Dementia and depression in older adults: a southeast European perspective: summary of a dementia psychogeriatric symposium held in Ohrid, Macedonia, 23 May 2013.

We present a report on the recent symposium on dementia and depression in older adults, held in Ohrid, Macedonia and discuss the urgent need for development of psychogeriatric and affiliated services in the Southeast European region. The limited epidemiological data from nine countries in this region suggest high variability of prevalence rates for mental health problems in older adults (>65 years of age). At the moment, there are over 520,000 older adults in the region living with dementia alone. The prevalence rates for dementia (%) are either similar to those of the developed countries (9-9.6% in build-up northern Greece and Albania, respectively) or substantially lower (3.6-4% in rural northern Greece and Montenegro, respectively). The latter may be due to either cultural diversity or lack of adequate medical health service provision and expertise to recognize and diagnose dementia. Indeed, there is a lack of organized specialized services for older adults with mental health problem in the region. The symposium raised the awareness of this problem in the region and called for networking between isolated individuals working in this field to improve the current situation and facilitate further development of adequate clinical services to meet the growing needs of the older adults in the countries of the Southeast Europe.

The association of poor economic condition and family relations in childhood with late-life depression.

BACKGROUND: Late-life depression encompasses both patients with late-life onset of depression (>60 years) and older adults with a prior and current history of depression. The aim of the study was to analyze the impact of the economic condition and family relations in childhood as risk factors for late-life depression. SUBJECTS AND METHODS: This was an analytical cross-sectional study comprising 120 subjects, 60 patients with unipolar depression and 60 subjects without depressive disorders, diagnosed in accordance with the 10-th International Classification of Mental and Behavioural Disorders. All participants in the study were above the age of 60 and there was no significant statistical difference in the sex proportion in both groups (p>0.05). Data for the examination were taken from a self-reported questionnaire designed for our aim. The Geriatric Depression Scale was used to measure depressive symptoms. RESULTS: Our results have shown that severe financial difficulties are important events in childhood and are risk factors for depression in the elderly (Chi-square=12.68, df=2, p=0.0018). Our investigation has found the association of family relations with late-life depression. In fact, conflictual relations in the family were more common in the experimental group than in the control group (Chi-square=14.32, df=3, p=0.0025). Furthermore, father's addiction to alcohol in childhood was associated with depression in later life (p=0.013). The difference in childhood emotional neglect and unequal treatment between siblings in both groups was insufficient to be confirmed statistically, but the examinees with this trauma had a threefold higher chance of having depression later in life (Odds ratio=3.04, 95% CL0.92 < OR<10.65; Yates chi-square=3.2, df=1, p=0.07). Subjects who have estimated their mother (p=0.019) or father (p=0.046) having negative personal character traits had a significantly greater risk for development of late-life depression. CONCLUSIONS: Negative socio-economic circumstances as well as family conflicts during childhood are associated with late-life depression. Father's addiction to alcohol and parents' negative personal character traits are associated with depression in the elderly.

Family relationships as a risk factor for late life depression.

AIM: To explore the association between depression in older adults and marital status, marital quality and relationships with close family members. METHODS: This study is cross-sectional, carried out at the Department of Geriatric Psychiatry of Skopje Psychiatric Hospital. We studied 120 subjects, 60 patients with unipolar depression and 60 subjects without depression. There is no significant difference in the sex proportion and the average age between the two groups. Data were taken by questionnaire designed for the study. The Geriatric Depression Scale was used to measure depressive symptoms. RESULTS: The patients with late life depression reported significantly more dissatisfaction with marital relationships in their life (p=0.048). The difference between the two groups in regard to living arrangements was statistically significant, because more patients lived in a geriatric institution (p<0.01). The quality of family relations was confirmed with a significant difference (p<0.001). Harmoniousness and toleration are considerably present in the families of the control group, while lack of interest, dislike and permanent conflictual relationships considerably predominate in the families of the experimental group. High significance was confirmed with regard to the feeling of emotional neglect and a feeling of being an unloved member of the family in the patients with depression. CONCLUSION: Dissatisfaction with marital relationships was associated with a considerable risk of late life depression. The patients with late life depression reported significantly more conflictual family relations, a feeling of poor attention and neglect and the sense of not being a loved member of the family.

Risk factors for dementia of the Alzheimer and vascular type.

The current study was aimed at examining the risk factors in 30 patients with Alzheimer's dementia and 30 patients with vascular dementia. The reports of the caregivers and the medical documentation were used to estimate the risk factors. The condition for the patients to enter this study was the age above 60 years. The results showed that the average age in the patients with dementia of the Alzheimer type was statistically significantly higher than in the patients with vascular dementia (p<0.0043), which is the confirmation that the most potential risk factor for Alzheimer's disease is aging, and for vascular dementia it is an additional factor. The incomplete education is more common in patients with Alzheimer's disease than in the group with vascular dementia and the difference had statistical significance (p=0.0199). The patients with vascular dementia have higher rate of heart disease (p=0.0002), hypertension (p=0.0005) and diabetes mellitus (p=0.0228) than in the group with Alzheimer's disease with a statistically significant difference. In regard to marital status, head injury and smoking, the difference had no significance in either groups.