English (pdf)
Article in xml format
Article references
Automatic translation
Send this article by e-mail
Cited by SciELO 
Cited by Google 
Similars in
SciELO 
Similars in Google 
Permalink
Introduction
In older adults, the emotional situation is affected by various factors such as physical health, social relationships, traumatic events and/or significant losses, among others. Therefore, they usually experience feelings of loneliness, isolation, and, consequently, depression1.
Depression is one of the main mental disorders with the highest prevalence in older adults and its development is affected by different factors. The WHO estimates that by 2030 the main cause of death worldwide will be mental disorders. These estimations indicate that between 2015 and 2050 the world population over 60 years of age with some type of depressive symptoms will grow from 12% to 22%. Currently, the worldwide prevalence of depression in older adults is 13.5 %2. In Mexico, mental disorders rank fourth between all medical cases, being depression one of the most frequent illnesses (7.8%)3.
Depression in older adults is a disorder that affects significantly the quality of life of this population. This emotional illness is characterized by persistent feelings of sadness, loss of interest in activities that they used to enjoy, sleeping difficulties, changes in appetite, and reduced energy. It can also trigger memory and concentration problems as well as thoughts of death or suicide4,5.
There are several factors associated with depression in older adults, including presence of chronic diseases (diabetes or cardiovascular diseases), the loss of loved ones and friends, loneliness, social isolation, financial problems, changes in their social roles, and lack of family support. All these factors can have a negative impact on their emotional well-being4,5.
It is important to highlight that depression is not a normal event during the aging process and that it can be effectively treated. Early diagnosis and access to appropriate treatment (e.g. cognitive behavioral therapy and antidepressant medications) can improve their symptoms and quality of life6.
Therefore, the objective of this study was to identify the prevalence and factors associated with depression in older adults from the municipality of Mochitlan, Guerrero. In addition, this research was aimed at describing their emotional state, since, to the best of our knowledge, there are no current studies focused on assessing this problem in this particular population.
Materials and methods
Study type
The research followed a mixed approach. Whereas the qualitative approach applied an ethnographic method, the quantitative cross-sectional analytical component used a simple random sampling method, through the formula:
Instrument
Information collection was conducted directly at two time points. In the first one, qualitative data was obtained through an instrument that has four sections: sociodemographic data, health status, substance use, and geriatric depression. For the last item, the Yesavage (GDS-15) geriatric depression scale was applied, which was designed by Jerome A. Yesavage and collaborators in 1983. In 1986 the scale was modified to a shorter version containing 15 positive and negative questions, which can be answered as “yes” or “no”7. Its internal consistency is 0.78. The Kaiser-Meyer-Olkin test to measure sampling adequacy produced a coefficient of 0.70 and a construct reliability of 0.87. This instrument is recommended by the National Institute of Geriatrics for its application in geriatric populations8. The Cronbach’s Alpha coefficient was used for the reliability or internal consistency of this research, with a result of 0.867.
Qualitative data was collected during the second time point through a semi-structured interview that contained three open questions and was applied to the focus group made up of seven older adults who agreed to participate. The COVID-19 pandemic was a factor that limited a greater participation. The questions were taken and adapted from Yesavage (GDS-15) geriatric depression scale. The oral responses were recorded to guarantee a complete register.
The dependent variable was Depression, which was measured through the Yesavage (GDS-15) geriatric depression scale that included 15 items. The score contained four ranges: normal (0-4); mild (5-8); moderate (9-10); and serious (12-15). The independent variables were sociodemographic data, characteristics of the home, basic services, tenure, and number of people living in the home, accompaniment (living alone or accompanied), epidemiological data (diseases diagnosed in older adults) and substance consumption.
The analysis of quantitative data was carried out through the SPSS version 21 statistical package. The descriptive analysis was conducted using graphs and tables with frequencies and percentages. Chi2, Tau-b, and Tau-c were applied to the bivariate analyses of the relationship between dependent and independent variables. The qualitative assessment involved the initial transcription of the interviews and the data were interpreted through codes, subthemes, and themes, which facilitated the interpretation of the findings. Subsequently, the themes were described based on theoretical aspects and validated with the content of the interviews.
Ethical considerations
The participants were male and female adults aged 60 years and older, form the municipality of Mochitlan, Guerrero, who agreed to participate voluntarily by signing the informed consent that explained clearly the objectives of the study, procedures to be carried out, possible risks and benefits associated with their participation, as well as the guarantee of privacy and confidentiality. The study was conducted from October 2021 to July 2022.
They study way reviewed and approved by researchers and professors of the University and followed the ethical principles established in article 100 of the Health General Law and the official Mexican Standard NOM-012-SSA3-20129,10.
Results
65.38% of the participants were women (17). The mean age was 71.81 years (standard deviation of 8.025), while the age range was 60 to 99 years. 80.77% (21) were married, 50% (13) had a job, 8 of them being farmers (61.54%) and 7 participants working more than 7 hours a day (53.85%). 96.15% of the participants had a monthly income that was lower than $500 MXN (25).
Based on the Geriatric Depression Scale (GDS-15), 65.4% of participants prefer to stay at home, 53.8% think that the majority of people are in a better situation, 46.2% have stopped doing the activities or tasks that they used to do, 42.3% feel useless, and 38.5% mention that they feel helpless and unprotected (Table 1).
Table 1 Items of the Geriatric Depression Scale (GDS-15) applied to the study population
Source: Depression survey in older adults from the Municipality of Mochitlan, Guerrero. May 2022
50% (13) of participants had depression, of which 38.46% (10), 7.69% (2), and 3.85% (1) had mild, moderate, and serious depression, respectively (Figure 1). It was found a relationship with bone fractures (chi2 0.000) and associations with the following variables: gender (Tau-C 0.268); importance of religion in their lives (Tau-C 0.846); being born in the municipality (Tau-C 0.580); knowing how to read (Tau-C 0.733); type of job (Tau-C 0.332); working hours (Tau-C 0.329); monthly income (Tau-C 0.298); being affiliated to a health institution (Tau-C 0.249); type of material being used to build most of the house (Tau-C 0.27); and whether the participants like to live with the people they are with now (Tau-C 0.685) (Table 2).
Table 2 Distribution of depression according to its relationship or association with the independent variables
The qualitative analysis focused on interviews of seven older adults and covered three aspects: feelings-emotions; health issues; and protection.
In the Feelings-emotions found, some were positive, in which peace, tranquility and well-being were expressed, that is, a state of calm and satisfaction where the older adult enjoys his or her time of rest and carries out activities normally, feeling strong and with vitality to continue living (OA1, OA3). “I feel a little calm” (OA1, OA3). They also express excitement, they report feeling strength, energy and courage to endure and face difficulties that they experience in this stage, such as the changes and situations or difficulties that arise. (OA1, OA4). “I don't feel helpless, for me it is a weakness” (OA1, OA4).
A feeling of safety is also a positive emotion, understood as a state where danger and other conditions that may cause physical, psychological or material damage can be controlled in order to preserve health and well-being. Consequently, older adults need a greater care to avoid accidents and this is the reason why sometimes they prefer to stay at home since it is the only place where they feel safe. “When I am at home I am fine, I am not going out anymore (OA7). “Better being at home rather than being somewhere else” (OA6).
Negative feelings in older adults were expressed by a change in mood, there are changes in the emotional aspect, different negative emotions are presented, which can sometimes be controlled (OA5). That is to say, memories make people feel emotions. When thinking about the past, the older adult longs for the times when he could work and support his home. Unfortunately, the years have passed and he has lost his capacity with the passage of time (OA7). “I was a working man and now I can't do it anymore. When I go to the field and I want to cut firewood, the ricochets of the ax hurt me. […] (OA1, OA7).
Hopelessness is the feeling of not finding alternative solutions to a certain situation or not having expectations for the future. Older adults feel this way because they cannot improve their lives, they feel they are useless, and the only thing that is coming is death. “I cannot do things as I used to do it and that bothers me. How I will be able to survive now that I am not able to do anything, that is the problem” (OA7).
Different emotions were manifested, including externalized boredom due to feeling uninterested in what surrounds them, having nothing to do or feeling that life is boring. However, fun or recreational activity was manifested, understood as an activity that takes place in free time, being a moment of distraction and rest from usual activities.
“Sometimes I go out with my children to have fun but it is not fun if the situation is not convenient for me” (OA5). “When I am at home I get bored. I must go out even if it is to the town or where I work and when I come back I am relieved how I am not used to being without doing something, I was a working man” (OA7).
In health problems, physical deterioration caused by a series of changes and complications was evident, affecting physical capacity, mainly walking, which may be due to the wear and tear that occurs around the age of 60, reducing bone mass and tissues, they atrophy, this results in older adults losing the ability to move and perform activities. “I can't work anymore” (OA1); “I cannot walk”; “[…] at home what else can I do, I work with my pickaxe, I sit for a while when I get tired, my shoulders are torn” (OA7).
Protection is expressed by feeling security and family support, caring for a person so that they do not suffer harm and protecting them; in addition to care between members who have family ties or ties and live in the same home. “[...] when children have obligations, there is little they can help you now because they have their children, before they did it because they did not have a family, I feel that with a lot of work I am getting ahead with my family and I will help with what I can, it is no longer the same as before [...]” (AM7).
Boredom can cause depression. It is an emotional state of where the interest and motivation to carry out diverse activities are lost. Older adults experience these feelings due to changes that they experience at this stage and/or difficulties caused by diseases that prevent them from performing normal activities such as farm work. Therefore, they feel bored being at home and they like to go out to do the activities they used to do before in order to feel lightened, but sometimes their health situation becomes a limitation (OA2, OA7). “I feel bored because I cannot walk or go out” (OA2). “[…] yes, I get bored, I must go out even if it is to the town or where I work and when I come back I fell relieved. I am not used to this feeling as I was a working man and now I feel like this, I need to walk through the fields, but I cannot do it anymore” (OA7).
Helplessness is expressed by feeling vulnerable, alone, sad and afraid; when there is no one to take care of them, it produces a feeling of inner unrest. In older adults this is closely related to the presence of diseases or mobility problems that limit the ability to work, generating economic instability; they report receiving very little or no help from their children (OA2, OA6, and OA7). “I can't work anymore” (AM2) “Sometimes I get desperate because of illnesses” (AM6) “[…] I can't work like before, that's what saddens me, what to do to support myself, is the problem [...] I feel that with a lot of work we are coping with things with my family and I will help with what I can, it is no longer the same, for that reason I feel sad, helpless or useless for no longer being able to do things like before [...]” (AM7).
Depression is one of the main reasons why older adults decide not to leave the house since it is a condition that affects their thoughts and feelings, which causes them to stay at home and lose the desire to go out. Some of the reasons to avoid going out are: older adults may not be in the mood or feel without energy; joint problems; or body pain (e.g. hips, shoulders, elbows, wrists, fingers, knees, and ankles, among others). “[…] yes because I cannot walk” (OA2), “Sometimes when my children go out I go with them to have fun, but if the situation is not convenient for me then I do not go” (OA5) (Figure 2).
Discussion
Research on depression in older adults is a topic of great relevance because of the increase in their life expectancy and the fast growing rate of this population worldwide. Depression in this age group is a serious public health problem as it can have significant consequences for the quality of life and well-being of older adults. The prevalence of depression varies considerably, according to estimations from different studies. The prevalence registered in this study (50%) is similar to the one obtained by Peña et al.11 in Guerrero (50.7%) and Salvador et al.12 in Ecuador (54.9%), but it is lower than the figures reported by Miranda et al.13 (89%) in Ecuador, Cárdenas et al.14 (81%) and De los Santos et al.15 in México (74,3%). In contrast, our prevalence value is higher than the one reported by Borrayo et al.16, in Guatemala.
This study found mild (38.46%), moderate (7.69%), and serious (3.85%) depression in the study population. These results differ from those reported by Peña-Marcial et al.11, who registered 81% and 16% for moderate and serious depression, respectively. Similarly, Miranda et al.13 observed a 60% of mild depression and a 29% of established depression; as well as the study by Lliguisupa et al.17, who report 35.3% mild depression and 11% established depression.
The results show that depression affects both genders differently (0.268). This observation coincides with the study of Cardenas et al.14, who reported that depression was more common in women, suggesting a relationship between gender and depression (χ2=823 and p=0.007). Also, Miranda et al.13, and Salvador et al.12, have shown that women are at a higher risk for depression. Likewise, Peña-Marcia et al.11, reported that 50.7% of the study population were women experiencing some degree of depression.
The data from this research carried out show that the type of job (0.332) and monthly income (0.298) were related to the presence of depression. These results coincide with the study by Cárdenas et al.14, in which a relationship was found with domestic activities and not doing any activity, presenting a higher frequency of moderate depression in 79.8% and 77.8% respectively (χ2=13.27 and p=0.004). Socioeconomic status also showed a relationship with depression, as did the study conducted by Miranda et al.13, in which low socioeconomic status was a potential risk factor for depression (55%).The data of this investigation also show that type of job (0.332) and monthly income (0.298) are related to the presence of depression.
Likewise, this study found a relationship of other factors such as the importance of religion in their lives (0.846), being native (0.580), knowing how to read (0.733), number of daily working hours (0.329), belonging to a healthcare institution (0.249), type of institution (0.290), construction material of the home floor (0.325), the person feels comfortable living alone or with other people (0.044). A relationship with the presence of bone fractures was identified χ2 (p=0.000). However, these findings differ from the results of other studies.
The feelings-emotions present in this stage were positive such as tranquility, well-being, strength, encouragement, security and fun and/or negative which included mood swings, longing, hopelessness and boredom. It is mentioned that there are physical problems due to wear and tear, which makes walking difficult, and for this reason older adults prefer to stay at home where they feel comfort, security and protection, some have the support that their family provides them.
These findings coincide with the study by Estupiñán-Palacios et al.18, who found that health problems lead to a feeling of hopelessness and emptiness in your life. The data is based on what is reported by the Ministry of Health of Colombia, about the aging process, which brings with it the loss of the ability to develop habits, causing significant changes in the environment19. Also coinciding with the study by Martínez-Mendoza et al.20, which showed the presence of diseases, as well as alterations in their emotional state due to loneliness and distance from their loved ones, which is reflected in sadness, irritability and melancholy.
Samaniego-Zhunio et al.21 showed that emotions are a reaction that includes experiential, behavioral and physiological elements, through which the person tries to deal with a significant situation or event.
Conclusions
Our results show that depression is a multifactorial health problem that affects older adults, as it is the last stage of their lives when they face: losses, crisis, as well as physical, psychological, family, social, and economic decay, which manifest as mood changes, longing, and hopelessness that sometimes they cannot handle, triggering a great risk for the appearance of diseases. Nevertheless, there are also positive feelings such as tranquility, strength, encouragement, and security, which function as protective factors and may improve the quality of live of older adults.
Recommendations: Health care professionals should conduct continuous screening strategies to identify properly and quickly depression in the elderly population and implement proper interventions coordinated with a multidisciplinary and interdisciplinary team, involving the family, in order to follow up on diagnosed adults according to the Mexican Official Standard NOM-025-SSA2-2014.
To encourage the personnel who work at first level assistance institutions to conduct home visits in order to know, prevent, and follow up on problems and/or needs of older adults.
It is suggested that professional from education institutions should conduct research on elderly populations that live at their own homes in order to identify problems they may experience and search for strategies to improve their quality of life.
