Presentation on theme: "Presented by: William D. Cabin, PhD, JD, MSW, MA Vision & Aging Session 3401.0, Abstract 296092, Monday, November 17, 2014, 2:30-4:o0PM American Public."— Presentation transcript:
Presented by: William D. Cabin, PhD, JD, MSW, MA Vision & Aging Session 3401.0, Abstract 296092, Monday, November 17, 2014, 2:30-4:o0PM American Public Health Association, New Orleans, LA Eyes Wide Open: The Relationship Between Sensory Limitations & Elderly Depression
I. The Sociological Framework Social Construction of Reality orients creation of constructs of depression (Berger & Luckmann,1967; Bolton, 2008;Szasz,1984, 2010) Stigmatization of “normal sorrow” may occur (Horwitz,Wakefield, Spitzer, 2007) (DSM revision in progress) Medicalization:Over-reliance on pharmacology to prevent, treat, and cure may occur (Conrad, 2007; Szasz, 2007) On to the reality………
II. The Problem: Elderly Depression- Constructs and Nature & Prevalence Major Depression: 16.2% (33MM) have experienced in their lifetime in U.S., across all ages Hospital outpatient visits for depression increased by 48% between 1995-2005 American adults’ depressive disorders estimated to generate $36 billion in salary-equivalent lost productivity; potential for psychological, emotional, and physical impacts Associated with other chronic conditions: asthma, arthritis, cancer, cardiovascular disease, diabetes, obesity & myocardial infraction, sensory impairment (based on literature review)
Elderly Depression Elderly = persons 65 years of age or older Wide variation in estimate & types of depression: 1-5% all community dwelling elderly have clinically defined major depression; 7-36% of elderly medical outpatients have clinically defined major depression; 11.5-40% among hospitalized elderly are depressed; 13.5% of elderly receiving formal home care are depressed; & 50% of elderly in long-term care facilities are depressed Often under-diagnosed & under-treated
Estimates increase when add: Elderly with sub-syndromal depression (i.e. less than full DSM-IV definition of major depression) adds another 8- 20% community-dwelling elderly) Late-life depression among community dwelling elderly (8- 20%) Geriatric primary care patients (37% have either clinically or symptom-assessed depression) NYC estimate: 14% of elderly depressed, with 50% living alone (NYCDFTA, 2010) 90% US & NYC elderly are community-dwelling Major risk factor for functional disability Relationship to co-morbidities (often two-way)
III. Literature Review Why Necessary? Professional belief that individual-level explanations of depression are insufficient; Interest in social inequalities and disparities in health & mental health; Interest in the nature & consequences of the aging population, including depression; and Need for increased knowledge to guide policy, practice and research decisions.
Found two major review articles & an updated search One (Mair, Diez Roux, & Galea, 2008) based on PubMed (79 articles) & Psych Info (168) search covering 1/90-8/07, focusing on depression across all ages. 45 articles reviewed. Built on work of Truong & Ma (2006) systematic review of 29 articles on relationship of neighborhood and mental health. Second (Kim, 2008) based on PubMed (1966-4/1/08) & Social Services Citation Index (1956-4/1/08). Found only 28 articles meeting his criteria (13 were not in Mair, et al. review). Depression across all ages. Literature Review
Cabin update- used same keywords in NYU Bobst Library Bobcat database for 1/07-5/31/14. Total of 1,940 articles, only 2 relevant & not in other two reviews (Beard, Tracy, Vlahov & Galea, 2008 and Beard, Cerda, Blaney; Ahern, Vlahou & Galea, 2009) Cabin literature review on association of depression with other physical & mental health conditions
Major Limitations of Existing Research/Areas of Research Improvements Most on adults; limited number on children and elderly (10 on elderly, but age definitions varied; not all in US). Mainly cross-sectional Over-reliance on self-report Limited use of external validating data sources f neighborhood variables Variation in definition of many variables Variation in instruments used to measure depression Variations in neighborhood definitions Limited number of studies on neighborhood level variables (vs. individual), especially built environment
Major Substantive Findings 1. Mair, et al. (2008): 82% of studies (37 of 45) had at least one neighborhood characteristic associated with depression/depressive symptoms, after controlling for individual-level characteristics, usually a combination of age, gender, race/ethnicity, marital status, and income; 52% of the different structural characteristics (i.e. neighborhood socioeconomic & racial/ethnic composition; residential stability; built environment; & service environment) examined were significantly associated with depression/depressive symptoms;
Built environment measures were more consistently associated with depression/depressive symptoms than socioeconomic composition, racial/ethnic composition, or residential stability. 68% of the social processes (neighborhood disorder, social cohesiveness and ties with neighborhood, and perceived exposure to crime, violence, drug use & graffiti) examined were significantly associated with depression/depressive symptom.
2. Kim (2008) Social disorder (crime, violence, safety, illicit drug access): higher the level, the higher the odds of depression (6 studies) Physical conditions/built environment (housing, streets, walking surfaces): the worse the built environment, the higher the level/odds of depression (3 studies) Neighborhood SES: limited evidence of protective factor for depression.
3. Beard, et al. (2008) Longitudinal (baseline & 6-18-30 months f/up) NYC-based; used telephone surveys; adults Primarily individual-level variables Poor physical health, low income, prior family history, high life stressors, being separated and low social support (neighborhood-level variable) are predictors of greater risk for late-life depression.
4. Beard, et al. (2009) Longitudinal; NYC-based; persons 50 or older Began 2005 from existing database; 2007 follow-up Neighborhood effects: Neighborhood affluence can be protective factor against worsening depression, adjusting for all other individual and neighborhood factors. Neither ethnicity nor residential stability associated with depressive symptoms. Individual effects: high neuroticism; high initial stressor score; increased post-baseline stressor score (i.e., worsening stress level); being African American; & a lower baseline frequency of contact with social networks were predictors of worsening depression
IV. Using the Brookdale Demonstration Initiative in Health Urban Aging (BDI) Why? To explore research gap regarding elderly depression and individual and neighborhood-level predicators Literature reviews indicate only 5 studies on depression for persons 65 or older in the United States What is BDI? Conducted in 2008 1,870 Respondents from more than 50 NYC senior centers 24-page survey Administered by interviewers in 6 different languages Done by Brookdale Center on Healthy Aging and Longevity with NYC Department for the Aging (DFTA) funding.
Three Step Process: 1. The Sample Profile Mean Age: 70 Depression Measure (On 0-27 score range from Phq 9): Mean: 3.6 None: 72% (0-4) ; Mild 18% (5-9); Moderate 7% (10-14) Moderately severe: 2% (15-19); Severe: 1% (20-27) 2.Statistical significance of Selected Variables (based on Literature Review) to Depression (PHQ-9 based): - 48 variables identified in BDI database related to variables in literature review (11 neighborhood; 20 demographic/activity; 17 physical health/comorbidity). - 40 of 48 had a statistically significant relationship to depression (p≤.05) 3. Stepwise Regression Analysis conducted using the 40 variables.
Results: Eight Variables together are most predictive of elderly depression, explaining 18% of variance in response (r square =.18). Eight Variables: visual impairment (p=.000); frequent falling (p=.000); lower income (p=.000); little leisure- time physical activity (p=.000); low neighborhood satisfaction (p=.000); trouble hearing (p=.000); arthritis/rheumatoid arthritis (p=.001); & being disabled (p=.005)
Implications Research & Practice New Emphasis on potential relationships between physical activity, falls, and sensory impairment. Focus future mining of BDI database by consolidating multiple variables into key factors to analyze based on conceptual model for mental health and old Americans (see Fahs, Gallo, and Cabin, 2010 unpublished). Increased mental health professional focus on early identification of sensory impairment.
Implications (continued) Policy Medicare & Medicaid on eligibility, coverage, and reimbursement for sensory impairment diagnosis and treatment, including necessary equipment/devices in home and community-based settings. Particularly important with ACA focus on ACOs, health homes, Medicaid expansion, clinical evidence-based practice, and mental health and substance abuse equity coverage and inclusion in standard benefit plans. Role of Senior Centers (see also NYAM Report, 2010) Senior Center- Health/Mental Health/Home Care Provider Collaborations (link to NORCs) Increased Case for Preventive Gerontology in policy, building on Goldman, et al. (2009).
Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: “No relationships to disclose”