Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-25T02:15:39.222Z Has data issue: false hasContentIssue false
  • English
  • Français

Predisposing and Facilitating Factors of Severe Psychological Distress among Frail Elderly Adults

Published online by Cambridge University Press:  31 March 2010

Michel Préville ,
Réjean Hébert ,
Gina Bravo  and
Richard Boyer
Michel Préville*
Affiliation:
University of Sherbrooke
Réjean Hébert
Affiliation:
University of Sherbrooke
Gina Bravo
Affiliation:
University of Sherbrooke
Richard Boyer
Affiliation:
University of Montreal and L. H. Lafontaine Hospital
*
Requests, etc., Dr. Michel Préville, Gerontology Research Center, Sherbrooke Geriatric University Institute, 1036 Belvédère South, Sherbrooke, Québec, Canada, J1H 4C4. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

A sample of frail older adults (65 years and over) living at home or institutionalized (n = 664) with a significant functional limitation was used to document predisposing and facilitating factors of severe psychological distress among frail elderly adults. Our results indicated that 48.2 per cent of the older adults living at home presented severe psychological distress symptoms, compared to 34.3 per cent of elderly adults living in institutions. The probability of reporting a severe level of psychological distress was associated with the respondents' social support, cognitive and functional status. When the respondents' cognitive and functional status were controlled, no evidence of a significant association was found between the respondents' age, gender, marital status, education or income and the level of their psychological distress symptoms. Our results showed that 77.9 per cent of the respondents with severe psychological distress symptoms were still severely distressed 12 months after their first interview. Findings suggest that severe psychological distress represents an important challenge for practitioners in gerontology and geriatrics. It is suggested that other studies focusing on the consequences of psychological distress on older adults' quality of life, functional decline, institutionalization and mortality may help document the gravity of this symptomatology in the elderly population.

Résumé

Un échantillon de la population âgée (65 ans et plus) vivant à domicile ou en institution avec une limitation fonctionnelle significative (n = 664) a été utilisé pour documenter les facteurs prédisposants et facilitants associés à la détresse psychologique sévère chez les personnes âgées en perte d'autonomie. Nos résultats indiquent que 48,2 pour cent des sujets vivant à domicile présentaient une symptomatologie sévère de détresse psychologique, comparativement à 34,3 pour cent des personnes vivant en institution. La probabilité de rapporter un niveau sévère de détresse psychologique a été associée au statut fonctionnel et cognitif des répondants et à la disponibilité d'un soutien social. Après que l'association entre le statut cognitif et fonctionnel des répondants et les symptômes de détresse psychologique ait été contrôlée, aucune association significative n'a pu être mis en évidence entre l'âge, le sexe, le statut civil, l'éducation, le revenu et le niveau de détresse psychologique des répondants. Nos résultats ont montré que 77,9 pour cent des répondants ayant des symptômes sévères de détresse psychologique étaient encore en détresse sévère 12 mois plus tard. Nos résultats suggèrent que la détresse psychologique sévère chez les personnes âgées constitue un défi important pour les intervenants en gérontologie et gériatrie. Il est suggéré que d'autres recherches documentent les conséquences de ces symptômes sur la qualité de vie, la perte d'autonomie, le risque d'institutionnalisation et de mortalité de façon à évaluer la gravité de ce phénomène dans cette population.

Keywords

Psychological DistressFrail Older AdultsDétresse psychologiquepersonnes âgées avec une limitation fonctionnelle significative
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 21 , Issue 2 , Summer/Été 2002 , pp. 195 - 204
Copyright
Copyright © Canadian Association on Gerontology 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*This study was supported by the Conseil québécois de la recherche sociale (grant number 952138). The authors thank Ms. Bernadette Wilson who provided editing comments.

References

Ames, D. (1991). Epidemiological studies of depression among the elderly in residential and nursing homes. International Journal of Geriatric Psychiatry, 6, 347–354.CrossRefGoogle Scholar
Ames, D. (1993). Depressive disorders among elderly people in long-term institutional care. Australian & New Zealand Journal of Psychiatry, 27(3), 379–391.CrossRefGoogle ScholarPubMed
Armenian, H.K., Pratt, L.A., Gallo, J., & Eaton, W.W. (1998). Psychopathology as a predictor of disability: a population-based follow-up study in Baltimore, Maryland. American Journal of Epidemiology, 148(3), 269–275.CrossRefGoogle ScholarPubMed
Berkman, L.F., Berkman, C.S., Kasl, S., Freeman, D.H., Leo, L., Ostfeld, A.M., Cornoni-Huntley, J., & Brody, J.A. (1986). Depressive symptoms in relation to physical health and functioning in the elderly. American Journal of Epidemiology, 124(3), 372–388.CrossRefGoogle ScholarPubMed
Berry, J.M., Storandt, M., & Coyne, A. (1984). Age and sex differences in somatic complaints associated with depression. Journal of Gerontology, 39(4), 465–467.CrossRefGoogle ScholarPubMed
Blazer, D., & Williams, C.D. (1980). Epidemiology of dysphoria and depression in an elderly population. American Journal of Psychiatry, 137(4), 439–444.Google Scholar
Blazer, D.G. (1982). Social support and mortality in an elderly community population. American Journal of Epidemiology, 115(5), 684–694.CrossRefGoogle Scholar
Blazer, D.G. (1993). Depression in late life (2nd ed.). St. Louis, MI: Mosby Year Book.Google Scholar
Blazer, D.G., Hughes, D.C., & George, L.K. (1987). The epidemiology of depression in an elderly community population. The Gerontological Society of America, 27(3), 281–287.Google Scholar
Bolla-Wilson, K., & Bleecker, M.L. (1989). Absence of depression in elderly adults. Journal of Gerontology, 44(2), 53–55.CrossRefGoogle ScholarPubMed
Borson, S., Barnes, R.A., Kukull, W.A., Okimoto, J.T., Veith, R.C., Inui, T.S., Carter, W., & Raskind, M.A. (1986). Symptomatic depression in elderly medical outpatients I. Prevalence, demography, and health service utilization. Journal of American Geriatric Society, 34(5), 341–347.CrossRefGoogle ScholarPubMed
Boyer, R., Préville, M., Légaré, G., & Valois, P. (1993). La détresse psychologique dans la population non-institutionnalisée: résultats normatifs de l'enquête santé Québec [Psychological distress in the general population: normative results from the Quebec Health Survey]. Journal canadien de Psychiatrie, 38(5), 339–343.CrossRefGoogle Scholar
Bruce, M.L., Kim, K., Leaf, P.J., & Jacobs, S. (1990). Depressive episodes and dysphoria resulting from conjugal bereavement in a prospective community study. American Journal of Psychiatry, 147(5), 608–611.Google Scholar
Burke, W.J., Houston, M.J., Boust, S.J., & Roccaforte, W.H. (1989). Use of the geriatric depression scale in dementia of the Alzheimer type. Journal of American Geriatric Society, 37(9), 856–860.CrossRefGoogle ScholarPubMed
Callahan, C.M., Wolinsky, F.D., Stump, T.E., Nienaber, N.A., Hui, S.L., & Tierney, W.M. (1998). Mortality, symptoms, and functional impairment in late-life depression. Journal of General Internal Medicine, 13(11), 746–752.CrossRefGoogle ScholarPubMed
Conn, D.K., Lee, V., Steingart, A., & Silberfeld, M. (1992). Psychiatric services: a survey of nursing homes and homes for the aged in Ontario. Canadian Journal of Psychiatry, 37(8), 525–530.CrossRefGoogle ScholarPubMed
Desrosiers, J., Bravo, G., Hébert, R., & Dubuc, N. (1995). Reliability of the revised functional autonomy measurement system (SMAF) for epidemiological research. Age and Aging, 24, 402–406.CrossRefGoogle ScholarPubMed
Dillman, D.A. (1978). Mail and telephone surveys: The total design method. New York, NY: John Wiley & Sons.Google Scholar
Dufouil, C., Fuhrer, R., Dartigues, J.F., & Alperovitch, A. (1996). Longitudinal analysis of the association between depressive symptomatology and cognitive deterioration. American Journal of Epidemiology, 144(7), 634–41.CrossRefGoogle ScholarPubMed
Feinson, M.C., & Thoits, P.A. (1986). The distribution of distress among elders. Journal of Gerontology, 41(2), 225–233.CrossRefGoogle ScholarPubMed
Frane, J. (1990). Description and estimation of missing data. BMDP Statistical Software Manual: Volume 2. University of California Press.Google Scholar
Gouvernement du Québec. (1992). Et la santé, ça va en 1992–1993? Volume I, Rapport de l'Enquête Santé Québec [Quebec Health Survey Report]. Québec: Les Publications du Québec.Google Scholar
Hébert, R. (1982). l'évaluation de l'autonomie fonctionnelle des personnes âgées [Assessment of functional autonomy in the elderly]. Canadian Family Physician, 28, 754–762.Google Scholar
Hébert, R., Bravo, G., & Girouard, D. (1992). Validation de l'adaptation française du Modified Mini-Mental State (3MS) [Validation of the French adaptation of the Modified Mini-Mental State (3MS)]. La Revue de gériatrie, 17(8), 443–450.Google Scholar
Hébert, R., Carrier, R., & Bilodeau, A. (1988). The Functional Autonomy Measurement System (SMAF): description and validation of an instrument for the measurement of handicaps. Age Ageing, 17(5), 293–302.CrossRefGoogle ScholarPubMed
Hébert, R., Dubuc, N., Buteau, M., Roy, C., Desrosiers, J., Bravo, G., Trottier, L., & St-Hilaire, C. (1997). Services requis par les personnes âgées en perte d'autonomie: évaluation clinique et estimation des coûts selon le milieu de vie. [Services needs of the frail elderly and estimated costs for different types of residences]. Gouvernement du Québec, Ministère de la Santé et des Services sociaux. Québec: Les Publications du Québec.Google Scholar
Hennekens, C.H., & Buring, J.E. (1987). Epidemiology in medicine. Boston: Little, Brown & Company.Google Scholar
Himmelfarb, S. (1984). Age and sex differences in the mental health of older persons. Journal of Consulting and Clinical Psychology, 52(5), 844–856.CrossRefGoogle ScholarPubMed
Hosmer, D.W., & Lemeshow, S. (1989). Applied Logistic Regression. New York, NY: John Wiley & Sons.Google Scholar
Ilfeld, F.W. (1976). Further validation of a psychiatric symptom index in a normal population. Psychological Reports, 39, 1215–%1228.CrossRefGoogle Scholar
Kafonek, S., Ettinger, W.H., Roca, R., Kittner, S., Taylor, N., & German, P.S. (1989). Instruments for screening for depression and dementia in a long-term care facility. Journal of American Geriatric Society, 37(1), 29–34.CrossRefGoogle ScholarPubMed
Katz, I.R., & Parmelee, P.A. (1997). Overview. In Rubinstein, R.L. & Lawton, M.P. (Eds.), Depression in long term and residential care: advances in research and treatment (pp. 1–25). New York, NY: Springer Publishing Company.Google Scholar
Kennedy, G.J., Kelman, H.R., & Thomas, C. (1990). The emergence of depressive symptoms in late life: the importance of declining health and increasing disability. Journal of Community Health, 15(2), 93–104.CrossRefGoogle ScholarPubMed
Kennedy, G.L., Kelman, H.R., & Thomas, C. (1991). Persistence and remission of depressive symptoms in late life. American Journal of Psychiatry, 148, 174–178.Google ScholarPubMed
Kennedy, G.J., Kelman, H.R., Thomas, C., Wisniewski, W., Metz, H., & Bijur, P. (1989). Hierarchy of characteristics associated with depressive symptoms in an urban elderly sample. American Journal of Psychiatry, 146(2), 220–225.Google Scholar
Klerman, G.L., & Weissman, M.M. (1989). Increasing rates of depression. Journal of American Medical Association, 261(15), 2229–%2235.CrossRefGoogle ScholarPubMed
Krause, N. (1986a). Stress and sex differences in depressive symptoms among older adults. Journal of Gerontology, 41(6), 727–731.CrossRefGoogle ScholarPubMed
Krause, N. (1986b). Social support, stress, and well-being among older adults. Journal of Gerontology, 41(4), 512–519.CrossRefGoogle ScholarPubMed
Krause, N., Liang, J., & Keith, V. (1990). Personality, social support, and psychological distress in later life. Psychology and Aging, 5(3), 315–326.CrossRefGoogle ScholarPubMed
Mirowsky, J., & Ross, C.E. (1992). Age and depression. Journal of Health and Social Behavior, 33(3), 187–205.CrossRefGoogle ScholarPubMed
Murrell, S.A., Himmelfarb, S., & Wright, K. (1983). Prevalence of depression and its correlates in older adults. American Journal of Epidemiology, 117(2), 173–185.CrossRefGoogle ScholarPubMed
Murrell, S.A., & Norris, F.H. (1991). Differential social support and life change as contributors to the social class-distress relationship in older adults. Psychology and Aging, 6(2), 223–231.CrossRefGoogle Scholar
Neff, J.A., Husaini, B.A., & McCorkel, J. (1980). Psychiatric and medical problems in rural communities. Social Science and Medicine, 14A(4), 331–336.Google ScholarPubMed
NIH, Consensus Development Panel on Depression in Late Life. (1992). Diagnosis and treatment of depression in late life. Journal of the American Medical Association, 268(8), 1018–%1024.CrossRefGoogle Scholar
Nobert, Y., Asselin, S., Duchesne, L., Gauthier, H., Jean, S., & Laroche, D. (1996). Les conditions de vie au Québec: un portrait statistique. Bureau de la statistique du Québec. Québec: Les Publications du Québec.Google Scholar
Palinkas, L.A., Wingard, D.L., & Barrett-Connor, E. (1990). The biocultural context of social networks and depression among the elderly. Social Science and Medicine, 30(4), 441–447.CrossRefGoogle ScholarPubMed
Parmelee, P.A., Katz, I.R., & Lawton, M.P. (1989). Depression among institutionalized aged: assessment and prevalence estimation. Journals of Gerontology, 44(1), M22–M29.CrossRefGoogle ScholarPubMed
Parmelee, P.A., Katz, I.R., & Lawton, M. P. (1992a). Incidence of depression in long-term care settings. Journals of Gerontology, 47(6): M189–M196.CrossRefGoogle ScholarPubMed
Parmelee, P.A., Katz, I.R., & Lawton, M.P. (1992b). Depression and mortality among institutionalized aged. Journals of Gerontology, 47(1)P3–P10.CrossRefGoogle ScholarPubMed
Préville, M., Boyer, R., Potvin, L., Perrault, C., & Légaré, G. (1992). La démoralisation: détermination de la validité et de la fiabilité de la mesure utilisée dans l'Enquête Santé Québec [Demoralization: validity and reliability of the index used in the Quebec Health Survey], Cahier de recherche no. 7, Enquête Santé Québec.Google Scholar
Roberts, R.E., Kaplan, G.A., Shema, S.J., & Strawbridge, W.J. (1997). Prevalence and correlates of depression in an aging cohort: the Alameda County Study. Journals of Gerontology, 52(5): S252–S258.CrossRefGoogle Scholar
Robins, L.N., Locke, B.Z., & Regier, D.A. (1991). An overview of psychiatric disorders in America. In Robins et Regier (Eds.), Psychiatric disorders in America (pp. 328–366). New York, NY: Free Press.Google Scholar
Rodin, G., & Voshart, K. (1986). Depression in the medically ill: an overview. American Journal of Psychiatry, 143(6), 696–705.Google ScholarPubMed
Rovner, B.W., German, P.S., Brant, L.J., Clark, R., Burton, L., & Folstein, M.F. (1991). Depression and mortality in nursing homes. Journal of the American Medical Association, 265(8), 993–996.CrossRefGoogle ScholarPubMed
Tannock, C., & Katona, C. (1995). Minor depression in the aged. Concepts, prevalence and optimal management. Drugs & Aging, 6(4), 278–292.CrossRefGoogle ScholarPubMed
Teng, E.L., & Chui, H.C. (1987). The Modified Mini-Mental State (3MS) examination. Journal of Clinical Psychiatry, 48(8), 314–318.Google ScholarPubMed
Turner, R.J., & Noh, S. (1988). Physical disability and depression: a longitudinal analysis. Journal of Health and Social Behavior, 29(1), 23–37.CrossRefGoogle ScholarPubMed
Unutzer, J., Patrick, D.L., Simon, G., Grembowski, D., Walker, E., Rutter, C., & Katon, W. (1997). Depressive symptoms and the cost of health services in HMO patients aged 65 years and older. A 4-year prospective study. Journal of the American Medical Association, 277(20), 1618–%1623.CrossRefGoogle Scholar
Wancata, J., Benda, N., Hajji, M., Lesch, O.M., & Muller, C. (1998). Prevalence and course of psychiatric disorders among nursing home admissions. Social Psychiatry & Psychiatric Epidemiology, 33(2), 74–79.CrossRefGoogle ScholarPubMed
Williamson, G.M., & Schulz, R. (1992). Physical illness and symptoms of depression among elderly outpatients. Psychology and Aging, 7(3), 343–351.CrossRefGoogle ScholarPubMed