Abstract
Introduction: The elderly population is growing all over the world with attendant increase in occurrence of comorbid conditions. Using data from a longitudinal study of community-dwelling elderly persons in Nigeria, we explored the prevalence and corelates of hypertension and depression as well as the factors associated with the comorbidity of these two conditions.
Methods: The Ibadan Study of Ageing, a longitudinal community-based cohort study conducted between 2003 and 2009 on the profile and determinants of successful ageing. A multistage cluster random sampling was used to select a cohort of elderly participants from across eight contiguous Yoruba-speaking states in Nigeria- Ekiti, Kogi, Kwara, Lagos, Ogun, Ondo, Osun, and Oyo. Participants (non-institutionalized elderly, aged 65 years or over) were assessed at 4 time points: baseline(2003/2004) and annually from 2007 (wave 1), 2008 (wave 2 and 2009 (wave 3). Data was collected in face-to-face interviews; depression was assessed using the World Mental Health initiative version of the Composite International Diagnostic Interview (CIDI), social engagement was assessed using an adapted World Health Organization Disability Assessment Schedule WHODAS) and functional disability using activities of daily living (ADL) and instrumental activities of daily living (IADL). Hypertension was defined according to the Joint National Committee-7(JNC-7) recommendations as systolic blood pressure of 140 mmHg and above, diastolic blood pressure of 90mmHg. This current study is based on cross-sectional data from the wave 1(2007) assessment.
Results: Of the 1597 participants, 58% were females and 42% were 70 years and older. The mean age was 74.2 years (SD ±7.8). Nine hundred and ninety-eight (62.5%) participants had hypertension while 177 (10.6%) met the criteria for major depression while comorbid depression and hypertension was present in 122 (7.1%). The comorbidity of hypertension and depression was significantly associated with gender (higher in women) (p=0.001), insomnia (p=0.001), lack of family participation (p<0.001), lack of community participation (p=0.002), and experiencing a negative life event in the past year (p=0.003). In a multivariate analysis, lack of participation in family activities was associated with an increased risk of co-morbidity between hypertension and depression (OR 4.51, p=0.000, CI 2.14-9.50).
Conclusions: These findings suggest that the comorbidity of depression and hypertension could potentially be minimized by modifying social risk factors such as keeping the elderly involved in family and community life participation by promoting their involvement in recreational and volunteer activities as well as social gatherings.
Keywords: Depression. Hypertension. Elderly. Nigeria
Résumé
Introduction: La population âgée augmente dans le monde entier, avec une augmentation préposée de maladies concomitantes. En utilisant les données d’une étude longitudinale des personnes âgées vivant dans la communauté au Nigéria, nous avons exploré la prévalence et les corelats de l’hypertension et de la dépression ainsi que les facteurs associés à la comorbidité de ces deux conditions.
Méthodes: L’étude de Vieillissement d’Ibadan, une étude de cohorte longitudinale communautaire menée entre 2003 et 2009 sur le profil et les déterminants du vieillissement réussi. Un échantillonnage aléatoire en grappes à plusieurs degrés a été utilisé pour sélectionner une cohorte de participants âgés provenant de huit États contigus de langue yoruba au Nigéria - Ekiti, Kogi, Kwara, Lagos, Ogun, Ondo, Osun et Oyo. Les participants (personnes âgées non institutionnalisées, âgés de 65 ans ou plus) ont été évalués à 4 points de temps: ligne de base (2003/2004) et annuellement à partir de 2007 (vague 1), 2008 (vague 2) et 2009 (vague 3). Les données ont été recueillies en interviews face-à-face; la dépression a été évaluée à l’aide de la version de l’initiative mondiale pour la santé mentale du Composite International de Diagnostic Interview (CIDI), l’engagement social a été évalué à l’aide d’un calendrier adapté d’évaluation du handicap de l’Organisation mondiale de la santé (WHODAS) et l’incapacité fonctionnelle en utilisant les activités de la vie quotidienne (AVQ) ) et les activités instrumentales de la vie quotidienne (AIVQ). L’hypertension a été définie selon les recommandations du Joint National Committee-7 (JNC-7) comme une pression artérielle systolique de 140 mmHg et plus, une pression artérielle diastolique de 90 mmHg. Cette étude actuelle est basée sur des données transversales issues de l’évaluation de la vague 1 (2007).Résultats : Sur les 1597 participants, 58% étaient des femmes et 42% avaient 70 ans et plus. L’âge moyen était de 74,2 ans (ET ± 7,8). Neuf cent quatre-vingt-dix-huit (62,5%) participants souffraient d’hypertension tandis que 177 (10,6%) répondaient aux critères de dépression majeure tandis que la dépression et l’hypertension comorbides étaient présentes chez 122 (7,1%). La comorbidité de l’hypertension et de la dépression était significativement associée au sexe (plus élevé chez les femmes) (p = 0,001), à l’insomnie (p = 0,001), au manque de participation familiale (p <0,001), au manque de participation communautaire (p = 0,002), et avoir vécu un événement de vie négatif au cours de la dernière année (p = 0,003). Dans une analyse multivariée, le manque de participation aux activités familiales était associé à un risque accru de comorbidité entre l’hypertension et la dépression (OR 4,51, p = 0,000, IC 2,14-9,50).
Conclusions : Ces résultats suggèrent que la comorbidité de la dépression et de l’hypertension pourrait être réduite au minimum en modifiant les facteurs de risque sociaux tels que garder les personnes âgées afin d’être impliqué dans la participation de vie familiale et communautaire en favorisant leur participation à des activités récréatives et bénévoles ainsi qu’aux rassemblements sociaux.
Mots clés: Dépression. Hypertension. Les personnes âgées. Nigeria
Correspondence: Dr. S. Ajayi, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria. Email: soajayi@hotmail.com
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