key: cord-0719968-8mvy6hde authors: Briggs, Robert; McDowell, Cillian P.; De Looze, Céline; Kenny, Rose Anne; Ward, Mark title: Depressive symptoms among older adults pre- and post- COVID-19 pandemic date: 2021-09-13 journal: J Am Med Dir Assoc DOI: 10.1016/j.jamda.2021.09.003 sha: 7daf361c0e0c7b3870b2cae771288acd33193ebd doc_id: 719968 cord_uid: 8mvy6hde Objectives It is a concern that public health measures to prevent older people contracting COVID-19 could lead to a rise in mental health problems such as depression. The aim of this study therefore is to examinetrends of depressive symptomsbefore and during the COVID-19 pandemic in a large cohort of older people. Design Observational study with 6-year follow-up. Setting& Participants Over 3,000 community-dwelling adults aged ≥60 yearsparticipating in The Irish Longitudinal Study on Ageing (TILDA). Methods Mixed-effects multilevel models were used to describe trends in depressive symptoms across 3 waves of TILDA; Waves 4 (2016), 5 (2018) and a final wave conductedJuly-November 2020. Depressive symptoms were measured using 8-item CES-D, a score ≥9 indicating clinically significant symptoms. Results The prevalence of clinically significant depressive symptoms at Waves 4 and 5 was 7.2% (6.5–7.9) and 7.2% (6.5–8.0) respectively. This more than doubled to 19.8% (18.5–21.2) during the COVID-19 pandemic. There was no change in CES-D scores between Waves 4 and 5 (β=0.09 (-0.04 – 0.23) but a large increase in symptoms was observed during the pandemic (β=2.20 (2.07–2.33)). Age ≥70 years was independently associated with depressive symptoms (β=0.45 (0.18–0.72)) during the pandemic but notfrom Wave 4 to 5 (β=0.09 (-0.18–0.36)). Living with others was associated with lower burden of symptoms during the pandemic (β=-0.40 (-0.71 - -0.09)) but not between Waves 4 and 5 (β=-0.40 (-0.71 - -0.09)). Conclusions& Implications This study demonstrates significant increases in the burden of depressive symptoms amongst older people during the COVID-19 pandemic, particularly those aged ≥70 years and/or living alone. Even a small increase in the incidence of late life depression can have major implications for healthcare systems and societies in general. Improving access to age-attuned mental health care should therefore be a priority. It is a concern that public health measures to prevent older people contracting COVID-19 6 could lead to a rise in mental health problems such as depression. 7 The aim of this study therefore is to examinetrends of depressive symptomsbefore and 8 during the COVID-19 pandemic in a large cohort of older people. There was no change in CES-D scores between Waves 4 and 5 (β=0.09 (-0.04 -0.23) but a 25 large increase in symptoms was observed during the pandemic (β=2.20 (2.07-2.33)). 26 Age ≥70 years was independently associated with depressive symptoms (β=0.45 (0.18-27 0.72)) during the pandemic but notfrom Wave 4 to 5 (β=0.09 (-0.18-0.36)). Living with 28 others was associated with lower burden of symptoms during the pandemic (β=-0.40 (-0.71 29 --0.09)) but not between Waves 4 and 5 (β=-0.40 (-0.71 --0.09)). 30 Conclusions& Implications 31 This study demonstrates significant increases in the burden of depressive symptoms 32 amongst older people during the COVID-19 pandemic, particularly those aged ≥70 years 33 and/or living alone. 34 Even a small increase in the incidence of late life depression can have major implications for 35 healthcare systems and societies in general. Improving access to age-attuned mental health 36 care should therefore be a priority. Introduction 43 Older people have been disproportionately affected by the COVID-19 pandemic. If they 44 contract SARS-CoV-2, older people are more likely to become unwell, to require 45 hospitalisation and to die from the illness. 1 People with COVID-19 aged 65-74 years are three 46 to five times more likely to be admitted to hospital than younger people, with aneven 47 higher likelihood of hospital admission in those aged > 75 years, 2,3 and frail, older people 48 with COVID-19 are also more likely to develop delirium. 4 The mortality rate for hospitalised 49 people aged ≥70 years with COVID-19 is 27% (compared to an overall mortality rate of 12%), 50 and patients aged ≥80 years have a 60% higher risk of death compared to patients aged 70-51 79 years. 5 52 Older people have also been disproportionately affected by restrictions on social contact 53 that have been implemented generally as part of public health response to the COVID-19 54 pandemic. Shielding or cocooning, which reduces face-to-face contact to prevent 55 transmission of COVID-19, has generally been advised for older and other at-risk groups. In 56 Ireland, people aged ≥70 years were advised to stay indoors, have groceries and medicines 57 delivered and avoid contact with friends and family in order to minimise spread within a 58 high-risk group, delay peaks in case numbers and relieve pressure on health services. 6 59 While the overall aim of shielding is to prevent transmission of COVID-19 within a vulnerable 66 population, the restrictions on group exercise and social interaction, as well as the 67 limitations lockdowns may impose on access to timely healthcare or other important 68 services, may adversely affect the health of older people. 7 Given the well-established links 69 between both social engagement and physical activity with mental health in later life, 8,9 it is 70 a concern that, while these measures may prevent older people contracting COVID-19, they 71 could lead to a rise in problems such as depression. 10 72 Several studies have demonstrated a high burden of depressive symptoms among older 73 people during the COVID-19 pandemic, particularly in those who are cocooning or 74 shielding. 11-13 There has not yet been a longitudinal analysis of a community-dwelling cohort 75 of older adults to examine the changing prevalence of clinically significant depressive 76 symptoms before and during the pandemic. 77 The aim of this study thereforeis to examine the trend of depressive symptoms, and 78 ascertain the prevalence of clinically significant symptoms, pre and post the COVID-19 79 pandemic in a nationally-representativecohort of community-dwelling older people. We 80 alsoestimate the effect of known risk factors related to COVID-19 and related restrictions on 81 depression during the pandemic. Our hypothesis was that factors such as age ≥70 years and The COVID-19 study data was collected via SCQs. SCQs were sent to the homes of TILDA 115 participants and once completed, they were returned by pre-paid post. Data collection took 116 place during the early months of the pandemic, from July 2020 to November 2020. During 117 this time, 3,922 questionnaires were returned, giving a response rate of 71%. 118 Compared to non-respondents, COVID survey respondents were younger (68.6 (95% CI 68.4 119 -68.9) years vs. 71.7 (95% CI 71.3 -72.1) years; p<0.001), less likely to be living alone (25% 120 vs 27%), had a higher likelihood of tertiary educational (45% vs 27%), were less likely to 121 smoke (8% vs 13%) and to be have functional impairment (39% vs 11%). There were no 122 differences in sex distribution (Both 56% female). Picking up a small coin from a table. Heart disease was defined as prior heart 146 attack/myocardial infarction, congestive cardiac failure or angina, ascertained by self-147 report.Self-report was also elicited for chronic disease burden, with respondents asked 148 specifically about a history of cancer, liver disease, kidney disease, thyroid problems, Table 1 shows the characteristics of TILDA participantsat Wave 5 and of those who also 194 participated in the Covid-19 study. A higher proportion of those who also participated in the 195 COVID-19 study were aged ≥70 years, lived in an urban setting, had tertiary/higher levels of 196 educational attainment, had higher rates of alcohol misuse and ADL impairment. Just under 197 6% (196/3,490) either contracted COVID-19 themselves or unfortunately lost a friend or 198 relative to The prevalence of clinically significant depressive symptoms at Wave 4 was 7.2% (95% CI 6.5 200 -7.9) and 7.2% (95% CI 6.5 -8.0) at Wave 5, rising significantly to 19.8% (95% CI 18.5 - The two-way interaction models shown in Table 4 with an increase from 2.9 (95% CI 2.7 -3.2) to 5.2 (95% CI 4.9 -5.4) in those aged ≥70 years 239 compared to an increase from 3.1 (95% CI 2.8 -3.3) to 5.0 (95% CI 4.7 -5.2) in those aged < 240 70 years. 241 The prevalence of significant depressive symptoms amongst participants who either 242 contracted COVID-19 themselves or lost a relative/friend to COVID-19 was similar to that of 243 the rest of the cohort (21% vs 20%, p = 0.613) and there also no significant difference in 244 mean CES-D between these groups (5.6 (95% CI 5.0 -6.2) vs. 5.1 (95% CI 4.9 -5.2); t=-1.79; 245 p = 0.0735)). 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Data from The Irish Longitudinal Study on 365 Ageing (TILDA) What is the Longitudinal Relationship between 367 Gait Abnormalities and Depression in a Cohort of Community-Dwelling Older People? 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