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Preventing depression in homes for older adults: are effects sustained over 2 years?
- Authors:
- SCHAIK Dinga J.F. van, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 29(2), 2014, pp.191-197.
- Publisher:
- Wiley
Methods: A 2-year follow-up study of a pragmatic randomised controlled trial was conducted in 14 residential homes in the Netherlands to evaluate the 2-year effects of a stepped-care programme to prevent the onset of a major depressive disorder (MDD). A total of 185 residents (Center for Epidemiologic Studies Depression Scale score >7), who did not meet the diagnostic criteria for MDD, were randomised to a stepped-care programme (n = 93) or to usual care (n = 92). Stepped-care participants sequentially underwent watchful waiting, a self-help intervention, life review and a consultation with the general practitioner. The primary outcome measure was the incidence of MDD during a period of 2 years, according to the Mini International Neuropsychiatric Interview. Results: After 2 years, the incidence of MDD was not significantly reduced in the intervention group compared with the control group. However, in the completer analysis, on the basis of 79 residents who completed the 2-year measurements, there was a significant difference in favour of the intervention group. Dropout percentages were high (44%), mostly accounted for by illness and death (68%). Conclusion: A minority of residents had benefit from the intervention that sustained after 2 years in the completer group. Yet, these findings cannot be generalised as the majority of the residents did not opt for participation in the project and many dropped out. Ways should be sought to motivate residents with depressive symptoms to engage in preventive interventions. (Edited publisher abstract)
BE-ACTIV: a staff-assisted behavioral intervention for depression in nursing homes
- Authors:
- MEEKS Suzanne, et al
- Journal article citation:
- Gerontologist, 48(1), February 2008, pp.105-114.
- Publisher:
- Oxford University Press
This article (a) describes a 10-week, behavioural, activities-based intervention for depression that can be implemented in nursing homes collaboratively with nursing home activities staff and (b) presents data related to its development, feasibility, and preliminary outcomes. BE-ACTIV, which stands for Behavioral Activities Intervention, was developed in two pilot study phases: a treatment development phase and a feasibility–outcome phase with a small, randomized trial. The intervention was piloted with five depressed residents in a single nursing home in collaboration with the social services and activities staff. In the second phase randomized 20 residents from six nursing homes to receive either the intervention or treatment as usual. The intervention was well received by residents, family, and staff members. Experience with the intervention and input from staff members resulted in modifications to streamline the intervention and improve implementation. Results suggest that BE-ACTIV reduced institutional barriers to participation in pleasant activities, increased resident control over activity participation, increased overall activity participation, and improved depressive symptoms. Despite low power, statistical and graphical comparisons suggest superiority of the intervention over treatment as usual. Because depression among nursing home residents is prevalent, heterogeneous, and often treatment resistant, there is a need for effective, low-cost interventions that are ecologically acceptable and efficient. BE-ACTIV is a promising intervention; it is brief, addresses institutional barriers, involves facility staff in treatment, and is acceptable to residents. As such, BE-ACTIV merits further evaluation to establish efficacy and effectiveness.
Dementia and depression among nursing home residents in Lebanon: a pilot study
- Authors:
- CHAHINE L.M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(4), April 2007, pp.283-285.
- Publisher:
- Wiley
The aim of this study was to investigate the prevalence of dementia and depression among a portion of nursing home residents (NHR) in Lebanon and describe the characteristics of NHR afflicted with dementia and depression. Of 200 NHR from three NH in Lebanon, 117 were selected by random sampling. Data on demographics and medical history were collected. An Arabic version of the Mini-Mental Status Examination and Geriatric Depression Scale (GDS) were administered. The final sample consisted of 102 NHR. Sixty-one (59.8%) had dementia of some kind. Seventeen (27.9%) had mild dementia, 14 (22.9%) had moderate dementia, and 30 (49.2%) had severe dementia. Forty-five (57.7%) of the NHR tested had depression as measured by a GDS score of more than 10. Dementia and depression were present in more than half of the NHR in our sample. The results highlight the importance of screening NHR for dementia and depression on admission and at regular time intervals.
The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment
- Authors:
- DAVISON T. E., et al
- Journal article citation:
- Aging and Mental Health, 11(1), January 2007, pp.82-88.
- Publisher:
- Taylor and Francis
Previous research has demonstrated a high level of depression in nursing homes. The current study was designed to determine the prevalence of depression, using a structured diagnostic interview, among older people with and without mild-moderate cognitive impairment residing in low-level care facilities. The results demonstrated that, consistent with previous research in nursing homes, 16.9% of older people were diagnosed with major depressive disorder. Less than half of these cases had been detected or treated. Individuals with moderate cognitive impairment were more likely to be depressed, but cognitive impairment did not appear to act as a strong impediment to the detection of depression by general practitioners. A low awareness of their use of antidepressant medications was demonstrated among older people prescribed this treatment, including those with normal cognitive function. Reasons for the poor recognition of depression among older people are discussed.
Recognising and managing depression in residents of aged care homes: the final report of the Challenge Depression project
- Author:
- HAMMOND CARE GROUP
- Publisher:
- Australia. Department of Health and Ageing
- Publication year:
- 2004
- Pagination:
- 55p.
- Place of publication:
- Canberra, ACT
A survey of 1758 residents in 168 aged care homes from every state and territory in Australia was carried out to ascertain the scale of the problem of depression amongst residents. Results from residents able to complete the Geriatric Depression Scale indicate that 51% of high care and 30% of low care residents are depressed. Results from those only able to be assessed with the Cornell Rating Scale (the severely cognitively impaired) indicate that 38% of high care and 26% of low care residents are depressed. Under normal circumstances a significant proportion of depressed residents go unnoticed. Staff were often not aware of information that would help them to notice and understand the depression in the people around them. When staff are obliged to look at residents in a systematic way their recognition of the symptoms of depression improves.
Fear of falling and depressive symptoms in Chinese elderly living in nursing homes: fall efficacy and activity level as mediator or moderator?
- Authors:
- CHOU K.-L., YEUNG F. K. C., WONG E. C. H.
- Journal article citation:
- Aging and Mental Health, 9(3), May 2005, pp.255-261.
- Publisher:
- Taylor and Francis
This study examines the relationship between fear of falling and depressive symptoms as well as the role of participation in physical activity and fall efficacy in the linkage between the fear of falling and depression. A sample of 100 residents living in nursing homes in Hong Kong were interviewed. Using multiple regression models, it was found that elderly persons who had greater fear of falling tended to report depressive symptoms more frequently after controlling socio-demographic and physical health status variables. In addition, activity involvement and fall efficacy acted as mediators and moderators in the link between the fear of falling and depression.
The relationship between quality of life in a nursing home and personal, organizational, activity-related factors and social satisfaction: a cross-sectional study with multiple linear regression analyses
- Authors:
- MAENHOUT Annelies, et al
- Journal article citation:
- Aging and Mental Health, 24(4), 2020, pp.649-658.
- Publisher:
- Taylor and Francis
Objectives: This study aimed to investigate quality of life in nursing home residents and the relationship with personal, organizational, activity-related factors and social satisfaction. Methods: In a cross-sectional survey study in 73 nursing homes in Flanders, Belgium, 171 cognitively healthy residents were randomly recruited (mean age 85.40 years [±5.88]; 27% men, 73% women). Quality of life, as the dependent/response variable, was measured using anamnestic comparative self-assessment (range −5 to +5). Multiple linear regression (forward stepwise selection) was used (1) to investigate which factors were significantly related to nursing home residents’ quality of life and (2) to model the relationship between the variables by fitting a linear equation to the observed data. Results: Nursing home residents reported a quality of life score of 2.12 (±2.16). Mood, self-perceived health status, social satisfaction and educational level were withheld as significant predictors of the anamnestic comparative self-assessment score (p < 0.001), explaining 38.1% of the variance in quality of life. Conclusions: Results suggest that a higher quality of life in nursing homes can be pursued by strategies to prevent depression and to improve nursing home residents’ subjective perception of health (e.g. offering good care) and social network. It is recommended that nursing homes prepare for future generations, who will be more educated. (Publisher abstract)
Prevalence and correlates of major depressive disorder, bipolar disorder and schizophrenia among nursing home residents without dementia: systematic review and meta-analysis
- Authors:
- FORNARO Michele, et al
- Journal article citation:
- British Journal of Psychiatry, 216(1), 2020, pp.6-15.
- Publisher:
- Cambridge University Press
Background: The elderly population and numbers of nursing homes residents are growing at a rapid pace globally. Uncertainty exists regarding the actual rates of major depressive disorder (MDD), bipolar disorder and schizophrenia as previous evidence documenting high rates relies on suboptimal methodology. Aims: To carry out a systematic review and meta-analysis on the prevalence and correlates of MDD, bipolar disorder and schizophrenia spectrum disorder among nursing homes residents without dementia. Method: Major electronic databases were systematically searched from 1980 to July 2017 for original studies reporting on the prevalence and correlates of MDD among nursing homes residents without dementia. The prevalence of MDD in this population was meta-analysed through random-effects modelling and potential sources of heterogeneity were examined through subgroup/meta-regression analyses. Results: Across 32 observational studies encompassing 13 394 nursing homes residents, 2110 people were diagnosed with MDD, resulting in a pooled prevalence rate of 18.9% (95% CI 14.8–23.8). Heterogeneity was high (I2 = 97%, P≤0.001); no evidence of publication bias was observed. Sensitivity analysis indicated the highest rates of MDD among North American residents (25.4%, 95% CI 18–34.5, P≤0.001). Prevalence of either bipolar disorder or schizophrenia spectrum disorder could not be reliably pooled because of the paucity of data. Conclusions: MDD is highly prevalent among nursing homes residents without dementia. Efforts towards prevention, early recognition and management of MDD in this population are warranted. (Publisher abstract)
Cost-effectiveness of a stepped care programme to prevent depression and anxiety in residents in homes for the older people: a randomised controlled trial
- Authors:
- BOSMANS J. E., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 29(2), 2014, pp.182-190.
- Publisher:
- Wiley
Background: Depression and anxiety are common in residents of elderly homes. Both disorders have negative effects on functioning, well-being and health-care utilisation. Besides treatment, prevention can be an option to reduce the burden of mental disorders. The objective of this study was to evaluate the cost-effectiveness of a stepped care programme to prevent the onset of depression and anxiety disorders in residents of elderly homes compared with usual care from a societal perspective. Methods: Outcomes were incidence of depression and/or anxiety, severity of depressive and anxiety symptoms and quality-adjusted life years. Health-care utilisation was measured during interviews. Multiple imputation was used to impute missing cost and effect data. Uncertainty around cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and acceptability curves were created. Results: The incidence of depression and anxiety combined in the intervention group was not reduced in comparison with the usual care group. There was also no effect on the other outcomes. Mean total costs in the intervention group were €838 higher than in the usual care group, but this difference was not statistically significant (95% confidence interval, −593 to 2420). Cost-effectiveness planes showed that there was considerable uncertainty. Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.46 for reducing the incidence of depression and anxiety combined. Conclusion: A stepped care programme to prevent depression and anxiety in older people living in elderly homes was not considered cost-effective in comparison with usual care. (Publisher abstract)
Beside the Geriatric Depression Scale: the WHO-Five Well-being Index as a valid screening tool for depression in nursing homes
- Authors:
- ALLGAIER Antje-Kathrin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 28(11), 2013, pp.1197-1204.
- Publisher:
- Wiley
The aim of the study was to compare criterion validities of the WHO-Five Well-being Index (WHO-5) and the Geriatric Depression Scale 15-item version (GDS-15) and 4-item version (GDS-4) as screening instruments for depression in nursing home residents. Data from 92 residents aged 65–97 years without severe cognitive impairment (Mini Mental State Examination ≥15) were analysed. Criterion validities of the WHO-5, the GDS-15 and the GDS-4 were assessed against diagnoses of major and minor depression provided by the Structured Clinical Interview for DSM-IV. Subanalyses were performed for major and minor depression. Areas under the receiver operating curve (AUCs) as well as sensitivities and specificities at optimal cut-off points were computed. Prevalence of depressive disorder was 28.3%. The AUC value of the WHO-5 (0.90) was similar to that of the GDS-15 (0.82). Sensitivity of the WHO-5 at its optimal cut-off of ≤12 was significantly higher than that of the GDS-15 at its optimal cut-off of ≥7. The WHO-5 was equally sensitive for the subgroups of major and minor depression, whereas the GDS-15 was sensitive only for major depression, but not for minor depression. For specificity, there was no significant difference between WHO-5 and GDS-15, but both instruments outperformed the GDS-4. The WHO-5 demonstrated high sensitivity for major and minor depression. Being shorter than the GDS-15 and superior to the GDS-4, the WHO-5 is a promising screening tool that could help physicians improve low recognition rates of depression in nursing home residents. (Edited publisher abstract)