Depression in the old-old elderly residing in Maltese community nursing homes

This article is based on the author’s research in partial fulfilment of the author’s awarding of the degree of Bachelor of Psychology (Honours) at the University of Malta.

Depression is a mood disorder characterised by a loss of interest in everyday life, feelings of helplessness and anhedonia, which is the inability to experience pleasure. It is also known as major depressive disorder or clinical depression; affecting the overall well-being of an individual.

International research on depression amongst the old-old (those aged 90 years and over) is scarce. To my knowledge, locally in Malta prior to this research, no large-scale studies of this kind, amongst this cohort, existed.

Ageing is generally understood to be the final stage of development. Older adults are categorised as ‘young-old’ and the ‘old’, who are aged 65-74 and 75-84 respectively, with the ‘old-old’ aged 85 and over. The World Health Organisation in 2015 reported that the global population of older adults will more than double, from approximately 900 million in 2015 to around two billion in 2050.

Most professionals in the field of geriatrics and gerontology share a consensus that depression is a highly serious and prevalent condition that hits many people in older adult life. This is partially understandable due to a severe decline in activities of daily living and even loss of independence and privacy. In fact, generally at least one fourth of residents aged 65 and over in nursing homes around the world suffer from a depressive disorder.

Literature has argued that there are evidence-based theories of a relationship between depression and dementia. Various studies have attempted to provide evidence that depression can be a precursor of dementia in later life and old age. Some theories suggest that both dementia and depression have shared risks. For example, vascular disease may be connected to the aetiology of vascular dementia as well as the development of vascular depression.

According to WHO, the global population of older adults will more than double, from approximately 900 million in 2015 to around two billion in 2050.

The aims of the research

Today, the number of older adults residing in nursing homes has increased and is expected to continue increasing as the number of older adults continues to rise.

Consequently, the overall objective of the current study was to investigate the prevalence of depression amongst the ‘old-old’ (90 years and over) residing in community nursing homes. Furthermore, as per literature suggesting that depression was related to cognitive decline, a secondary aim of the study was to correlate cognitive function with depression.

Finally, the study aimed to shed light on one aspect of mental health amongst this cohort using the data to make recommendations regarding the continued care and well-being of this sector of the population.

The assessment

In order to answer the aims of the study, a quantitative approach to the research was necessary. The final sample consisted of 43 persons (72.1% female) recruited from 4 different community nursing homes. The inclusion criteria for participation in this study was being 90 years and over, and having a Mini-Mental State Exam (MMSE) score of 20 and over. A score of less than 20 indicates an impairment in cognitive functioning. The MMSE is one of the most extensively used screening tool to test for impaired cognition.

To assess Depression, the Geriatric Depression Scale (GDS) was used. The GDS has been recommended as a standard tool to measure the degree of depression in older adults, thus aiding and easing comparison of research and replication of any studies made. It is a 30-item assessment tool, and whilst on its own cannot diagnose Depression, it aids professionals in diagnosis.

The statistical program used to analyse the data was the Statistical Package for the Social Science (SPSS). Four main statistical tests were utilised to analyse the data. These were the Shapiro–Wilk Test, the Independence Sample T-Test, the One-Way ANOVA test, and the Pearson Correlation Coefficient test.

51.2% clustered under the depressed category

The sample consisted of 43 participants aged between 90 and 98 years, with a mean age of 92.2 years and a median age of 92 years (SD: 1.92). From the sample, 27.9% were male and 72.1% were female.

The sample was categorised into 2 groups according to their GDS scores (Depressed or Not Depressed). Results indicated that 51.2% were clustered under the depressed category and 48.8% under the not depressed category. This indicated that amongst this sample, slightly more persons (51%) were depressed.

As per the research aims, MMSE and GDS scores were correlated. The scatter plot displayed a very weak negative relationship between the GDS and MMSE scores. In fact, there were no visible trends between the two scores. Results of the Pearson Correlation Analysis confirm that there was no significant relationship between the two scales as the P-Value exceeded the 0.05 level of significance. Therefore, amongst this sample the relationship between cognitive functioning and depression was not significant. This showed that Depression may be diagnosed without cognitive impairment being present.

An Error Bar Graph displaying 95% confidence intervals for mean MMSE and GDS scores if the whole population of older adults aged 90 and over had to be included in the study was conducted. The graph showed that results would be comparable to the results of the current study, and thus over half of the local population of older adults aged 90 and over would potentially be living with depression.

Over half of the local population of older adults aged 90 and over would potentially be living with depression.

It’s our job to fight the stigma

This study, which was a first in Malta amongst this particular cohort, sheds light on the possibility that mild depressive symptoms appear to be present in over 50% of the old-old residing in local nursing homes. It is generally understood that some symptoms of depression such as being withdrawn, lack of appetite, diminished energy levels or loss of interest in activities can easily be attributed to ‘old age’, but this is not necessarily and always the case.

Consequently, if the condition remains undetected, then older adults who may already have other health issues will be deprived of the right treatment, thus ultimately hindering overall well-being. More than half of the patients interviewed in this study seemed to indicate that they might be suffering from depression. These are signs that clearly show that older adults living in long term care need more attention, care and help.

Nowadays, it is generally understood that more and more people are living well beyond their nineties and it is important that future research should give this age group its due attention so that these individuals can enjoy a healthy active and independent life especially when the concept of ‘Active Ageing’ is nowadays being promoted.

It is a trans-disciplinary job, as students, as friends, as family members and as professionals and practitioners to remove the stigma surrounding the geriatric society, and do their best to make the lonely feel valued and loved.


Mr Yaser Teebi graduated with a Bachelor of Psychology (Honours) degree in 2017 and obtained his Master of Gerontology and Geriatrics degree in 2019, both with Merit. He has just completed (awaiting results) his Master of Psychology in Clinical Psychology degree, as he aims to become a warranted Clinical Psychologist in Malta. He is currently employed within the Psychology Department at a Rehabilitation Hospital in Malta.

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