Depression Screening of Elderly Community‐Dwelling Japanese

To the Editor: The recent finding on the prevalence and models of depressive symptoms in older Estonians is supported by our research in Japan.1 Depression screening tests in community-dwelling elderly people (aged ≥65) have been implemented in eight rural towns in Shiga Prefecture, Japan. Shiga Prefecture is located adjacent to Kyoto, the old capital of Japan, and has a population of around 82,000. According to the Yale Task Force on Geriatric Assessment, the single question, “Do you often feel sad or depressed?” is recommended as the screening criterion for depression in older adults. The single-question criterion is believed to be as accurate as the Geriatric Depression Scale.2 Using self-reported questionnaires, the single-question screening was conducted along with additional tests of activities of daily living (ADLs) and subjective quality of life (QOL) for 12,132 elderly people (77.4% of the eligible population) in the eight towns in Shiga Prefecture. For the assessment of basic ADLs, the scores for seven items (walking, ascending and descending stairs, feeding, dressing, using the toilet, bathing, and grooming) were summed using a rating scale from 0 (completely dependent) to 3 (completely independent) into a basic ADL score (0–21). For advanced ADLs, we employed the Tokyo Metropolitan Institute of Gerontology index rating scale of 0 to 13.3 This scale includes instrumental ADLs (0–5), intellectual activity (0–4), and social role (0–4). Five indicators of QOL (sense of subjective health, relationship with family, relationship with friends, financial satisfaction, and subjective happiness) were rated on a 100-mm visual analog scale (worst QOL on the left end of the scale, best on the right). The participants were asked to describe the level of their QOLs by marking on the scale for each indicator. The distance in mm was measured from the left end to the marked position to determine each QOL score.4, 5 The average proportion of subjects with depression (defined as positive in single-question Yale Depression Screen) was 32.2% (range 28.0–36.2%). The proportion was significantly higher in women (mean 36.1%, range 32.5–40.3%) than men (mean 26.9%, range 22.0–30.2%). Elderly subjects with depression had significantly lower scores for each item of the ADLs and QOLs than those without depression as assessed by single-question screening test even after the adjustment for age was made (Table 1). Previous reports on prevalence of depression in community-dwelling elderly varied widely. This variation may be due, in part, to differences in screening methods. The Taiwan study reported 25.7%,6 the U.S. study (Oakland, CA) reported 14%,7 and another U.S. study (Piedmont, NC) reported 26.8%.8 Our data revealed a higher proportion of depressive elderly subjects in Japan (32.2%) than in those countries but a lower proportion than that of elderly Estonians (40.2%). Our findings suggest that, in considering their strategy for treatable subjects with depression in the community, family physicians managing geriatric patients should be aware that about 30% of community-dwelling elderly subjects have screening-based depression and that the depression is deeply associated with lower ADLs and QOL in the elderly population. Taizo Wada, MDMasayuki Ishine, MDToru Kita, MD, PhDDepartment of Geriatric Medicine Kyoto University Graduate School of Medicine Kyoto, Japan Michiko Fujisawa, MDDepartment of Epidemiology National Institute of Longevity Science Aichi, Japan Kozo Matsubayashi, MD, PhDCenter for Southeast Asian Studies Kyoto University Kyoto, Japan