Course, risk factors, and prognostic factors in elderly primary care patients with mild depression: a two-year observational study

Challenges of nurses and care management of depressed older adults: a narrative literature review

BACKGROUND

The number of older adults with depression has increased in recent years. In relation to this, conducting a narrative review helps provide a better understanding of the adaptive functioning of depressed older adults and the significance of interventions in reducing depression. This narrative review investigates the nurses' management of depressed older adult patients. It also presents a detailed investigation of the barriers preventing nurses from successfully implementing nursing care for older adults.

METHODS

A narrative literature review was performed on four electronic databases, namely, (i) Cumulative Index of Nursing and Allied Health Literature, (ii) Pubmed, (iii) PsycINFO and (iv) Taylor and Francis. English language and peer-reviewed journal articles were included.

RESULTS

A total of 19 articles were selected for the review, and four main themes were generated: (i) the challenges in implementing depression care management, (ii) the role of social support in depression treatment, (iii) the pharmacological management approach and (iv) the health care management process.

CONCLUSION

Nurses experience several challenges in implementing depression care management. The role of social support in the treatment of depression, pharmacological management and different types of health care management strategies all provide solutions for depressed older adults. The review findings provide insights for improving health care nursing services for depressed older adults and reducing the negative health outcomes in this population.

Behavioural activation in nursing homes to treat depression (BAN-Dep): study protocol for a pragmatic randomised controlled trial

INTRODUCTION

Depression is a common disorder among older people living in residential aged care facilities. Several trials have demonstrated the effectiveness of behavioural therapies in treating depressive symptoms in older adults living in the community and in residential aged care. Behavioural Activation is demonstrably effective even when delivered by non-specialists (staff without formal psychological training), although strategies for adapting its use in residential aged care facilities are yet to be explored. This study will determine whether training residential care staff in the use of a structured Behavioural Activation programme is more effective at decreasing depressive symptoms among older residents than internet-based training about depression recognition and management alone.

METHOD AND ANALYSIS

The behavioural activation in nursing homes to treat depression (BAN-Dep) trial is a pragmatic two-arm parallel clustered randomised controlled trial. It will recruit 666 residents aged 60 or older from 100 residential aged care facilities, which will be randomly assigned to the Behavioural Activation or control intervention. Staff in both treatment groups will be encouraged to complete the Beyondblue Professional Education to Aged Care e-learning programme to improve their recognition of and ability to respond to depression in older adults. Selected staff from intervention facilities will undergo additional training to deliver an 8-module Behavioural Activation programme to residents with subthreshold symptoms of depression-they will receive ongoing Mental support from trained Behavioural Activation therapists. Outcome measures will be collected by blind research officer at baseline and after 3, 6 and 12 months. The Patient Health Questionnaire-9 is the primary outcome measure of the study.

ETHICS AND DISSEMINATION

The trial will comply with the principles of the Declaration of Helsinki for Human Rights and is overseen by the University of Western Australia (reference RA/4/20/4234) and Melbourne Health (reference number HREC/18/MH/47) Ethics Committees. The results of this research project will be disseminated through publications and/or presentations in a variety of media to health professionals, academics, clinicians and the public. Only de-identified group data will be presented.

TRIAL REGISTRATION

ACTRN12618000634279.

A pilot programme evaluation of social farming horticultural and occupational activities for older people in Italy

The aim of this study was to evaluate a 1-year social farming programme conducted between 2014 and 2015, including horticultural and occupational activities on six agricultural farms for older people in good general health. Social farming is a practice that uses agricultural resources to provide health, social or educational services to vulnerable groups of people. Activity participation, social relationships, physical activity, and the quality of life of the participants were assessed using a pretest, posttest design. A total of 112 subjects were interviewed at baseline, though only 73 participants were retained through the end of the follow-up, resulting in a dropout rate of 34%. Data analysis revealed significant improvements in both social relationships and overall occupational engagement at the end of the programme, with significant increases in the frequency of contact with friends or relatives as well as the number of activities performed by the participants. This work adds to the literature on the effects of social farming and indicates that farming may provide opportunities for older people to engage in activities that stimulate social behaviours.

Development and external validation of a prediction rule for an unfavorable course of late-life depression: A multicenter cohort study

BACKGROUND

Given the poor prognosis of late-life depression, it is crucial to identify those at risk. Our objective was to construct and validate a prediction rule for an unfavourable course of late-life depression.

METHODS

For development and internal validation of the model, we used The Netherlands Study of Depression in Older Persons (NESDO) data. We included participants with a major depressive disorder (MDD) at baseline (n = 270; 60-90 years), assessed with the Composite International Diagnostic Interview (CIDI). For external validation of the model, we used The Netherlands Study of Depression and Anxiety (NESDA) data (n = 197; 50-66 years). The outcome was MDD after 2 years of follow-up, assessed with the CIDI. Candidate predictors concerned sociodemographics, psychopathology, physical symptoms, medication, psychological determinants, and healthcare setting. Model performance was assessed by calculating calibration and discrimination.

RESULTS

111 subjects (41.1%) had MDD after 2 years of follow-up. Independent predictors of MDD after 2 years were (older) age, (early) onset of depression, severity of depression, anxiety symptoms, comorbid anxiety disorder, fatigue, and loneliness. The final model showed good calibration and reasonable discrimination (AUC of 0.75; 0.70 after external validation). The strongest individual predictor was severity of depression (AUC of 0.69; 0.68 after external validation).

LIMITATIONS

The model was developed and validated in The Netherlands, which could affect the cross-country generalizability.

CONCLUSIONS

Based on rather simple clinical indicators, it is possible to predict the 2-year course of MDD. The prediction rule can be used for monitoring MDD patients and identifying those at risk of an unfavourable outcome.

Childhood Abuse and the Two-Year Course of Late-Life Depression

OBJECTIVES

Late-life depression often has a chronic course, with debilitating effects on functioning and quality of life; there is still no consensus on important risk factors explaining this chronicity. Cross-sectional studies have shown that childhood abuse is associated with late-life depression, and in longitudinal studies with chronicity of depression in younger adults. We aim to investigate the impact of childhood abuse on the course of late-life depression.

DESIGN

Two-year longitudinal cohort study.

SETTING

Data were derived from the Netherlands Study of Depression in Older Persons (NESDO).

PARTICIPANTS

282 participants with a depression diagnosis in the previous 6 months (mean age: 70.6 years), of whom 152 (53.9%) experienced childhood abuse.

MEASUREMENTS

Presence of childhood abuse (yes/no) and a frequency-based childhood abuse index (CAI) were calculated. Dependent variable was depression diagnosis after 2 years.

RESULTS

Multivariable mediation analysis showed an association between childhood abuse and depression diagnosis at follow-up. Depression severity, age at onset, neuroticism, and number of chronic diseases were important mediating variables of this association, which then lost statistical significance. For childhood abuse (yes/no), loneliness was an additional, significant mediator. Depression severity was the main mediating variable, reducing the direct effect by 26.5% to 33.3% depending on the definition of abuse (respectively, 'yes/no" abuse and CAI).

CONCLUSIONS

More depressive symptoms at baseline, lower age at depression onset, higher levels of neuroticism and loneliness, and more chronic diseases explain a poor course of depression in older adults who reported childhood abuse. When treating late-life depression it is important to detect childhood abuse and consider these mediating variables.

Trajectory Pathways for Depressive Symptoms and Their Associated Factors in a Chinese Primary Care Cohort by Growth Mixture Modelling

Background

The naturalistic course for patients suffering from depressive disorders can be quite varied. Whilst some remit with little or no intervention, others may suffer a more prolonged course of symptoms. The aim of this study was to identify trajectory patterns for depressive symptoms in a Chinese primary care cohort and their associated factors.

Methods and Results

A 12-month cohort study was conducted. Patients recruited from 59 primary care clinics across Hong Kong were screened for depressive symptoms using the Centre for Epidemiologic Studies Depression Scale (CES-D) and monitored over 12 months using the Patient Health Questionnaire-9 items (PHQ-9) administered at 12, 26 and 52 weeks. 721 subjects were included for growth mixture modelling analysis. Using Akaike Information Criterion, Bayesian Information Criterion, Entropy and Lo-Mendell-Rubin adjusted likelihood ratio test, a seven-class trajectory path model was identified. Over 12 months, three trajectory groups showed improvement in depressive symptoms, three remained static, whilst one deteriorated. A mild severity of depressive symptoms with gradual improvement was the most prevalent trajectory identified. Multivariate, multinomial regression analysis was used to identify factors associated with each trajectory. Risk factors associated with chronicity included: female gender; not married; not in active employment; presence of multiple chronic disease co-morbidities; poor self-rated general health; and infrequent health service use.

Conclusions

Whilst many primary care patients may initially present with a similar severity of depressive symptoms, their course over 12 months can be quite heterogeneous. Although most primary care patients improve naturalistically over 12 months, many do not remit and it is important for doctors to be able to identify those who are at risk of chronicity. Regular follow-up and greater treatment attention is recommended for patients at risk of chronicity.

The two-year course of late-life depression; results from the Netherlands study of depression in older persons

BACKGROUND

We aimed to examine the course of depression during 2-year follow-up in a group clinically depressed older persons. Subsequently, we studied which socio-demographic and clinical characteristics predict a depression diagnoses at 2-year follow-up.

METHODS

Data were used from the Netherlands Study of Depression in Older persons (NESDO; N = 510). Diagnoses of depression DSM-IV-TR criteria were available from 285 patients at baseline and at 2-year follow-up. Severity of the depressive symptoms, as assessed with the Inventory of Depressive Symptoms (IDS), was obtained from 6-monthly postal questionnaires. Information about socio-demographic and clinical variables was obtained from the baseline measurement.

RESULT

From the 285 older persons who were clinically depressed at baseline almost half (48.4%) also suffered from a depressive disorder two years later. Patients with more severe depressive symptoms, comorbid dysthymia, younger age of onset and more chronic diseases were more likely to be depressed at 2-year follow-up. 61% of the persons that were depressed at baseline had a chronic course of depressive symptoms during these two years.

CONCLUSIONS

Late-life depression often has a chronic course, even when treated conform current guidelines for older persons. Our results suggest that physical comorbidity may be candidate for adjusted and intensified treatment strategies of older depressed patients with chronic and complex pathology.

What characterizes late-life depression?

This article analyzes late-life depression, looking carefully at what defines a person as elderly, the incidence of late-life depression, complications and differences in symptoms between young and old patients with depression, subsyndromal depression, bipolar depression in the elderly, the relationship between grief and depression, along with sleep disturbances and suicidal ideation.