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To investigate patterns and correlates of depression among Norwegian older adults (age 70+), 1995-2019, and estimate the number of older adults with depression by 2050. Three surveys of the Trøndelag Health Study (Norway): HUNT2 (1995-96), HUNT3 (2007-08), and HUNT4 (2017-19). 22,822 home dwellers aged 70 + who participated in at least one of the three surveys. Depression was defined as scores [greater than or equal to]8 on the depression subscale of the Hospital Anxiety and Depression Scale. Covariates included sex, age, education, marital status, and reported loneliness. Depression prevalence (%) was standardized to the Norwegian population by age, sex, and education for years close to the initial HUNT survey year (1995, 2006, and 2016). Projection of the total number of individuals with depression in the coming decades were estimated. Predictors of depression were analyzed with logistic regression and the potential reduction in depression prevalence by reducing the prevalence of loneliness was estimated. Standardized depression prevalence decreased from 16.7% (HUNT2) to 14.9% (HUNT3), and 11.5% (HUNT4), and was highest among men, the oldest (85+), the lower-educated, and in earlier surveys (all p < 0.001). Living alone was also associated with higher depression prevalence, but only if loneliness was present. While depression rates are falling, we expect the number of depressed individuals to double by 2050 as the population ages. Depression rates among adults aged 70 + decreased by 50% from 1995 to 2019, but less so among the oldest old. The rates were highest among single older men. Despite decreasing prevalence, the number of depressed older adults will increase significantly in the future. Given the major individual and societal costs of depression, this trend is alarming for societies preparing for the challenges posed by population aging. This can, however, be addressed by addressing predictors of depression.

To investigate patterns and correlates of depression among Norwegian older adults (age 70+), 1995-2019, and estimate the number of older adults with depression by 2050. Population-based cross-sectional study. Three surveys of the Trøndelag Health Study (Norway): HUNT2 (1995-96), HUNT3 (2007-08), and HUNT4 (2017-19). 22,822 home dwellers aged 70 + who participated in at least one of the three surveys. Depression was defined as scores ≥8 on the depression subscale of the Hospital Anxiety and Depression Scale. Covariates included sex, age, education, marital status, and reported loneliness. Depression prevalence (%) was standardized to the Norwegian population by age, sex, and education for years close to the initial HUNT survey year (1995, 2006, and 2016). Projection of the total number of individuals with depression in the coming decades were estimated. Predictors of depression were analyzed with logistic regression and the potential reduction in depression prevalence by reducing the prevalence of loneliness was estimated. Standardized depression prevalence decreased from 16.7% (HUNT2) to 14.9% (HUNT3), and 11.5% (HUNT4), and was highest among men, the oldest (85+), the lower-educated, and in earlier surveys (all p < 0.001). Living alone was also associated with higher depression prevalence, but only if loneliness was present. While depression rates are falling, we expect the number of depressed individuals to double by 2050 as the population ages. Depression rates among adults aged 70 + decreased by 50% from 1995 to 2019, but less so among the oldest old. The rates were highest among single older men. Despite decreasing prevalence, the number of depressed older adults will increase significantly in the future. Given the major individual and societal costs of depression, this trend is alarming for societies preparing for the challenges posed by population aging. This can, however, be addressed by addressing predictors of depression.

When designing interventions and policies to implement evidence based healthcare, tailoring strategies to the targeted individuals and organizations has been recommended. We aimed to gather insights into the ideas of a variety of people for implementing evidence-based practice for patients with chronic diseases, which were generated in five European countries. A qualitative study in five countries (Germany, Netherlands, Norway, Poland, United Kingdom) was done, involving overall 115 individuals. A purposeful sample of four categories of stakeholders (healthcare professionals, quality improvement officers, healthcare purchasers and authorities, and health researchers) was involved in group interviews in each of the countries to generate items for improving healthcare in different chronic conditions per country: chronic obstructive pulmonary disease, cardiovascular disease, depression in elderly people, multi-morbidity, obesity. A disease-specific standardized list of determinants of practice in these conditions provided the starting point for these groups. The content of the suggested items was categorized in a pre-defined framework of 7 domains and specific themes in the items were identified within each domain. The 115 individuals involved in the study generated 812 items, of which 586 addressed determinants of practice. These largely mapped onto three domains: individual health professional factors, patient factors, and professional interactions. Few items addressed guideline factors, incentives and resources, capacity of organizational change, or social, political and legal factors. The relative numbers of items in the different domains were largely similar across stakeholder categories within each of the countries. The analysis identified 29 specific themes in the suggested items across countries. The type of suggestions for improving healthcare practice was largely similar across different stakeholder groups, mainly addressing healthcare professionals, patient factors and professional interactions. As this study is one of the first of its kind, it is important that more research is done on tailored implementation strategies.

Background Depression in older adults is mainly treated in general practice but is often constrained by limited resources in primary healthcare services and suboptimal access to assistance from specialized care. This study aimed to evaluate the effectiveness of a structured collaborative model between GPs and geriatric psychiatrists compared to standard follow-up for individuals aged ≥ 65 with depression. Methods Patients with moderate depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores of 10–19) were invited to participate in a cluster-randomized controlled trial evaluating a structured collaborative intervention model involving GPs and geriatric psychiatrists. The core component of the intervention consisted of two consecutive joint consultations with the GP, patient, and geriatric psychiatrist, supplemented by individual GP-patient consultations. PHQ-9 assessments were conducted at baseline and at 6, 12, and 18 months. The primary outcome was a ≥ 50% reduction in PHQ-9 scores. Results 35 general practitioners initially agreed to participate, yet only 19 managed to recruit one or more depressed patients. Consequently, a total of 34 patients were enrolled in the study, with 30 providing survey responses during the follow-up period for subsequent analysis. Binary analysis (≥ 50% symptom reduction) showed a greater likelihood of improvement in the intervention group compared to the control, though this difference did not reach statistical significance. Notably, both groups showed significant mean PHQ-9 score reductions (3.4 and 4.0, respectively) at 18 months, but differences in mean PHQ-9 scores between the groups across all time points were not statistically significant. Conclusion This study did not yield significant results for the collaborative model implemented. Major challenges in the recruitment process likely contributed to the low participation rate, which may explain the absence of positive findings. Trial registration The study was registered the 15.09.2019 in ClinicalTrials.gov with ID: NCT04078282.

Social media may have the double potential to support and undermine mental health, and research is needed to investigate these relationships in age-specified populations. The purpose of this study was to investigate associations between the use of social media and psychological distress among older adults (60 years and above) both nine and 19 months after the outbreak of the COVID-19 pandemic. An online repeated cross-sectional survey was conducted in Australia, Norway, the United Kingdom, and the United States. Participants (9 months: n = 679; 19 months: n = 238) reported the extent of social media use, motives for using social media, and level of psychological distress using the 12-item version of the General Health Questionnaire (GHQ-12). The data were analysed with descriptive analyses, independent t-tests and multiple linear regression analyses. Time spent on social media was not associated with psychological distress. Higher psychological distress was associated with higher scores on using social media to ‘reduce loneliness’ at both measurement points. At nine months, higher psychological distress was associated with higher scores on using social media for ‘entertainment’, but the association was not statistically significant at 19 months. Psychological distress was associated with the motive to ‘maintain relationships’ at 19 months, but not at nine months. Guidance for older adults’ use of social media should emphasise how they can be used to promote communication and maintain existing relationships.

Background There are several subtypes of dementia caused by different pathophysiology and with different clinical characteristics. Irrespective subtype, the disease is progressive, eventually leading to the need for care and supervision on a 24/7 basis, often provided in nursing homes (NH). The progression rate and course of the disease might vary according to subtype. The aim of this study was to explore whether the mortality rate for NH residents varied according to the subtype of dementia. Methods NH residents were followed from admission to NH over a period of 36 months or until death with annual follow-up examinations. Demographic and clinical data were collected. The diagnosis of dementia and its subtype at baseline (BL) were set according to international accepted criteria. Kaplan-Meier analysis was performed to estimate median survival time. A Cox regression model was estimated to assess the impact of dementia diagnosis and demographic and clinical variables on mortality. Results A total of 1349 participants were included. When compared to persons with Alzheimer’s disease (AD), persons with frontotemporal dementia (FTD) and dementia with Lewy bodies or Parkinson’s disease dementia (DLB/PDD) were younger and had more neuropsychiatric symptoms. Median survival for the total sample was 2.3 years (95% confidence interval: 2.2–2.5). When compared to persons with AD, having no dementia or unspecified dementia was associated with higher mortality, while we found similar mortality in other subtypes of dementia. Higher age, male gender, poorer general health, higher dependency in activities of daily living, and more affective symptoms were associated with higher mortality. Conclusion Mortality did not differ across the subtypes of dementia, except in persons with unspecified dementia or without dementia, where we found a higher mortality. With a median survival of 2.3 years, NH residents are in the last stage of their lives and care and medical follow-up should focus on a palliative approach. However, identifying the subtype of dementia might help carers to better understand and address neuropsychiatric symptoms and to customize medical treatment.

To investigate patterns and correlates of depression among Norwegian older adults (age 70+), 1995-2019, and estimate the number of older adults with depression by 2050. Three surveys of the Trøndelag Health Study (Norway): HUNT2 (1995-96), HUNT3 (2007-08), and HUNT4 (2017-19). 22,822 home dwellers aged 70 + who participated in at least one of the three surveys. Depression was defined as scores [greater than or equal to]8 on the depression subscale of the Hospital Anxiety and Depression Scale. Covariates included sex, age, education, marital status, and reported loneliness. Depression prevalence (%) was standardized to the Norwegian population by age, sex, and education for years close to the initial HUNT survey year (1995, 2006, and 2016). Projection of the total number of individuals with depression in the coming decades were estimated. Predictors of depression were analyzed with logistic regression and the potential reduction in depression prevalence by reducing the prevalence of loneliness was estimated. Standardized depression prevalence decreased from 16.7% (HUNT2) to 14.9% (HUNT3), and 11.5% (HUNT4), and was highest among men, the oldest (85+), the lower-educated, and in earlier surveys (all p < 0.001). Living alone was also associated with higher depression prevalence, but only if loneliness was present. While depression rates are falling, we expect the number of depressed individuals to double by 2050 as the population ages. Depression rates among adults aged 70 + decreased by 50% from 1995 to 2019, but less so among the oldest old. The rates were highest among single older men. Despite decreasing prevalence, the number of depressed older adults will increase significantly in the future. Given the major individual and societal costs of depression, this trend is alarming for societies preparing for the challenges posed by population aging. This can, however, be addressed by addressing predictors of depression.

Background The tailoring of implementation interventions includes the identification of the determinants of, or barriers to, healthcare practice. Different methods for identifying determinants have been used in implementation projects, but which methods are most appropriate to use is unknown. Methods The study was undertaken in five European countries, recommendations for a different chronic condition being addressed in each country: Germany (polypharmacy in multimorbid patients); the Netherlands (cardiovascular risk management); Norway (depression in the elderly); Poland (chronic obstructive pulmonary disease—COPD); and the United Kingdom (UK) (obesity). Using samples of professionals and patients in each country, three methods were compared directly: brainstorming amongst health professionals, interviews of health professionals, and interviews of patients. The additional value of discussion structured through reference to a checklist of determinants in addition to brainstorming, and determinants identified by open questions in a questionnaire survey, were investigated separately. The questionnaire, which included closed questions derived from a checklist of determinants, was administered to samples of health professionals in each country. Determinants were classified according to whether it was likely that they would inform the design of an implementation intervention (defined as plausibly important determinants). Results A total of 601 determinants judged to be plausibly important were identified. An additional 609 determinants were judged to be unlikely to inform an implementation intervention, and were classified as not plausibly important. Brainstorming identified 194 of the plausibly important determinants, health professional interviews 152, patient interviews 63, and open questions 48. Structured group discussion identified 144 plausibly important determinants in addition to those already identified by brainstorming. Conclusions Systematic methods can lead to the identification of large numbers of determinants. Tailoring will usually include a process to decide, from all the determinants that are identified, those to be addressed by implementation interventions. There is no best buy of methods to identify determinants, and a combination should be used, depending on the topic and setting. Brainstorming is a simple, low cost method that could be relevant to many tailored implementation projects.

Psychosis (delusions or hallucinations) in Alzheimer’s disease (AD + P) occurs in up to 50% of individuals and is associated with significantly worse clinical outcomes. Atypical antipsychotics, first developed for schizophrenia, are commonly used in AD + P, suggesting shared mechanisms. Despite this implication, little empirical research has been conducted to examine whether there are mechanistic similarities between AD + P and schizophrenia. In this study, we tested whether polygenic risk score (PRS) for schizophrenia was associated with AD + P. Schizophrenia PRS was calculated using Psychiatric Genomics Consortium data at ten GWAS p value thresholds (PT) in 3111 AD cases from 11 cohort studies characterized for psychosis using validated, standardized tools. Association between PRS and AD + P status was tested by logistic regression in each cohort individually and the results meta-analyzed. The schizophrenia PRS was associated with AD + P at an optimum PT of 0.01. The strongest association was for delusions where a one standard deviation increase in PRS was associated with a 1.18-fold increased risk (95% CI: 1.06–1.3; p = 0.001). These new findings point towards psychosis in AD—and particularly delusions—sharing some genetic liability with schizophrenia and support a transdiagnostic view of psychotic symptoms across the lifespan.

Background Elderly patients with depression are underdiagnosed, undertreated and run a high risk of a chronic course. General practitioners adhere to clinical practice guidelines to a limited degree. In the international research project Tailored Implementation for Chronic Diseases, we tested the effectiveness of tailored interventions to improve care for patients with chronic diseases. In Norway, we examined this approach to improve adherence to six guideline recommendations for elderly patients with depression targeting healthcare professionals, patients and administrators. Methods We conducted a cluster randomised trial in 80 Norwegian municipalities. We identified determinants of practice for six recommendations and subsequently tailored interventions to address these determinants. The interventions targeted healthcare professionals, administrators and patients and consisted of outreach visits, a website presenting the recommendations and the underlying evidence, tools to manage depression in the elderly and other web-based resources, including a continuous medical education course for general practitioners. The primary outcome was mean adherence to the recommendations. Secondary outcomes were improvement in depression symptoms as measured by patients and general practitioners. We offered outreach visits to all general practitioners and practice staff in the intervention municipalities. We used electronic software that extracted eligible patients from the general practitioners’ lists. We collected data by interviewing general practitioners or sending them a questionnaire about their practice for four patients on their list and by sending a questionnaire to the patients. Results One hundred twenty-four of the 900 general practitioners (14 %) participated in the data collection, 51 in the intervention group and 73 in the control group. We interviewed 77 general practitioners, 47 general practitioners completed the questionnaire, and 134 patients responded to the questionnaire. Amongst the general practitioners who provided data, adherence to the recommendations was 1.6 percentage points higher in the intervention group than in the control group (95 % CI −6 to 9). Conclusions The effectiveness of our tailored intervention to implement recommendations for elderly patients with depression in primary care is uncertain, due to the low response rate in the data collection. However, it is unlikely that the effect was large. It remains uncertain how best to improve adherence to evidence-based recommendations and thereby improve the quality of care for these patients. Trial registration ClinicalTrials.gov: NCT01913236 .