Older and Wiser or More Complex?

Quality of life and depressive symptoms in older adults: findings from an integrated epilepsy self-management data set Kiriakopoulos ET, Briggs F, Fiorelli N, McGee RE, Johnson EK, Jobst BC, Shegog R, Sepulveda R, Sprulli T, Escoffery C, Quarells RC, McVoy M, Priy S, Adeniyi C, Sajatovic M. Epilepsy Behav . 2026 Jul 16;184:111199. Background: In the U.S., about one million people with active epilepsy are adults aged 55 + . Older adults with epilepsy (OAWE) experience complex health conditions that compromise quality of life (QOL). The contribution of depressive symptom dimensions to health-related QOL remains underexplored in OAWE. Methods: We analyzed baseline data from 13 epilepsy self-management studies in the CDC-sponsored MEW-DB (Managing Epilepsy Well Database), including adults ages 55 and older (N = 198). The primary outcome was health-related QOL, assessed via the 10-item Quality of Life in Epilepsy scale (QOLIE-10), which was inverse rank normalized (mean = 0, SD = 1). Primary predictors included the Patient Health Questionnaire (PHQ-9) total score, cognitive and somatic symptom sub scores, and suicide ideation. Multivariable mixed-effects linear regression was used to assess associations. Models included a random intercept for originating study. Results: Participants were x̄ = 60.8 years (range: 55-79); 60.6% female and 68.7% White. On average, participants had mild depressive symptoms (mean PHQ-9 = 8.3). Depressive symptom severity was significantly associated with worse QOL. Cognitive (β = 0.17 SD, 95% CI: 0.12-0.21, p = 5.6 × 10 −13 ), somatic (β = 0.19 SD, 95% CI: 0.14-0.23, p = 3.3 × 10 −17 ), and total depressive (PHQ-9 total) symptoms (β = 0.10 SD, 95% CI: 0.08-0.12, p = 3.8 × 10 −21 ) were associated with worse QOLIE-10 total scores when adjusting for likely confounders. Suicide ideation was not associated with QOLIE-10 (β = 0.07 SD, 95% CI: −0.15 to 0.29, p = 0.51). Past 30-day seizure occurrence was associated with worse total QOLIE-10 only when depressive terms were excluded from the multivariable model (β = 0.38 SD, 95% CI: 0.05-0.72, p = 0.024). Conclusions: Among OAWE, depressive symptoms are strongly linked to reduced QOL. These findings underscore the importance of integrated mental health screening and intervention for OAWE.