According to statistics from the National Institute of Mental Health, an estimated two million older adults have a depressive disorder and another five million more show symptoms of depression (1).  Depression is a growing problem among the older adult population.  “Depression in older adults not only causes distress and suffering but also leads to impairments in physical, mental, and social functioning”(2).  By maintaining physical health and social interactions, however, older adults can greatly reduce the risk of depression. 

According to a report of the Surgeon General, however, depression often remains undiagnosed and untreated within the older adult population because “depression in older people is hard to disentangle from the many other disorders that affect older people”(3).  Therefore, “the startling reality is that a substantial proportion of older patients receive no treatment or inadequate treatment for their depression”(4).

In Southeastern Pennsylvania, while only 8.9% of older adults reported having a diagnosed mental health condition, when screened for symptoms of depression, 12.8% of older adults reported major depression (5).  Among older adults who are in fair or poor health, 23.5% reported major depression. 

Just as poor physical health can lead to depression, depression can “delay recovery from or worsen the outcome of other diseases”(6).  Because of these strong ties between physical and mental health status, to understand how to reduce the risk of depression among older adults, it is important to also examine how older adults can maintain their overall physical health and well-being. 

Using data from PHMC’s Community Health Data Base 2002 Household Health Survey, the following article examines the physical and mental health status of adults in SEPA and analyzes ways in which older adults can remain physically and mentally healthy with age and thereby reduce their risk of depression.

Maintaining Physical and Mental Health with Age

According to the Administration on Aging, physical activity among older adults can improve their health status and quality of life, relieve depression and also prevent or delay certain diseases or disabilities (7).  By exercising and watching their diet, therefore, older adults not only improve their overall physical health, but they also greatly reduce their risk for depression.  Older adults in SEPA who are in fair or poor health are three times more likely to report signs of depression than older adults who are in excellent or good health (23.5% vs. 7.7%). 

• Nearly half of all older adults in SEPA report that they exercise regularly for thirty minutes or more at least three times per week (46.4%).
  
• Older adults who exercise regularly are less likely to be in fair or poor health compared to older adults who only sometimes exercise (26.2% vs. 31.6%).  Nearly half of all older adults who do not exercise are in fair or poor health (47.2%). (See Figure 1)
  
• Among older adults who never exercise, one in five report signs of depression (19.6%), as compared to 12.7% of older adults who exercise 1-2 days per week, and 9.7% of older adults who exercise regularly 3 times a week or more.
  
• One in four older adults in SEPA are obese (24.3%) and another 37.9% are overweight.  Combined, nearly two-thirds of the older adult population in the region is overweight or obese (62.2%).  Of these, more are likely to report fair or poor health compared to adults who maintain a normal body weight (34.5% vs. 29.4%). 
  
• Overweight and obese older adults are also more likely to report signs of depression than adults with a normal body weight (13.9% vs. 10.6%).

In addition to exercising regularly and maintaining a normal body weight, results indicate that older adults who remain socially active and involved in their community are less likely to report poor physical and mental health.

• In SEPA, over half of all older adults participate in at least one community group or organization (53.5%).    
  
• Among those who participate, only 25.2% report being in fair or poor health as compared to 38.7% of adults who do not participate in any groups.  
  
• Those who are involved in their communities are also less likely to report signs of depression.  Less than ten percent of adults who participate in at least one community group report signs of depression (9.3%) as compared to 16.7% of older adults who do not participate.
  
• Older adults in SEPA who live in a community in which neighbors have worked together on a community project are less likely to report signs of depression than those whose neighbors have not worked together (10.2% vs. 15.7%).
  
• Nearly one-third of older adults in SEPA who feel they do not belong in their neighborhood report signs of depression (31.5%), as compared to 11.0% of adults who feel they belong.

Older adults who maintain frequent contact with friends and relatives are also less likely to report symptoms of depression. 

• Among older adults who speak with friends and relatives on the phone once a day, 11.1% report signs of depression.  Comparatively, 12.4% of older adults who speak to their friends and relatives at least once per week and 14.0% who speak to friends and family less than once a week report signs of depression. (See Figure2)
  
• More than one in five older adults who never speak to friends and relatives on the phone report signs of depression (22.9%). 
  
• Older adults who see friends and family members more often are less likely to report signs of depression: 11.3% of those who see relatives almost every day report signs of depression, as compared to 14.6% who see relatives once a week and 17.3% who see relatives less than once a month.  Half of all older adults who never see friends and family members who they do not live with report signs of depression (48.5%).

Results from PHMC’s Community Health Data Base 2002 Household Health Survey show that adults who are physically active and maintain a healthy body weight, are less likely to be in fair or poor health and are less likely to report signs of depression.  In addition, by staying involved in their communities and maintaining close contact with friends and family, older adults are less likely to be depressed.

For information regarding PHMC’s Community Health Data Base 2002 Household Health Survey, or to learn more about the mental health status of older adults in Southeastern Pennsylvania, contact Diana Levengood, at (215) 731-2039 or dianal@phmc.org.

Notes:

(1) Symptoms of depression include: sad mood, loss of interest or pleasure in activities that were once enjoyed, change in appetite or weight, difficulty sleeping or oversleeping, physical slowing or agitation, energy loss, feelings of worthlessness or inappropriate guilt, difficulty thinking or concentrating, and recurrent thoughts of death or suicide.                                                       National Institute of Mental Health.  Older Adults:  Depression and Suicide Facts, 2004.  (www.nimh.nih.gov). 
(2) U.S. Surgeon General.  Mental Health:  A Report of the Surgeon General, 2004. (www.surgeongeneral.gov)
(3) U.S. Surgeon General.  Mental Health:  A Report of the Surgeon General, 2004. (www.surgeongeneral.gov)
(4) U.S. Surgeon General.  Mental Health:  A Report of the Surgeon General, 2004. (www.surgeongeneral.gov)
(5) This survey only includes older non-institutionalized adults.   The depression scale is from the Center for Epidemiological Studies Depression (CES-D) symptoms index.  Major depression is determined by four or more of the following items occurring in the past week: feelings of depression, feelings that everything they did was an effort, restless sleep, unhappiness, loneliness, feelings that others were unfriendly, unenjoyment of life, sadness, feelings that others disliked them, and an inability to get going.
(6) National Institute of Mental Health.  The Invisible Disease: Depression, 2004.  (www.nimh.nih.gov)
(7) Administration on Aging.  Promoting Healthy Lifestyles:  Physical Activity and Nutrition, 2004. (www.aoa.dhhs.gov)