Research reportChronic conditions and major depression in community-dwelling older adults
Introduction
The world's population continues to age at a record pace (Schellenberg and Ostrovky, 2008, Centers for disease control and prevention, 2007, European Commission, 2007). Nearly one-third of the Canadian population was considered a baby-boomer in the 2006 census, with those over 65 making up over 13.7% of the population (Statistics Canada, 2007). Recent estimates indicate that the proportion of seniors in the Canadian, American and world populations will double over the next 25 to 50 years (Centers for disease control and prevention, 2007, Statistics Canada, 2007, World Health Organization, 2003). The average life expectancy of both men and women in Europe, Canada, and the United States is also steadily increasing; this change will place a large burden on health care systems around the world (Centers for disease control and prevention, 2007, European Commission, 2007, Statistics Canada, 2007, World Health Organization, 2003). As such, research on seniors' physical and mental health becomes important as it has implications on the effectiveness and capacity of health care systems to manage this growing demographic group.
Seniors typically report lower levels of personal health satisfaction and are more likely to access the health care system than any other group (Himelhoch et al., 2004, Bartels and Pratt, 2009). As a person's age increases, so does their risk of developing a long-term medical condition (Taylor et al., 2004). Prior epidemiological studies conducted in Canada estimated the prevalence of at least one chronic condition to be 65.7% in the Canadian community-dwelling population (Patten et al., 2005). The prevalence of chronic and degenerative diseases has greatly increased in other western countries over the past two decades (Flemming et al., 2005, Marengoni et al., 2009, Puts et al., 2008). The most common chronic medical conditions associated with older age include arthritis, cataracts and heart disease, however there is considerable variability in the general population (Patten et al., 2005). Furthermore, it is common for elderly persons to have more than one chronic health condition (Taylor et al., 2004).
The presence of depressive symptoms in seniors represents another rising health concern. Data recently released from the Canadian Institute for Health Information revealed that 44% of seniors in residential care facilities have symptoms that are consistent with major depression (Canadian Institute of Health Information, 2010). Major depressive symptoms were evident in 17% of Dutch seniors participating in a longitudinal study of health and depression (Beekman et al., 1995). The presence of depression can worsen a physical health problem and increase chances of mortality (Golden et al., 2008, Penninx et al., 1999). Depression has been shown to reduce an individual's quality of life, increase disability, and increase health care utilization (Penninx et al., 1999, Whooley and Browner, 1998).
The relationship between depression and chronic disease in seniors is thought to be bidirectional. Depression may affect disease progression directly, through biological mechanisms such as increased inflammation and cardiovascular responses to stress, or indirectly, through personal engagement in unhealthy behaviors or poor adherence to treatment regimens (Penninx et al., 1999). Conversely, deteriorating health can lead to greater emotional strain on an individual that could precipitate the development of depression (Golden et al., 2008). Research has found that the presence depression in seniors free of cardiovascular disease increases the risk of coronary heart disease and total mortality (Ariyo et al., 2000, Ziegelstein, 2001). Depressive disorder is also a significant risk factor of incident stroke in seniors (Larson et al., 2001), as well as cancer (Penninx et al., 1998), diabetes (Bell et al., 2005, Golden et al., 2008) and myocardial infarction (Ziegelstein, 2001).
Much of the research conducted in this area has used clinical samples to estimate rates of depression comorbidity in seniors with chronic health concerns. There is comparatively little known about depression in community-living older adults with chronic conditions. The relationship between depression and chronic illnesses may be quite different for individuals who are not in hospital or confined to long term care facilities. Given that the majority of older adults reside in the community and not in care centers, a comprehensive investigation is needed to estimate rates of comorbidity in the general population. In this study we analyzed data from a large population-based mental health survey. The objectives of this analysis were to estimate (1) the prevalence of long-term medical conditions and of comorbid major depression, and (2) the associations between major depression and various chronic medical conditions in general population of older adults (over 50 years of age) and seniors (65 years and older).
Section snippets
Population and sampling
For the objectives of this analysis, data from the Canadian Community Health Survey — Mental Health and Wellbeing (CCHS-1.2) were used. The CCHS-1.2 was Canada's first national mental health survey using a nationally representative sample. The CCHS-1.2 data were collected by Statistics Canada between May 2002 and December 2002. Detailed information about the CCHS-1.2 methodology employed in this study can be found in Gravel and Beland (2005). Briefly, the target population included persons aged
Results
There were 15,591 participants over 50 years of age who had valid information on demographic variables, depression and chronic medical conditions. The demographic variables characterizing this population are presented in Table 1. Persons over 50 years of age comprised 38.0% of the total adult CCHS-1.2 sample. The 50 to 64 year old demographic group comprised 22.2% of the adult sample and persons over 65 years of age made up 15.8% of the adult sample.
The overall prevalence of having at least one
Discussion
The CCHS-1.2 data show that chronic health conditions are highly prevalent in Canadian seniors, particularly arthritis/rheumatism, high blood pressure and back problems. Furthermore, major depression was highly comorbid with many chronic health conditions. The three long-term medical conditions with the highest comorbidity with major depression are chronic fatigue syndrome, fibromyalgia and migraine headaches. Our study contributes to a growing literature on the health problems associated with
Role of funding source
This analysis was supported by an operating grant from Alberta Health Services. JianLi Wang is also supported by a New Investigator award from the Canadian Institutes of Health Research. The research and analysis are based on data from Statistics Canada. The opinions expressed do not represent the views of Statistics Canada. Alberta Health Services had no role in the study design collection, analysis or interpretation of the data, as well as the writing of the report and the decision to submit
Conflict of Interest
Kirsten M. Fiest, Shawn R. Currie, Jeanne V.A. Williams, and JianLi Wang have no disclosures or conflicts of interest to report.
Acknowledgement
We thank Statistics Canada for the data necessary to complete our analysis. Also Ms. Shelley Verhulst who assisted in related discussions and proof-reading of the manuscript.
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