Depression in late life-prevalence and preventive intervention

Background Depression in older people often goes undetected but has severe consequences on physical health, functioning and quality of life. As the aging population is growing, mental ill-health already is and will continue to be an important public health problem. There is a need for adequate strategies to meet this challenge. Aims (1) To investigate the prevalence of and the association between depressive symptoms and loneliness in relation to age and sex in a random Swedish sample in the age group 65-80 years, and to investigate to what extent those scoring ≥ 8 in the depression dimension of the Hospital Anxiety and Depression Scale (HAD) had visited health care professionals and/ or used antidepressive medication. (2) To evaluate the effect of group discussions, in which structured reminiscence and a Problem Based Method (PBM) were used, on depressive symptoms, Quality of Life (QoL) and Self-Rated Health (SRH) among older people. (3) To describe the individual´s experiences of the year before and the time after retirement. (4) To evaluate the factorial structure of the HAD in a general older population 65-80 years and to examine the possible presence of differential item functioning (DIF) related to sex. Result More men than women reported depressive symptoms, few were offered psychological treatment and a quarter used antidepressant medication. Depressive symptoms were associated with loneliness and this association decreased with increasing age. Participation in group discussions resulted in a decrease in depressive symptoms and an increase in QoL and SRH. Both expectations and fears were experienced the year before and the time after retirement. The psychometric evaluation of the HAD showed a two-factorial structure and invariance regarding sex. Conclusion The result highlights the importance of detecting depressive symptoms and loneliness in older people and offer adequate treatment. Transition into retirement should receive more attention both from a health care and organizational perspective. Group discussions with structured reminiscence and PBM as a nursing intervention, seem to be a promising method to prevent depressive symptoms in older people, but further research is needed. The HAD can be recommended to assess anxiety and depression among a general population 65-80 years old.