INGERSOLL-DAYTON Berit, CAMPBELL Ruth, HA Jung-Hwa
Journal article citation:
Journal of Gerontological Social Work, 52(1), January 2009, pp.2-16.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
When older people reminisce about the past, powerful feelings of anger, sadness and betrayal can emerge that have significant mental health implications. This paper describes a therapeutic model of forgiveness developed by Enright and discusses its applicability to a social work intervention in which 20 people (mostly women and all White) aged 57-82 participated in two different forgiveness groups which met weekly for eight sessions, with a four-month follow-up session. Measures of forgiveness and biopsychosocial functioning were taken before and after the intervention, The results showed that participants experienced long term improvement in forgiveness and depression, and short term improvement in physical health, but no improvement in anxiety or social support. The implications for social workers are discussed.
When older people reminisce about the past, powerful feelings of anger, sadness and betrayal can emerge that have significant mental health implications. This paper describes a therapeutic model of forgiveness developed by Enright and discusses its applicability to a social work intervention in which 20 people (mostly women and all White) aged 57-82 participated in two different forgiveness groups which met weekly for eight sessions, with a four-month follow-up session. Measures of forgiveness and biopsychosocial functioning were taken before and after the intervention, The results showed that participants experienced long term improvement in forgiveness and depression, and short term improvement in physical health, but no improvement in anxiety or social support. The implications for social workers are discussed.
Journal of Aging and Social Policy, 21(2), April 2009, pp.130-143.
Publisher:
Routledge
Place of publication:
Philadelphia, USA
Data from the National Home and Hospice Care Survey indicate that patients receiving home care from non-profit agencies were more likely to be discharged within 30 days under Medicare cost-based payment than patients served by for-profit agencies. However, there were no meaningful differences in discharge outcomes between non-profit and for-profit clients suggesting that, under a cost-based payment system, non-profit agencies may behave more efficiently than for-profit agencies.
Data from the National Home and Hospice Care Survey indicate that patients receiving home care from non-profit agencies were more likely to be discharged within 30 days under Medicare cost-based payment than patients served by for-profit agencies. However, there were no meaningful differences in discharge outcomes between non-profit and for-profit clients suggesting that, under a cost-based payment system, non-profit agencies may behave more efficiently than for-profit agencies.
Subject terms:
home care, older people, outcomes, private sector, voluntary organisations;
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.
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.
Subject terms:
longitudinal studies, older people, outcomes, primary care, depression;
The eleven studies, all randomised controlled trials, included in this systematic review varied considerably in their study methodology and the type and delivery of the physical activity (PA) interventions used. The results suggest that positive outcomes can be seen in older people in the short term but evidence of medium-term and long-term effects on depression and depressive symptoms is lacking. Further research is needed to investigate longer term outcomes, the types of physical activity that may be beneficial, the effects of the duration and intensity of interventions, and cost-effectiveness.
The eleven studies, all randomised controlled trials, included in this systematic review varied considerably in their study methodology and the type and delivery of the physical activity (PA) interventions used. The results suggest that positive outcomes can be seen in older people in the short term but evidence of medium-term and long-term effects on depression and depressive symptoms is lacking. Further research is needed to investigate longer term outcomes, the types of physical activity that may be beneficial, the effects of the duration and intensity of interventions, and cost-effectiveness.
Extended abstract:
Author
BLAKE H.; et al.;
How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review.
Journal citation/publication details
Clinical Rehabilitation, 23(10), pp.873-887.
Summary
The eleven studies, all randomised controlled trials, included in this systematic review varied considerably in their study methodology and the type and delivery of the physical activity (PA) interventions used. The results suggest that positive outcomes can be seen in older people in the short term but evidence of medium-term and long-term effects on depression and depressive symptoms is lacking. Further research is needed to investigate longer term outcomes, the types of physical activity that may be beneficial, the effects of the duration and intensity of interventions, and cost-effectiveness.
Context
Moderate exercise has been associated with a diverse range of health benefits, including a reduction in clinical depression, but research on the effects of exercise interventions as treatment for depressed older adults is limited. The aim of this study was to 'assess the efficacy of physical exercise interventions for alleviating depressive symptoms in depressed older people' over 60 years old.
Methods
What sources were searched? The electronic databases searched were: Medline, EMBASE, CINAHL, PsycINFO (all from the date of inception to May 2008), the Cochrane Library (Issue 2, 2008), and the National Research Register (NRR). Reference lists of relevant articles and previous reviews were hand searched for further material.
What search terms/strategies were used? A broad search strategy was developed using key words and synonyms for 'physical activity', 'older people' and 'depressive symptoms'. An example of a search strategy is detailed in an appendix.
What criteria were used to decide on which studies to include? Studies had to be randomised and controlled, or quasi-experimental, trials of exercise interventions delivered by trained individuals to people aged 60 or older who had been diagnosed with depressive symptoms at recruitment. At least 80% of participants had to be over 60 in order for studies to be eligible. Studies were not excluded on the basis of language.
Who decided on their relevance and quality? The abstracts and titles of articles identified from the electronic database searches were screened for relevance and full-text articles were obtained for further examination. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) and the Scottish Intercollegiate Guidelines Network (SIGN) guidelines (Table 3).
How many studies were included and where were they from? Of the 4,385 references initially identified, 29 were selected for further review, ten of which met the inclusion criteria; reasons for exclusion are presented in Table 1. One additional study was identified from the reference list searches. The geographical setting of the studies is not reported.
How were the study findings combined? The reviewers independently extracted data onto standardised forms with disagreements resolved by discussion. The characteristics and results of the included studies are summarised in Table 2 and as a narrative synthesis. Meta-analysis was not undertaken due to the heterogeneity of the studies.
Findings of the review
The 11 studies, all randomised controlled trials, varied in: the use of depression screening instruments; the type of physical activity and the intensity and duration of the PA intervention; the outcome measures used, and; the length of follow-up.
Most of the studies reported significant reduction in depression or depressive symptoms, immediately post intervention for participants in the PA activity groups compared to controls. The results for the studies in which the medium-term (3-12 months) effects were measured were mixed. Long-term (over 12 months) effects were measured in only two studies, again with mixed results.
Authors' conclusions
'Exercise intervention exerts a clinically relevant effect on depressive symptoms in older people'.
British Journal of Learning Disabilities, 37(3), September 2009, pp.207-212.
Publisher:
Wiley
A non-equivalent comparison group design was used to compare the quality of life of 59 people in three groups; older people without an intellectual disability living in older people's homes (n = 20), older people with an intellectual disability living in older people's homes (n = 19) and older people with an intellectual disability living in intellectual disability homes (n = 20). Data were collected on participant characteristics, adaptive behaviour and three aspects of quality of life; community involvement, participation in domestic living and choice making. The three groups were comparable in terms of gender, ethnicity and additional impairments but the older people without an intellectual disability were older and had more adaptive skills than the other groups. Older people with an intellectual disability experienced better quality of life outcomes in terms of participation in meaningful activity and community access when they lived in intellectual disability homes compared with older people's homes. It was not possible to achieve reliability on the measure of choice-making. This study provides some evidence to suggest that older people with an intellectual disability may be best served in intellectual disability homes rather than older people homes and that it is an area of research which needs further exploration.
A non-equivalent comparison group design was used to compare the quality of life of 59 people in three groups; older people without an intellectual disability living in older people's homes (n = 20), older people with an intellectual disability living in older people's homes (n = 19) and older people with an intellectual disability living in intellectual disability homes (n = 20). Data were collected on participant characteristics, adaptive behaviour and three aspects of quality of life; community involvement, participation in domestic living and choice making. The three groups were comparable in terms of gender, ethnicity and additional impairments but the older people without an intellectual disability were older and had more adaptive skills than the other groups. Older people with an intellectual disability experienced better quality of life outcomes in terms of participation in meaningful activity and community access when they lived in intellectual disability homes compared with older people's homes. It was not possible to achieve reliability on the measure of choice-making. This study provides some evidence to suggest that older people with an intellectual disability may be best served in intellectual disability homes rather than older people homes and that it is an area of research which needs further exploration.
Subject terms:
learning disabilities, older people, outcomes, quality of life, care homes, group homes;
This reports on research that set out to examine the extent to which LinkAge Plus (LAP) has been a tool for capacity building. A wide range of initiatives were created across the eight LAP pilot sites. The report analyses how they can contribute to an overall framework for effective capacity building. Contents include: capacity building: theory, research and policy; better use of existing services which increases number and range of older people benefiting from improved outcomes; development of new services creating different outcomes for older people.
This reports on research that set out to examine the extent to which LinkAge Plus (LAP) has been a tool for capacity building. A wide range of initiatives were created across the eight LAP pilot sites. The report analyses how they can contribute to an overall framework for effective capacity building. Contents include: capacity building: theory, research and policy; better use of existing services which increases number and range of older people benefiting from improved outcomes; development of new services creating different outcomes for older people.
Subject terms:
independence, older people, outcomes, access to services, capacity building, empowerment;
When government funding for long-term care is reduced, participant outcomes may be adversely affected. This study investigated the effect of program resources on individuals enrolled in the Michigan Home- and Community-Based Services (HCBS) waiver program for elderly and disabled adults. Using dates of major policy and budget changes, 4 distinct time periods between October 2001 and December 2005 were defined. Minimum Data Set for Home Care assessment records for HCBS participants (n = 112,182) were used to examine temporal trends in formal care hours and 6 outcomes: emergency room (ER) use, hospitalization, caregiver burden, death, nursing facility (NF) use, and permanent NF placement. Controlling for demographics, functional status, and cognitive status, adjusted odds of outcomes were obtained using discrete-time survival analysis. As resources diminished, mean formal care hours decreased, declining most for persons with moderate functional or cognitive impairment, for up to an approximately 30% decrease. In the most financially restricted period, 3 adverse outcomes increased relative to baseline: hospitalization, ER use, and permanent NF placement. Reductions in resources for home care were associated with increased probability of adverse outcomes. Cutting funds to home care programs can increase utilization of other more costly services, thus offsetting potential health care savings. Policymakers must consider all ways in which budget reductions and policy changes can affect participants.
When government funding for long-term care is reduced, participant outcomes may be adversely affected. This study investigated the effect of program resources on individuals enrolled in the Michigan Home- and Community-Based Services (HCBS) waiver program for elderly and disabled adults. Using dates of major policy and budget changes, 4 distinct time periods between October 2001 and December 2005 were defined. Minimum Data Set for Home Care assessment records for HCBS participants (n = 112,182) were used to examine temporal trends in formal care hours and 6 outcomes: emergency room (ER) use, hospitalization, caregiver burden, death, nursing facility (NF) use, and permanent NF placement. Controlling for demographics, functional status, and cognitive status, adjusted odds of outcomes were obtained using discrete-time survival analysis. As resources diminished, mean formal care hours decreased, declining most for persons with moderate functional or cognitive impairment, for up to an approximately 30% decrease. In the most financially restricted period, 3 adverse outcomes increased relative to baseline: hospitalization, ER use, and permanent NF placement. Reductions in resources for home care were associated with increased probability of adverse outcomes. Cutting funds to home care programs can increase utilization of other more costly services, thus offsetting potential health care savings. Policymakers must consider all ways in which budget reductions and policy changes can affect participants.
Subject terms:
home care, long term care, older people, outcomes, service uptake, cutbacks, financing;
The purpose of this longitudinal study was to determine the length of community tenure for adults aged 60 and older after application for nursing facility (NF) admission and to examine the proportion of older adults who lost community tenure due to either (a) death while a community resident or (b) permanent NF admission. In this 5-year prospective study, older adults who had applied for NF admission and were diverted (residing in the community 30 days later) were tracked. Four waves of NF applicants (N = 2,882) were identified, and those diverted (n = 599) were tracked for 60 months at 3-month intervals. Sixty months after diversion, 18.0% of older adults (n = 108) were residing in the community, 39.2% died as community residents (n = 235), and 42.7% (n = 256) became permanent NF residents. In all, 414 diverted older adults (69.1%) died during the 5 years following NF application, with the majority of deaths occurring while older adults were community residents.
The purpose of this longitudinal study was to determine the length of community tenure for adults aged 60 and older after application for nursing facility (NF) admission and to examine the proportion of older adults who lost community tenure due to either (a) death while a community resident or (b) permanent NF admission. In this 5-year prospective study, older adults who had applied for NF admission and were diverted (residing in the community 30 days later) were tracked. Four waves of NF applicants (N = 2,882) were identified, and those diverted (n = 599) were tracked for 60 months at 3-month intervals. Sixty months after diversion, 18.0% of older adults (n = 108) were residing in the community, 39.2% died as community residents (n = 235), and 42.7% (n = 256) became permanent NF residents. In all, 414 diverted older adults (69.1%) died during the 5 years following NF application, with the majority of deaths occurring while older adults were community residents.
Subject terms:
home care, long term care, longitudinal studies, older people, outcomes, community care;
Journal of Gerontological Social Work, 52(1), January 2009, pp.17-31.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
This study examines the treatment efficacy of a mental health geriatric interdisciplinary team in Tennessee, which includes social workers, a psychologist, a clinical nurse specialist, a psychiatrist, case managers and a programme manager, all with geriatric training. The sample consisted of 69 community dwelling clients aged 55 or older with severe mental health problems defined as schizophrenia, schizoaffective disorder, bipolar disorder or major recurrent depression. The majority had major recurrent depression. The results show a reduction in depressive symptoms and psychiatric hospital admissions, and an increase in life satisfaction, at six-month follow-up. No changes were found in health status or in medical hospital admissions.
This study examines the treatment efficacy of a mental health geriatric interdisciplinary team in Tennessee, which includes social workers, a psychologist, a clinical nurse specialist, a psychiatrist, case managers and a programme manager, all with geriatric training. The sample consisted of 69 community dwelling clients aged 55 or older with severe mental health problems defined as schizophrenia, schizoaffective disorder, bipolar disorder or major recurrent depression. The majority had major recurrent depression. The results show a reduction in depressive symptoms and psychiatric hospital admissions, and an increase in life satisfaction, at six-month follow-up. No changes were found in health status or in medical hospital admissions.
Subject terms:
integrated services, older people, outcomes, severe mental health problems, community health care, evaluation;
International Journal of Geriatric Psychiatry, 24(3), March 2009, pp.283-291.
Publisher:
Wiley
This study assesses the relative value of dementia for predicting hospitalization outcomes, taking into account comorbidity, functional and nutritional status in 435 inpatients (age 85.3 ± 6.7; 207 cognitively normal, 48 with mild cognitive impairment and 180 demented) from the acute and rehabilitation geriatric hospital of Geneva. Hospitalization outcomes (death in hospital, length of stay, institutionalisation and formal home care needs) were predicted using logistic regression models with sociodemographic characteristics, cognitive status, comorbid Charlson index-CCI, functional and nutritional status as independent variables. Moderate and severe dementia and poor physical function strongly predicted longer hospital stay, institutionalization and greater home care needs in univariate analyses. CCI was the best single predictor, with a four-fold difference in mortality rates between the highest and lowest scores. In multivariate analysis, the best predictor of institutionalisation was dementia, whereas the best predictor of death in hospital or longer hospital stay was higher comorbidity score, regardless of cognitive status. Functional status was the best predictor of greater home care needs. Dementia in very old medically ill inpatients was predictive only of discharge to a nursing home. Higher levels of comorbidity and poor functional status were more predictive than dementia for the other three hospitalization outcomes. Thus, comorbid medical conditions, functional and nutritional status should be considered, together with cognitive assessment, when predicting hospitalization outcome.
This study assesses the relative value of dementia for predicting hospitalization outcomes, taking into account comorbidity, functional and nutritional status in 435 inpatients (age 85.3 ± 6.7; 207 cognitively normal, 48 with mild cognitive impairment and 180 demented) from the acute and rehabilitation geriatric hospital of Geneva. Hospitalization outcomes (death in hospital, length of stay, institutionalisation and formal home care needs) were predicted using logistic regression models with sociodemographic characteristics, cognitive status, comorbid Charlson index-CCI, functional and nutritional status as independent variables. Moderate and severe dementia and poor physical function strongly predicted longer hospital stay, institutionalization and greater home care needs in univariate analyses. CCI was the best single predictor, with a four-fold difference in mortality rates between the highest and lowest scores. In multivariate analysis, the best predictor of institutionalisation was dementia, whereas the best predictor of death in hospital or longer hospital stay was higher comorbidity score, regardless of cognitive status. Functional status was the best predictor of greater home care needs. Dementia in very old medically ill inpatients was predictive only of discharge to a nursing home. Higher levels of comorbidity and poor functional status were more predictive than dementia for the other three hospitalization outcomes. Thus, comorbid medical conditions, functional and nutritional status should be considered, together with cognitive assessment, when predicting hospitalization outcome.