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Depression indicators in a national sample of older community and care home patients: applying the Quality and Outcomes Framework
- Authors:
- HARRIS Tess, et al
- Journal article citation:
- British Journal of General Practice, 61(583), February 2011, pp.135-138.
- Publisher:
- Royal College of General Practitioners
Depression is common and often under-recognised in older people, particularly care home residents and is associated with chronic health problems. The importance of detecting depression in these adults has been recognised by the UK Quality and Outcomes Framework (QOF) which rewards GPs for depression case finding in patients with diabetes and ischaemic heart disease. The objective of this study was to examine the use of case finding and assessment of depression in older community and care home patients. In a national primary care database sample of older people (65 years and over) depression screening was recorded in the last 15 months for 81% (83,588/103,821) of the community and 58% (1702/2940) of care home residents with diabetes or heart disease. Overall, 66% (1418/2145) of community and 22% (26/118) of care home residents with a new depression episode had a depression-severity assessment recorded. Age, sex, and higher care home dementia prevalence did not explain these differences. It appears that older people in general, and those in care homes in particular, are not being screened for depression or having their severity assessed as often as younger adults. The authors suggest that GPs need to consider how to improve their case finding in these groups, especially those in care homes, given their markedly increased risk of depression.
Communication in heart failure: perspectives from older people and primary care professionals
- Authors:
- BARNES Sarah, et al
- Journal article citation:
- Health and Social Care in the Community, 14(6), November 2006, pp.482-490.
- Publisher:
- Wiley
The objective of this study was to explore the attitudes of older people and primary care professionals towards communication of diagnosis, prognosis and symptoms in heart failure. Forty-four interviews were conducted with people aged over 60 years with heart failure (New York Heart Association III–IV) recruited from general practices in the UK. Ten focus groups were held with primary care professionals involved in heart failure management. Data were analysed thematically with the aid of the NUD*IST computer program. Participants reported problems with communication, including not being given enough information about their condition, or being given complex information that they did not understand. Many understood little about heart failure and the causes of, and ways to manage, their symptoms. Few participants had had discussions about the prognosis with any health professional, and this was confirmed in professional accounts. Difficulties with terminology were frequently reported: a diagnosis of 'heart failure' was rarely communicated to patients to avoid causing anxiety. Educational needs were identified by most primary care professionals in relation to heart failure management and specifically in relation to communication. In conclusion, communication was identified as being inadequate within primary care from both the patient and professional perspectives. These findings point to a need for an educational intervention tailored specifically to the need to improve the communication skills of primary care professionals in chronic heart failure.
Medical comorbidity in late-life depression
- Authors:
- TAYLOR Warren D., McQUOID Douglas R., KRISHNAN Ranga Rama
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(10), October 2004, pp.935-943.
- Publisher:
- Wiley
Medical comorbidity is common in elderly patients with depression, however the difference between depressed and non-depressed elderly populations is not well established. Additionally, differences between subgroups of depressed populations, including those with MRI-defined vascular depression and those with late-onset compared with early-onset depression are not well described. The authors compared self-report of medical disorders between 370 depressed elders and 157 non-depressed control subjects. Subjects were additionally dichotomized based on presence or absence of subcortical MRI lesions and age of onset. Medical comorbidity was assessed by self report only, and depressed subjects were additionally assessed by the clinician-rated Cumulative Illness Rating Scale. When compared with the non-depressed group, depressed subjects were significantly more likely to report the presence of hypertension, heart disease, gastrointestinal ulcers, and hardening of the arteries. Analyses of subjects with subcortical disease demonstrated they were significantly older, more likely to have depression, and more likely to report the presence of hypertension. Finally, the depressed cohort with late-onset depression (occurring after age 50 years) had more male subjects, exhibited greater CIRS scores, and greater prevalence of hypertension, but these did not reach a level of statistical significance after applying a Bonferroni correction. Vascular comorbidities are common in depressed elders. The differences in the report of hypertension supports past work investigating a vascular contribution to late-life depression. Given the association between depression and poor medical outcomes of cardiac disease, this population deserves clinical scrutiny and further research.
Congestive heart failure patients' perceptions of quality of life: the integration of physical and psychosocial factors
- Authors:
- BOSWORTH H. B., et al
- Journal article citation:
- Aging and Mental Health, 8(1), January 2004, pp.83-91.
- Publisher:
- Taylor and Francis
Congestive heart failure (CHF) lowers survival and worsens the quality of life (QOL) of over four million older Americans. Both clinicians and standardized instruments used to assess the QOL of patients with CHF focus primarily on physical symptoms rather than capturing the full range of psychosocial concerns. The purpose of this study was to gather descriptions of the components of QOL as understood by patients living with CHF. Focus groups were conducted with patients with known CHF, New York Heart Association (NYHA) class I-IV, and left ventricular fraction of <40%. Focus groups were audiotaped, transcribed, and reviewed for common and recurrent themes using the methods of constant comparisons. We conducted three focus groups (n = 15) stratified by NYHA stage with male patients ranging in age from 47-82 years of age. Five patients were classified with NYHA stage III/IV and ten with NYHA stage I/II. Thirty attributes of QOL were identified which fell into five broad domains: symptoms, role loss, affective response, coping, and social support. Expectedly, patients reported the importance of physical symptoms; however, participants also identified concern for family, the uncertainty of prognosis, and cognitive function as dimensions of QOL. Changes in patients' lives attributed to CHF were not always considered deficiencies; rather, methods of coping with CHF were identified as important attributes representing possible opportunities for personal growth. Clinicians must understand the full range of concerns affecting the QOL of their older patients with CHF. The findings suggest that psychosocial aspects and patient uncertainty about their prognosis are important components of QOL among CHF patients.
Measuring disease: a review of disease-specific quality of life measurement scales
- Author:
- BOWLING Ann
- Publisher:
- Open University Press
- Publication year:
- 2001
- Pagination:
- 415p.,bibliog.
- Place of publication:
- Buckingham
- Edition:
- 2nd.
In assessing the outcome of disease and treatments, measurement scales must be relevant to their specific effects, necessitating the use of disease-specific questionnaires rather than more generic measures. This book reviews disease-specific measure of quality of life and, where relevant popularly used symptom and single dimension scales. Disease covered include: cancers, psychiatric and psychological conditions, respiratory diseases, neurological conditions, rheumatological conditions, cardiovascular diseases, HIV/AIDS, and others.