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Coping with health stresses and remission from late-life depression in primary care: a two-year prospective study
- Authors:
- WALLACE Meredith L., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(2), February 2012, pp.178-186.
- Publisher:
- Wiley
Identifying the predictors of late-life depression that are amenable to change can lead to the development of improved interventions. The aim of this study was to investigate the impact of 2 different strategies on late-life depression in older, primary care patients. Health-oriented goal engagement strategies involve the investment of cognitive and behavioural resources to achieve health goals. Alternatively, disengagement strategies involve the withdrawal of these resources from obsolete or unattainable health goals, combined with goal restructuring. The participants were 271 adults aged 59 years and over who took part in the Prevention of Suicide in Primary Care Elderly: Collaborative Trial, a 2-year randomised clinical trial for treating depression in older adults. The use of health-oriented engagement and disengagement strategies, along with other risk factors for depression, were analysed to identify subgroups of individuals at risk for not achieving depression remission. The findings showed that the use of disengagement strategies from unattainable health goals predicted earlier remission of depression, particularly among more severely depressed older patients. The use of engagement strategies did not predict earlier remission.
Major depression and emergency medical services utilization in community-dwelling elderly persons with disabilities
- Authors:
- LEE Benjamin W., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(12), December 2008, pp.1276-1282.
- Publisher:
- Wiley
The objective of this research was to examine the association between major depression and emergency medical services (EMS) use by community-dwelling older adults with disabilities. A prospective observational study including 1,444 participants age 65+ in 19 counties in three US states that participated in the Medicare Primary and Consumer-Directed Care Demonstration. Eligibility criteria included needing or receiving help with either 2+ activities of daily living (ADLs) or 3+ instrumental ADLs, and having received recent significant healthcare services use. The presence of major depression was measured at baseline by the MINI Major Depressive Episode module. EMS utilization data for the following 2 years were obtained from a daily journal concurrently completed by each subject or a caregiver. More persons with major depression (43%) than without (35%) reported EMS use. When other factors were controlled in a logistic regression model, this effect was no longer statistically significant. However, of those with at least one episode of EMS transport, the depressed reported significantly (25%) more episodes than the non-depressed. Major depression was significantly associated with more EMS episodes in both Poisson and ordinary least squares regression models. Depressed disabled older adults who utilize EMS have more EMS episodes than those without depression. This higher use may be driven in part by affective illness. Research is needed to determine whether more EMS episodes are necessary to address symptoms of major depression, especially suicidal ideation, or whether they are due to other illnesses that are exacerbated by symptoms of major depression.
Predictors of response to the ‘Coping with Depression’ course for older adults: a field study
- Authors:
- HARINGSMA R., et al
- Journal article citation:
- Aging and Mental Health, 10(4), July 2006, pp.424-434.
- Publisher:
- Taylor and Francis
This field study explored the prognostic factors of the immediate and long-term effects of the Coping with Depression course for older adults (CWD). With the aim of both indicated as well as secondary prevention, the course is provided by the prevention departments of the community mental health care system in the Netherlands. A total of 317 course participants (age 55–85 years; 69% female) took part in this study; 41% had a major depressive disorder (MDD). A variety of demographic, clinical, psychosocial and treatment factors of possible relevance for indicated and secondary prevention were investigated. Random coefficient regression models and logistic regression models were used to examine their contribution to the immediate and maintenance effect. The course was beneficial for all participants, and the level of depression reached at the end of the course was maintained over the next 14-months. Current MDD, high levels of anxiety, less previous depressive episodes and more education predicted a larger benefit. However, the clinical significance of these predictors was too small to justify further triage. Further treatment should be considered for the participants with a post-treatment score ≥16. Group-membership was not a significant predictor of the variation in effect.
Depression and mental health in care homes for older people
- Authors:
- DENING Tom, MILNE Alisoun
- Journal article citation:
- Quality in Ageing, 10(1), March 2009, pp.40-46.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
Depression and dementia are prevalent mental health conditions in care homes. This article discusses the prevelence of depression and dementia in care homes; the quality of care provided; and concludes by highlighting four suggestions for improving the quality of care.
Religious involvement and health outcomes among older persons in Taiwan
- Author:
- YEAGER D. M.
- Journal article citation:
- Social Science and Medicine, 63(8), October 2006, pp.2228-2241.
- Publisher:
- Elsevier
The authors use data from a nationally representative, longitudinal survey of older Taiwanese to examine the relationship between religious involvement—including religious affiliation, religious attendance, beliefs, and religious practices—and self-reported measures of overall health status, mobility limitations, depressive symptoms, and cognitive function; clinical measures of systolic and diastolic blood pressure, serum interleukin-6, and 12-h urinary cortisol; and 4-year mortality. Frequency of religious attendance shows the strongest, most consistent association with health outcomes. But, with only one exception, this relationship disappears in the presence of controls for health behaviors, social networks, and prior health status. Religious attendance remains significantly associated with lower mortality even after controlling for prior self-assessed health status, but the coefficient is substantially reduced. Other aspects of religiosity are only sporadically associated with health and, in all cases, private religious practices and stronger beliefs are associated with worse health; again, this relationship disappears after controlling for prior health status. These results suggest that reverse causality may partly account for both the positive and negative correlations between religiosity and health. We find no significant associations between religious involvement and biological markers. Notably, even after controlling for prior health, participation in social activities has a more robust effect on health than religious attendance. Consequently, we question whether the purported health benefits are attributable to religion or to social activity in general.
Older people with chronic schizophrenia
- Authors:
- KARIM S., OVERSHOTT R., BURNS A.
- Journal article citation:
- Aging and Mental Health, 9(4), July 2005, pp.315-324.
- Publisher:
- Taylor and Francis
Older people with chronic schizophrenia are a numerically small but important group with complex clinical and service needs. Along with a reduction in positive schizophrenic symptoms with increasing age, a majority suffer from negative symptoms, cognitive deficits, depression, side effects due to long-term use of antipsychotics and co-morbid medical problems. They may have social disabilities making them vulnerable to poverty, isolation and poor quality of life. Evidence suggests that judicious use of antipsychotics combined with psychotherapy and psychosocial interventions are effective. There are shortcomings in the standard of both hospital and community care, and the cost implications of providing adequate services are high.
Depression: it's not inevitable and it is treatable
- Author:
- LEGGE Adam
- Journal article citation:
- Community Nurse, 2(11), January 1997, pp.16-17.
- Publisher:
- Emap Healthcare
Asks why depression in older people is so often neglected and offers ways in which community health teams can treat it.
Integrated homes, care and support: measuring outcomes for healthy ageing
- Authors:
- HOLLAND Carol, et al
- Publisher:
- Extra Care Charitable Trust
- Publication year:
- 2019
- Pagination:
- 36
- Place of publication:
- Coventry
This report looks at the benefits to residents of living in ExtraCare villages and schemes, highlighting improvements in both health and wellbeing. It summarises research findings from a collaborative project between Aston Research Centre for Healthy Ageing (ARCHA) and the ExtraCare Charitable Trust, covering the period from 2012 to 2018. The findings identify improvements in residents: physical health – with increased levels of exercise and reduced risk of falls; psychological wellbeing – with lower levels of depression and improvements in memory and cognitive skills; and social wellbeing, with lower levels of loneliness for residents in extra care than the national averages. The research also looks at potential cost savings due to reduction in healthcare use. It estimates that living in ExtraCare could save the NHS around £1,994 per person, on average, over 5 years. (Edited publisher abstract)
Social exclusion experienced by older adults: factors for designing healthcare settings in Taipei, Taiwan
- Authors:
- HSIEH Mei-O, LEUNG Patrick
- Journal article citation:
- Social Work in Health Care, 58(4), 2019, pp.368-381.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Research has demonstrated that social exclusion can lead to negative implications on an individual’s health status. In response to the need to examine health disparities among the older adult populations, this study explores social exclusion issues faced by older Taiwanese adults as a predictive factor to healthcare. The 80-item Social Inclusion/Exclusion Scale was developed and validated with input from 327 older adults recruited from 40 social service agencies in Taiwan. Findings suggest that to improve the overall health status among older Taiwanese adults, healthcare reforms must aim to increase social inclusion levels through a better understanding of five factors at both the service provider and individual levels: 1) knowledge of service provisions, 2) depression, 3) individual autonomy, 4) types of care home, and 5) gender-sensitive practice. (Publisher abstract)
A qualitative study of nurses’ clinical experience in recognising low mood and depression in older patients with multiple long-term conditions
- Authors:
- WATERWORTH Susan, et al
- Journal article citation:
- Journal of Clinical Nursing, 24(17-18), 2015, pp.2562-2570.
- Publisher:
- John Wiley and Sons
Aims and objectives: To explore how nurses’ recognise depression in older patients with multiple long-term conditions and the strategies they use to support the patient. Background: Depression decreases an older person's quality of life and sense of wellness, and increases functional impairment. The positive role of nurses working with patients with long-term conditions is now being recognised internationally; however, there is a gap in the research about how nurses recognise depression in older patients and how this impacts on their practice. Design: This is a qualitative study informed by a constructivist grounded theory approach. Methods: In-depth telephone interviews were conducted with 40 nurses working in geographically diverse areas in New Zealand. Results: Having the conversation with older patients about their low moods, or specifically about depression was not something that all the nurses had, or felt they could have. While some nurses knew they could provide specific advice to patients, others believed this was not their responsibility, or within the scope of their role. Conclusion: Faced with an increasing number of older people with long-term conditions, one of which maybe depression itself or as a result of living with other long-term conditions, ongoing monitoring and support pathways are necessary to prevent further decline in the older person's quality of life and well-being. Relevance to clinical practice: Nurses in primary health care can build on current knowledge and skills to increase their capability to promote ‘ageing well’ with older people who have long-term conditions and depression. (Publisher abstract)