24
Use of more than 5 medications
No	329	152	46.2	1
Yes	131	73	55.7	1.21	1.00;1.46
Hospitalization in the last 12 months
No	374	172	46.0	1
Yes	87	52	59.8	1.30	1.06;1.59
Self-reported weight loss in the last 12 months
No	278	125	45.0	1
Yes	159	90	56.6	1.26	1.04;1.52
Fall in the last 12 months
No	316	138	43.7	1
Yes	143	87	60.8	1.39	1.16;1.67
Functional/Activities of daily living (ADL) incapacity
No	303	135	44.6	1
Yes	159	90	56.6	1.27	1.06;1.53
Functional/Instrumental activities of daily Living (IADL) incapacity
No	132	53	40.2	1
Yes	330	172	52.1	1.30	1.03;1.64
Visual impairment
No	199	85	42.7	1
Yes	263	140	53.2	1.25	1.02;1.52
Hearing impairment
No	346	163	47.1	1
Yes	116	62	53.4	1.13	0.93;1.39

Variable	Adjusted prevalence ratio^a	95%CI
Self-rated health (Regular/Bad/Very bad)	1.47	1.31;1.66
Report of five or more illnesses (Yes)	1.34	1.09;1.65
Hospitalization in the last twelve months (Yes)	1.26	1.04;1.54
Friends in the institution (No)	1.24	1.03;1.49

Components	Percentage of variance explained	Cumulative percentage
1 (Functioning)	11.5	11.5
2 (Social support)	11.3	22.8
3 (Sensory deficiency)	10.5	33.3
4 (Institutionalization)	8.4	41.7
5 (Health condition)	7.4	49.2

Variable	Component
	1	2	3	4	5
Functional capacity in ADL^b	0.708	0.101	0.103
Functional capacity in IADL^c	0.705		0.201
Cognitive deficit	0.653		-0.138
Friends outside the institution	-0.162	0.722		0.193	0.202
Having visitors		0.661		-0.109
Friends in the institution		0.583	0.146	0.259
Gender	0.342	-0.423		0.383	0.235
Religiousness	0.137	0.385		-0.147	-0.116
Hearing impairment			0.751
Visual impairment			0.685		-0.167
Age group	0.209	-0.152	0.513	0.365	0.233
Level of education		0.142		0.706
Length of institutionalization			-0.227	0.563	-0.129
Hospitalization in the last 12 months	0.117		0.172	-0.109	0.725
Self-rated health	0.211		0.280		-0.596

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E-mail: revsp@usp.br

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[1] Correspondence
: Lívia Maria Santiago Departamento de Fonoaudiologia – HUCFF Rua Rodolpho Rocco, 255/9E11 Cidade Universitária 21941-913 Rio de Janeiro, RJ, Brasil E-mail: liviamsantiago@gmail.com