Depression in older adults

Changes in Mood in New Enrollees at a Program of All-Inclusive Care for the Elderly

OBJECTIVES

To examine changes in mood after nine months of enrollment in a Program of All-Inclusive Care for the Elderly (PACE).

DESIGN

Cohort study.

SETTING

Alexian Brothers PACE, St. Louis, Missouri.

PARTICIPANTS

Newly enrolled patients 55 years of age and older, living in the PACE service area, eligible for nursing facility care and able to live safely in the community, with continuous care, for at least nine months (N = 182).

MAIN OUTCOME MEASURES

Geriatric Depression Scale (GDS)-15 score at the pre-admission evaluation (PAE) and the nine-month evaluation (9ME).

RESULTS

Of the 182 patients evaluated, 27% (n = 49) met the definition of depression as defined by the GDS-15 score of ≥ 6 at the PAE. At the 9ME, only 11% of patients met the depression criteria (P < 0.001). Of the patients who met the criteria for depression at the PAE, 80% of patients (n = 39) no longer met these criteria at the 9ME (P = 0.029). Similar findings were observed by age, gender, and race. Greater improvement was observed among those who were depressed at the PAE; the depressed cohort improved by 5.0 points (P < 0.001) on the GDS-15 scale from the PAE to the 9ME, whereas the nondepressed cohort improved by 0.6 points (P = 0.003).

CONCLUSION

The use of PACE as an alternative intervention may be a good option to improve mood in older adults.

Cognitive deficits in geriatric depression: clinical correlates and implications for current and future treatment

The purpose of this article is to identify the cognitive deficits commonly associated with geriatric depression and describe their clinical significance. The complex relationship between geriatric depression and dementia is summarized and possible shared mechanisms discussed. Evidence regarding whether the cognitive deficits in depression may be mitigated with medication or with computerized cognitive remediation is presented.

Garden walking and art therapy for depression in older adults: a pilot study

The purpose of this pilot study was to compare garden walking (either alone or guided) with art therapy in older adults with depression. Depression was measured using the Geriatric Depression Scale (GDS) and stories of sadness/joy. Prior to the intervention, 47% of participants had depression scores in the severe range and 53% in the mild range. At the end of the intervention, none of the participants had scores in the severe range, 89% had scores in the mild range, and 11% had scores in the normal range. Results of the GDS data using repeated measures analysis of variance indicated significant decreases in depression for all three groups from pretest to posttest. All participants, regardless of group assignment, had a lower percentage of negative-emotion word use and a higher percentage of positive-emotion word use over time. This study provides evidence for nurses wishing to guide older adults in safe, easy, and inexpensive ways to reduce depression.

Integrating the international classification of functioning, disability, and health model into massage therapy research, education, and practice

Without an increase in clearly defined and clinically significant outcomes research in massage therapy (MT), the practice is in jeopardy of remaining on the fringes of accepted and utilized therapeutic care. This reality will slow the integration of MT into routine preventive, rehabilitative, curative, and supportive care. The International Classification of Functioning, Disability, and Health (ICF) developed by the World Health Organization is a comprehensive model of functioning and disability that provides a universal taxonomy of human functioning that is recognized globally. Integration of the ICF model into MT research, education, and practice would provide a foundation for a common language, particularly in regard to examining outcomes of MT.Here, we review the dynamic and respected ICF model as it applies to massage research, outcomes dissemination, education, and practice, with these specific objectives:To describe the specific domains of the ICF modelTo apply the described ICF domains to current massage practice and researchTo discuss how integration of the ICF model enhances communication and translation among those within and to those outside the MT fieldThe ICF model is ideal for application to MT interests because it works outside the typical focus on pathology or a specific organ system. Instead, the ICF focuses on impairment or limitations in functioning associated with health conditions. The ICF also highlights and incorporates the complex interactions of environment and personal factors and the impact that those factors exert on the domains of body structure, activity, and participation. This interaction has unique implications for MT practitioners, researchers, and clients/patients. Furthermore, the ICF model provides a framework for classifying outcomes, which is a critical aspect of clinical research.

The Effect of Healing Gardens and Art Therapy on Older Adults With Mild to Moderate Depression

This study evaluated the effect of garden walks alone, garden walks with guided imagery, and art therapy on mild to moderate depression in older adults. Focus group interviews at the end of the 6-week intervention suggest that all 3 interventions were helpful to participants with mild to moderate depression.

Assessment of Psychoemotional and Behavioral Status in Patients with Dementia

Depression and behavioral symptoms occur in many older adults with dementia and result in serious consequences, including nursing home admissions, decreased functional ability, mortality, and increased healthcare costs. Assessment of depression in this population is challenging and is facilitated by using interviewer-rated instruments as an adjunct to clinical judgment. Clinicians should select a perspective that enables them to view behavioral symptoms associated with dementia in a therapeutic manner. Care for depression and behavioral symptoms should be individualized to match presenting symptoms. Issues related to psychoemotional and behavioral assessment are: (1) implementation of effective psychogeriatric models of care and (2) incorporating evidenced-based knowledge into practice settings.