A Longitudinal Analysis of Disparities of Depression Among U.S. Older Adults with Chronic Conditions within Different Age Groups

Background: In 2016, 38% of U.S. older adults aged 65 and older had at least one chronic condition, 47% had 2-3 chronic conditions, and 15% had four or more chronic conditions. Depression is one of the most common mental disorders among older adults who suffer from chronic conditions. This study aims to understand the disparities of depression of older adults with chronic conditions among different age groups, and explore the risk and protective factors associated with depression.

Methods: This study applied the latest rounds (round 5 to round 9) of the National Health and Aging Trends Study (NHATS) to analyze the risk and protective factors associated with depression. In total, 3,541 older adults who were sample persons, had at least one chronic condition, and participated in all 5 rounds were included in the present study. The Transactional Theory of Stress and Coping (TTSC) model was utilized to select predictors. Descriptive analysis was conducted for all predictors, and generalized estimating equations (GEE) was applied to explore and identify the risk and protective factors.

Results: Participants who were 80 to 84 (e^b= .726, P= .018), 85 to 90 (e^b= .653, P= .006), and 90+ (e^b= .555, P= .001) years old were less likely to have depression. Those who were Black (e^b= 1.745, P< .001), Indian/Asian/Native Hawaiian/Pacific Islander (e^b= 1.583, P= .022), and Hispanic (e^b= 2.152, P< .001) were more likely to have depression. Participants who reported good (e^b= 1.426, P= .034), fair (e^b= 1.939, P< .001), and poor (e^b= 1.130, P< .001) self-rated health were more likely to have depression. Participants who had more chronic conditions (e^b= 1.152, P< .001) were more likely to have depression, but those who had better cognitive capacity (e^b= .953, P< .001) were less likely to have depression. Participants who had more negative feelings (e^b= 1.474, P< .001), worse self-realization (e^b= 1.221, P< .001), and worse self-efficacy and resilience (e^b= 1.084, P= .002) were more likely to have depression. Participants who attended more physical activities (e^b= .891, P= .011) and more social activities (e^b= .871, P< .001) were less likely to have depression. Participants who had more technological devices (e^b= .873, P< .001) were less likely to have depression. Depression in visit 4 (e^b= .683, P< .001) and visit 5 (e^b= .797, P= .011) were less likely to occur over time.

Conclusion: Recommendations from healthcare providers, and proper education of healthy lifestyle and the dissemination of related information can also make a difference in helping older adults gain better physical and mental health to prevent them from suffering depression. A systematic effort involving from the federal government to older adults themselves can jointly cooperate in prompting older adults to join more physical activities to reduce mobility-related injuries or even death. Joint efforts involving policymakers, healthcare practitioners, researchers, and social workers are needed to develop new and creative mental health programs and interventions to help minimize the impacts of depression by extending the decline of depression over time.