Depression and Other Geriatric Syndromes in Institutionalized Oldest Old

Background. Oldest old are the fastest growing age group in Russia. The prevalence of depression increases with age and occurs more commonly among oldest old compared to lower age groups. At the same time, the frequency of depression and its association with geriatric syndromes in institutionalized oldest old is poorly studied.

Aim. To  assess the frequency of  depression, the presence and nature of  its associations with other geriatric syndromes in persons aged ≥90 years, who live in long term care facilities (LTCF).

Materials and methods. The study involved 351 men and women aged 90 years and older permanently residing in the LTCF of Moscow. Depression was ascertained with the Geriatric Depression Scale. (GDS-15). All the subjects underwent a  comprehensive geriatric assessment. To  diagnose the frailty, we  used the Short Physical Performance Battery (SPPB). The Bartel index was used to  assess performance of  activities of  daily living. Instrumental activities of  daily living were assessed using the Lawton scale. Nutritional status was assessed based on the Mini-Nutritional Assessment (MNA). To detect urinary and fecal incontinence, a scale of activities of daily living (Bartel index) was used, which contains relevant questions. Constipation syndrome was diagnosed in the presence of less than 3 bowel movements per week. An orthostatic test was performed to detect orthostatic hypotension. The presence of falls, sensory deficits, chronic pain and drug therapy were also assessed.

Results. Depression was diagnosed in 67.2% of oldest old. A higher incidence of depression was found in women (77.5% vs. 68.7%; p=0.074). Only 2.73% of oldest old with depression received antidepressants. The presence of chronic pain (OR 1.89; 95% CI 1.16–3.08; p=0.010), hearing deficiency (OR 2.20; 95% CI 1.29–3.74; p=0.004) and frailty (OR 5.33; 95% CI 2.56–11.12; pp<0.001) is independently associated with the presence of depression.

Conclusion. The study showed a  high incidence of  depression with insufficient therapy in  institutionalized oldest old. Independent risk factors of depression that are of practical importance for clinicians have been identified: frailty, hearing impairment and chronic pain syndrome.

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