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A controlled evaluation of monthly maintenance interpersonal psychotherapy in late-life depression with varying levels of cognitive function
- Authors:
- CARREIRA Kristen, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(11), November 2008, pp.1110-1113.
- Publisher:
- Wiley
This study evaluated the effect of maintenance Interpersonal Psychotherapy (IPT) on recurrence rates and time to recurrence of major depression in elderly patients with varying levels of cognitive function. Two-year maintenance study of monthly maintenance IPT vs supportive clinical management (CM) in remitted depressed elderly who were participants in a previously reported placebo-controlled study of maintenance paroxetine and IPT (Reynolds et al., [2006]). Cox regression analysis was used to test interactions between cognitive status (Dementia Rating Scale score) and treatment (IPT, CM) with respect to recurrence of major depression. A significant interaction between cognitive status and treatment was observed: lower cognitive performance was associated with longer time to recurrence in IPT than in CM. Subjects with average cognitive performance showed no effect of maintenance IPT vs CM on time to recurrence. Monthly maintenance IPT confers protection against recurrence of major depression in elders with lower cognitive functioning.
Prevalence of depression and anxiety symptoms in elderly patients admitted in post-acute intermediate care
- Authors:
- YOHANNES A. M., BALDWIN R. C., CONNOLLY M. J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(11), November 2008, pp.1141-1147.
- Publisher:
- Wiley
Depression and anxiety symptoms are common in medically ill older patients. This study investigated the prevalence and predictors of depression and anxiety symptoms in older patients admitted for further rehabilitation in a post acute intermediate care unit, in the North West of England. One hundred and seventy-three older patients (60 male), aged mean (SD) 80 (8.1) years, referred for further rehabilitation to intermediate care. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale, and severity of depression examined by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended ADL Scale and quality of life by the SF-36. Sixty-five patients (38%) were identified with depressive symptoms, 29 (17%) with clinical depression, 73 (43%) with anxiety symptoms, and 43 (25%) with clinical anxiety. 15 (35%) of the latter did not have elevated depression scores (9% of the sample). Of those with clinical depression, 14 (48%) were mildly depressed and 15 (52%) moderately depressed. Longer stay in the unit was predicted by severity of depression, physical disability, low cognition and living alone. Clinical depression and anxiety are common in older patients admitted in intermediate care. Anxiety is often but not invariably secondary to depression and both should be screened for. Depression is an important modifiable factor affecting length of stay. The benefits of structured management programmes for anxiety and depression in patients admitted in intermediate care are worthy of evaluation.
Potentially inappropriate management of depressive symptoms among Ontario home care clients
- Authors:
- DALBY Dawn M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(6), June 2008, pp.650-659.
- Publisher:
- Wiley
The authors' objective was to examine the prevalence and correlates of potentially inappropriate pharmacotherapy (including potential under-treatment) for depression in adult home care clients by means of a cross-sectional study of clients receiving services from Community Care Access Centres in Ontario, 3,321 of whom were assessed with the Resident Assessment Instrument for Home Care (RAI-HC). A score of 3 or greater on the Depression Rating Scale, a validated scale embedded within the RAI-HC, indicates the presence of symptoms of depression. Medications listed on the RAI-HC were used to categorise treatment into two groups: potentially appropriate and potentially inappropriate antidepressant drug therapy. Adjusted logistic regression models were used to explore relevant predictors of potentially inappropriate pharmacotherapy. The results showed 414 (12.5%) had symptoms of depression and 17% received an appropriate antidepressant. Over half (64.5%) received potentially inappropriate pharmacotherapy (including potential under-treatment). At age 75 or older, higher levels of caregiver stress and the presence of greater comorbidity were associated with a higher risk of potentially inappropriate pharmacotherapy in multivariate analyses. Documentation of any psychiatric diagnosis on the RAI-HC and receiving more medications were significantly associated with a greater likelihood of appropriate drug treatment. It was concluded that most clients with significant depressive symptoms were not receiving appropriate pharmacotherapy. Having a documented diagnosis of a psychiatric condition on the RAI-HC predicted appropriate pharmacotherapy. By increasing recognition of psychiatric conditions, the use of standardised, comprehensive assessment instruments in home care may represent an opportunity to improve mental health care in these settings.
Help to reduce depression
- Authors:
- LYNE Jake, MOXON Sallie, SOCIAL CARE INSTITUTE FOR EXCELLENCE
- Journal article citation:
- Community Care, 13.11.08, 2008, p.34, 36.
- Publisher:
- Reed Business Information
The results of a recent research project have found that care workers can help control depression among older people. The authors summarise some of the key messages from the study. In the second part of the article, the Social Care Institute for Excellence (SCIE) provides details of selected resources on reducing depression in older people.
Impact of support groups on well-being of older women
- Author:
- SEGRIST Kathleen A.
- Journal article citation:
- Journal of Gerontological Social Work, 51(1/2), 2008, pp.42-52.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
In this research study the Geriatric Depression Scale and the Philadelphia Geriatric Center Morale Scale were administered to 36 women aged 60 or older participating in either a peer-run or a staff-run support group, and nine women not attending any support group. Scores on the Geriatric Depression Scale showed significant differences between the women in the peer-run and comparison groups, but no such differences between women in the peer-run and staff-run groups, or between the staff-run and comparison groups. Analysis of the date from the other scale indicated no significant differences between women in any of the groups. The implications for those who run support groups for older adults, or who train peer group facilitators, are discussed. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Depression in elderly life sentence prisoners
- Authors:
- MURDOCH Nicholas, MORRIS Paul, HOLMES Clive
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(9), September 2008, pp.957-962.
- Publisher:
- Wiley
This study aimed to determine the prevalence and associated risk factors of depression in elderly life sentence prisoners. One hundred and twenty-one elderly life/indeterminate sentence prisoners from two category B prisons in the United Kingdom were interviewed using the Geriatric Depression Scale and the relationship with prison and non prison specific variables analysed. Over half of the prisoners scored above the threshold for mild depression. The length of sentence served and other prison related variables were not associated with the depression score. However, the imported chronic physical ill health was strongly related to depression score. Depression in long term prisoners is common and is related to the burden of imported chronic ill health as opposed to specific effects of imprisonment.
The effects of ECT on cognitive functioning in the elderly: a review
- Authors:
- TIELKES Caroline E M, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(8), August 2008, pp.789-795.
- Publisher:
- Wiley
This study aimed to review all studies from 1980-2006 on ECT and cognition in the elderly with a minimum age of 55 years or a mean age of 55 years, and with valid measurements of cognition before and after ECT. Nine out of the 15 eligible studies were focused exclusively on the elderly. Three studies reported verbal learning- and recall problems post ECT, while three studies found positive effects of ECT on memory, speed of processing and concentration. Global cognitive functioning in patients with cognitive impairment improved in all studies. At follow up, most studies reported improvement of cognitive functions. Learning verbal information and executive functioning were impaired in M-ECT patients whereas global cognition remained stable after M-ECT over a year. To date research of ECT on cognitive functioning in the elderly is very limited. Small sample size, lack of controls, use of a single screening instrument and a short follow up period may explain the conflicting results. Given the clinical importance, more extensive research on cognition in elderly treated with ECT is urgently needed.
Body mass index, waist circumference, waist-hip ratio and depressive symptoms in Chinese elderly: a population-based study
- Authors:
- HO Roger C. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(4), April 2008, pp.401-408.
- Publisher:
- Wiley
Studies that investigated the relationship between obesity and depressive symptoms in the elderly have generated conflicting findings, partly because of the use of body mass index (BMI) alone to measure obesity in the elderly. The use of BMI fails to account for varying proportions of muscle, fat and bone, and few studies have used other measures of central obesity, such as waist-hip ratio (WHR) and waist circumference (WC). This study examined whether individually BMI, WHR and WC were consistently associated with depressive symptoms in the elderly. Analysis of cross-sectional data of 2,604 community dwelling Chinese elderly aged 55 and above, including socio-emotional characteristics, self-rated health and functional status, anthropometric measurements and Geriatric Depression Scale (15 items, GDS-15). There was a negative trend in the prevalence of depressive symptoms (GDS 5) across increasing BMI categories: 16.9% in low BMI, 14.2% in normal weight, 12.1% in moderate to high BMI. The associations for moderate to high BMI relative to normal BMI, were statistically significant after controlling for confounding variables. However, no consistent trends in the prevalence of depressive symptoms and OR's were observed for increasing WHR and WC categories. Results suggest that waist-hip and circumference measures of central obesity did not support an inverse relationship of obesity and depressive symptoms. An inverse relationship of BMI with depressive symptoms may indicate greater physiologic and functional reserve from greater muscle mass that protects against depressive symptoms.
Brief interventions to prevent depression in older subjects: a systematic review of feasibility and effectiveness
- Author:
- COLE Martin G.
- Journal article citation:
- American Journal of Geriatric Psychiatry, 16(6), June 2008, pp.435-443.
- Publisher:
- Lippincott Williams and Wilkins
This systematic review proposed to explore the feasibility and effectiveness of brief interventions to prevent depression in older subjects. Computer databases were searched for potentially relevant articles published up until August, 2007. The bibliographies of relevant articles were searched for additional references and all the retrieved articles were screened to meet the following five inclusion criteria: original research, subjects mean age 40 years or more, controlled trial of a brief (<12 weeks) intervention to prevent depression, determination of depression status 6 months or more after enrolment, and use of an acceptable definition of depression. To examine feasibility, study enrolment, completion, and compliance rates were tabulated. To examine effectiveness, differences in depression symptom outcome scores or, when possible, absolute risk reductions (ARR) and relative risk reductions (RRR) for depression were tabulated. Fourteen trials were located. All were trials of brief psychosocial interventions. Many had one or more methodological limitations. Eight trials had positive results. In three trials there were significant differences in depression symptom outcome scores favouring the intervention group. Guidelines to improve the quality of future trials are proposed.
Prevalence of clinically significant depressive symptoms in an epidemiologic sample of community-dwelling elders with milder forms of cognitive impairment in Hong Kong SAR
- Authors:
- CHAN Sandra S. M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(6), June 2008, pp.611-617.
- Publisher:
- Wiley
Depression and cognitive impairment in later-life have great bearings on public health. The two conditions often co-occur and have mutual implications on short-term risk and long-term prognosis. A two-phase epidemiologic survey on the prevalence of dementia in elders aged 60 and over was conducted in Hong Kong in 2005-06. In the first phase, 6,100 randomly selected community dwelling elders were assessed with a Cantonese version of Mini-Mental State Examination (C-MMSE) and Abbreviated Memory Inventory for Chinese (AMIC), of whom 2,073 were screened positive and invited for second phase cognitive and psychiatric assessment. 35.5% of screen-positive subjects participated in Phase 2 assessment conducted by psychiatrists for diagnosis of dementia. Severity of dementia was determined using Clinical Dementia Rating Scale (CDR). Cornell Scale for Depression in Dementia (CSDD) and a structured bedside cognitive battery were also administered to each subject. The results showed that 1.7% of subjects with CDR 0.5 and 5.9% of subjects with CDR 1 had clinically significant depressive symptoms. Score on CSDD correlated positively with duration of cognitive symptoms, scores on CIRS and CMMSE in linear regression model. In a logistic regression model, male gender, duration of cognitive symptoms, CIRS and CMMSE was associated with increased risk for clinically significant depressive symptoms. It was concluded that in the sample, milder forms of cognitive impairment were associated with increased risk for depression in the presence of other risk factors such as male gender, higher physical illness burden and longer duration of cognitive symptoms.