Table 3. Results of included studies.
| Study; year; country of sample | N5 | Identified Risk factors or protective factors |
Instruments measuring factors | Risk (95% CI) adjusted |
Risk (95-% CI) unadjusted | Risk type | Type Of multivariate analysis |
Quality rating; scores | Depression in the past excluded | Variables adjusted for |
|---|---|---|---|---|---|---|---|---|---|---|
| Ibadan Study of Ageing; 2011; Nigeria [18] |
892 |
Men - Women Rural residence No Regular contact with friends |
Rural classified as <12000 households CIDI |
2.5 (1.4–4.4) 2.1 (1.1–3.7) |
Unadjusted results not provided for men/women separately | OR | LR | High;14/16 | yes | Age Sex |
| Ibadan Study of Ageing; 2018; Nigeria [19] | 1394 |
MenOccupational attainment (reference: skilled) • Trade • Elementary WomenRural residenceNo regular contacts with family |
Self-report, categorised based on International standard classification of occupations Rural classified as <12000 households CIDI |
1.4 (1.0–2.0) 1.5 (1.1–2.1) 1.3 (1.0–1.7) 2.2 (1.0–4.7) |
1.4(1.0–2.0) 1.5(1.1–2.1) 1.3(1.0–1.7) 2.2(1.0–4.7) |
HR | CRM | High;14/16 | yes | Age |
| Aichi Gerontological Evaluation Study (AGES) project; 2019; Japan [20] | 3464 |
Men: 1 or more life events Age Poorer self-reported health Protective factors: Having hobbies Sense of coherence: medium Sense of coherence: high Women: 1 or more life events Age old-old (compared to young-old) Protective factors Sense of coherence: high Sense of coherence: no response |
Question “did you experience any of the following events: (…)” 13-item Sense of Coherence scale (SOC-13) Question “did you experience any of the following events: (…)” 13-item Sense of Coherence scale (SOC-13) |
1.64 (1.22–2.19) 1.33 (0.96–1.86) 1,92 (1.35–2.78) 0.59 (0,40–0,86) 0.58 (0.41–0.82) 0.24 (0.16–0.35( 1.49 (1.11–2.01) 1.55 (1.11–2.15) 0.35(0,23–0,52) 0.44 (0.26–0.75) |
Unadjusted results not provided | OR | GLM | Medium;13/16 | no | Frequency of meeting friends Emotional support: Receiving + providing Instrumental support Receiving + providing Hobbies (yes/no) Participation in organization Life events Illness Self-reported health IADL Sense of coherence Age Marital status Educational level Equivalent income (all variables dichotomous) |
| The Tsurugaya Project; 2005; Japan; [21] | 475 |
Not having someone with whom one can consult in trouble Not having someone who can take care of you when you are ill in bed |
Question: yes/no Question: yes/no |
2.6 (1.2–5.3) 3.0 (1.4–6.1) |
Results adjusted for sex, age: 2.8(1.5–5.2) 2.9(1.6–5.3) |
OR | LR | High;14/16 | no | Sex Age Presence/absence of spouse Numbers of people in household History of physical disease Age at finishing education Cognitive function Physical function Level of pain Self-rated health GDS-score at baseline |
| The JAGES prospective cohort study; 2016; Japan [22] | 10458 |
Low Childhood Socioeconomic status Low Annual household income |
Question to participants arranged at 5-point Likert scale Question: < 2 million yen |
1.27 (1.08–1.50) 1.32 (1.08–1.60) |
Adjusted for age and sex: 1.44(1.23–1.69) - |
ARR | BR | Medium;12/16 | no | Age Sex Childhood socioeconomic status Education (High, middle, low) Adult socioeconomic status: longest occupation (non-manual, manual, no occupation) Annual household income (high, middle low) Living situation (Own home, Rent home, Other) Disease status Health behaviours (smoking, alcohol, walking time) Social relationships (marital status, employment status, social participation, social support, general trust) Municipality of residence |
| Obu Study of Health Promotion in the elderly; 2018; Japan [23] | 3106 |
PROTECTIVE FACTORS Light physical exercise Taking enrichment lessons Using personal computer Participation in events at the community Centre Attending a community meeting Predictive Factors No light physical exercise Not taking enrichment lessons Not using a personal computer No participation in events at the community Centre Not attending a community meeting |
Question: yes/no Question: yes/no Question: yes/no Question: yes/no Question: yes/no Question: yes/no Question: yes/no Question: yes/no Question: yes/no Question: yes/no |
0.74(0.56–0.98) 0.62 (0.46–0.85) 0.68 (0.48–0.97) 0.54 (0.40–0.72) 0.69 (0.52–0.92) 1.35 (1.02–1.79) 1.61 (1.18–2.17) 1.47 (1.03–2.08) 1.85 (1.39–2,50) 1.45 (1.09–1.92) |
0.62 (0.48–0.81) 0.50 (0.38–0.67) 0.51 (0.37–0.69) 0.41 (0.31–0.54) 0.52 (0.39–0.67) 1.61 (1,23–2,08) 2.00(1.49–2.63) 1.96(1.44–2.70) 2.44(1,85–3,22) 1.92(1,49–2.56) |
OR | MLR | High; 15/16 | yes | Age, Gender, Education, Current smoking status, Alcohol consumption Living status Self-rated health Scores on MMSE Score on SPPB Total number of medication doses GDS at baseline |
| Obu study of Health Promotion for the Elderly; 2015; Japan [24] | 3025 |
Poor self-rated general health Frailty |
Question: “How good was your health” Limitations in physical tests in 5 Domains (mobility, strength, endurance, physical activity, weight loss) |
1.86 (1.30–2.66) 1.86 (1.05–3.28) |
Adjusted for Sex + Age: 3.27(2.35–4.55) Not given Unadjusted results not provided |
OR | MLR | High; 15/16 | yes | Age Sex Education Self-rated general health Fear of falling Smoking status Alcohol MMSE SPPB Frailty status GDS score at baseline |
| Obu study of Health Promotion for the Elderly; 2016; Japan [25] | 3066 |
Gait speed slower than 1.0 m/s Sedentary behaviour time per day 240–480 minutes > = 480 minutes Using sleep medication |
6.4 m walkway at participants usual gait speed, gait time measured between 2.0–4.4 m Self-report: International Activity Questionnaire Not specified |
1.95 (1.25–3.04) 1.60 (1.09–2.38) 1.64 (1.02–2.64) 1.94 (1.40–2.67) |
Adjusted for Sex + Age: 2.08(1.34–3.22) 1.59(1.08–2.34) 1.72(1.08–2.75) 1.98(1.44–2.72) Unadjusted results not given |
OR | MLR | High;15/16 | yes | Age Sex Educational history Current smoking status Current alcohol consumption Living arrangements Habit of going out General cognition Mobility Sedentary behaviour time Household and locomotive activities time |
| Survey of Health and Living Status of the Elderly in Taiwan; 2010; Taiwan [26] | 1487 | Female Sex Change of variables between baseline and follow up as independent variables: Worse perceived health stress Worse perceived financial stress Worse Life satisfaction Worse Functional condition |
Self-rated scale Self-rated scale Life Satisfaction Index (LSI-A) ADL and IADL |
1.58 (1.14–2.19) 3.06 (2.21–4.24) 2.02 (1.41–2.89) 1.92 (1.29–2.84) 2.39 (1.72–3.33) |
Unadjusted results not provided | OR | Multivariate regression analysis | Medium; 13/16 |
no | Sex Age Education Marital status Ethnicity Occurence of new disease Perceived health stress Perceived financial stress Instrumental social support Emotional social support Life satisfaction Functional condition |
| Yang et al.; 2015; Taiwan [27] |
1467 | Ongoing heart disease Worsening ADL2 Worsening IADL Ongoing Arthritis or rheumatism |
Not specified ADL-Scale Six items from older OARS IADL-survey Not specified |
1.64(1.17–2.30) 1.80(1.28–2.52) 1.86(1.25–2.75) 1.50(1.08–2.09) |
1.75(1.28–2.40) 2.08(1.55–2.79) 2.20(1.53–3.16) 1.67(1.22–2.29) |
OR | LR | Medium; 12/16 | no | Sex Age ADL change IADL chage Mobility change Perceived health status Comorbidities |
| Kim et al 2006; South Korea [28] | 521 | Pre-existing heart disease Lower HDL cholesterol |
Self-reported Assay of blood sample |
2.2 (1.3–3.7) 1.3 (1.1–1.6) |
2.1(1.3–3.3) No information |
OR | MLR | High;14/16 | No information | Age Gender Education Level of disability |
| Lyness et al.; 2009; USA [29] | 405 | Minor or subsyndromal depression at baseline Physical Self-Maintenance Scale total score >0 History of major or minor depression Other psychiatric disorder |
SCID (DSM-IV) Physical Self-Maintenance Scale (higher scale indicates poorer functioning) SCID (DSM-IV) SCID (DSM-IV) of any current alcohol-related or anxiety disorder |
2.86 (1.33–6.15) 2.86 (1.19–6.84) 2.47 (1.12–5.44) 2.67 (1.22–5.86) |
Unadjusted results not provided | IRR | GLMLG | Lower; 8/16 | no | Not specified |
| Health and Retirement Study; 2019; USA [30] | 4914 | Insomnia symptoms (vs. no symptoms) 2 symptoms 3 symptoms 4 symptoms Protective factors White race/Caucasian (vs. black/African American, other) Participating in physical activity Years of education |
Question: How often do you have trouble 1) Falling asleep 2) Waking up during night 3) Waking up to early 4) How often do you feel rested in the morning Question Question: yes or no No information |
2.80 (1.48–5.32) 4.44 (2.42–8.15) 6.74 (3.70–12.29) 0.72 (0.54–0.98) 0.51 (0.37–0.71) 0.92 (0.89–0.96) |
Unadjusted results not provided | HR | CPHA | Medium;13/16 | no | Age Sex Race BMI Smoking Alcohol Physical activity Years of education |
| The Vienna Transdanube Aging study (VITA); 2009; Austria [31] | 331 | Score on Fuld Object Memory Evaluation (cognitive function) Protective factors “troubles with relatives” |
Fuld Object Memory Evaluation | 0.90 (0.88–0.99) 0.5 (0.28–0.89) p = 0.18 |
Unadjusted results not provided | OR | SMOLR | Medium; 11/16 | yes | Not specified |
| ESPRIT study of neuropsychiatric disorders in French elderly; 2010; France [32] | 1131 |
MEN Low LDL-C levels at bl WOMEN - |
Venous blood sample, determined by Friedwald formula |
1.98 (1.06–3.72) |
Adjusted for educational level 1.90 (1.25–2.89) |
HR | MCM | Medium; 12/16 | No, but adjusted for history of depression | Age Education level Marital status Cognitive impairment BMI Mobility Ischemic pathologies Hypertension Diabetes Alcohol and tobacco intect Recent loss of appetite Apo” History of psychiatric disorder |
| ESPRIT study of neuropsychiatric disorders in French elderly; 2015; France [14] | 415 (only women) |
WOMEN Homozygotes for minor Allele of GPR50-Polymorphism rs561077:AA |
Buccal samples, Genotyping by LGC Genomics |
1.77 (1.18–2.67) |
Unadjusted results not provided | HR | CPHA with delayed entry | Medium;12/16 | no | Age Education MMSE Incapacities, Cardiovascular ischemic pathologies Current anxiety disorders |
| The French Three City study; 2013; France; [33] | 2307 | 2-year decrease in distance visual function | Self-report; switching between, from without difficulties to at least “with difficulties” or from “with difficulties” to “unable” from baseline to 2 year follow-up | 3.03 (1.75–5.23) | Unadjusted results not provided | OR | MLM | High; 14/16 | no | Study Centre Age Gender Time since baseline Income Living alone Ischemic pathologies Diabetes Respiratory diseases Number of medications Obesity Mobility impairment Cognitive impairment falls |
| The French Three-City study; 2011; France [34] | 3824 | Insomnia symptoms Sleep quality • Average • Poor Difficulty initiating sleep • Frequently • Often Difficulty maintaining sleep • Frequently • Often Early Morning Awakening • Rarely • Frequently • Often Number of Insomnia symptoms • 2 • 3–4 Prescribed sleep medication |
Face-to face interview; sleep-questionnaire Self-report + control of medication/recipe by interviewer/ drug inventory |
1.27 (1.05–1.54) 1.62 (1.32–1.98) 1.71(1.26–2.32) 1.65(1.19–2.28) 1.88(1.35–2.62) 1.63(1.01–2.62) 1.92(1.18–3.13) 1.31(1.01–1.70) 1.55(1.14–2.09) 1.58(1.16–2.15) 1.56(1.15–2.11) 1.75(1.28–2.40) 1.71(1.33–2.20) |
1.81 (1.52–2.16) 2.14 (1.77–2.58) 3.16(2.40–4.14) 2.33 (1.74–3.12) 3.56(2.64–4.81) 1.96(1.25–3.07) 2.66(1.68–4.22) 1.155(1.26–1.90) 2.22(1.67–2.94) 3.17(2.06–4.88) 2.24(1.70–2.96) 3.03 (2.28–4.02) Unadjusted result not provided |
OR | LR | High;14/16 | no | Study Centre CES-D at baseline Gender Age Education Living alone Coffee consumption Alcohol consumption Smoking Chronic disease Past Major depression Disability Prescribed sleep medication intake Homeopathic and non-prescription treatments for sleep |
| AMSTEL; 2000; Netherlands [35] | 1940 | Loss of spouse Personal history of disorder IADL decrease (>1pt) Baseline IADL disability New chronic disease Baseline chronic disease |
CAMDEX-interview IADL IADL not specified not specified |
3.11 (2.10–4.60) 1.75 (1.26–2.43) 1.71 (1.28–2.27) 1.44 (1.10–1.90) 1.41 (1.05–1.90) 1.40 (1.08–1.80) |
2.30(1.19–1.80) 1.61(1.25–2.06) 1.73(1.39–2.14) 1.55(1.26–1.92) 1.40(1.11–1.77) 1.46(1.19–1.80) |
RR | SLR | Medium;14/16 | no | Age Sex Education social support Personal history of depression Family history of depression Chronic diseases ADL disability IADL disability MMSE<26 Anxiety syndrome New organic syndrome New Anxiety syndrome Changes between bl and follow-up: Partner died Relocation All ADL decrease All IADL decrease New chronic diseases |
| AMSTEL; 2006; Netherlands; [36] | 1915 | Loss of spouse Recent IADL decrease Baseline IADL disability Chronic illness at bl |
Interview IADL IADL interview |
2.93 (1.93–4.47) 1.53 (1.12–2.10) 1.78 (1.28–2.48) 1.45 (1.10–1.91) |
Unadjusted results not provided | OR | MLR | High;15/16 | no | Age Sex Education Marital status Social support Personal history of depression Family history of psychiatric disorder Baseline chronic diseases Baseline ADL disability Baseline IADL disability Low MMSE(<26) Life events |
| German Study on Ageing, Cognition, Dementia in Primary Care Patients (AgeCoDe Study); 2013; Germany [2] | 2512 | Age (85+) Mobility impairment Vision impairment MCI Subjective memory impairment Current smoking |
SIDAM-ADL-Scale1 SIDAM-ADL-Scale1 Consensus criteria by the International Working Group on mild cognitive Impairment Question Self-report |
1.83 (1.24–2.70) 2.53 (1.97–3.25) 1.41 (1.04–1.91) 1.52 (1.10–2.10) 1.33 (1.01–1.74) 1.69 (1.13–2.53) |
2.11(1.47–3.03) 2.91(2.31–3.66) 1.65(1.23–2.21) 1.68(1.25–2.24) 1.54(1.20–1.96) 1.69(1.13–2.53) |
HR |
CPHR | High;16/16 | no | Sex Age Living alone Marital status Level of education Mobility impairment Vision impairment Hearing impairment IADL impairment Somatic comorbidity Mild cognitive impairment Subjective memory impairment Current alcohol consumption Current smoking apoE4 |
| LEILA 75+.; 2012; Germany [37] | 1265 | Female gender Satisfactory Self-rated health status (Functional Impairment) Poor/very poor Self-rated health status (Functional Impairment) Stroke in the past (comorbidity) Risky alcohol consumption Higher specialist visits Protective factors Higher social network score, pre point |
IADL3 26 Item IADL3 26 Item Question Self-report: g/day (= 20g w, 30g m) Self-report last 12 months Social Network Index, determined by the authors |
2.93 (1.50–5.73) 2.60 (1.31–5.14) 2.64 (1.28–5.46) 2.78 (1.27–6.09) 2.33 (1.09–4.96) 1.61 (1.03–2.52) 0.84 (0.74–0.95) |
Unadjusted results not provided | HR | CPHR | High;14/16 | no | Age Gender Educational level Marital status Living situation (ref. alone) Self-rated health status ADL MMSE Myocardial infarction Stroke Specialist visits in last 12 months Hospitalization in last 12 months Stressful life events Social network score Alcohol consumption Family history of mental illness (Impatient treatment of near relatives, suicide of relatives) |
| Evergreen Project; 2003; Finland [38] | 384 | Age |
1.09(1.03–1.16) |
Unadjusted results not provided | OR | LR | High;14/16 | no | Mobilty groups Physical activity groups Gender Age Number of chronic illnesses Length of education |
|
| GERDA Project; 2014; Finland [39] | 115 | Hypertension History of stroke GDS-15 Score at baseline |
RR > = 160/95mmHg after 5min of Rest or treatment/previous diagnosis of hypertension Medical records, report of patients/relatives GDS-15 |
2.83 (1.08–7.42) 3.25 (1.12–9.44) 1.39 (1.09–1.76) |
Unadjusted results not provided | OR | MLR | Medium;11/16 | no | Age Gender Poor self-rated health Taking Anxiolytics History of stroke Delirium during preceding month Hypertension Impaired hearing GDS-score at bl Number of medications |
| Kungsholmen project 2000; Sweden [40] |
894 | History of depression/anxiety | Medical records, examination of participants | 4.8 (1.7–7.9) | Unadjusted results not provided | OR | LR | Medium;12/16 | no | Gender Age>85 Education <8 years Being immigrant Marriage status Being institutionalised Using home care Somatic illness Dementia Not feeling well History of depression/anxiety History of psychosis Disabilitiees in daily life Hearing disabilities Visual impairment No regular visitors Having no friends Being unsatisfied with social network |
| English longitudinal study of the Ageing (ELSA); 2008; [41] | 2929 | Visual impairment Older Age Female sex No. of illnesses Mobility impairment IADL-Impairment Current Smoker Family negative interaction |
Self-rated scale Interview number of medical conditions in eight areas Interview Interview IADL-impairment Interview Interview 3-Items |
1.66 (1.21–2.27) 1.30 (1.09–1.55) 1.42 (1.11–1.81) 1.18 (1.06–1.32) 1.48 (1.14–1.93) 1.52 (1.06–2.12) 1.50 (1.06–2.12) 1.14 (1.08–1.21) |
Unadjusted results not provided | OR | MR | Medium;11/16 | no | Visual impairment Hearing impairment Both visual and hearing impairment Age Sex Marriage status Education Working status Income Number of medical conditions Mobility impairment ADL impairment IADL impairment Ex-smoker Current smoker Alcohol user Family support Family negative interactions |
| English Longitudinal Study of the Ageing (ELSA);2007; England [42] | 2814 | Older Age Female Gender Poor sight Mobility disability IADL disability Current smoking Negative interaction with family Pain |
Interview: fair, poor, or legally blind Self-reported Difficulty in at least 1 of 5 activities Self-reported Difficulty in at least 1 of 7 IADL activities Self-reported, 3-Item Score Question, moderate or severe pain |
1.35 (1.13–1.61) 1.35 (1.06–1.71) 1.46 (1.12–1.90) 1.35 (1.03–1.78) 1.45 (1.10–1.91) 1.43 (1.03–1.96) 1.13 (1.07–1.20) 1.54 (1.19–2.00) |
Unadjusted results not provided | OR | LR | Medium;12/16 | no | Age Gender Education Pain Poor sight Mobility disability IADL disability Current smokers Negative interaction with family Marriage status Working status Heart disease Diabetes, stroke Lung disease Bone disease Cancer ADL disability Two measures of social networks for family income |
| Survey of Health, Ageing and Retirement in Europe (SHARE); 2019; Several Countries6 [43] | 17067 |
Female gender Poor self-rated health Loneliness Older Age ADL-impairment Financial difficulty Cognition (<15) Chronic diseases (> = 2) Worse Education |
Subjective rating of health Short loneliness scale ADL impairment in > = 1 interview Specific items from SHARE Project assessed: immediate recall, delayed recall, subtraction calculation skills, verbal fluency Heart disease, hypertension, cholesterol, stroke, diabetes, chronic lung disease, cancer, ulcer, Parkinson, fractures, dementia Years of Schooling: Less than 10 years |
99.9% CI 1.78 (1.77–1.78) 1.67 (1.66–1.67) 1.63 (1.62–1.64) 1.44 (1.43–1.44) 1.34 (1.34–1.35) 1.30 (1.30–1.31) 1.27 (1.27–2.28) 1.24 (1.23–1.24) 1.09 (1.09–1.10) |
Unadjusted results not provided. | OR | MBLR | High;14/16 | no | Gender Self-rated health Loneliness Age ADL impairment Financial difficulty Cognition Chronic disease Education |
| Nihon University Japanese Longitudinal Study of Aging: NUJLSOA; Japan [44] |
3065 | Sleep disturbances: Difficulty initiating sleep Psychological stress Poor Self-Rated health |
Self-reportet response to question (yes/no) Self-report (Do you have psychological stress? Yes/no answer) Self-report (How do you rate your present general health condition? Excellent/good/fair/poor/very poor) |
1.592 (1.012–2.504) 1.553 (1.125–2.145) 2.517 (1.778–3.562) |
2.042 (1.391–2.997) 1.846 (1.375–2.479) 2.589 (1.881–3.563) |
OR | MLR | Medium; 12/16 | no | Age Gender Educational history Place of residence Sleep duration Excessive daily sleepiness Discomfort feeling in the legs Subjective sleep sufficiency Psychological stress Self-rated health ADL |
| Prospective community-based study of late-life psychiatric morbidity in Kwangju; South Korea [45] |
792 | Insomnia | According to answers to questions: Difficulty in initiation or maintenance of sleep with a frequency of 3 nights or more per week. |
1.8 (1.2–2.9) | 1.7 (1.1–2.7) | OR | LR | Medium 13/16 | no | Age Gender Education Housing Past occupation Current employment Living area Life events Social deficit Physical activity GMS organicity GMS anxiety Daily drinking |
ARR = Adjusted Risk Ratio BMI = Body Mass Index; BR = Binomial Regression; CPHR = Cox proportional hazard regression; CPHA = Cox Proportional Hazard Analysis; CRM = Cox Regression Model; DSM = Diagnostic and Statistical Manual of Mental Disorders; GDS = Geriatric Depression Scale; GLM: Generalized Linear Model; GLMLL: Generalized Linear Model with Logistic Link; GMSS = Geriatric Mental State Schedule; GMS-AGECAT = Automated Geriatric Examination for Computer Assisted Taxonomy- Geriatric Mental State Schedule; HAM-D = Hamilton Depression Rating Scale; HR = Hazard Ratio; IRR = Incident Risk Ratio; JAGES = Japan Gerontological Evaluation Study; Leila 75+ = Leipzig Longitudinal Study of the Ageing; LR = Logistic regression; MADRS = Montgomery-Åsberg Depression Scale; MCM = Multivariate Cox Model; MINI = Mini-International Neuropsychiatric Interview; MBLR = Multivariate Binary logistic regression; MLM = Mixed logistic model; MLR: Multiple logistic regression/Multivariate Logistic Regression; MMSE = Mini Mental Status Examination; OR = Odds Ratio; RBDI = Finish modified version of Beck´s 13-item depression scale; RR = Relative Risk; SLR = Stepwise logistic regression; SMOLR = Stepwise Multiple Ordinal Logistic Regression; SCID = Structured Clinical Interview for DSM-IV; SLEs = Stressful life events; SPPB = Short Physical Performance Battery.
1Structured Interview for Diagnosis of Dementia of Alzheimer Type, Multi-infarct Dementia and Dementia of Other Etiology.
2Activities of Daily Living
3Instrumental Activities of Daily Living by Lawton and Brody, 1969
4Social network index according to Wenger and Tucker 2002
5number of participants included into the analysis
6Denmark, Sweden, Switzerland, Luxembourg, Austria, Germany, Belgium, France, Slovenia, Czech Republic, Estonia, Spain, Italy, Israel.