Objective: The purpose of this research was to identify various ways that depression is manifested in older adults.
Design: The research used a psychometric design to develop and evaluate an instrument for the assessment of depression in older adults. Phase 1 of the study included instrument development and evaluation using factor analysis and cluster analysis. Phase 2 of the study involved pilot-testing of the instrument.
Materials and Methods: In Phase 1 of the study, data from a previous study of community-dwelling older adults (n=168) were re-analyzed. In Phase 2 of the study, community-dwelling older adults (n=55) were interviewed.
Results: Phase 1 results were two-fold. Principal axis factor analysis with an oblique rotation was selected and explained 51% of the variance with five factors retained. The five factors were:
Factor 1 Melancholic Behavior,
Factor 2 Negative Behavior,
Factor 3 Worry,
Factor 4: Sleep Impairment, and
Factor 5 Appetite Impairment.
Cluster analysis revealed 4 clusters:
1. non-depressed,
2. depressed with mild to moderate melancholic behavior, negative behavior, and worry and moderate to severe sleep and appetite impairment,
3. depressed with mild to moderate negative behavior and appetite impairment and moderate to severe sleep impairment, and
4. depressed with moderate to severe sleep and appetite impairment.
Phase 2 results of interrater reliability (n=21) were for the total scale a Pearson r = 0.94 and Kendalls Tau = 0.76. Scores for each subscale were:
Factor 1 Melancholic Behavior r = 0.92, Tau = 0.80;
Factor 2 Negativistic Behavior r = 0.91, Tau = 0.79;
Factor 3 Worry r = 0.88, Tau = 0.90;
Factor 4 Sleep Impairment r = 0.94, Tau = 0.79; and
Factor 5 Appetite Impairment r = 0.84, Tau =0.79.
Additional Phase 2 results (n=55) were:
1. of those invited to participate, 65% agreed to participate in the study;
2. 55% were not depressed, 41% were mildly depressed, 2% were moderately depressed, and 2% were severely depressed; and
3. depressed older adults reported concerns about a lack of meaning and purpose in their lives while non-depressed older adults reported feeling a sense of meaning and purpose in their lives.
Conclusion: The conclusions of the research are:
1. A 22-item, interviewer-rated scale for older adults regardless of their cognitive status was developed in an attempt to better understand and measure depression in older adults.
2. The instrument (and other depression instruments for older adults) may be missing important items related to meaning and purpose in life.
3. Due to the heterogeneity of older adults, it may be necessary to examine understudied subpopulations of older adults such as Appalachian older adults in order to fully identify and measure the various common ways that depression manifests in older adults.
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