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Davison TE, Bhar S, Wells Y, Owen PJ, You E, Doyle C, Bowe SJ, Flicker L. Psychological therapies for depression in older adults residing in long-term care settings. Cochrane Database Syst Rev 2024; 3:CD013059. [PMID: 38501686 PMCID: PMC10949416 DOI: 10.1002/14651858.cd013059.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Depression is common amongst older people residing in long-term care (LTC) facilities. Currently, most residents treated for depression are prescribed antidepressant medications, despite the potential availability of psychological therapies that are suitable for older people and a preference amongst many older people for non-pharmacological treatment approaches. OBJECTIVES To assess the effect of psychological therapies for depression in older people living in LTC settings, in comparison with treatment as usual, waiting list control, and non-specific attentional control; and to compare the effectiveness of different types of psychological therapies in this setting. SEARCH METHODS We searched the Cochrane Common Mental Disorders Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, five other databases, five grey literature sources, and two trial registers. We performed reference checking and citation searching, and contacted study authors to identify additional studies. The latest search was 31 October 2021. SELECTION CRITERIA We included randomized controlled trials (RCTs) and cluster-RCTs of any type of psychological therapy for the treatment of depression in adults aged 65 years and over residing in a LTC facility. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles/abstracts and full-text manuscripts for inclusion. Two review authors independently performed data extraction and risk of bias assessments using the Cochrane RoB 1 tool. We contacted study authors for additional information where required. Primary outcomes were level of depressive symptomatology and treatment non-acceptability; secondary outcomes included depression remission, quality of life or psychological well-being, and level of anxious symptomatology. We used Review Manager 5 to conduct meta-analyses, using pairwise random-effects models. For continuous data, we calculated standardized mean differences and 95% confidence intervals (CIs), using endpoint data, and for dichotomous data, we used odds ratios and 95% CIs. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 19 RCTs with 873 participants; 16 parallel group RCTs and three cluster-RCTs. Most studies compared psychological therapy (typically including elements of cognitive behavioural therapy, behavioural therapy, reminiscence therapy, or a combination of these) to treatment as usual or to a condition controlling for the effects of attention. We found very low-certainty evidence that psychological therapies were more effective than non-therapy control conditions in reducing symptoms of depression, with a large effect size at end-of-intervention (SMD -1.04, 95% CI -1.49 to -0.58; 18 RCTs, 644 participants) and at short-term (up to three months) follow-up (SMD -1.03, 95% CI -1.49 to -0.56; 16 RCTs, 512 participants). In addition, very low-certainty evidence from a single study with 82 participants indicated that psychological therapy was associated with a greater reduction in the number of participants presenting with major depressive disorder compared to treatment as usual control, at end-of-intervention and short-term follow-up. However, given the limited data on the effect of psychological therapies on remission of major depressive disorder, caution is advised in interpreting this result. Participants receiving psychological therapy were more likely to drop out of the trial than participants receiving a non-therapy control (odds ratio 3.44, 95% CI 1.19 to 9.93), which may indicate higher treatment non-acceptability. However, analyses were restricted due to limited dropout case data and imprecise reporting, and the finding should be interpreted with caution. There was very low-certainty evidence that psychological therapy was more effective than non-therapy control conditions in improving quality of life and psychological well-being at short-term follow-up, with a medium effect size (SMD 0.51, 95% CI 0.19 to 0.82; 5 RCTs, 170 participants), but the effect size was small at postintervention (SMD 0.40, 95% CI -0.02 to 0.82; 6 RCTs, 195 participants). There was very low-certainty evidence of no effect of psychological therapy on anxiety symptoms postintervention (SMD -0.68, 95% CI -2.50 to 1.14; 2 RCTs, 115 participants), although results lacked precision, and there was insufficient data to determine short-term outcomes. AUTHORS' CONCLUSIONS This systematic review suggests that cognitive behavioural therapy, behavioural therapy, and reminiscence therapy may reduce depressive symptoms compared with usual care for LTC residents, but the evidence is very uncertain. Psychological therapies may also improve quality of life and psychological well-being amongst depressed LTC residents in the short term, but may have no effect on symptoms of anxiety in depressed LTC residents, compared to control conditions. However, the evidence for these effects is very uncertain, limiting our confidence in the findings. The evidence could be strengthened by better reporting and higher-quality RCTs of psychological therapies in LTC, including trials with larger samples, reporting results separately for those with and without cognitive impairment and dementia, and longer-term outcomes to determine when effects wane.
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Affiliation(s)
- Tanya E Davison
- Research and Innovation, Silverchain, Melbourne, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
- Health and Innovation Transformation Centre, Federation University, Ballarat, Australia
| | - Sunil Bhar
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Yvonne Wells
- Australian Institute for Primary Care & Ageing, La Trobe University, Melbourne, Australia
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age (AUPOA), Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Colleen Doyle
- National Ageing Research Institute, Melbourne, Australia
| | - Steven J Bowe
- Deakin Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Australia
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Leon Flicker
- Western Australian Centre for Health and Ageing (WACHA), University of Western Australia, Perth, Australia
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Plys E, Levy C. Depression within the First Year of Relocation to Residential Care/Assisted Living: Where You Come From Matters. J Appl Gerontol 2022; 41:2532-2541. [PMID: 35930794 DOI: 10.1177/07334648221117524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Depression is common within the first year of relocation to residential care/assisted living (RC/AL). Yet, few studies investigate the relationship between depression and relocation factors that might help identify at-risk residents, such as previous location. This study analyzed cross-sectional resident data (n = 2651) from the National Survey of Residential Care Facilities to test: (1) group differences between residents relocating from acute/post-acute facilities (e.g., hospital, rehabilitation facility) and community-based residences, and (2) the relationship between previous location and depression within the first year of relocation. The 921 (35%) residents relocating directly from acute/post-acute facilities were more likely to have depression (p < .001) and poorer outcomes on select health and psychosocial variables. After controlling for covariates, relocating directly from an acute/post-acute facility significantly related to depression (OR = 1.22). Findings highlight opportunities to improve routine screening and transitional care for this subpopulation of RC/AL residents at heightened risk for depression.
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Affiliation(s)
- Evan Plys
- Department of Psychiatry, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Cari Levy
- Department of Medicine, 19982Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.,Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine - Anschutz Medical Campus, Aurora, CO, USA
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3
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O’Sullivan JL, Schweighart R, Lech S, Kessler EM, Tegeler C, Teti A, Nordheim J, Gellert P. Concordance of self- and informant-rated depressive symptoms in nursing home residents with Dementia: cross-sectional findings. BMC Psychiatry 2022; 22:241. [PMID: 35382790 PMCID: PMC8981933 DOI: 10.1186/s12888-022-03876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is highly prevalent in nursing home residents living with moderate to severe dementia. However, assessing depressive symptoms in residents with dementia can be challenging and may vary by rater perspective. We aimed to investigate the concordance of, and factors associated with self- and informant-rated depressive symptoms in nursing home residents with dementia. METHODS Cross-sectional data was collected from N = 162 nursing home residents with dementia (age: 53-100; 74% women). Self-ratings were assessed with the Geriatric Depression Scale, while the depression and anxiety items of the Neuropsychiatric Inventory were used for informant-ratings. Cohen's Kappa was calculated to determine the concordance of both measures and of each with antidepressant medication. Multivariate associations with sociodemographic variables, self- and informant-rated quality of life, dementia stage, neuropsychiatric symptoms, functional status and antidepressant medication were analysed with linear mixed models and generalized estimating equations. RESULTS Concordance between self- and single item informant-rated depressive symptoms was minimal (Cohen's Kappa = .22, p = .02). No concordance was found for self-reported depressive symptoms and the combined informant-rated depression-anxiety score. Self-reported depression was negatively associated with self-rated quality of life (β = -.32; 95%CI: -.45 to -.19, p < .001), informant-rated quality of life (β = -.25; 95%CI: -.43 to -.07, p = .005) and functional status (β = -.16; 95%CI: -.32 to -.01, p = .04), whilst single item informant-rated depression revealed negative associations with informant-rated quality of life (β = -.32; 95%CI: -.52 to -.13, p = .001) and dementia stage (β = -.31; 95%CI: -.52 to -.10, p = .004). The combined informant-rated depression-anxiety score showed negative associations with self-rated quality of life (β = -.12; 95%CI: -.22 to -.03, p = .01) and dementia stage (β = -.37; 95%CI: -.67 to -.07, p = .02) and a positive association with neuropsychiatric symptoms (β = .30; 95%CI: .10 to .51, p = .004). No concordance was found with antidepressant medication. CONCLUSIONS In line with our expectations, low agreement and unique association patterns were found for both measures. These findings indicate that both instruments address different aspects of depression und underline the need for comprehensive approaches when it comes to detecting signs of clinically relevant depressive symptoms in dementia. TRIAL REGISTRATION The trial was registered with the ISRCTN registry (Trial registration number: ISRCTN98947160 ).
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Affiliation(s)
- Julie L. O’Sullivan
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Roxana Schweighart
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Sonia Lech
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany ,grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universitätzu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Eva-Marie Kessler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Christina Tegeler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Andrea Teti
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Johanna Nordheim
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
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Abdoli N, Salari N, Darvishi N, Jafarpour S, Solaymani M, Mohammadi M, Shohaimi S. The global prevalence of major depressive disorder (MDD) among the elderly: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 132:1067-1073. [PMID: 34742925 DOI: 10.1016/j.neubiorev.2021.10.041] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Major depressive disorder is characterized by a depressed mood or feeling of sadness, loss of interest or pleasure in everyday activities. Depressed individuals have a cognitive impairment, low self-esteem, difficulty making decisions, feeling helpless and hopeless. The factors that have been associated with depression include the lack of social support, living in rural areas, suffering from chronic diseases, smoking, and alcohol abuse. This study aimed to investigate the global prevalence of major depressive disorder in the elderly. METHOD The electronic database such as Web of Science (WoS), Scopus, SID, PubMed, Google Scholar, Mag Iran, and IranDoc were systematically searched for studies reporting the prevalence of major depressive disorderin the elderly published up to March 2021. Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) software. Heterogeneity between the studies was evaluated using the I2 index. Begg and Mazumdar rank correlation test was used to assess publication bias. RESULT A total of 20 studies involving 18953 participants were included in this study. The global prevalence of major depression in the elderly was 13.3 % (95 % CI: 8.4-20.3 %). In the subgroup analysis, the prevalence of major depression in elderly women was 11.9 % (95 % CI: 7.6-18.6) and men 9.7 % (95 % CI: 5.2-17.3). No comparison was made between the two sexes, but based on the confidence intervals and large overlap, the two groups are not statistically different. Among continents, Australia had the highest prevalence of major depression in the elderly at 20.1 % (CI: 14.5-27.2 %). This was followed by Europe at 12.9 % (95 % CI: 5.1-28.9 %). CONCLUSION Major depressive disorder has a growing trend in the elderly population of the world. The prevalence of major depression in the elderly depends on various clinical and demographic factors such as age and gender. Therefore, mental health and the quality of life (QoL) of the elderly are important. The present study emphasizes the importance of social support in mental health that can reduce depression in the elderly.
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Affiliation(s)
- Nasrin Abdoli
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran; Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Niloofar Darvishi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Sima Jafarpour
- Department of Psychiatry, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Mina Solaymani
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor, Malaysia.
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5
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Wuthrich VM, Meuldijk D, Jagiello T, Robles AG, Jones MP, Cuijpers P. Efficacy and effectiveness of psychological interventions on co-occurring mood and anxiety disorders in older adults: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:858-872. [PMID: 33368598 DOI: 10.1002/gps.5486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Co-occurring mood and anxiety disorders are common in older adult populations and are associated with worse long-term outcomes and poorer treatment response than either disorder alone. This systematic review and meta-analysis aimed to examine the efficacy and effectiveness of psychological interventions for treating co-occurring mood and anxiety disorders in older adults. METHOD The study was registered (PROSPERO CRD4201603834), databases systematically searched (MEDLINE, PSYCINFO, PubMed and Cochrane Reviews) and articles screened according to PRISMA guidelines. INCLUSION Participants aged ≥60 years with clinically significant anxiety and depression, psychological intervention evaluated against control in randomised controlled trial, changes in both anxiety and depression reported at post-treatment. ResultsFour studies were included (total n = 255, mean age range 67-71 years). Overall, psychological interventions (cognitive behavioural therapy, mindfulness) resulted in significant benefits over control conditions (active, waitlist) for treating depression in the presence of co-occurring anxiety (Hedges' g = -0.44), and treating anxiety in the presence of depression (Hedges' g = -0.55). However, conclusions are limited; the meta-analysis was non-significant, few studies were included, several were low quality and there was high heterogeneity between studies. Benefits at follow-up were not established. CONCLUSION Co-occurring anxiety and mood disorders can probably be treated simultaneously with psychological interventions in older adults with moderate effect sizes, however, more research is needed. Given comorbidity is common and associated with worse clinical outcomes, more high-quality clinical trials are needed that target the treatment of co-occurring anxiety and mood disorders, and report changes in diagnostic remission for both anxiety and mood disorders independently.
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Affiliation(s)
- Viviana M Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Denise Meuldijk
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.,Department of Psychology, Centre for Ageing, Cognition and Wellbeing, Macquarie University, Sydney, Australia
| | - Tess Jagiello
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Alberto González Robles
- Department of Basic, Clinical Psychology, and Neuropsychology, Universitat Jaume I, Castellón, Spain
| | - Michael P Jones
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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6
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Kelly J, Davison TE, McCabe MP. A psychological needs-based intervention to facilitate adjustment and improve wellbeing in newly admitted aged care residents: three illustrative case studies. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1909419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Julie Kelly
- Health & Ageing Research Group, Swinburne University of Technology, Melbourne, Australia
| | - Tanya E. Davison
- Health & Ageing Research Group, Swinburne University of Technology, Melbourne, Australia
| | - Marita P. McCabe
- Health & Ageing Research Group, Swinburne University of Technology, Melbourne, Australia
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7
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Chau R, Kissane DW, Davison TE. Risk Factors for Depression in Long-term Care: A Prospective Observational Cohort Study. Clin Gerontol 2021; 44:112-125. [PMID: 31264523 DOI: 10.1080/07317115.2019.1635548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Depression among older adults in long-term care remains a problem, despite the uptake of antidepressants and the development of intervention programs. A better understanding of the risk factors for depression is much needed. Guided by a systematic assessment of the evidence, this prospective observational cohort study sought to clarify existing evidence, identify modifiable risk factors and explore novel variables. Methods: Adults aged ≥65 (T1 n=147, T2 n= 81) were recruited from 15 long-term-care facilities in Melbourne, Australia. Cognitive impairment, functional impairment, pain, sleep disturbance, social support, and person-environment fit were investigated as risk factors. Outcomes were depressive symptoms and indicated Major Depressive Episode. Results: Generalized Estimating Equations (GEE) identified that changes in pain (b= 0.06, p<.05), sleep disturbance (b= 0.02, p< .001), social support (b= -0.02, p< .001) and person-environment fit (b= -0.02, p= <.01) were significantly associated with changes in depression score. Conclusions: Pain, sleep disturbance, social support, and person-environment fit are modifiable risk factors, making them strongly positioned to strategically inform prevention and intervention strategies. Clinical Implications: Individuals with clinically significant symptoms on these risk factors for depression should be selected for interventions that target these risk factors. For depressed individuals, psychotherapy should prioritize the potential role of these risk factors. Finally, these risk factors should be used as screening and monitoring variables: clinically significant changes in symptoms warrant investigation.
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Affiliation(s)
- Rebecca Chau
- School of Psychological Sciences, Monash University , Melbourne, Victoria, Australia
| | - David W Kissane
- Palliative Medicine Research, University of Notre Dame Australia , Sydney, Australia
| | - Tanya E Davison
- School of Health Sciences, Swinburne University of Technology , Melbourne, Victoria, Australia
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8
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Stargatt J, Bhar SS, Davison TE, Pachana NA, Mitchell L, Koder D, Hunter C, Doyle C, Wells Y, Helmes E. The Availability of Psychological Services for Aged Care Residents in Australia: A Survey of Facility Staff. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12244] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jennifer Stargatt
- Faculty of Health, Arts and Design, Swinburne University of Technology,
| | - Sunil S. Bhar
- Faculty of Health, Arts and Design, Swinburne University of Technology,
| | | | - Nancy A. Pachana
- School of Psychology and Counselling, University of Southern Queensland,
| | - Leander Mitchell
- School of Psychology and Counselling, University of Southern Queensland,
| | | | | | - Colleen Doyle
- Faculty of Health Sciences, Australian Catholic University,
| | - Yvonne Wells
- Lincoln Centre for Research on Ageing, La Trobe University,
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9
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Davison TE, Koder D, Helmes E, Doyle C, Bhar S, Mitchell L, Hunter C, Knight B, Pachana N. Brief on the Role of Psychologists in Residential and Home Care Services for Older Adults. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12209] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Deborah Koder
- Specialist Mental Health Services for Older People, Royal Prince Alfred Hospital,
| | | | - Colleen Doyle
- Australian Catholic University, Villa Maria Catholic Homes,
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology,
| | | | | | - Bob Knight
- School of Psychology and Counselling, University of Southern Queensland,
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10
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Anderson K, Wickramariyaratne T, Blair A. A feasibility study of group‐based cognitive behaviour therapy for older adults in residential care. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Katrina Anderson
- Aged Care Evaluation Unit, Southern NSW LHD, Queanbeyan, New South Wales, Australia,
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia,
| | - Tushara Wickramariyaratne
- Aged Care Evaluation Unit, Southern NSW LHD, Queanbeyan, New South Wales, Australia,
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia,
| | - Annaliese Blair
- Aged Care Evaluation Unit, Southern NSW LHD, Queanbeyan, New South Wales, Australia,
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia,
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11
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Evaluating the Effect of COVID-19 Pandemic Lockdown on Long-Term Care Residents' Mental Health: A Data-Driven Approach in New Brunswick. J Am Med Dir Assoc 2020; 22:187-192. [PMID: 33232682 PMCID: PMC7587131 DOI: 10.1016/j.jamda.2020.10.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/06/2020] [Accepted: 10/20/2020] [Indexed: 01/29/2023]
Abstract
Long-term care (LTC) residents, isolated because of the COVID-19 pandemic, are at increased risk for negative mental health outcomes. The purpose of our article is to demonstrate how the interRAI LTC facility (LTCF) assessment can inform clinical care and evaluate the effect of strategies to mitigate worsening mental health outcomes during the COVID-19 pandemic. We present a supporting analysis of the effects of lockdown in homes without COVID-19 outbreaks on depression, delirium, and behavior problems in a network of 7 LTC homes in New Brunswick, Canada, where mitigative strategies were deployed to minimize poor mental health outcomes (eg, virtual visits and increased student volunteers). This network meets regularly to review performance on risk-adjusted quality of care indicators from the interRAI LTCF and share learning through a community of practice model. We included 4209 assessments from 765 LTC residents between January 2017 to June 2020 and modeled the change within and between residents for depression, delirium, and behavioral problems over time with longitudinal generalized estimating equations. Though the number of residents who had in-person visits with family decreased from 73.2% before to 17.9% during lockdown (chi square, P < .001), the number of residents experiencing delirium (4.5%-3.5%, P = .51) and behavioral problems (35.5%-30.2%, P = .19) did not change. The proportion of residents with indications of depression decreased from 19.9% before to 11.5% during lockdown (P < .002). The final multivariate models indicate that the effect of lockdown was not statistically significant on depression, delirium, or behavioral problems. Our analyses demonstrate that poor mental health outcomes associated with lockdown can be mitigated with thoughtful intervention and ongoing evaluation with clinical information systems. Policy makers can use outputs to guide resource deployment, and researchers can examine the data to identify better management strategies for when pandemic strikes again.
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12
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Azulai A, Hall BL. Barriers to the Recognition of Geriatric Depression in Residential Care Facilities in Alberta. Issues Ment Health Nurs 2020; 41:887-898. [PMID: 32497452 DOI: 10.1080/01612840.2020.1742258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study explored the barriers that regulated nurse professionals encountered in recognizing and assessing geriatric depression in residential care facilities in the Canadian province of Alberta. The study used a convergent parallel mixed methods design, including a cross-sectional survey (N = 635) and qualitative interviews (N = 14) with regulated nurse professionals. Findings revealed six major barriers to the recognition of geriatric depression in Alberta, including 1) insufficient clinical knowledge and training in geriatric depression; 2) misconceived beliefs about geriatric depression; 3) limited access to resources; 4) unclear depression assessment protocol and procedures in facilities; 5) characteristics of models of care and organizational culture in facilities; and 6) communication difficulties among all stakeholders in the process. Socio-cultural values and beliefs about geriatric depression played a key role in the complex interaction of the various structural and agential barriers to the effective recognition and assessment of depression in residential care facilities in Alberta.
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Affiliation(s)
- Anna Azulai
- School of Social Work, Faculty of Health and Community Studies, MacEwan University, Edmonton, Alberta, Canada
| | - Barry L Hall
- Faculty of Social Work, University of Calgary, Calgary, Canada
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13
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How Do Regulated Nurse Professionals in Alberta Assess Geriatric Depression in Residential Care Facilities? Can J Aging 2020; 39:468-484. [PMID: 32723411 DOI: 10.1017/s0714980819000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Although geriatric depression is a prevalent, serious, and under-recognized mental health condition in residential care facilities, there is a dearth of related research in Canada. This exploratory mixed methods study examines the perspectives and practices of regulated nurse professionals on assessment of geriatric depression in residential care facilities in Alberta. Findings from the quantitative surveys (n = 635) and qualitative interviews (n = 14) suggest that geriatric depression is not systematically assessed in these care settings due to multiple challenges, including confusing assessment protocol, inconsistent use and contested clinical utility of current assessment methods in facilities, limited availability of mental health professionals in facilities, and the varied views of regulated nurse professionals on who is responsible for depression assessment in facilities. Implications and future research directions are discussed.
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Abstract
OBJECTIVES Depression rates are substantially higher among older adults in long-term care when compared with older adults in the community. Furthermore, the needs of older adults in long-term care are increasingly complex, and risk factors that contribute to depression in this population are unclear. This limits not only the identification of those at risk for depression but also the development of therapeutic interventions. This review summarizes the evidence on risk factors for depression. METHODS Searches were performed using CINAHL, Cochrane Library, Ovid Medline, PsycINFO and Scopus for research published 1980-2017. Data were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS Eleven studies met the inclusion criteria, representing a total of 11,703 participants, with a mean sample size of 1,064. The most consistently supported risk factor was cognitive impairment, followed by functional impairment and baseline depression score. CONCLUSIONS The studies lacked a systematic approach to investigating risk factors for depression, and the research remains largely atheoretical. Few risk factors were consistently studied, with over 20 risk factors examined no more than once each. Psychological and environmental risk factors, which may be modifiable and have the potential to inform therapeutic interventions and preventative strategies, remain under-studied. CLINICAL IMPLICATIONS The most consistently supported risk factors-cognitive impairment, functional disability and baseline depression score-have the potential to inform screening protocols and should be monitored longitudinally. When developing psychotherapeutic interventions, close consideration should be given to cognitive and functional impairment as barriers to implementation and uptake.
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Affiliation(s)
- Rebecca Chau
- a School of Psychological Sciences , Monash University , Clayton , Victoria , Australia.,b Department of Psychiatry , Monash University , Clayton , Victoria , Australia
| | - David W Kissane
- b Department of Psychiatry , Monash University , Clayton , Victoria , Australia
| | - Tanya E Davison
- c Institute for Health & Ageing , Australian Catholic University , Melbourne , Victoria , Australia
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Creighton AS, Davison TE, Kissane DW. The prevalence, reporting, and treatment of anxiety among older adults in nursing homes and other residential aged care facilities. J Affect Disord 2018; 227:416-423. [PMID: 29154158 DOI: 10.1016/j.jad.2017.11.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/29/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Little is known about anxiety in aged care populations, despite its increase in this frail population. This study investigated the prevalence, recording, and treatment rate of anxiety disorders among aged care residents. METHODS A cross-sectional, observational design was used to assess 180 elderly residents from 12 aged care facilities in Melbourne, Australia. Participants were assessed for threshold and subthreshold anxiety disorders and comorbid depression using the MINI for DSM-5. Medical files were also reviewed to determine whether there was any indication that anxiety had previously been detected, and what treatment those with a threshold/subthreshold diagnosis were receiving. RESULTS Overall prevalence of threshold and subthreshold anxiety disorders was 19.4% and 11.7%, respectively. Generalized anxiety disorder was the most common threshold disorder and agoraphobia was the most prevalent subthreshold anxiety disorder. While less than half of those with a threshold or subthreshold anxiety disorder had an indication of anxiety in their file, the majority received psychotropic medication. Cognitive impairment was not significantly associated with the prevalence or treatment of anxiety. CONCLUSIONS The prevalence of threshold and subthreshold anxiety in aged care settings is high, but remains under-reported by staff and GPs. Facility staff and GPs should ensure they are aware of how anxiety presents in elderly residents and routinely screen for this common mental health issue. This cohort had poor access to psychological treatments for their condition.
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Affiliation(s)
- Alexandra S Creighton
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Department of Psychiatry, Monash University, Clayton, Victoria, Australia
| | - Tanya E Davison
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia; Institute for Health & Ageing, Australian Catholic University, Melbourne, Victoria, Australia
| | - David W Kissane
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia.
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Ellis JM, Ben-Moshe R, Teshuva K. Laughter yoga activities for older people living in residential aged care homes: A feasibility study. Australas J Ageing 2017; 36:E28-E31. [DOI: 10.1111/ajag.12447] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Julie M Ellis
- School of Nursing and Midwifery; La Trobe University; Melbourne Victoria Australia
| | - Ros Ben-Moshe
- ‘Live life, LaughLife’; Melbourne Victoria Australia
- School of Psychology and Public Health; La Trobe University; Melbourne Victoria Australia
| | - Karen Teshuva
- Lincoln Centre for Research on Ageing; La Trobe University; Melbourne Victoria Australia
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Potter R, Sheehan B, Cain R, Griffin J, Jennings PA. The Impact of the Physical Environment on Depressive Symptoms of Older Residents Living in Care Homes: A Mixed Methods Study. THE GERONTOLOGIST 2017; 58:438-447. [DOI: 10.1093/geront/gnx041] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rachel Potter
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Bart Sheehan
- Centre for Rehabilitation Research in Oxford, University of Oxford, UK
| | - Rebecca Cain
- Warwick Manufacturing Group, University of Warwick, Coventry, UK
| | - James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul A Jennings
- Warwick Manufacturing Group, University of Warwick, Coventry, UK
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McCabe MP, Mellor D, Karantzas G, Von Treuer K, Davison TE, O'Connor D. Organizational factors related to the confidence of workers in working with residents with dementia or depression in aged care facilities. Aging Ment Health 2017; 21:487-493. [PMID: 26666515 DOI: 10.1080/13607863.2015.1118011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES There has been limited research examining how organizational factors are associated with the level of confidence of residential aged care staff in managing both residents' depression and the behavioural and psychological symptoms of residents with dementia (BPSD). This study investigated this issue. METHOD A cross-sectional study design was employed. In total, 255 aged care staff (131 senior staff, 124 junior staff) from 21 residential care facilities participated in the study. All staff completed measures of self-efficacy in managing BPSD as well as confidence in working with older people with depression. They also completed measures of organizational climate (autonomy, cohesion, trust, pressure, support, recognition, fairness and encouragement of innovation) and measures of workplace experience (job role, number of years working in aged care facilities), job stress and satisfaction, and knowledge of depression. RESULTS The results demonstrated that autonomy, trust, support, and job stress were associated with confidence in managing BPSD, while the factors related to confidence in managing depression were autonomy, support, job stress, job satisfaction, and knowledge of depression. CONCLUSION These findings highlight that organizational climate factors need to be addressed in order to increase staff confidence in managing BPSD and depression. In particular, the findings demonstrate the importance of fostering organizational environments in which autonomy is promoted and there is support and cooperation among aged care staff. Attention to these factors is likely to increase the confidence of staff as they carry out their carer role.
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Affiliation(s)
- Marita P McCabe
- a Institute for Health and Ageing , Australian Catholic University , Melbourne , Australia
| | - David Mellor
- b School of Psychology , Deakin University , Melbourne , Australia
| | - Gery Karantzas
- b School of Psychology , Deakin University , Melbourne , Australia
| | | | - Tanya E Davison
- c Department of Psychiatry , Monash University , Melbourne , Australia
| | - Daniel O'Connor
- a Institute for Health and Ageing , Australian Catholic University , Melbourne , Australia
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Hsiao YC, Chen CY. Exploring Individual, Family, and Extrafamilial Factors Associated With Depression Among Elderly Residents of Care Settings. Int J Aging Hum Dev 2017; 86:219-241. [DOI: 10.1177/0091415017699938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated simultaneously the associations among individual, family, and extrafamilial factors and depression among elderly residents of care settings in Taiwan. The data for this study were obtained from the Vulnerability and Social Exclusion among Different Groups of Disadvantaged Elderly in an Aging Society: Phenomena and Strategies (1/2) project, which was conducted in Taipei City and Taipei County in 2007. We applied multiple regression procedures to a sample of 327 residents of care settings (48.3% women) who were mild physical impairment or physically independent and cognitively clear for determining factors associated with depression and their cumulative effects. We discovered that 24.5% of the residents were depressed. Physical mobility, number of chronic diseases, and self-assessed health status were significantly associated factors in all models. In the final model, we determined that one third of extrafamilial factors were significantly associated with depression, after controlling for all other variables. In addition, we observed an overall trend of increased mean scores of depression with an increase in the number of risk factors. The results imply that interventions aimed at preventing depression in elderly persons living in care settings, particularly persons with multiple risk conditions such as impaired physical mobility and medical comorbidities, should be designed to include extrafamilial elements. Establishing strong connections between elderly care setting residents and the institutional and neighborhood environments can help prevent depression.
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Affiliation(s)
- Yi-Chen Hsiao
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei City, Taiwan, ROC
| | - Chun-Yuan Chen
- Institute of Labor, Occupational Safety and Health, Ministry of Labor, New Taipei City, Taiwan, ROC
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Affiliation(s)
- Malcolm J Hopwood
- Veterans' Psychiatry Unit, Director, Brain Disorders Program; Austin Health; Heidelberg West Victoria
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McLaren S, Turner J, Gomez R, McLachlan AJ, Gibbs PM. Housing type and depressive symptoms among older adults: a test of sense of belonging as a mediating and moderating variable. Aging Ment Health 2014; 17:1023-9. [PMID: 23750874 DOI: 10.1080/13607863.2013.805402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Higher levels of depression have been documented among older adults who reside in an assisted living facility, compared with those who remain in their own homes. The aims of the current study were to test whether the relationship between housing type and depressive symptoms was mediated by a sense of belonging and whether housing type and sense of belonging interact to influence the depressive symptoms among older adults (moderation model). METHOD A sample of 257 older adults who lived in their own homes and 166 older adults who lived in an assisted living facility completed the psychological subscale of the Sense of Belonging Instrument and the Center for Epidemiologic Studies Depression Scale. RESULTS Results showed that a sense of belonging partially mediated the relationship between housing type and depressive symptoms, such that living in a nursing home was associated with lower levels of belonging, and lower levels of belonging were, in turn, associated with higher levels of depressive symptoms. Residing in an assisted living facility was associated with depressive symptoms at low and average levels of belonging. CONCLUSION Results highlight the need for more research on the role of sense of belonging as an influencing factor on depressive symptoms among institutionalised older adults for both theoretical and treatment goals.
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Affiliation(s)
- Suzanne McLaren
- a School of Health Sciences, University of Ballarat , Ballarat , Australia
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Knight T, Skouteris H, Townsend M, Hooley M. The act of giving: a pilot and feasibility study of theMy Life Storyprogramme designed to foster positive mental health and well-being in adolescents and older adults. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2014. [DOI: 10.1080/02673843.2014.881297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Klug G, Lacruz ME, Emeny RT, Häfner S, Ladwig KH, Huber D. Aging without depression: a cross-sectional study. Psychodyn Psychiatry 2014; 42:5-22. [PMID: 24555458 DOI: 10.1521/pdps.2014.42.1.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The aim of the study was to analyze the association between secure attachment style, loneliness, and social network as risk factors for late-life depression. METHODS This cross-sectional study examined 969 subjects of the KORA-Age study. We applied the Relationship-Specific Attachment Scales for Adults (Beziehungsspezifische Bindungsskalen für Erwachsene, BBE), the UCLA Loneliness Scale, and the Social Network Index (SNI). Depression was operationalized through the Geriatric Depression Scale (GDS-15) and/or use of antidepressants. Logistic-regression models were calculated, sex-stratified, and controlled for age and living status. RESULTS For men, lower depression scores were associated with higher attachment security scores (OR = 0.26, 95% CI = 0.15-0.44) and not reporting feelings of loneliness (OR = 0.27, 95% CI = 0.14-0.53). For women, independent determinants of not having late life depression consist of not feeling lonely (OR = 0.22, 95% CI = 0.13-0.38). DISCUSSION Loneliness is a risk factor for late life depression in women and men, attachment style is a risk factor more for men, while social network size is not a risk factor.
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Reid N, Eakin E, Henwood T, Keogh JWL, Senior HE, Gardiner PA, Winkler E, Healy GN. Objectively measured activity patterns among adults in residential aged care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:6783-98. [PMID: 24304508 PMCID: PMC3881141 DOI: 10.3390/ijerph10126783] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/26/2013] [Accepted: 11/27/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the feasibility of using the activPAL3(TM) activity monitor, and, to describe the activity patterns of residential aged care residents. DESIGN Cross-sectional. SETTING Randomly selected aged care facilities within 100 km of the Gold Coast, Queensland, Australia. PARTICIPANTS Ambulatory, older (≥60 years) residential aged care adults without cognitive impairment. MEASUREMENTS Feasibility was assessed by consent rate, sleep/wear diary completion, and through interviews with staff/participants. Activity patterns (sitting/lying, standing, and stepping) were measured via activPAL3(TM) monitors worn continuously for seven days. Times spent in each activity were described and then compared across days of the week and hours of the day using linear mixed models. RESULTS Consent rate was 48% (n = 41). Activity patterns are described for the 31 participants (mean age 84.2 years) who provided at least one day of valid monitor data. In total, 14 (45%) completed the sleep/wear diary. Participants spent a median (interquartile range) of 12.4 (1.7) h sitting/lying (with 73% of this accumulated in unbroken bouts of ≥30 min), 1.9 (1.3) h standing, and 21.4 (36.7) min stepping during their monitored waking hours per day. Activity did not vary significantly by day of the week (p ≥ 0.05); stepping showed significant hourly variation (p = 0.018). CONCLUSIONS Older adults in residential aged care were consistently highly sedentary. Feasibility considerations for objective activity monitoring identified for this population include poor diary completion and lost monitors.
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Affiliation(s)
- Natasha Reid
- School of Physiotherapy, Curtin University, Bentley, WA 6102, Australia
| | - Elizabeth Eakin
- School of Physiotherapy, Curtin University, Bentley, WA 6102, Australia
| | - Timothy Henwood
- Blue Care Research & Practice Development Centre, School of Nursing and Midwifery, University of Queensland, Brisbane, QLD 4072, Australia; E-Mail:
| | - Justin W. L. Keogh
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia; E-Mail:
- Human Potential Centre, Auckland University of Technology, Auckland 1010, New Zealand
- Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia
| | - Hugh E. Senior
- Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia; E-Mail:
| | - Paul A. Gardiner
- Centre for Longitudinal and Life Course Research, School of Population Health, The University of Queensland, Brisbane, QLD 4072, Australia; E-Mail:
- Translating Research into Practice (TRIP) Centre, Mater Research, South Brisbane, QLD 4101, Australia
| | - Elisabeth Winkler
- School of Physiotherapy, Curtin University, Bentley, WA 6102, Australia
| | - Genevieve N. Healy
- Baker IDI Heart & Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Physiotherapy, Curtin University, Bentley, WA 6102, Australia
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Irvine AB, Billow MB, McMahon E, Eberhage MG, Seeley JR, Bourgeois M. Mental illness training on the Internet for nurse aides: a replication study. J Psychiatr Ment Health Nurs 2013; 20:902-12. [PMID: 23379724 PMCID: PMC3655099 DOI: 10.1111/jpm.12035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
Abstract
Internet training courses for nurse aides (NAs) in long-term care facilities (LTCs) have been shown to be effective. Little is known, however, about Internet training effects on NAs in a non-research context, or about continued utilization of an available training programme. In this research, a replication study was conducted with the Internet training programme Caring Skills: Working with Mental Illness. Three LTCs provided the training to all NAs, each within a 1-month interval scheduled during consecutive months. Supervisors were interviewed subsequently about their experiences organizing and supervising the training. Participants in all three LTCs showed positive pre-post-tests effects with large effect sizes on situational knowledge and self-efficacy, and knowledge about mental illness. Users rated the programme highly, and they indicated that it would improve quality of their resident care. Supervisors praised the training, and they said NAs were using recommended training behaviours. Although available to all staff, nursing and other staff made little use of the training in subsequent months. Training for NAs on the Internet thus appears feasible, and it is perceived to be beneficial for resident care. Plans for continued utilization and dissemination of best practices to other staff, however, should be integrated when planning for staff training on the Internet.
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Allgaier AK, Kramer D, Saravo B, Mergl R, Fejtkova S, Hegerl U. Beside the Geriatric Depression Scale: the WHO-Five Well-being Index as a valid screening tool for depression in nursing homes. Int J Geriatr Psychiatry 2013; 28:1197-204. [PMID: 23463576 DOI: 10.1002/gps.3944] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 01/22/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. METHODS Data from 92 residents aged 65-97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. RESULTS Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 (0.92) at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 (0.69) at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression (0.92), whereas the GDS-15 was sensitive only for major depression (0.85), but not for minor depression (0.54). For specificity, there was no significant difference between WHO-5 (0.79) and GDS-15 (0.88), but both instruments outperformed the GDS-4 (0.53). CONCLUSIONS The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents.
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Affiliation(s)
- Antje-Kathrin Allgaier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
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Davison TE, Karantzas G, Mellor D, McCabe MP, Mrkic D. Staff-focused interventions to increase referrals for depression in aged care facilities: a cluster randomized controlled trial. Aging Ment Health 2013; 17:449-55. [PMID: 23116088 DOI: 10.1080/13607863.2012.738412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE While there is evidence that depression training can improve the knowledge of staff in residential care facilities, there is an absence of research determining whether such training translates into practice change. This study aimed to evaluate the impact of staff training and the introduction of a protocol for routine screening and referral for depression on the numbers of residents detected and referred by care staff for further assessment. METHOD A cluster randomized controlled design was used to compare the referral rates for residents in seven facilities randomly allocated into one of three conditions: staff training, staff training plus a screening and referral protocol and wait-list control. Participants were 216 aged care residents (M age = 87 years), who agreed to a 12-month audit of their facility file. RESULTS Staff training on its own did not increase the rate of referrals for depression; however, staff training plus the screening protocol and referral guidelines did lead to a significant increase in the number of residents who were referred to a medical practitioner for further assessment. However, this increase in care staff referrals did not result in substantial changes in the treatment prescribed for residents. CONCLUSION Staff training in depression, supplemented with a protocol for routine screening and guidelines on referring residents, can improve pathways to care. However, strategies to overcome barriers to appropriate subsequent treatment of depression are required for staff-focused initiatives to translate into better outcomes for depressed older adults. Methodological limitations of this study are discussed.
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Affiliation(s)
- Tanya E Davison
- Aged Mental Health Research Unit, School of Psychology and Psychiatry, Monash University, Melbourne, Australia.
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Atkins J, Naismith SL, Luscombe GM, Hickie IB. More age-care staff report helping care recipients following a brief depression awareness raising intervention. BMC Nurs 2013; 12:10. [PMID: 23561001 PMCID: PMC3623647 DOI: 10.1186/1472-6955-12-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 03/27/2013] [Indexed: 11/10/2022] Open
Abstract
Background Those working with elderly care recipients require a good working knowledge of depression and appropriate help giving responses. While it is important for age-care staff to recognize depression in care recipients it is also critical that they know the appropriate course of action to assist a care recipient who may be depressed. This study aims to determine the knowledge of age-care staff of appropriate help giving responses, their confidence in knowing what kind of assistance to provide and their actual likelihood of providing help to potentially depressed care recipients and to examine if these measures improve following an intervention training program. Methods One hundred and two age-care staff were surveyed on their confidence in helping age-care recipients and on their knowledge of appropriate ways to provide assistance. Staff then participated in a two hour depression awareness raising intervention. The survey was repeated immediately following the training and again six months later. Results Staff confidence in knowing how to provide assistance increased significantly subsequent to training and remained significantly improved at the six month follow up. In addition, a significantly higher proportion of staff reported helping care recipients at the six month follow up. Conclusions This study highlights the potential of a brief staff training program to provide a cost effective means to improve staff self-confidence and increase the likelihood of staff providing assistance to depressed care recipients.
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Affiliation(s)
- Joanna Atkins
- Brain & Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
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O'Connor M, Tan H, O'Connor D, Workman B. Is the frequent death of residents in aged care facilities a significant cause of grief for residents with mild dementia? PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x12y.0000000031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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McCabe MP, Karantzas GC, Mrkic D, Mellor D, Davison TE. A randomized control trial to evaluate the beyondblue depression training program: does it lead to better recognition of depression? Int J Geriatr Psychiatry 2013; 28:221-6. [PMID: 22555988 DOI: 10.1002/gps.3809] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 03/14/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this study was to determine if a depression training program could assist aged care staff to better recognize depression among older people in residential care. The use of a "paper trail" for a screening tool and a study champion in combination with this training was evaluated to determine if this improved the level of detection of depression. METHOD The study took the form of a randomized control trial. A total of 107 professional carers from residential aged care services in Melbourne, Australia, participated in the study. Thirty-four carers were allocated to the training-only group and completed a six-session depression training program, 35 carers were allocated to the training-plus-screening protocol group, and 38 carers were assigned to a wait-list control group. In total, 216 residents were screened for depression. Carers in all conditions were asked to identify those residents who they perceived to be depressed. Residents were independently assessed with the SCID-I to determine their depression status. RESULTS Trained staff were not found to be better in detecting depression than non-trained staff. Staff in the training-plus-screening condition correctly identified more residents as depressed, but also classified more non-depressed residents as depressed. CONCLUSION The findings demonstrate the need for a greater focus on recognizing depression among carers working in aged care facilities. Protocols should be developed to assist carers to detect, refer, and monitor depression in residents.
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Affiliation(s)
- Marita P McCabe
- School of Psychology, Deakin University, Melbourne, Australia.
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van Asch IFM, Nuyen J, Veerbeek MA, Frijters DHM, Achterberg WP, Pot AM. The diagnosis of depression and use of antidepressants in nursing home residents with and without dementia. Int J Geriatr Psychiatry 2013; 28:312-8. [PMID: 22588705 DOI: 10.1002/gps.3830] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 04/11/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the prevalence of diagnosed depressive disorders, depressive symptoms and use of antidepressant medication between nursing home residents with and without dementia. METHODS This cross-sectional study used Minimal Data Set of the Resident Assessment Instrument 2.1 data collected in seven nursing homes located in an urbanized region in the Netherlands. Trained nurse assistants recorded all medical diagnoses made by a medical specialist, including dementia and depressive disorder, and medication use. Depressive symptoms were measured with the Depression Rating Scale. Multivariate logistic regression analysis was used to compare data between residents with and without dementia. RESULTS Included in the study were 1885 nursing home residents (aged 65 years or older), of which 837 had dementia. There was no significant difference in the prevalence of diagnosed depressive disorder between residents with (9.6%) and without dementia (9.8%). Residents with dementia (46.4%) had more depressive symptoms than residents without dementia (22.6%). Among those with depressive symptoms, residents with dementia had the same likelihood of being diagnosed with a depressive disorder as residents without dementia. Among residents with a diagnosed depressive disorder, antidepressant use did not differ significantly between residents with dementia (58.8%) and without dementia (57.3%). The same holds true for residents with depressive symptoms, where antidepressant use was 25.3% in residents with dementia and 24.6% in residents without dementia. CONCLUSIONS Regarding the prevalence rates of diagnosed depressive disorder and antidepressant use found in this study, our findings demonstrate that there is room for improvement not only for the detection of depression but also with regard to its treatment.
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Affiliation(s)
- Iris F M van Asch
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands.
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Tan HM, O'Connor MM, Howard T, Workman B, O'Connor DW. Responding to the death of a resident in aged care facilities: Perspectives of staff and residents. Geriatr Nurs 2013; 34:41-46. [DOI: 10.1016/j.gerinurse.2012.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 08/01/2012] [Accepted: 08/06/2012] [Indexed: 11/26/2022]
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Davison TE, McCabe MP, Knight T, Mellor D. Biopsychosocial factors related to depression in aged care residents. J Affect Disord 2012; 142:290-6. [PMID: 22901400 DOI: 10.1016/j.jad.2012.05.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 05/09/2012] [Accepted: 05/09/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND While depression is common in residential aged care settings, there is an absence of research into factors that may be associated with this condition. This pilot study examined the relationship between depression and multiple biopsychosocial factors among residents of aged care facilities. METHODS Participants were 50 aged care residents with a diagnosis of major depressive disorder, based on a clinical assessment using the SCID-I, and a matched sample of 50 residents without depression. The sample consisted of 80 women and 20 men without significant cognitive impairment, with a mean age of 83.0 years (SD=7.2 years). Participants completed a diagnostic interview with a clinical psychologist to determine the presence or absence of a mood disorder, and a set of scales related to demographics, depressive symptoms, physical health, functional disability, religiosity, and psychological wellbeing. RESULTS The unique predictors of scores on the Geriatric Depression Scale-15 were environmental mastery, purpose in life, and autonomy. These three variables discriminated between participants with and without a diagnosis of MDD with 80% accuracy. LIMITATIONS Findings were limited by the cross-sectional methodology and small sample size of cognitively intact English-speaking aged care residents. Replication is required with a prospective longitudinal design with a broader sample of residents. CONCLUSIONS Psychological variables were more important in understanding depression among aged care residents than traditional risk factors such as medical illness and disability. While preliminary, these findings highlight possible targets to prevent and treat depression in aged care settings.
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Affiliation(s)
- Tanya E Davison
- Aged Mental Health Research Unit, Monash University, Kingston Centre, Warrigal Road, Cheltenham, VIC 3192, Australia.
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Karantzas GC, Davison TE, McCabe MP, Mellor D, Beaton P. Measuring carers' knowledge of depression in aged care settings: the Knowledge of Late Life Depression Scale-Revised. J Affect Disord 2012; 138:417-24. [PMID: 22284014 DOI: 10.1016/j.jad.2012.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 12/02/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
BACKGROUND Aged care staff is increasingly relied upon to assist with the recognition and treatment of depression in older care recipients. However, there exist few reliable and comprehensive measures that assess aged care staffs' knowledge about late life depression. The Knowledge of Late-Life Depression Scale is one such scale. In this study we modified this measure in an attempt to improve its psychometric properties so that it can be used with confidence in research and practise. Our modifications to the original measure resulted in the Knowledge of Late-Life Depression Scale-Revised. METHOD Aged care staff (N=149) from 20 low level care facilities and community care facilities in Melbourne, Australia, completed the Knowledge of Late-Life Depression Scale-Revised. RESULTS Using Confirmatory Factor Analysis and reliability analysis, the Knowledge of Late-Life Depression Scale-Revised was found to demonstrate three robust and internally consistent factors. These factors were: symptoms of depression, facts about depression, and myths of depression. The revised measure was found to yield superior psychometric properties compared to the original measure. LIMITATIONS Replication studies are required, especially with other aged carer samples to ensure that the factor structure and internal consistency of the measure are supported across different aged care contexts in Australia and elsewhere. CONCLUSIONS The Knowledge of Late-Life Depression-Revised is a measure that can be used by researchers and agencies to assess the knowledge of depression among professional care staff. The measure is expected to be especially useful as an assessment tool for training and educational purposes.
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An evaluation of a national program to implement the Cornell Scale for Depression in Dementia into routine practice in aged care facilities. Int Psychogeriatr 2012; 24:631-41. [PMID: 22137149 DOI: 10.1017/s1041610211002146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Screening tools have been recommended for use in aged care to improve the detection and treatment of depression. This study aimed to evaluate the impact of a program for the routine implementation of the Cornell Scale for Depression in Dementia in Australian facilities, to determine whether use of the instrument by nurses led to further monitoring of depressive symptoms, medical referral, and changes in treatments prescribed for depression. METHODS A file review was completed for 412 participants out of a total of 867 older people (47.5%) who resided in ten aged care facilities. The review examined Cornell Scale assessment data, medication charts, medical history, nursing progress notes, and resident care plans. Nursing staff who administered the Cornell Scale to each participant were also interviewed, and ten facility managers took part in an interview to determine barriers to the effective implementation of the instrument. RESULTS The Cornell Scale had been administered to 46.8% of the sample in the previous 12 months, with 25% of these participants scoring 9-13 and 27% scoring 14 and above. Less than one third of the residents with high scores were monitored by the staff following the assessment. Only 18% of residents with high scores were referred for further assessment of depression, while 10% received a treatment change. CONCLUSIONS The absence of a protocol for responding to high Cornell Scale scores limited the potential of this program to result in widespread improved treatment of depressed older people. The use of the Cornell Scale by aged care nurses with limited training raised concern.
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Blair Irvine A, Billow MB, Eberhage MG, Seeley JR, McMahon E, Bourgeois M. Mental illness training for licensed staff in long-term care. Issues Ment Health Nurs 2012; 33:181-94. [PMID: 22364430 PMCID: PMC3565566 DOI: 10.3109/01612840.2011.639482] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Licensed care staff working in long-term care facilities may be poorly prepared to work with residents with mental illness. This research reports on the program evaluation of Caring Skills: Working with Mental Illness, a training program delivered on the Internet. It was tested with a randomized treatment-control design, with an eight-week follow-up. The training provided video-based behavioral skills and knowledge training. Measures included video situations testing and assessment of psycho-social constructs including empathy and stigmatization. ANCOVA analysis at 4-weeks posttest showed significant positive effects with medium-large effect sizes, which were largely maintained at the 8-week follow-up. The training was well-received by the users.
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Irvine AB, Billow MB, Bourgeois M, Seeley JR. Mental illness training for long term care staff. J Am Med Dir Assoc 2011; 13:81.e7-13. [PMID: 21450251 DOI: 10.1016/j.jamda.2011.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Revised: 01/26/2011] [Accepted: 01/28/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Mental illness is prevalent among nursing home residents, but staff are not well trained to deal with it. This research evaluated an Internet mental illness training program designed for certified direct care workers, ie, nurse aides (NAs). Pilot research was also conducted to explore effects and acceptance of the same program with a sample of licensed health professionals (LHPs). DESIGN Trial 1: Pre-post randomized treatment and control design for NAs; Trial 2: Quasi-experimental pre-post within-subjects design for LHPs. SETTING Both studies were conducted on the Internet. PARTICIPANTS Trial 1: n = 70 NAs; Trial 2: n = 16 LHPs. INTERVENTION Internet-based behavioral skills training and knowledge building, using video modeling with mastery learning instructional design. MEASUREMENTS Video situations testing and assessment of psychosocial constructs associated with behavior change; follow-up interviews with a sample of treatment NAs. RESULTS Trial 1: Multivariate analysis of covariance analysis showed positive results (P = .003) for knowledge, attitudes, self-efficacy, and behavioral intention, with medium-large effect sizes. The training was well received by the users. Trial 2: Paired t tests showed significant effects on 5 of 6 outcome measures, with medium-large effect sizes, and it was well received by the LHP sample. CONCLUSIONS Internet training can be an effective approach to help staff work with residents with mental illness. In this research, it showed significant positive effects and was well received by NAs and by LHPs.
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Affiliation(s)
- A Blair Irvine
- Oregon Center for Applied Science, Eugene, OR 97401, USA.
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Abstract
ABSTRACTThis study investigated the association between environmental mastery and depression in a sample of 96 older adults (aged 64–98 years) in residential care. The participants completed a scale that assessed depression along with measures for risk factors for depression such as functional capacity, self-evaluated physical health, bereavement experiences and environmental mastery. The results showed that 49 per cent of the variance in participants' scores in depression could be attributed to their self-reported level of environmental mastery. Given the complexity of depression and the likelihood of reduced environmental mastery among older adults in residential care, the construct was further assessed as a mediating variable between the risk factors and depression. With environmental mastery taken as such, the explained variance in depression increased to 56 per cent. It was concluded that environmental mastery may be one of the more important factors affecting the mental health of older adults living in residential care and that strategies for increasing the residents' environmental mastery are important to their psychological wellbeing. The discussion notes that among the questions needing further investigation are whether older adults who experience high environmental mastery make the transition from community living to residential nursing home care more successfully than others, and whether perceived mastery diminishes over time or occurs at the point of transition from community independent living to dependent supported living.
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Abstract
BACKGROUND Understanding the prevalence, incidence and cofactors of depression among long-term elderly nursing home (LTNH) residents domiciled for eight months or more may help optimize depression treatment in this vulnerable group. We quantified first year depression in American LTNH residents and the associations between depression and resident/facility characteristics. METHODS Data were obtained from the Minimum Data Set and Online Survey Certification and Reporting for 634,060 LTNH residents admitted from 1999 to 2005 in 4,216 facilities. Depression first diagnosed at admission and at subsequent quarterly intervals through the first year of stay was examined. Logistic regressions modeled correlates of newly identified depression in each time-period. RESULTS Recorded depression at admission and during the first year increased from 1999 to 2005. By 2005, 54.4% of LTNH residents had depression diagnosed over the first year; 32.8% at admission and a further 21.6% later during the first year. Antidepressant use was reported prior to depression diagnosis for 48% of those first identified depressed after admission. Men, non-Hispanic blacks, never married, and severely-cognitively impaired LTNH residents were less often identified with depression, particularly at admission. Pain and physical comorbidity were positively associated with depression identified throughout the first year. Prior institutionalization was associated with depression at admission, but not new depression after admission. Facility characteristics had weaker associations with depression. CONCLUSIONS High depression rates at admission and during the first year indicate a need to monitor and treat large numbers of American LTNH residents for depression. Reduced associations between demographics and depression as stays progress suggest other factors have increased roles in depression etiology.
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Abstract
BACKGROUND The IPA Taskforce on Mental Health Issues in Long-Term Care Homes seeks to improve mental health care in long-term care (LTC) homes. The aim of this paper is to provide recommendations on comprehensive assessment of depression and behavioral problems in order to further stimulate countries and professionals to enhance their quality of care. METHODS Existing guidelines on comprehensive assessment of depression or behavioral problems in nursing home (NH) patients or patients residing in LTC homes were collected and a literature review was carried out to search for recent evidence. RESULTS Five guidelines from several countries all over the world and two additional papers were included in this paper as a starting point for the recommendations. Comprehensive assessment of depression in LTC homes consists of a two-step screening procedure: an investigation to identify factors that influence the symptoms, followed by a formal diagnosis of depression according to DSM-IV-TR or the Provisional Diagnostic Criteria for Depression in Alzheimer Disease in cases of dementia. Comprehensive assessment of behavioral problems encompasses three steps: description and clarification of the behavior, additional investigation, and assessment of probable causes of the behavior. The procedure starts in the case of moderate behavioral problems. CONCLUSION The recommendations given in this paper provide a useful guide to professional workers in the LTC sector, but clinical judgment and the consideration of the unique aspects of individual residents and their situations is necessary for an optimal assessment of depression and behavioral problems. The recommendations should not be rigidly applied and implementation will differ from country to country.
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Abstract
BACKGROUND The prevalence of depression among older people receiving care is high, yet the rate of treatment of this disorder is low. One way to improve the pathway to care is to train care staff to recognize the symptoms of depression and raise their confidence in responding to them. In this study we evaluated the efficacy of the beyondblue Depression Training Program to achieve this aim. METHODS Staff (N = 148) from low level care facilities and community care facilities in metropolitan Melbourne completed the beyondblue Depression Training Program, while staff in other facilities (N = 96) acted as controls. Pre-program, post-program and follow-up questionnaire data were collected and referrals for depression by staff were recorded. RESULTS Training improved carers' knowledge about depression, their self-efficacy in responding to signs of depression and their attitudes towards working with depressed aged care recipients. In addition, training increased the number of referrals for depression made by carers. CONCLUSION Training aged care staff in depression can improve the pathways to care for depressed care recipients, and has the potential to improve the quality of life of older people.
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Snowdon J, Rosengren D, Daniel F, Suyasa M. Australia's use of the Cornell scale to screen for depression in nursing homes. Australas J Ageing 2010; 30:33-6. [PMID: 21395938 DOI: 10.1111/j.1741-6612.2010.00450.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To examine the utility of the Cornell scale for depression in dementia (CSDD), following its introduction as a routine measure in nursing homes. METHODS The CSDD is administered in Australian nursing homes as section 10 of the Aged Care Funding Instrument. CSDD, cognitive and behavioural ratings, and medication use, recorded in three Sydney nursing homes in 2008-2009 were reviewed. Staff discussed what actions were taken if CSDD scores indicated depression. RESULTS Of 223 residents, 23% scored >12 on the CSDD, indicating probable depression. Another 21% were possibly depressed and 29% not depressed. The CSDD had not been completed for 27%, commonly because preliminary screening indicated no depression, but sometimes because severe cognitive impairment made various CSDD items impossible to rate. Second CSDD assessments had usually not been made. CONCLUSION Nursing homes need to document policies that will ensure best use is made of CSDD findings.
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Affiliation(s)
- John Snowdon
- Discipline of Psychiatry, Sydney Medical School, Sydney, New South Wales, Australia.
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Baller M, Boorsma M, Frijters DHM, van Marwijk HWJ, Nijpels G, van Hout HPJ. Depression in Dutch homes for the elderly: under-diagnosis in demented residents? Int J Geriatr Psychiatry 2010; 25:712-8. [PMID: 19806603 DOI: 10.1002/gps.2412] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Although community-based studies reported an increased incidence of depression among demented persons compared with non-demented persons, it is not clear whether this relationship also exists among institutionalised elderly persons. The aim of this study was to compare the prevalence of diagnosed depressive disorders and mood symptoms between demented and non-demented residents living in Dutch homes for the elderly. METHODS Cross-sectional analysis in 16 homes for the elderly of routine outcome measurements by trained nurse assistants using the Resident Assessment Instrument (RAI) between January 2007 and April 2008. Nurse assistants recorded all known medical diagnoses including dementia and depression, as well as a structured observation of the presence or absence of 11 mood symptoms over the last 3 days. RESULTS 313 demented and 463 non-demented residents with complete data were included (99% of all residents, mean age 84 years). 24.6% of participants were diagnosed with a depressive disorder, with no statistically significant difference between demented and non-demented persons (p = 0.237). Mood symptoms were more prevalent in demented residents (p < 0.001, OR 2.14, 95%CI 1.56-2.93). Among residents with mood symptoms, demented residents were less likely to be diagnosed with a depressive disorder than non-demented residents (p = 0.039, OR 0.61, 95%CI 0.38-0.98). CONCLUSIONS The prevalence of diagnosed depressive disorders was comparable between demented and non-demented residents. However, demented residents suffered more from mood symptoms and may be at risk of under-diagnosis of depression.
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Affiliation(s)
- Menke Baller
- Department of General Practice, EMGO-Institute, VU University Medical Center, Amsterdam, The Netherlands
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Damián J, Pastor-Barriuso R, Valderrama-Gama E. Descriptive epidemiology of undetected depression in institutionalized older people. J Am Med Dir Assoc 2010; 11:312-9. [PMID: 20511097 DOI: 10.1016/j.jamda.2010.01.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 01/26/2010] [Accepted: 01/26/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To measure the prevalence and associated factors of undetected depression in institutionalized older people. DESIGN AND SETTING Epidemiologic cross-sectional study in nursing homes and residential facilities. PARTICIPANTS A stratified cluster sample of residents 65 years of age and older living in institutions of Madrid (Spain). MEASUREMENTS Residents were considered to be depressed if they met at least 1 of the following 3 criteria: 10-item Geriatric Depression Scale score of 4 or higher, physician's diagnosis, or antidepressant use. Prevalence of undetected depression was defined as the proportion of depressed residents without documented diagnosis or treatment. RESULTS A total of 255 of 579 residents had depression (weighted prevalence 46.1%, 95% confidence interval [CI] 41.0%-51.3%) and 108 depressed residents were undetected (undetection prevalence 41.5%, 95% CI 33.2%-50.2%). Undetection was lower in younger residents, private versus public facilities (sex-, age-, and size-adjusted prevalence ratio [PR] 0.59, 95% CI 0.37-0.94), and larger facilities (sex-, age-, and ownership-adjusted PR 0.94 per 50-bed increase, 95% CI 0.88-1.00). Undetected depression was higher in residents with poor self-rated health (sex- and age-adjusted PR 1.83, 95% CI 1.24-2.73), whereas the opposite came about for physician-rated health (PR 0.65, 95% CI 0.44-0.95). Undetection decreased 11% (95% CI 4%-17%) per 1-medication increase, and it was lower in patients with Alzheimer disease, anxiety, and arrhythmia. CONCLUSIONS Number of medications and self-rated health were the main determinants of undetected depression. Physician-rated health, facility characteristics (size and ownership), and some diseases could also be considered.
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Affiliation(s)
- Javier Damián
- National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
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Prevalence of mood, anxiety, and substance-abuse disorders for older Americans in the national comorbidity survey-replication. Am J Geriatr Psychiatry 2009; 17:769-81. [PMID: 19700949 DOI: 10.1097/jgp.0b013e3181ad4f5a] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Current information on the prevalence of psychiatric disorders among older adults in the United States is lacking. Prevalence of anxiety, mood, and substance disorders was examined by age (18-44, 45-64, 65-74, and 75 years and older) and sex. Covariates of disorders for older adults (65 years and older) were explored. DESIGN Cross-sectional epidemiologic study, using data from the National Comorbidity Survey-Replication. SETTING Community-based epidemiologic survey. PARTICIPANTS Representative national sample of community-dwelling adults in the United States. MEASUREMENTS The World Health Organization Composite International Diagnostic Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorders. RESULTS Prevalence of 12-month and lifetime mood, anxiety, and substance-use disorders was lower for older adults (65 years and older) than younger age groups: 2.6% for mood disorder, 7.0% for anxiety disorder, 0 for any substance-use disorder, and 8.5% for any of these disorders (for any disorder, 18-44 years = 27.6%, 45-64 years = 22.4%). Among older adults, presence of a 12-month anxiety disorder was associated with female sex, lower education, being unmarried, and three or more chronic conditions. Presence of a 12-month mood disorder was associated with disability. Similar patterns were noted for lifetime disorders (any disorder: 18-44 years = 46.4%, 45-64 years = 43.7%, and 65 years and older = 20.9%). CONCLUSIONS This study documents the continued pattern of lower rates of formal diagnoses for elders. These rates likely underestimate the burden of late-life psychiatric disorders, given the potential for underdiagnosis, clinical significance of subthreshold symptoms, and lack of representation from high-risk older adults (e.g., medically ill, long-term care residents).
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Knight T, Mellor D. Social inclusion of older adults in care: Is it just a question of providing activities? Int J Qual Stud Health Well-being 2009. [DOI: 10.1080/17482620701320802] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
OBJECTIVES Individual clinical interviews are typically viewed as the "gold standard" when diagnosing major depressive disorder (MDD) and when examining the validity of self-rated questionnaires. However, this approach may be problematic with older people, who are known to underreport depressive symptomatology. This study examined the effect of including an informant interview on prevalence estimations of MDD in an aged-care sample. DESIGN The results of an individual clinical interview for MDD were compared with those obtained when an informant interview was incorporated into the assessment. Results from each diagnostic approach were compared with scores on a self-rated depression instrument. SETTING Low-level aged-care residential facilities in Melbourne (equivalent to "residential homes," "homes for the elderly," or "assisted living facilities" in other countries). PARTICIPANTS One hundred and sixty-eight aged-care residents (mean age: 84.68 years; SD: 6.16 years) with normal cognitive functioning. MEASUREMENTS Individual clinical interviews were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders. This interview was modified for use with staff informants. Self-reported depression was measured using the Geriatric Depression Scale-15 (GDS-15). RESULTS The estimated point prevalence of MDD rose from 16% to 22% by including an informant clinical interview in the diagnostic procedure. Overall, 27% of depressed residents failed to disclose symptoms in the clinical interview. The concordance of the GDS-15 with a diagnosis of MDD was substantially lower when an informant source was included in the diagnostic procedure. CONCLUSION Individual interviews and self-report questionnaires may be insufficient to detect depression among older adults. This study supports the use of an informant interview as an adjunct when diagnosing MDD among cognitively intact aged-care residents.
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McCabe MP, Russo S, Mellor D, Davison TE, George K. Effectiveness of a training program for carers to recognize depression among older people. Int J Geriatr Psychiatry 2008; 23:1290-6. [PMID: 18543348 DOI: 10.1002/gps.2067] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Depression is a mental disorder that is frequently not detected among older people. The current study was designed to evaluate the effectiveness of a training program to assist carers to better recognize depression among older people in both community and residential care settings. METHODS In total, 52 professional carers (26 in community care, 26 in residential care) across a range of occupations completed a four session (for personal care attendants) or six session (for registered nurses or managers) training program. The program provided training for staff to identify and respond appropriately to signs of depression. In addition, nurses and managers were trained on the use of screening tools and referral processes. Outcomes were evaluated at post-test, and 6-month follow-up. RESULTS The results demonstrated that for all groups training was effective in increasing carers' knowledge of depression and self-efficacy in detecting depression, as well as reducing the barriers to care at both post-test and 6-month follow-up. CONCLUSIONS The training program evaluated in the current study was effective in increasing the level of skills necessary for care staff to better detect depression among older people in both community and residential care settings. Further research is needed to determine if these improved skills are sustained over time, and if they actually improve the level of recognition of depression among older people.
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Affiliation(s)
- Marita P McCabe
- School of Psychology, Deakin University, Melbourne, Australia.
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