Dark side of the town: depressive symptoms in disadvantaged senior citizens.

OBJECTIVES: Depression is frequently overlooked in older adults. Detection of depressive symptoms (DS) is important in primary care. This study aimed to detect the rate, risk factors and effects of DS in a disadvantaged older population.
DESIGN: Descriptive study.
SETTING: Community based rehabilitation centers and Sehzadebasi medical center of Istanbul Metropolitan Municipality (IMM). PARTICIPANTS: 1163 Consecutive patients at least 60 years old, and applied to IMM; mostly poor and/or without health insurance. MEASUREMENTS: Detailed history and geriatric scales were obtained. Depressive symptoms (DS) were defined as 14 or more points in 30 item Geriatric Depression Scale. Relations of DS and ordinal variables were tested by Chi-square; DS and numeric variables by T-test. Multiple regressions followed.
RESULTS: Younger old and women subjects were in majority. The rate of DS was 52%, while 9.1% have depression diagnosis in their history. After multiple regressions, lack of health insurance was found to be the strongest independent risk factor for DS (p < 0.0001). Other variables that remained significant were: Limited mobility, lower Instrumental Activities of Daily Living and Tinetti Balance scores, onset insomnia, nightly awakenings and reported dizziness (p values = 0.008; 0.021; 0.005; 0.022; 0.04 and 0.03 respectively).
CONCLUSION: These results indicate the need for comprehensive geriatric assessment in primary care to detect DS, in addition to negative effect of DS on sleep and independency. Health insurance coverage of the senior citizens also is an important challenge.