JMIR Publications

ABSTRACT

Background:

The number of centenarians worldwide is expected to increase dramatically, reaching 3.4 million by 2050 and more than 25 million by 2100. Despite these projections, depression remains a prevalent yet underdiagnosed and undertreated condition among the very old that carries significant health risks.

Objective:

This study aimed to identify and achieve consensus on the most representative signs and symptoms of depression in near-centenarians and centenarians (aged 95 years and over) through an e-Delphi study with an international and interdisciplinary panel of experts. Ultimately, the outcomes of this study might help create a screening instrument that is specifically designed for this unique population.

Methods:

A modified e-Delphi study was carried out to achieve expert consensus on depressive symptoms in near-centenarians and centenarians. A panel of 28 international experts was recruited. Consensus was defined as 70% agreement on the relevance of each item. Data were collected through an online questionnaire over three rounds. Experts rated 104 items that were divided into 24 dimensions and 80 criteria to identify the most representative signs and symptoms of depression in this age group.

Results:

The panel consisted of experts from various countries, including physicians with experience in old age psychiatry and/or geriatrics, as well as nurses and psychologists. The response rate remained consistent over rounds (71-75%). Four new dimensions and eight new criteria were proposed by the experts, and consensus was reached for 24 out of 28 dimensions (85.7%) and 70 out of 88 criteria (79.5%). Most consensual potentially relevant dimensions were Lack of Hope (100%), Loss of interest (96.4%), Lack of reactivity to pleasant events (96.4%), Depressed mood (92.9%), and Previous episodes of depression or diagnosed depression (90.5%). Additionally, most consensual potentially relevant criteria were Despondency, gloom, despair (100%), Depressed (100%), Lack of reactivity to pleasant events or circumstances (100%), Suicidal ideation (100%), Suicide attempt(s) (100%), Ruminations (96.4%), Recurrent thoughts of death or suicide (96.4%), Feelings of worthlessness (96.2%), Critical life events (95.2%), Anhedonia (95.2%), Loss of interest in activities (92.9%), Loss of pleasure in activities (92.9%), and Sadness (92.3%). Moreover, when assessing depression in very old age, the duration, number, frequency, and severity of signs and symptoms should also be taken into account as evidenced by high expert agreement.

Conclusions:

The classification of most elements as ‘relevant’ highlights the importance of a multidimensional approach for an optimal depression screening among the very old. This study offers a first step toward improving depression assessment in near-centenarians and centenarians. The development of a more adapted screening tool could improve early detection and intervention, enhancing the quality of mental health care for the very old.