A systematic review of older adults' request for or attitude toward euthanasia or assisted-suicide.

OBJECTIVES: Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have increased among older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical health, psychological, social, quality of life, religious, or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. METHOD: The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times from February 2016 until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. RESULTS: This review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decisions. Most studies (17) investigated attitudes toward EUT/PAS (9 through hypothetical scenarios). Younger age, lower religiosity, higher education, and higher socio-economic status were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical health, psychological, and social factors. Findings were difficult to compare across studies because of the variety of sample characteristics and outcomes measures. CONCLUSION: Future studies should adopt common and explicit definitions of EUT/PAS, as well as research designs (e.g. mixed longitudinal) that allow for better consideration of personal, social, and cultural factors, and their interplay, on EUT/PAS decisions.

Smaller hippocampal volume in current but not in past depression in comparison to healthy controls: Minor evidence from an older adults sample.

BACKGROUND: Structural neuroimaging studies revealed a consistent pattern of volumetric reductions in both hippocampus (HC) and anterior cingulate cortex (ACC) of individuals with major depressive episode(s) (MDE). This study investigated HC and ACC volume differences in currently depressed individuals (n = 150), individuals with a past lifetime MDE history (n = 79) and healthy controls (n = 287). METHODS: Non-demented individuals were recruited from a cohort of community-dwelling older adults (ESPRIT study). T1-weighted magnetic resonance images and FreeSurfer Software (automated method) were used. Concerning HC, a manual method of measurement dividing HC into head, body, and tail was also used. General Linear Model was applied adjusting for covariates. RESULTS: Current depression was associated with lower left posterior HC volume, using manual measurement, in comparison to healthy status. However, when we slightly changed sub-group inclusion criteria, results did not survive to correction for multiple comparisons. CONCLUSIONS: The finding of lower left posterior HC volume in currently depressed individuals but not in those with a past MDE compared to healthy controls could be related to brain neuroplasticity. Additionally, our results may suggest manual measures to be more sensitive than automated methods.

Antidepressant use and cognitive decline in community-dwelling elderly people - The Three-City Cohort.

BACKGROUND: Cognitive impairment is very common in late-life depression, principally affecting executive skills and information processing speed. The aim of the study was to examine the effect of antidepressant treatment on cognitive performances over a 10-year period. METHODS: The community-based cohort included 7381 participants aged 65 years and above. Five cognitive domains (verbal fluency, psychomotor speed, executive function, visuospatial skills and global cognition) were assessed up to five times over 10 years of follow-up. Treatment groups included participants under a specific antidepressant class at both baseline and the first follow-up and their follow-up cognitive data were considered until the last consecutive follow-up with a report of antidepressant use of the same class. Linear mixed models were used to compare baseline cognitive performance and cognitive decline over time according to antidepressant treatment. The models were adjusted for multiple confounders including residual depressive symptoms assessed by the Center for Epidemiologic Studies-Depression scale. RESULTS: At baseline, 4.0% of participants were taking antidepressants. Compared to non-users, tricyclic antidepressant users had lower baseline performances in verbal fluency, visual memory and psychomotor speed, and selective serotonin reuptake inhibitor users in verbal fluency and psychomotor speed. For the two other cognitive abilities, executive function and global cognition, no significant differences were found at baseline irrespective of the antidepressant class. Regarding changes over time, no significant differences were observed in comparison with non-users whatever the cognitive domain, except for a slight additional improvement over the follow-up in verbal fluency skills for tricyclic antidepressant users. CONCLUSIONS: In this large elderly general population cohort, we found no evidence for an association between antidepressant use and post-treatment cognitive decline over 10 years of follow-up in various cognitive domains.

[Clinical specificities of suicidal behaviour in the elderly]. / Spécificités cliniques des conduites suicidaires de la personne âgée.

Suicidal behaviour, notably in the elderly, is a complex phenomenon which is part of a process which is often pathological. The suicidal crisis is thereby difficult to detect in the elderly. However, there are tools and multidisciplinary strategies which must be favoured and which enable the risk and protection factors to be analysed in order to prevent suicide in old age.

Iowa Gambling Task Performance in Elderly Persons with a Lifetime History of Suicidal Acts.

OBJECTIVES: Suicide in the elderly is a major public health problem. In the present study, we aimed to further understand the mechanisms of suicidal vulnerability in the elderly, focusing on high-risk decision-making. This trait-like impairment has been extensively studied in adolescent and middle-aged suicide attempters, but less often in older persons. DESIGN: Case-control study. SETTING: Community and university hospital. PARTICIPANTS: All participants were aged 65 and older. Thirty-five persons with a lifetime history of suicide attempts and depressive disorder were compared with 52 individuals with a past history of depressive disorder but no history suicidal acts, and 43 healthy comparison subjects. MEASUREMENTS: The Iowa Gambling Task was used as a measure of value-based decision-making. RESULTS: Taking into account age, sex, and Beck depression scores, no difference in decision-making performance was found between the three groups. The group of suicide attempters exhibited a significant heterogeneity, however, with those using violent means performing worse than non-violent attempters. CONCLUSIONS: This study does not confirm the hypothesis of a significant role for poor Iowa Gambling Task performance as a general marker of suicidal behavior among the elderly but highlights its association with the specific subtype of violent suicidal attempters. Combined with previous findings among other age groups, it suggests that Iowa Gambling Task impairment may be a risk marker of vulnerability to violent suicidal acts. Future prospective studies should assess if this may represent a risk marker for suicide completion.

Dietary inflammatory index and recurrence of depressive symptoms: Results from the Whitehall II Study.

There is a growing interest in understanding the role of inflammation in diet-depression relationship. The present study examined whether the dietary inflammatory index (DII, a measure of the inflammatory potential of individuals' diets) is associated with recurrent depressive symptoms (DepS) (CES-D score>16 or taking antidepressants both at baseline and follow-up) assessed over 5 years in middle-aged men (n=3178) and women (n=1068) from the Whitehall II Study. For each increment of 1 SD of DII score, odds of recurrent DepS increased by 66% (95 % CI:1.30-2.12) in women while no significant association between DII and recurrent DepS was observed in men (OR=1.12, 95 % CI: 0.92-1.36). This association was little attenuated after adjustment for confounders and after taking into account levels of interleukin-6 and C-reactive protein. In conclusion, there is an association between pro-inflammatory diet and recurrent DepS in women which seems not be driven by circulating inflammatory markers.