OR WAIT null SECS
Depression and Diet in Elderly Community-Dwelling Mexican and European Americans
February 2007, Vol. XXIV, No. 2
Elderly persons with illnesses and inadequate nutrition can manifest age-associated cognitive, emotional, and behavioral disorders.1 If untreated, mental health issues may contribute to the public health burden of disability as the proportion of older persons in the population grows.2 In 2000, 13.1% of all Americans were aged 65 years and older. By 2050, that proportion will increase dramatically to 21.8%.3 Although some mental disorders can be treated with drugs and psychotherapy, screening for mental health problems in the elderly is not routine in health promotion programs in the community.4
Currently, Hispanic persons make up the largest ethnic minority group in the United States. They are also the fastest growing ethnic group among the elderly, and nearly 50% of the Hispanic population is of Mexican origin. Furthermore, there appear to be substantial ethnic disparities in functional status between Mexican American (MA) and European American (EA) elderly persons, with MAs having markedly higher rates of disability compared with EAs.5,6
Nutrition-including energy and protein intake and lean body mass-plays an important role in aging.7 As the size and diversity of the elderly population increase, nutritional issues will assume greater significance. A variety of physiologic, psychological, economic, and social changes that accompany aging can adversely affect nutritional status, causing serious nutritional deficiencies and generalized malnutrition. Functional dependency, morbidity, mortality, and greater use of health care resources are associated with poor nutrition.8,9 For older adults, nutritional status is a major contributor to quality of life.10,11
The primary cause of disability in the United States and the rest of the world is depression.12 The World Health Organization predicts that by 2020, depression will be second only to heart disease as a cause of disability and premature death in established market economies.13 Between 1987 and 1997, the percentage of Americans in whom depression was diagnosed and treated more than tripled.14 The annual cost of depression has been estimated to be $30 to $40 million; depression affects nearly 18 million adults each year.15
Mood disorders continue to be a significant health care issue for the elderly and are associated with disability, decreased quality of life, functional decline, mortality from comorbid medical conditions (including suicide), demands on caregivers, and increased use of health services. Depression is the most common mental disorder among the elderly.16 An estimated 15% of all persons aged 65 years and older are in need of mental health services.17 Because previous studies have not focused on nutritional status and depression among community-dwelling elders, we conducted a cross-sectional study on cognitively eligible community-dwelling elderly persons.
Using the Centers for Epidemiological Studies on Depression; English and Spanish versions18 questionnaire and incorporating other demographic/health questions, interviews were completed with 116 subjects. Dietary intake was assessed using the 24-hour recall with food models. Table 1 presents the baseline characteristics of the study participants.
Our results showed that about 68% of participants in the sample exhibited depressive symptoms; however, there were no significant differences in depressive symptoms associated with sex or education level in MA and EA elderly persons. Body mass index and average percentage of body fat did not differ in relation to depressive symptoms. However, those who exhibited depressive symptoms ate less total fat (P = .041) and less saturated fat (P = .037) than those who did not show depressive symptoms.
Regardless of sex, level of education, or depressive symptoms, carbohydrates, fiber, and calcium intake were below recommended levels (Table 2). There was no difference in the micronutrient intakes in relation to depressive symptoms.
While recommended nutrient intake for older adults has increased in recent years,19 decreased energy needs with age typically result in reduced food intake,20 making it particularly difficult for older adults to maintain optimal nutritional status, health, and well-being. Consequently, older Americans are having trouble meeting the recommended number of daily food group servings in their decreased caloric intake. Both nutrient density and quantity are essential to meet the recommended intake levels, and it is crucial to recommend that the elderly make wise food choices for better mental and physical health.21
Depressive symptoms were previously found to be one of the most common causes of malnutrition in a sample of elderly outpatients.22 Regardless of race and sex, elderly persons with depression in our community sample were found to have different nutritional intake than their counterparts who were not depressed. Our results showed that the diet quality and diet density of elderly persons with depression were inadequate. They were eating less fats and fiber and more carbohydrates than the nondepressed sample.
Because this was a cross-sectional study, we could not ascertain whether depression was the result of differential nutritional status or vice versa. Only associations were observed in this study. Because of the small sample size, a small but relevant effect may not have been detected. However, this study provided additional evidence of the need to create comprehensive intervention programs, incorporating screening for both depression and poor nutritional status, that will target geriatric populations.
The National Institute of Mental Health has published consensus statements on the diagnosis and management of depression in late life.23-25 These seminal reports demonstrated that although the treatment of depression in this population should be vigorous, in fact, late-life depression is underdiagnosed and undertreated because of the inadequacy of existing services, and elderly persons in community settings have been particularly underserved.23,24
Access to mental health care services for most elderly persons in the community is inadequate, and the coordination of services is lacking. Our study and other studies have shown that there is an immediate need for collaboration among patients, families, researchers, clinicians, government agencies, and third-party payers to improve diagnosis, treatment, and service delivery for elderly persons with mood disorders in community settings,26 and more attention should be given to nutritional issues in geriatric mental health research.
Dr Ashley Love is assistant professor in the department of health and kinesiology at the University of Texas at San Antonio and research assistant professor in the department of family and community medicine at the University of Texas Health Sciences Center in San Antonio.
Dr Robert Love is chief resident in the department of psychiatry at the Wilford Hall Medical Center at Lackland Air Force Base in Texas and in the department of psychiatry at the University of Texas Health Sciences Center in San Antonio.
The authors report no conflicts of interest regarding the subject matter of this article.
References1. Bhat RS, Chiu E, Jeste DV. Nutrition and geriatric psychiatry: a neglected field. Curr Opin Psychiatry. 2005; 18:609-614.
2. Satcher DS. Executive summary: a report of the Surgeon General on mental health. Public Health Rep. 2000;115:89-101.
3. Campbell P. Current population reports. Population Projections of the United States by Age, Race, and Hispanic Origin: 1995-2050. US Census Bureau Web site; 1998. Available at: http://www.census.gov/prod/2/pop/p25/p25-1131.pdf. Accessed September 13, 2006.
4. Amarantos E, Martinez A, Dwyer J. Nutrition and quality of life in older adults. J Gerontol A Biol Sci Med Sci. 2001;56(special no. 2):54-64.
5. Hazuda H, Espino DV. Aging, chronic disease, and physical disabilities in Hispanic elderly. In: Markides KS, Miranda M, eds. Minorities, Aging and Health. Thousand Oaks, Calif: Sage Publications; 1997.
6. US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. 2000. Available at: http://www.healthypeople.gov/document/pdf/uih/2010uih.pdf. Accessed September 13, 2006.
7. Im A, Archdeacon P, Chong D. Nutrition needs of the elderly. In: Edwards NM, Maurer MS, Wellner R, eds. Aging, Heart Disease, and Its Management: Facts and Controversies. Totowa, NJ: Humana Press; 2002:29-44.
8. Schroll M. Aging, food patterns and disability. Forum Nutr. 2003;56:256-258.
9. Keller HH. Nutrition and health related quality of life in frail older adults. J Nutr Health Aging. 2004;8:245-252.
10. Barr JT, Schumacher GE. The need for a nutrition-related quality-of-life measure. J Am Diet Assoc. 2003; 103:177-180.
11. Gollub EA, Weddle DO. Improvements in nutritional intake and quality of life among frail homebound older adults receiving home-delivered breakfast and lunch. J Am Diet Assoc. 2004;104:1227-1235.
12. Murray CJL, Lopez AD, eds. The global burden of disease: a comprehensive assessment of mortality and disability from disease, injuries and risk factors in 1990 and projected to 2020. Global Burden of Disease and Injury Series. Vol 1. Cambridge, Mass: Harvard University Press; 1996.
13. Lopez AD, Murray CC. The global burden of disease, 1990-2020. Nat Med. 1998;4:1241-1243.
14. Olfson M, Marcus SC, Druss B, et al. National trends in the outpatient treatment of depression. JAMA. 2002; 287:203-209.
15. Greenberg PE, Leong SA, Birnbaum HG, Robinson RL. The economic burden of depression with painful symptoms. J Clin Psychiatry. 2003;64(suppl 7):17-23.
16. Mirowsky J, Ross CE. Age and depression. J Health Soc Behav. 1992;33:187-212.
17. US Census Bureau. Profile of General Demographic Characteristics for the United States, 2000 [table]. 2000. Available at: http://www.census.gov/press-release/www/2001/tables/dp_us_2000.pdf. Accessed September 15, 2006.
18. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement. 1977;1:385-401.
19. Institute of Medicine of the National Academies. Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids. Washington, DC: National Academies Press; 2002/2005.
20. Wilson MM, Morley JE. Invited review: aging and energy balance. J Appl Physiol. 2003;95:1728-1736.
21. USDA Center for Nutrition Policy and Promotion. A focus on nutrition for the elderly: it’s time to take a closer look. Nutrition Insights. 1999:14.
22. Wilson MM, Vaswani S, Liu D, et al. Prevalence and causes of undernutrition in medical outpatients. Am J Med. 1998;104:56-63.
23. NIH Consensus Conference. Diagnosis and treatment of depression in late life. JAMA. 1992;268:1018-1024.
24. Lebowitz BD, Pearson JL, Schneider LS. Diagnosis and treatment of depression in late life. Consensus statement update. JAMA. 1997;278:1186-1190.
25. Alexopoulos GS. Depression in the elderly. Lancet. 2005;365:1961-1970.
26. Charney DS, Reynolds CF 3rd, Lewis L, et al. Depression and Bipolar Support Alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in late life. Arch Gen Psychiatry. 2003; 60:664-672.