Comparison of depression in the community-dwelling and assisted-living elderly

Depressive Symptoms among Older Residents in Assisted Living Facilities

Responding to the dramatic growth in Assisted Living Facilities (ALFs), the present study focused on mental health among older residents in ALFs. We assessed the effects of physical health constraints (chronic conditions, functional disability, and self-rated health) and psychosocial resources (social network, sense of mastery, religiosity, and attitude toward aging) on depressive symptoms. A sample of 150 residents ( Mage = 82.8, SD = 9.41) from 17 facilities in Florida was used for analyses. Higher levels of depressive symptoms were observed among older residents with a greater level of functional disability, poorer self-rated health, lower sense of mastery, less religiosity, and less positive attitude towards aging. In addition, the linkages between physical and mental health were modified by psychosocial resources. For older residents with more positive beliefs and attitudes (a higher sense of mastery, greater religiosity, and more positive attitudes toward aging), the adverse effects of functional disability or poorer self-rated health on depressive symptoms were attenuated. The protective roles of psychosocial resources against physical health constraints yield important implications for designing prevention and intervention strategies for the mental health of older populations in ALF settings.

The Mediating Role of Health Perceptions in the Relation Between Physical and Mental Health

Objective: Responding to the increased need for research on older residents in assisted living facilities (ALFs), this study assessed the connections between physical and mental health among 150 older residents in ALF settings. Method: The major focus of the study was to explore whether individuals' subjective perceptions of their own health mediate the associations between health-related variables (chronic conditions and functional disability) and depressive symptoms. Results: The analyses showed that the adverse effects of chronic conditions and functional disability on depressive symptoms were not only direct but also indirect through negative health perceptions. Discussion: The findings that health perceptions serve as an intervening step between physical and mental health provide important implications for promotion of mental well-being among older residents in ALFs. In addition to disease/disability prevention and health promotion efforts, attention should be paid to ways to enhance older individuals' positive beliefs and attitudes toward their own health and to promote healthful behaviors.

Cost-effectiveness of the 'Walcheren Integrated Care Model' intervention for community-dwelling frail elderly

BACKGROUND

An important aim of integrated care for frail elderly is to generate more cost-effective health care. However, empirical research on the cost-effectiveness of integrated care for community-dwelling frail elderly is limited.

OBJECTIVE

This study reports on the cost-effectiveness of the Walcheren Integrated Care Model (WICM) after 12 months from a societal perspective.

METHODS

The design of this study was quasi-experimental. In total, 184 frail elderly patients from 3 GP practices that implemented the WICM were compared with 193 frail elderly patients of 5 GP practices that provided care as usual. Effects were determined by health-related quality of life (EQ-5D questionnaire). Costs were assessed based on questionnaires, GP files, time registrations and reports from multidisciplinary meetings. Average costs and effects were compared using t-tests. The incremental cost-effectiveness ratio (ICER) was calculated, and bootstrap methods were used to determine its reliability.

RESULTS

Neither the WICM nor care as usual resulted in a change in health-related quality of life. The average total costs of the WICM were higher than care as usual (17089 euros versus 15189 euros). The incremental effects were 0.00, whereas the incremental costs were 1970 euros, indicating an ICER of 412450 euros.

CONCLUSIONS

The WICM is not cost-effective, and the costs per quality-adjusted life year are high. The costs of the integrated care intervention do not outweigh the limited effects on health-related quality of life after 12 months. More analyses of the cost-effectiveness of integrated care for community-dwelling frail elderly are recommended as well as consideration of the specific costs and effects.

The effects of a pro-active integrated care intervention for frail community-dwelling older people: a quasi-experimental study with the GP-practice as single entry point

Background

This study explored the effectiveness of a pro-active, integrated care model for community-dwelling frail older people compared to care as usual by evaluating the effects on a comprehensive set of outcomes: health outcomes (experienced health, mental health and social functioning); functional abilities; and quality of life (general, health-related and well-being).

Methods

The design of this study was quasi-experimental. In this study, 184 frail older patients of three GP practices that implemented the Walcheren Integrated Care Model were compared with 193 frail older patients of five GP practices that provided care as usual. In the Walcheren Integrated Care Model, community-dwelling elderly were pro-actively screened for frailty from the GP practice using the Groningen Frailty Indicator, and care needs were assessed with the EASYcare instrument. The GP practice functioned as single entry point from which case management was provided, and the GP was the coordinator of care. The entire process was supported by multidisciplinary meetings, multidisciplinary protocols and web-based patient files. The outcomes of this study were obtained at baseline, after 3 months and after 12 months and analyzed with linear mixed models of repeated measures.

Results

The Walcheren Integrated Care Model had a positive effect on love and friendship and a moderately positive effect on general quality of life. The ability to receive love and friendship and general quality of life decreased in the control group but was preserved in the experimental group. No significant differences were found on health outcomes such as experienced health, mental health, social functioning and functional abilities.

Conclusions

The results indicated that pro-active, integrated care can be beneficial for frail older people in terms of quality of life and love and friendship but not in terms of health outcomes and functional abilities. Recommendations for future research are to gain greater insight into what specific outcomes can be achieved with proactive and integrated care, considering the specific content of this care, and to allow for the heterogeneity of frail older people in evaluation research.

Trial registration

Current Controlled Trials ISRCTN05748494. Registration date: 14/03/2013.

Screening Depression Among Elderly in a City of Southeast Asia

INTRODUCTION

Changing family structure (Joint to Nuclear), increased life expectancy above 60 years of age, generation and communication gap, financial dependency on children leads to conflict among family members. This may sometime lead to old age home settlement of elderly people. All these condition leads to isolation and insecurity among elderly people and this condition affect the mental status of elderly people which may sometime lead to depression among Old Age Homes residents and family living elderly people.

OBJECTIVE

To study the prevalence of depression and diagnosed systemic morbidities among elderly people. To study the predictors of depression among study subjects.

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted among elderly people (age ≥60 years) residing in old age homes (OAHs) and in community/families in Lucknow, India. Multistage sampling technique was used to include required sample of subjects from the community and for OAHs all the elderly people living in OAHs were included. Geriatric depression scale was used to screen depression.

RESULTS

Depression was 27.7% among elderly people residing in OAHs while it was 15.6% those residing at their own homes. In community most frequent morbidity was hypertension (17.7%) while 41.1% elderly people had no diagnosed morbidity. In OAHs out of total the musculoskeletal morbidity (33.7%) was most frequent and 18.8% had no diagnosed morbidity. On multivariate analysis financial dependency and education were found to be statistically significant.

CONCLUSION

Depression was more common among elderly living in Old Age Homes as compare to those living in community. Hypertension, musculoskeletal morbidities and eye related morbidities were most frequent diagnosed morbidities. Financial Dependency & Education were found to be primary predictors of depression.

A pilot study of depression among older people in Rawalpindi, Pakistan

BACKGROUND

Depression is common among elderly in developed countries and it is more pronounced in institutional settings. In Pakistan there is a lack of empirical data on depression among this segment of the population particularly with reference to their living arrangements.The objectives of the present study are to report the magnitude of depression among elderly having two different residential arrangements and to examine the association of depression and its established demographic factors.

FINDINGS

Data were collected from 141 respondents. 108 were community residents (m = 57 and f = 51) and 33 were living in the care homes (m = 29 and f = 4).Prevalence of depression as assessed by Geriatric Depression Scale (GDS) among community and Care Homes (CHs) participants was 31.5 percent and 60.6 percent, respectively.On Centre of Epidemiological Studies Depression Scale (CES-D), 42.6 percent of the community and 69.7 percent of the CH respondents were deemed depressed. Before adjusting for any other potential risk factors the odds of being depressed was significantly increased if the study participants were living in CH, relatively older, female, not currently married, had low educational level, had lower Mini Mental State Examination (MMSE) scores, and reported lower perceived emotional and practical support. In a partially adjusted logistic regression model an increased risk of depression was not confounded by any of the above mentioned risk factors.However, the risk associated was not significant when it was adjusted for social support.

CONCLUSIONS

The findings of the current study are consistent with previous research and throws light on the dire need for interventions to address mental health needs of Pakistani elderly.Implications for improving the mental health status of elderly are also presented.

Increasing social activity attendance in assisted living residents using personalized prompts and positive social attention

Low levels of social activity involvement may have negative implications on overall quality of life for older adults living in residential care settings. Despite the recent growth of assisted living (AL) facilities, few studies have examined social activity participation in this environment. The present study assessed the effects of two prompt procedures that included different amounts of positive social attention (personalized prompts alone and combined with brief conversation) on the social activity attendance of 8 AL residents. Personalized prompts were designed to appeal to each participant on the basis of preference assessments regarding activity interests and preferred types of activity participation. During treatment conditions, increases in attendance occurred not only following treatment prompts but also during activities that were not preceded by treatment prompts. Similar effects were observed for both treatment prompts. Results suggest that personalized prompts and positive social attention can increase weekly social activity attendance in AL residents.

Assisted living facility administrator and direct care staff views of resident mental health concerns and staff training needs

This community needs assessment surveyed 21 administrators and 75 direct care staff at 9 larger and 12 smaller assisted living facilities (ALFs) regarding perceptions of resident mental health concerns, direct care staff capacity to work with residents with mental illness, and direct care staff training needs. Group differences in these perceptions were also examined. Both administrators and directcare staff indicated that direct care staff would benefit from mental health-related training, and direct care staff perceived themselves as being more comfortable working with residents with mental illness than administrators perceived them to be. Implications for gerontological social work are discussed.

Screening for pre-clinical disability in different residential settings

BACKGROUND

Preventing disability and offering effective interventions to older people during early decline in function is most likely to be effective if those most at risk of progressive disablement are able to be identified. Similarly the ability to easily identify a group with similar functional profile from disparate sectors of the community is of significant benefit to researchers. This study aimed to (1) describe the use of a pre-clinical disability screening tool to select a functionally comparable group of older men and women with early functional limitation from different settings, and (2) explore factors associated with function and disability.

METHODS

Self-reported function and disability measured with the Late-Life Function and Disability Instrument along with a range of physical performance measurements were compared across residential settings and gender in a sample of 471 trial participants identified as pre-clinically disabled after being screened with the Fried pre-clinical disability tool. Factors that might lie on the pathway to progressive disablement were identified using multiple linear regression analysis.

RESULTS

We found that a sample population, screened for pre-clinical disability, had a functional status and disability profile reflecting early functional limitation, regardless of residential setting or gender. Statistical models identified a range of factors associated with function and disability which explained a greater degree of the variation in function, than disability.

CONCLUSIONS

We selected a group of people with a comparable function and disability profile, consistent with the pre-clinical stage of disability, from a sample of older Australian men and women from different residential settings using the Fried pre-clinical disability screening tool. The results suggest that the screening tool can be used with greater confidence for research, clinical and population health purposes. Further research is required to examine the validity of the tool. These findings offer insight into the type of impairment factors characterising early functional loss that could be addressed through disability prevention initiatives.

TRIAL REGISTRATION

ACTRN01206000431527.

Determinants of living situation in a population of community-dwelling and assisted living-dwelling elders

OBJECTIVE

To determine what variables separate community-dwelling elders from assisted living-dwelling elders.

DESIGN

Cross-sectional.

SETTING

Community and assisted living facilities in Connecticut.

PARTICIPANTS

114 individuals (77 community dwelling, 37 assisted living).

ASSESSMENTS

Nutritional survey, 6-minute walk, Mini-Mental Status Exam (MMSE), Center of Epidemiologic Studies (CES)-Depression Scale, 25-OH vitamin D.

RESULTS

At baseline, assisted living-dwelling elders appeared to have lower serum 25-OH vitamin D levels, lower MMSE scores, higher CES-depression scale scores, and walked shorter distances in the 6-minute walk. Serum 25-OH vitamin D levels and 6-minute walk were significantly different between the 2 groups using logistic regression analysis. As serum 25-OH vitamin D levels increased, the probability of an elder living in an assisted living facility decreased, and as distance walked during the 6-minute walk increased, the probability of an elder living in an assisted living facility decreased.

CONCLUSIONS

Elders living in assisted living facilities had significantly lower 25-OH vitamin D levels and walked shorter distances during the 6-minute walk. These variables can be used to predict the probability of an elder living in an assisted living facility. The lack of effect of nutrition suggests that the role of vitamin D in this setting is in physical function.

Residential status and depression among Korean elderly people: a comparison between residents of nursing home and those based in the community

The purposes of this study were: (i) to compare the extent of depression in the nursing home and community-dwelling elderly people, and (ii) to find the variables including residential status and other related variables explaining depression in Korea. Two sets of secondary data were combined and used to achieve the objectives of this study. One data set relating to elderly people in nursing homes was from a part of 2002 Kyunggi Long-term Care System Construction Study by Kyunggi Research Institute, Kyunggi province, Korea. The other data set for community-dwelling elderly people was from a part of 2001 National Long-term Care Study by Korea Institute for Health and Social Affairs. The data set for this study included 307 elderly people living in nursing homes and 166 elderly people living in the community. Depression was measured and determined using the geriatric depression scale-short form (GDS-SF) Korean version, with scores of 8 or higher to indicate possible depression. A total of 39.3%[95% confidence interval (CI); 32.1-46.9%] of the sample in the community elderly showed symptoms of depression, higher than the rate found in the nursing home elderly (24.0%) (95% CI; 19.5-29.2%). The mean (standard deviation) GDS-SF score for the elderly in the nursing home was 6.1 (3.4), and 7.4 (4.3) for elderly in the community, the difference being statistically significant [t (275.5) = -3.33; P < 001]. As a result of multiple logistic regression analysis, residential status has appeared as an important predictor after controlling other related variables. The adjusted odds ratio of depression associated with the nursing home residents in residential status, all other factors being equal, was 3.14 (95% CI; 1.30-7.58). Community-dwelling elderly people have higher odds of depression. These findings suggest that there is a need to provide adequate health-related care services for the elderly people in the community.

STAR: a dementia-specific training program for staff in assisted living residences

PURPOSE

This article describes, and provides data on, an innovative, comprehensive, dementia-specific training program designed to teach direct care staff in assisted living residences to improve care and reduce problems in residents with dementia.

DESIGN AND METHODS

STAR-which stands for Staff Training in Assisted living Residences-provides two 4-hr workshops augmented by four individualized on-site consultations and three leadership sessions. Developed by means of an iterative process of implementation and revision, it was then evaluated in a small randomized controlled trial. A total of 114 staff and 120 residents in 15 residences participated.

RESULTS

STAR was exceptionally well received. Training details are provided with a discussion of unique challenges inherent in implementation. Following training, STAR residents evidenced significantly reduced levels of affective and behavioral distress compared with control residents. Furthermore, STAR residents improved whereas control residents worsened (p < .05). Staff with STAR staff training reported less adverse impact and reaction to residents' problems (p < .05) and more job satisfaction (p < .10) compared with control staff.

IMPLICATIONS

STAR is an effective training program for direct care staff working with dementia residents in assisted living. The importance of continued development and investigation of STAR efficacy and effectiveness is underscored by the growing numbers of residents with dementia who are receiving care in these settings.

The Maryland Assisted Living Study: Prevalence, Recognition, and Treatment of Dementia and Other Psychiatric Disorders in the Assisted Living Population of Central Maryland

OBJECTIVES

To obtain a direct estimate of the prevalence of dementia and other psychiatric disorders in residents of assisted living (AL) in Central Maryland, and their rates of recognition and treatment.

DESIGN

Comprehensive review of history and cognitive and neuropsychiatric evaluations using widely accepted instruments in a randomized cohort of AL residents, stratified by facility size. An expert multidisciplinary consensus panel determined diagnoses and appropriateness of treatment.

SETTING

Twenty-two (10 large and 12 small) randomly selected AL facilities in the city of Baltimore and seven Maryland counties.

PARTICIPANTS

One hundred ninety-eight volunteers who were residents of AL, 75% were aged 80 and older, and 78% were female. Potential participants were randomly chosen by room number. There was a 67% participation rate.

MEASUREMENTS

Overall rate of dementia, noncognitive active psychiatric disorders, and recognition and adequate treatment of dementia and psychiatric disorders, as determined by consensus panel.

RESULTS

Two-thirds (67.7%) of participants had dementia diagnosable according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (81% small facilities and 63% large). Family or caregivers recognized 78% to 80% of dementias. Seventy-three percent of dementias were adequately evaluated, and 52% were adequately treated. Of the 26.3% of participants who had an active noncognitive psychiatric disorder, 58% to 61% were recognized and 52% adequately treated.

CONCLUSION

Dementia and psychiatric disorders are common in AL and have suboptimal rates of recognition and treatment. This may contribute to morbidity and interfere with the ability of residents to age in place.

Differences in dementia services and settings across place types and regions

People with dementia have complex and unique social, environmental, and communication needs arising from impaired cognition. One response to dissatisfaction with the medical model of care in nursing homes has been the creation of more homelike and social options for care in the community. These options include community-based residential facilities and a variety of more independent senior dwellings. Staying in residential settings longer may be associated with benefits, including decreased financial burden and improved quality of life. However, with the boundaries between these place types often less than clearly drawn, it has become increasingly difficult to anticipate the specific services and environmental features provided by each. It is also difficult to effectively match facilities to the specific needs of older persons with dementia. Even social workers responsible for placements, especially in urban areas, may not be able to visit all local residential options. To better understand these new venues for dementia care, this study explored the range of services and settings available to people with dementia in three different place types in five Wisconsin counties: nursing homes, community-based residential facilities, and independent senior housing.

Patterns in functioning among residents of an affordable assisted living housing facility

PURPOSE

This is the second article reporting a project that (a) characterized the longitudinal functional patterns of residents in an affordable, assisted living housing (ALH) milieu for low-income people and (b) compared the ALH residents' functional patterns with those for similarly low-income, community-dwelling people.

DESIGN AND METHODS

Functioning was defined as the ability to perform activities of daily living and instrumental activities of daily living and respondents' competing risks such as death and institutionalization. The comparison samples were selected from the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. The analyses involved description of functional patterns and multinomial logit models to assess the relative likelihood that study participants experienced each pattern of functioning and competing risks.

RESULTS

About 42.4% of the ALH residents had stable high functioning, 32.9% deteriorated (e.g., had increased impairment, institutionalization, death), 3% improved in functioning, 6% exhibited moderate to severe impairment throughout the study, and the remainder returned to the community. Comparison of the ALH residents' functional patterns with those of the community-dwelling respondents indicated that the ALH residents' patterns generally were similar and in some ways better, adjusting for social-demographic factors and health; for example, the ALH residents were no different (statistically) in terms of improvement, decline, and death, but they were more likely to have stable high functioning.

IMPLICATIONS

The results suggest that the affordable ALH milieu enabled low-income residents to maintain function or cope well with functional decline. The comparison with community-dwelling participants provides evidence that the affordable ALH milieu was comparatively beneficial.

The extended effects of the life review in nursing home residents

To date, there is little information on the therapeutic effects of the life review beyond one year. This analysis followed fifty-two of 256 subjects who lived for at least three years in a nursing home. These participants received either a life review or friendly visit and took part in four repeated testings to determine the lasting effects of the life review at two and three years. Measures of integrity (life satisfaction, psychosocial well being, self-esteem) and despair (depression, hopelessness, and suicide intent) were used as pretest, posttest, and retest. Results showed a trend toward continued and by year three significant improvement over time in those who received the life review on measures of depression (t = -2.20, p < .03), life satisfaction (t = 2.51, p < .02), and self-esteem (t = -2.31, p < .03).

Cognitive Behavioral Group Therapy for Residents in Assisted-Living Facilities

Geriatric depression is a disabling illness that is associated with increased morbidity and mortality and deserves aggressive and early intervention. Cognitive-behavioral group therapy is an effective intervention for the treatment of geriatric depression and can be used with residents in an assisted living facility to manage and prevent depression. Cognitive-behavioral group therapy protocol modifications for residents in assisted-living facilities aids their participation and learning.