Depressão em idosos que vivem na comunidade: incidência, fatores preditivos e análise de sobrevivência
Introduction: Older adults with depression and depressive symptoms exhibit impairment in functionality, frailty, and social interactions, which is reflected in a worse quality of life. From a physical health perspective, depression is associated with multimorbidities, cardiovascular disease, and...
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| Formato: | doctoralThesis |
| Idioma: | pt_BR |
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Universidade Federal do Rio Grande do Norte
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| Endereço do item: | https://repositorio.ufrn.br/handle/123456789/49929 |
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| Resumo: | Introduction: Older adults with depression and depressive symptoms exhibit impairment in
functionality, frailty, and social interactions, which is reflected in a worse quality of life. From
a physical health perspective, depression is associated with multimorbidities, cardiovascular
disease, and all-cause mortality. With the increasing prevalence of depression/depressive
symptoms (DDS) related to demographic change and the aging of the global population, the
demand for knowledge increases, especially regarding predictive factors of DDS, as well as the
analysis of the association between this variable and mortality. Two objectives guided the
present research: First, to synthesize information obtained from the world scientific literature
about the incidence and predictive factors of DDS in the community-dwelling older adults’
population; second, to analyze depressive symptoms (DS) as a predictor of mortality in homebased older adults living in a medium-sized city in the Northeast of Brazil after 138 months.
Method: Different methods were used for each objective: Development of a Systematic Review
and Meta-Analysis Protocol about predictive factors of the depressive spectrum, registered in
PROSPERO. Six databases were established for the acquisition of the material to be evaluated:
PubMed, Web of Science, Scopus, Lilacs, Scielo and Cochrane. All steps were performed in a
paired manner. For the second objective, we carried out a survival analysis after 138 months of
participation of a sample of older adults aged 65 years and over, linked to the FIBRA Network
in the city of Campina Grande-PB, between the years 2008 and 2009. Mortality data were
collected from the Municipality Mortality Information System until February 2020. The
Kaplan-Meier (KM) technique and hypothesis test with Log Rank were used in the bivariate
analysis, followed by Cox Regression for female gender. Results: By directing to only
retrieving incidence from the Systematic Review, 17,336 documents found in the databases
were observed. After selection process, 46 articles were included. The cumulative incidence
(CI) was synthesized according to the instruments used to evaluate DDS. In an increasing order
we observed that the CI for diagnostic tools was 5.24% (95% CI 4.75-5.77), followed by the
use of screening tools: Center for Epidemiologic Studies Depression Scale 10.92% (95% CI
10.52-11.33), Geriatric Depression Scale 13.24% (95% CI 13.03-13.45) and other scales and
14.35% (95% CI 14.04-14.67). In survival analysis, DS in older adults at baseline did not have
a shorter survival time after 138 months, either from all-cause mortality (p=0.746) or from
cardiovascular causes (p=0.3). Conclusion: Despite the variation in CI observed, it is evident a
frequent occurrence of DDS in the community-dwelling older adults’ context, which triggers
the necessity of preventive actions and better-targeted early care in Primary Health Care. In survival analysis, the lack of association may reveal that other factors may play a mediating
role in the relationship found in the scientific literature between DDS and mortality, which does
not mean that DS have no association with mortality, since they alter behaviors, lifestyle, and
adherence to treatment of other diseases. |
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