Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China.
Department of Medicine & Therapeutics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.
BMC Geriatr. 2024 Apr 5;24(1):318. doi: 10.1186/s12877-024-04731-w.
Depression is a global health priority. Maintaining and delaying depressive symptoms in older adults is a key to healthy aging. This study aimed to identify depressive symptom trajectories, predictors and mortality, while also exploring the relationship between air quality and depressive symptoms in older adults in the Hong Kong community over 14 years.
This study is a longitudinal study in Hong Kong. The target population was community-dwelling older adults over age 65. Depressive symptoms were measured by the Geriatric Depression Scale (GDS-15). Group-based trajectory model was used to identify heterogeneity in longitudinal changes over 14 years and examine the associations between baseline variables and trajectories for different cohort members using multinomial logistic regression. The Kaplan-Meier method was employed to conduct survival analysis and explore the variations in survival probabilities over time among different trajectory group. Linear mixed model was used to explore the relationship between air quality and depressive symptoms.
A total of 2828 older adults were included. Three different trajectories of depressive symptoms in older people were identified: relatively stable (15.4%), late increase (67.1%) and increase (17.5%). Female, more number of chronic diseases, poor cognitive function, and poor health-related quality of life (HRQOL) were significantly associated with other less favorable trajectories compared with participants with stable levels of depressive symptoms. The late increase group had a lower mortality rate than the relatively stable and increased groups. Lower baseline ambient air pollutant exposure to NO over 14 years was significantly associated with fewer depressive symptoms.
In this study, we found that a late increase in depressive symptoms was the predominant trend in older Chinese people in Hong Kong. Poorer HRQOL was predictive of less favorable trajectories of depressive symptoms. Ambient air pollution was associated with depressive symptoms. This novel observation strengthens the epidemiological evidence of longitudinal changes in depressive symptoms and associations with late-life exposure to air pollution.
抑郁症是全球健康重点关注的问题。在老年人中维持和延缓抑郁症状是健康老龄化的关键。本研究旨在确定抑郁症状轨迹、预测因素和死亡率，同时探索 14 年间香港社区中空气质量与老年人抑郁症状之间的关系。
本研究是在香港进行的一项纵向研究。目标人群为年龄在 65 岁以上的社区居住老年人。使用老年抑郁量表（GDS-15）测量抑郁症状。使用基于群组的轨迹模型识别 14 年内纵向变化的异质性，并使用多项逻辑回归检查基线变量与不同队列成员轨迹之间的关系。采用 Kaplan-Meier 法进行生存分析，探索不同轨迹组随时间变化的生存概率差异。线性混合模型用于探索空气质量与抑郁症状之间的关系。
共纳入 2828 名老年人。确定了老年人抑郁症状的三种不同轨迹：相对稳定（15.4%）、后期增加（67.1%）和增加（17.5%）。与抑郁症状稳定水平的参与者相比，女性、更多的慢性疾病、较差的认知功能和较差的健康相关生活质量（HRQOL）与其他不太有利的轨迹显著相关。后期增加组的死亡率低于相对稳定组和增加组。在 14 年内，较低的基线环境空气污染物 NO 暴露量与较少的抑郁症状显著相关。
在这项研究中，我们发现香港老年华人中抑郁症状后期增加是主要趋势。较差的 HRQOL 是预测抑郁症状轨迹不良的指标。环境空气污染与抑郁症状有关。这一新的观察结果增强了纵向抑郁症状变化和与老年时期空气污染暴露相关联的流行病学证据。
