Depressive symptoms in the very old living alone: prevalence, incidence and risk factors

BACKGROUND: Living alone is one of many risk factors associated with depression. This project is nested within the ENABLE-AGE project designed to explore the relationship between housing environment and health in the very old living alone in their own homes. AIM: Our aim is to describe the prevalence, incidence and associated risk factors of clinically significant depressive symptoms in this population with particular emphasis on the role of the home environment. METHOD: We conducted a one year follow up of 376 subjects aged between 80 and 90 years old. Data collected included variables concerned with housing, social circumstances, physical health and psychological well being. RESULTS: A prevalence rate of 21% and an annual incidence of 12.4% (Geriatric Depression Score of five or more) were found. Risk factors associated with prevalence depression include not living close to friends and family ((OR 2.540, CI; 1.442, 4.466), poor satisfaction with living accommodation (OR; 0.840, CI; 0.735, 0.961) and poor satisfaction with finances (OR; 0.841, CI; 0.735, 0.961). Subsequent development of clinically significant depressive symptoms was associated with base line increased scores in depression (OR; 1.68, CI; 1.206, 2.341). CONCLUSIONS: These results are consistent with findings in the general population of similar age with the exception of considerably higher prevalence and incidence rates. However, we were unable to demonstrate that housing related variables were significant risk factors in terms of incidence cases. CLINICAL IMPLICATIONS: Older people living alone are particularly vulnerable to depression and may benefit from targeted screening and development of appropriate care pathways.