Is age a risk factor for depression among the oldest old with cancer?

Age is negatively related to depression among young and middle age patients with cancer. Nevertheless the relationship between age and depression among older patients with cancer is unclear. The goal of the current study is to assess the association of depression with increasing age among older patients with cancer.

Participants were 243 oncology out-patients, aged ≥65, either receiving treatment for active disease or within 6 months of completing treatment for active disease, with a Karnofsky score ≥70. Participants were grouped by age: "Younger-Old" - age 65-74 (N = 125); "Old" - age 75-84 (N = 49); and "Oldest-Old" -age ≥ 85 years (N = 69). Background data included: socio-demography; cancer type/staging/treatment; Charlson comorbidity index (CCI); Eastern Cooperative Oncology Group (ECOG) performance. Psychological data included: the 5-item Geriatric Depression Scale (GDS); "Distress Thermometer" (single item); and Cancer Perceived Agents of Social Support (12-item).

Depression levels were significantly higher among oldest-old participants in comparison to the old and younger-old groups: mean GDS scores were 0.93 ± 1.13, 1.27 ± 1.41 and 3.91 ± 1.35 respectively. After controlling for all potential confounders in a hierarchical logistic regression model, age-group significantly predicted both depression and distress. Receiver operating characteristic (ROC) analysis determined age 86 as the optimal cutoff for both clinical depression and distress.

Depression among older patients with cancer rises with increasing age, being extremely common among the oldest old. Age independently predicted depression, irrespective of medical variables, social support, or functional status. Findings highlight the importance of addressing the potentially unmet psychological needs of this rapidly growing patient population.