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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.
Fulfilled preferences, perceived control, life satisfaction, and loneliness in elderly long-term care residents
- Authors:
- ANDREW Nathaniel, MEEKS Suzanne
- Journal article citation:
- Aging and Mental Health, 22(2), 2018, pp.183-189.
- Publisher:
- Taylor and Francis
Objectives: Person-centred care constructs such as fulfilled preferences, sense of control, and life satisfaction might contribute to loneliness among nursing home residents, but these relationships have not been thoroughly explored. The aim of this study was to examine the relationship between fulfilled preferences and loneliness in nursing home residents with perceived control and life satisfaction as potential mediators. Methods: The study utilised a cross-sectional design, examining the targeted variables with a questionnaire administered by trained research staff. A convenience sample of 65 residents (median age = 71) of eight nursing homes were interviewed. Linear regression analysis was utilised to examine the mediation hypotheses. Results: The relationships between fulfilled preferences and loneliness (β = −.377, p = .002), fulfilled preferences and perceived control (β = −.577, p < .001), and perceived control and loneliness (β = .606, p < .001) were significant, and the relationship between fulfilled preferences and loneliness (β = −.040, p = .744) became non-significant when perceived control was included in the model. The relationships between fulfilled preferences and life satisfaction (β = .420, p < .001) and life satisfaction and loneliness (β = −.598, p < .001) were significant, and the relationship between fulfilled preferences and loneliness (β = −.152, p = .174) became non-significant when life satisfaction was included in the model. Conclusion: The findings suggest an important association between person-centred care, particularly fulfilling personal care and recreation preferences, and social-affective needs of long-term care residents. Fulfilling preferences may be an appropriate intervention target for loneliness. (Edited publisher abstract)
Psychological and social resources relate to biomarkers of allostasis in newly admitted nursing home residents
- Authors:
- MEEKS Suzanne, et al
- Journal article citation:
- Aging and Mental Health, 20(1), 2016, pp.88-99.
- Publisher:
- Taylor and Francis
Objectives: This paper presents preliminary baseline data from a prospective study of nursing home adaptation that attempts to capture the complexity of residents' adaptive resources by examining psychological, social, and biological variables from a longitudinal conceptual framework. The authors emphasis was on validating an index of allostasis. Method: In a sample of 26 long-term care patients, the authors measured 6 hormone and protein biomarkers to capture the concept of allostasis as an index of physiological resilience, related to other baseline resources, including frailty, hope and optimism, social support, and mental health history, collected via interview with the resident and collaterals. The authors also examined the performance of self-report measures reflecting psychosocial and well-being constructs, given the prevalence of cognitive impairment in nursing homes. Results: The results supported both the psychometric stability of our self-report measures, and the preliminary validity of our index of allostasis. Each biomarker was associated with at least one other resilience resource, suggesting that our choice of biomarkers was appropriate. As a group, the biomarkers showed good correspondence with the majority of other resource variables, and our standardised summation score was also associated with physical, social, and psychological resilience resources, including those reflecting physical and mental health vulnerability as well as positive resources of social support, optimism, and hope. Conclusion: Although these results are based on a small sample, the effect sizes were large enough to confer some confidence in the value of pursuing further research relating biomarkers of allostasis to psychological and physical resources and well-being. (Edited publisher abstract)
The Pleasant Events Schedule - Nursing Home Version: a useful tool for behavioral interventions in long-term care
- Authors:
- MEEKS Suzanne, SHAH Shruit N., RAMSEY Sarah K.
- Journal article citation:
- Aging and Mental Health, 13(3), May 2009, pp.445-455.
- Publisher:
- Taylor and Francis
Behavioural interventions for depression emphasize increasing engagement in pleasant events, requiring reliable and valid assessment of events. Versions of the Pleasant Events Schedule (PES) have been developed for this purpose. The goal of this study was to develop and evaluate a nursing home version of the PES. The PES-NH was developed on two samples of nursing home residents. First activity frequency and pleasantness for 10 residents of a large, urban facility in the US was sampled. Using these pilot data and PES-Alzheimer's Disease items, 37 more residents from the same facility were interviewed, yielding a comprehensive list of events that residents find pleasant. From the second sample of 48 residents, normative and psychometric data on the new scale are presented. A 30-item inventory was able to cover the content of daily activities available in nursing homes. Scales derived from these items were internally consistent and reliable over time. Frequency of event participation was related to perceptions of quality of life, depression and positive affect independent of the overall tendency to rate events as pleasantness. Event participation was unrelated to negative affect, suggesting that activity engagement is linked to depression through its impact on positive affect. Data from this study provide base rate information for planning pleasant event interventions in nursing homes. The PES-NH is a useful and valid tool for implementing behavioural interventions for depression in these settings.