New Research on Mood Symptoms in Older Adults

KEYWORDS:

• Depression
• Anxiety
• Aging
• Caregivers
• Parkinson’s Disease

Dear fellow clinical gerontologists

Mood disorders can be effectively treated in older adults, although the presentation and treatment are more complex when co-occurring with neurocognitive disorders. To this point, our issue opens with a review of 36 studies evaluating psychotherapeutic approaches for treating anxiety in persons living with Parkinson’s Disease (PD) (Roper et al., 2022). This Australian-based team found strong evidence for anxiety reduction using cognitive behavioral-based approaches, but mixed results for mindfulness-based approaches, with limited studies of acceptance and commitment therapy and other approaches. They recommend consideration of PD-specific anxiety symptoms and cognitions when treating anxiety. In a study examining anxiety in persons with mild cognitive impairment (MCI) or dementia, authors from the same team found mild-to-moderate anxiety symptoms in 163 patients as assessed by clinicians, which was moderately correlated with that assessed by carers, but only modestly correlated with patient self-report (Pacas Fronza et al., 2023).

Mood symptoms may accompany neurocognitive conditions for a variety of reasons, including adjusting to functional changes. In a longitudinal evaluation of National Health and Aging Trends Study (NHATS) data, having ceased driving was associated with greater depressive and anxiety symptoms at 1 year and 4 years of follow-up (Missell-Gray & Simning, 2023). This study did not address reasons for driving cessation, or mechanisms linking mood symptoms and driving cessation. A paper previously published in our journal noted that older adults who stop driving can have positive outcomes, particularly if they can access social support and volunteering activities (Bennetts & Taylor, 2022). Thus, additional studies of risk and protective mechanisms are warranted.

Two studies in this issue examine mood symptoms in caregivers of persons living with dementia. In a study widely by news sources, trajectory analyses identified three patterns of depressive symptoms in family caregivers (N = 226) over 5 years (Välimäki et al., 2022). One-third demonstrated increasing symptoms of depression over time, indicating the importance of following family caregiver mental health in clinical practice. A second study used network analysis of depressive and anxiety symptoms in family caregivers (N = 317) (García-Batalloso et al., 2023). The authors found that the high-stress reactivity group had strong interconnections of symptoms – with tension, apathy, sadness, and feeling depressed identified as bridging symptoms that should be targets for interventions.

Large-scale epidemiologic samples provide increasing opportunities for understanding factors that may contribute to late life depression using sophisticated analytic techniques. An analysis of older participants (16,478) in the Health and Retirement Study over 10 years considers bi-directional predictive relationships of loneliness and depression (Griffin et al., 2022). Their analysis finds no evidence of cross-lagged effects, meaning that deviations in loneliness did not predict deviations in depression or vice versa. The authors conclude that depression and loneliness are strongly associated trait-like phenomena. An analysis of participants (N = 31,464) in the Longitudinal Aging Study in India considers urban-rural differences in depression (Saravanakumar et al., 2023). Depression was more common in rural (9.5%) v urban (6.2%) groups, with higher rates in older women, associated with risk factors commonly found in the literature (e.g., poor health, low life satisfaction, low activity, etc.). A longitudinal study of depression in Chilean older adults (N = 424) contrasted with some of the above trends, finding that being female, lonely, living in an urban area, and other factors were risk factors for depression during COVID (Núñez-Cortés et al., 2023).

A number of studies in this issue examines strategies for managing mood symptoms and maintaining psychological wellness, refining the existing literature. In the first study (N = 250), cognitive appraisal but not emotional suppression mediated the relationship between mood in metacognition in older adults (Bacadini França et al., 2023). In a second study (N = 394), problem-focused coping along with gratitude and self-efficacy were associated with positive psychological outcomes in older adults (Melendez et al., 2023). In a third study (N = 141), self-compassion and mindfulness were associated with emotional distress, with emotional regulation partially mediating the relationship in family carers of older adults (Murfield et al., 2020). A fourth study found that older adults (N = 60) used less behavioral avoidance than younger adults (N = 70) when confronting social and medical scenarios, but age effects were not significant after accounting for variance in anxiety (Wuthrich & Mohlman, 2023). Finally, in an intriguing study of hospitalized older adults (N = 370), those whose family members visited for longer periods of time had fewer depressive symptoms for patients who were independent in activities of daily living; relationships between depressive symptoms and family support were not found for dependent older adults, even though their family members stayed longer (Shulyaev et al., 2023).

This issue closes where we started, focusing on anxiety in Parkinson’s disease. In a thoughtful case study, Apostol et al. (2023) describe the application of cognitive-behavioral therapy over 12 sessions, developing coping strategies to target worry, thereby reducing anxiety symptoms. These papers bring together literature review, epidemiologic methods, and more focused descriptive studies of adaptive mechanisms to shed new light on the presentation and treatment of mood symptoms in older adults. We thank all the authors for their important contributions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This material is the result of work supported with resources and the use of facilities at the VA Boston Healthcare System. The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.