Search results for ‘Subject term:"older people"’ Sort:
Results 1 - 10 of 77
The impact of executive function on response to cognitive behavioral therapy in late-life depression
- Authors:
- GOODKIND Madeleine S., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(4), 2016, pp.334-339.
- Publisher:
- Wiley
Objective: Late-life depression (LLD) is a common and debilitating condition among older adults. Cognitive behavioural therapy (CBT) has strong empirical support for the treatment of depression in all ages, including in LLD. In teaching patients to identify, monitor, and challenge negative patterns in their thinking, CBT for LLD relies heavily on cognitive processes and, in particular, executive functioning, such as planning, sequencing, organising, and selectively inhibiting information. It may be that the effectiveness of CBT lies in its ability to train these cognitive areas. Methods: Participants with LLD completed a comprehensive neuropsychological battery before enrolling in CBT. The current study examined the relationship between neuropsychological function prior to treatment and response to CBT. Results: When using three baseline measures of executive functioning that quantify set shifting, cognitive flexibility, and response inhibition to predict treatment response, only baseline Wisconsin Card Sort Task performance was associated with a significant drop in depression symptoms after CBT. Specifically, worse performance on the Wisconsin Card Sort Task was associated with better treatment response. Conclusions: These results suggest that CBT, which teaches cognitive techniques for improving psychiatric symptoms, may be especially beneficial in LLD if relative weaknesses in specific areas of executive functioning are present. (Publisher abstract)
Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up
- Authors:
- LICHT E., et al
- Journal article citation:
- British Medical Journal, 21.2.09, 2009, pp.463-466.
- Publisher:
- British Medical Association
This study aimed to investigate the duration of depression, recovery over time, and predictors of prognosis in an older cohort (55 years) in 32 general practices in West Friesland, the Netherlands. Participants were 234 patients aged 55 years or more with a prevalent major depressive disorder. Main outcome measures were depression at baseline and every six months using structured diagnostic interviews (primary care evaluation of mental disorders according to diagnoses in Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and a measure of severity of symptoms (Montgomery Åsberg depression rating scale). The main outcome measures were time to recovery and the likelihood of recovery at different time points. Multivariable analyses were used to identify variables predicting prognosis. The median duration of a major depressive episode was 18.0 months (95% confidence interval 12.8 to 23.1). 35% of depressed patients recovered within one year, 60% within two years, and 68% within three years. A poor outcome was associated with severity of depression at baseline, a family history of depression, and poorer physical functioning. During follow-up functional status remained limited in patients with chronic depression but not in those who had recovered. Depression among patients aged 55 years or more in primary care has a poor prognosis. Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.
Elderly suicide attempters: characteristics and outcome
- Authors:
- LEBRET Stephane, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(11), November 2006, pp.1052-1059.
- Publisher:
- Wiley
The authors made a descriptive survey to assess the outcome of elderly patients discharged from a hospital psychiatric service after a suicide attempt (rates of overall mortality and repeat attempts), to identify the factors that had a significant impact on their survival and to determine patient characteristics. Fifty-nine suicide attempters over 60 years of age admitted to hospital between 1993 and 2000 were included in the study. Their outcome was assessed by questioning their attending physicians over the telephone. We traced 51 of the 59 patients; 8 were lost to follow-up. Statistical analysis (Log Rank tests, Cox model) was computed to determine which factors altered the overall survival and the survival without further attempt. The patients sociodemographic, medical and psychiatric characteristics were recorded from hospital patient files. Elderly suicide attempters showed an increased mortality from suicide and natural causes and the risk of a repeat attempt increased in female patients with memory disorders. The factors altering survival were advanced age, pre-existing physical disability, several co-existing physical illnesses, severe physical consequences of the suicide attempt, history of psychiatric illness other than depression, memory disorders and one previous suicide attempt. The elderly suicide attempter was most likely to be a widowed woman suffering from social isolation, loneliness and depression. Elderly suicide attempters remained both physically and mentally vulnerable after their attempt. A repeat act represents a turning point in personal life progression which it is essential to detect.
Treatment, outcome and predictors of response in elderly depressed in-patients
- Authors:
- HEEREN T.J., et al
- Journal article citation:
- British Journal of Psychiatry, 170, May 1997, pp.436-440.
- Publisher:
- Cambridge University Press
Describes a study to assess the effectiveness of antidepressant treatment of depressed older people in the Netherlands. Concludes that a relatively poor outcome of the anti-depressant treatment of elderly depressives was found. A combination of low treatment expectations and fear of vigorous treatment seems to have been important.
Computerised cognitive behavioural therapy for depression and anxiety with older people: a pilot study to examine patient acceptability and treatment outcome
- Authors:
- McMURCHIE William, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(11), 2013, pp.1147-1156.
- Publisher:
- Wiley
The study aimed to determine the acceptability and treatment outcome of using Beating the Blues (BTB) with older people (65+ years). Specific aims included identifying the treatment uptake and drop-out rate, and describing the role of basic demographics in therapy uptake. Fifty-eight participants who were experiencing symptoms of depression were recruited from Older People Community Mental Health Teams across Tayside, Scotland. They were given a free choice of receiving treatment as usual (TAU) plus BTB (TAU + BTB) or TAU alone. All participants completed demographic questionnaires and a range of outcome measures at baseline, 2 months after baseline (end of treatment) and 3 months after baseline (follow-up). Thirty-three participants (56.9%) opted to receive BTB and reported having more experience and confidence using a computer than those who declined BTB. Twenty-four participants (72.7%) went on to complete all eight BTB sessions. Statistical analysis found significant differences between the two treatment groups, with the TAU + BTB group showing greater improvements in their symptoms of depression and anxiety than the TAU group by the end of treatment and at follow-up. Furthermore, the TAU + BTB group had a significantly higher percentage of participants who met criteria for clinically significant improvement in their symptoms of depression by the end of treatment and at follow-up. The results of this initial pilot study provide evidence that BTB may offer an acceptable and effective treatment option for older people. (Edited publisher abstract)
Specialist mental health consultation for depression in Australian aged care residents with dementia: a cluster randomized trial
- Authors:
- MCSWEENEY Kate, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(11), November 2012, pp.1163-1171.
- Publisher:
- Wiley
There is a high prevalence of depression in nursing home residents with dementia, and data has indicated an inadequate approach to the management of depression in this setting. This randomised controlled trial examined whether multidisciplinary specialist mental health consultation was more effective than care as usual in treating the depression of aged care residents with dementia. Three hundred and eighty nine older care residents were screened for dementia and major depression. Forty four were ultimately included in the intervention sample, selected from care facilities in Melbourne, Australia. Consultations involved individually tailored medical and psychosocial recommendations provided to care staff and general practitioners. All residents participated in a comprehensive pre-intervention diagnostic assessment. Findings revealed that multidisciplinary specialist mental health consultation was significantly more effective than care as usual in treating the clinical depression of aged care residents with dementia. At follow-up, 77% of the intervention group no longer met criteria for major depression. The authors concluded that the management of depressed older care residents could be improved by increasing access to specialist mental health consultation.
A self-help behavioral activation treatment for geriatric depressive symptoms
- Authors:
- MOSS Kathryn, et al
- Journal article citation:
- Aging and Mental Health, 16(5), July 2012, pp.625-635.
- Publisher:
- Taylor and Francis
This study investigated behavioural activation (BA) bibliotherapy as a treatment for late-life depressive symptoms. BA bibliotherapy was administered using Addis and Martell's Overcoming depression one step at a time as a stand-alone treatment that was completed by 26 participants over a 4-week period in Alabama, United States. Results of an immediate intervention group were compared with those of a delayed treatment control group and treatment response for both groups was evaluated at 1-month follow-up. Findings indicated that symptoms on a clinician-rated measure of depressive symptoms were significantly lower at post-treatment for those who received immediate BA bibliotherapy compared with those who were in the delayed treatment control condition. However, self-reported depressive symptoms were not significantly different. Self-reported depressive symptoms were significantly lower from pre-treatment to 1-month follow-up. The authors concluded that BA could be useful in treating mild depressive symptoms in older adults.
Prognostic factors, course, and outcome of depression among older primary care patients: the PROSPECT study
- Authors:
- BOGNER Hillary R., et al
- Journal article citation:
- Aging and Mental Health, 16(4), May 2012, pp.452-461.
- Publisher:
- Taylor and Francis
Major depression describes a clinically diverse set of people; while some patients may respond quickly to treatment, others may have a slower road to recovery. The aim of this study was to examine whether there are patterns of evolving depression symptoms among older primary care patients that are related to prognostic factors and long-term clinical outcomes. The study used data from the PROSPECT study, a multi-site, collaborative study of depression treatment in primary care settings for elderly patients. Primary care practices were randomly assigned to usual care or to an intervention consisting of a depression care manager offering algorithm-based depression care. For this study, 599 adults aged 60 years and older meeting criteria for major depression or clinically significant minor depression were randomly selected. Analysis revealed 3 patterns of change in depression symptoms over 12 months: high persistent course (19.1%); high declining course (14.4%); and low declining course (66.5%). Being in the intervention condition was more likely to be associated with a course of high and declining depression symptoms than high and persistent depression symptoms. Patients with a course of high and persistent depression symptoms were much more likely to have a diagnosis of major depression at 24 months compared with patients with a course of low and declining depression symptoms.
An exploratory study of inducing positive expectancies for psychotherapy
- Authors:
- WOODHEAD Erin L., IVAN Iulia I., EMERY Erin E.
- Journal article citation:
- Aging and Mental Health, 16(1-2), January 2012, pp.162-166.
- Publisher:
- Taylor and Francis
Older adults have significantly lower rates of psychotherapy use than both younger and middle-aged adults. This article considers whether priming patients for successful treatment outcomes can increase patient motivation for treatment and improve psychotherapy initiation. The study investigated whether explicit presentation of outcome data about the effectiveness of psychotherapy among older adults increased positive expectancy for treatment. The participants were an ethnically diverse sample of 50 adults over 60 years who screened positive for depression and had been referred to the BRIGHTEN Program, an interdisciplinary geriatric mental health programme. Prior to treatment initiation, the participants were presented with outcome data. During semi-structured interviews, the participants were asked to rate and respond to the data. The results suggest that information about the effectiveness of psychotherapy was important to participants, and that higher importance ratings were associated with increased rates of starting psychotherapy. This association was partially explained by the outcome data increasing hopefulness for successful treatment. More severely depressed patients were more likely to rate the outcome data as more important. The study suggests that explicit presentation of the effectiveness of psychotherapy may create positive expectancies for treatment among older adults.
Change in stress and social support as predictors of cognitive decline in older adults with and without depression
- Authors:
- DICKINSON Whitney J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(12), December 2011, pp.1267-1274.
- Publisher:
- Wiley
This study investigated whether increased in stressful life events or decreased social support lead to subsequent cognitive decline among older adults, with and without depression. Participants included 112 depressed and 101 non-depressed older people who enrolled in the Neurocognitive Outcomes of Depression in the Elderly study in the United States. They were clinically assessed, agreed to interviews on stressful life events and social support, and underwent neuropsychological tests. Cognitive measure was by way of the Consortium to Establish a Registry in Alzheimer's disease Total Score (CERAD TS). Findings revealed that a decline in the total number of stressors was associated with a subsequent improvement on CERAD TS. In terms of social support and decreased social interaction, instrumental social support predicted decline in cognitive performance. The authors concluded that biological studies should be conducted to further understand the relationship between stress, social support and cognition in older people, both with and without depression.