TY - JOUR T1 - Antidepressant Use and Cognitive Decline: The Health and Retirement Study. JF - Am J Med Y1 - 2015 A1 - Jane S Saczynski A1 - Allison B Rosen A1 - Ryan J McCammon A1 - Zivin, Kara A1 - Susan E. Andrade A1 - Kenneth M. Langa A1 - Sandeep Vijan A1 - Paul A Pirraglia A1 - Becky A. Briesacher KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Antidepressive Agents KW - Cognition KW - Cross-Sectional Studies KW - Depressive Disorder KW - Female KW - Follow-Up Studies KW - Geriatric Assessment KW - Humans KW - Incidence KW - Male KW - Middle Aged KW - Reference Values KW - Risk Assessment KW - Sex Distribution KW - Surveys and Questionnaires KW - United States AB -

BACKGROUND: Depression is associated with cognitive impairment and dementia, but whether treatment for depression with antidepressants reduces the risk for cognitive decline is unclear. We assessed the association between antidepressant use and cognitive decline over 6 years.

METHODS: Participants were 3714 adults aged 50 years or more who were enrolled in the nationally representative Health and Retirement Study and had self-reported antidepressant use. Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed at 4 time points (2004, 2006, 2008, 2010) using a validated 27-point scale. Change in cognitive function over the 6-year follow-up period was examined using linear growth models, adjusted for demographics, depressive symptoms, comorbidities, functional limitations, and antidepressant anticholinergic activity load.

RESULTS: At baseline, cognitive function did not differ significantly between the 445 (12.1%) participants taking antidepressants and those not taking antidepressants (mean, 14.9%; 95% confidence interval, 14.3-15.4 vs mean, 15.1%; 95% confidence interval, 14.9-15.3). During the 6-year follow up period, cognition declined in both users and nonusers of antidepressants, ranging from -1.4 change in mean score in those with high depressive symptoms and taking antidepressants to -0.5 change in mean score in those with high depressive symptoms and not taking antidepressants. In adjusted models, cognition declined in people taking antidepressants at the same rate as those not taking antidepressants. Results remained consistent across different levels of baseline cognitive function, age, and duration of antidepressant use (prolonged vs short-term).

CONCLUSIONS: Antidepressant use did not modify the course of 6-year cognitive change in this nationally representative sample.

PB - 128 VL - 128 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25644319?dopt=Abstract U2 - PMC4618694 U4 - Antidepressants/Cognition/Depression/CES Depression Scale/CES Depression Scale/COMORBIDITY/Depressive Symptoms ER - TY - JOUR T1 - Trends in depressive symptom burden among older adults in the United States from 1998 to 2008. JF - J Gen Intern Med Y1 - 2013 A1 - Zivin, Kara A1 - Paul A Pirraglia A1 - Ryan J McCammon A1 - Kenneth M. Langa A1 - Sandeep Vijan KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cohort Studies KW - Cost of Illness KW - Cross-Sectional Studies KW - depression KW - Female KW - Humans KW - Male KW - Middle Aged KW - United States AB -

CONTEXT: Diagnosis and treatment of depression has increased over the past decade in the United States. Whether self-reported depressive symptoms among older adults have concomitantly declined is unknown.

OBJECTIVE: To examine trends in depressive symptoms among older adults in the US between 1998 and 2008.

DESIGN: Serial cross-sectional analysis of six biennial assessments.

SETTING: Health and Retirement Study (HRS), a nationally-representative survey. PATIENTS OR OTHER PARTICIPANTS Adults aged 55 and older (N = 16,184 in 1998).

MAIN OUTCOME MEASURE: The eight-item Center for Epidemiologic Studies Depression scale (CES-D8) assessed three levels of depressive symptoms (none = 0, elevated = 4+, severe = 6+), adjusting for demographic and clinical characteristics.

RESULTS: Having no depressive symptoms increased over the 10-year period from 40.9 % to 47.4 % (prevalence ratio [PR]: 1.16, 95 % CI: 1.13-1.19), with significant increases in those aged ≥ 60 relative to those aged 55-59. There was a 7 % prevalence reduction of elevated symptoms from 15.5 % to 14.2 % (PR: 0.93, 95 % CI: 0.88-0.98), which was most pronounced among those aged 80-84 in whom the prevalence of elevated symptoms declined from 14.3 % to 9.6 %. Prevalence of having severe depressive symptoms increased from 5.8 % to 6.8 % (PR: 1.17, 95 % CI: 1.06-1.28); however, this increase was limited to those aged 55-59, with the probability of severe symptoms increasing from 8.7 % to 11.8 %. No significant changes in severe symptoms were observed for those aged ≥ 60.

CONCLUSIONS: Overall late-life depressive symptom burden declined significantly from 1998 to 2008. This decrease appeared to be driven primarily by greater reductions in depressive symptoms in the oldest-old, and by an increase in those with no depressive symptoms. These changes in symptom burden were robust to physical, functional, demographic, and economic factors. Future research should examine whether this decrease in depressive symptoms is associated with improved treatment outcomes, and if there have been changes in the treatment received for the various age cohorts.

PB - 28 VL - 28 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23835787?dopt=Abstract U2 - PMC3832736 U4 - Depression/Risk-Factors/Retirement/Older Adults/Depressive Symptoms ER - TY - JOUR T1 - Burden of cirrhosis on older Americans and their families: analysis of the health and retirement study. JF - Hepatology Y1 - 2012 A1 - M. O. Rakoski A1 - Ryan J McCammon A1 - John D Piette A1 - Theodore J Iwashyna A1 - J. A. Marrero A1 - Lok, Anna S A1 - Kenneth M. Langa A1 - Volk, Michael L KW - Aged KW - Black People KW - Caregivers KW - Comorbidity KW - Cost of Illness KW - Databases, Factual KW - Disability Evaluation KW - Female KW - Health Care Costs KW - Health Status KW - Hispanic or Latino KW - Humans KW - Incidence KW - Liver Cirrhosis KW - Male KW - Medicaid KW - Medicare KW - Prevalence KW - Prospective Studies KW - Retirement KW - United States KW - White People AB -

UNLABELLED: Prevalence of cirrhosis among older adults is expected to increase; therefore, we studied the health status, functional disability, and need for supportive care in a large national sample of individuals with cirrhosis. A prospective cohort of individuals with cirrhosis was identified within the longitudinal, nationally representative Health and Retirement Study. Cirrhosis cases were identified in linked Medicare data via ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes and compared to an age-matched cohort without cirrhosis. Two primary outcome domains were assessed: (1) patients' health status (perceived health status, comorbidities, health care utilization, and functional disability as determined by activities of daily living and instrumental activities of daily living), and (2) informal caregiving (hours of caregiving provided by a primary informal caregiver and associated cost). Adjusted negative binomial regression was used to assess the association between cirrhosis and functional disability. A total of 317 individuals with cirrhosis and 951 age-matched comparators were identified. Relative to the comparison group, individuals with cirrhosis had worse self-reported health status, more comorbidities, and used significantly more health care services (hospitalizations, nursing home stays, physician visits; P < 0.001 for all bivariable comparisons). They also had greater functional disability (P < 0.001 for activities of daily living and instrumental activities of daily living), despite adjustment for covariates such as comorbidities and health care utilization. Individuals with cirrhosis received more than twice the number of informal caregiving hours per week (P < 0.001), at an annual cost of US $4700 per person.

CONCLUSION: Older Americans with cirrhosis have high rates of disability, health care utilization, and need for informal caregiving. Improved care coordination and caregiver support is necessary to optimize management of this frail population.

PB - 55 VL - 55 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21858847?dopt=Abstract U2 - PMC3462487 U4 - alcohol Abuse/cirrhosis/cirrhosis/Self assessed health/COMORBIDITY/health care/HOSPITALIZATION/physician visits/physician visits ER -