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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)
GPs' perspectives on preventive care for older people: a focus group study
- Authors:
- DREWES Yvonne M., et al
- Journal article citation:
- British Journal of General Practice, 62(604), November 2012, pp.582-583.
- Publisher:
- Royal College of General Practitioners
The aims of preventive care for older people may differ from the traditional targets of preventing diseases or injuries and include the maintenance of independence and wellbeing. This qualitative study explored Dutch GPs' perspectives on preventive care for older people in six focus groups involving a total of 37 GPs. Whether or not to implement preventive care for older people depends on the patient's individual level of vitality, as perceived by the GP. For older people with a high level of vitality, GPs confine their role to standardised disease-oriented prevention on a patient's request. It is when the vitality levels in older people fall that the scope of preventive care shifts from prevention of disease to prevention of functional decline. For older, vulnerable people, GPs expect most benefit from a proactive, individualised approach, enabling them to live as independently as possible. Based on these responses, a conceptual model for preventive care for different groups of older people was developed. It focuses on five main dimensions: aim of care (prevention of disease versus prevention of functional decline), concept of care (disease model versus functional model), initiator (older persons themselves versus GP), target groups (people with requests versus specified risk groups), and content of preventive care (mainly cardiovascular risk management versus functional decline).
A stepped care relapse prevention program for depression in older people: a randomized controlled trial
- Authors:
- APIL Sachlan R. A., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(6), June 2012, pp.583-591.
- Publisher:
- Wiley
The feasibility and the effectiveness of a Stepped Care Program (SCP) for preventing relapse of depression in older people were examined in a randomised controlled trial. Stepped care consisted of watchful waiting; bibliotherapy; individual cognitive behavioural therapy; and indicated treatment. Participants, (n=136, mean age 65.6 years, 72% female), who had suffered at least one episode of major depression in the past, were randomised to receive a SCP or Care As Usual (CAU). They were recruited from a mental health organisation in the Hague. The primary outcome measure was incidence of a new depressive episode. Of 1725 previously depressed persons, 175 were willing to take part in the study, 136 of whom were eligible. Treatment satisfaction with stepped care was high. At 12-month follow-up, no difference in incidence of depression between SCP and CAU was found. Medical patient records showed that missing data were often related to relapse. In this study, SCP was not more effective in preventing relapse than CAU. It is suggested that watchful waiting as a first step in SCP may actually cause harm by delaying preventive treatment; prevention as an integral part of regular treatment might lead to higher participation rates.
Improvement in personal meaning mediates the effects of a life review intervention on depressive symptoms in a randomized controlled trial
- Authors:
- WESTERHOF Gerben J., et al
- Journal article citation:
- Gerontologist, 50(4), August 2010, pp.541-549.
- Publisher:
- Oxford University Press
This study investigated the impact of a life review intervention on personal meaning in life and the mediating effect of personal meaning on depressive symptoms as the primary outcome of this form of indicated prevention. A randomised controlled trial was conducted with 83 older people obtaining life review compared to 88 watching a video about the art of growing older. Measurements took place before and after the intervention as well as at a 6 month follow-up. Findings revealed that those who followed life review initially improved in personal meaning more than those in the control group, although at follow-up the difference was no longer significant. Improvements in meaning during the intervention predicted decreases in depressive symptoms later in time and mediated the effects of the programme on depressive symptoms. The authors concluded that personal meaning is important in contemporary society, which some older people find difficult to achieve. The findings show that it is possible to support older people in their search for meaning by means of life review and that this helps in alleviating depressive symptoms.
Target groups for the prevention of late - life anxiety
- Authors:
- SMIT Filip, et al
- Journal article citation:
- British Journal of Psychiatry, 190(5), May 2007, pp.428-434.
- Publisher:
- Cambridge University Press
Anxiety disorders in older people are highly prevalent, yet there is little evidence to guide targeted prevention strategies. Anxiety was measured with the Hospital Anxiety and Depression anxiety sub-scale in 1931 people aged 55-85 years followed over 3 years. Risk factors were identified that had a high combined attributable fraction, indicative of substantial health gains when the adverse effect of the risk factors can be contained. Factors significantly associated with increased risk of developing anxiety included sub-threshold anxiety, depression, two or more chronic illnesses, poor sense of mastery, poor self-rated health and low educational level. The identified risk groups are small, thus providing prevention with a narrow focus, and health gains are likely to be more substantial than in groups not exposed to these risk factors. Nevertheless, more research is needed to produce evidence on target groups where prevention has optimal impacts.
Older people's views of falls-prevention interventions in six European countries
- Authors:
- YARDLEY Lucy, et al
- Journal article citation:
- Gerontologist, 46(5), October 2006, pp.650-660.
- Publisher:
- Oxford University Press
This study conducted semi-structured interviews to assess perceived advantages and barriers to taking part in falls-related interventions were carried out in six European countries (Denmark, the Netherlands, Germany, Greece, Switzerland and United Kingdom) with 69 people aged 68 to 97 years. The sample was selected to include people with very different experiences of participation or nonparticipation in falls-related interventions, but all individuals were asked about interventions that included strength and balance training. The results found attitudes were similar in all countries and contexts. People were motivated to participate in strength and balance training by a wide range of perceived benefits (interest and enjoyment, improved health, mood, and independence) and not just reduction of falling risk. Participation also was encouraged by a personal invitation from a health practitioner and social approval from family and friends. Barriers to participation included denial of falling risk, the belief that no additional falls-prevention measures were necessary, practical barriers to attendance at groups (e.g., transport, effort, and cost), and a dislike of group activities. Implications: Because many older people reject the idea that they are at risk of falling, the uptake of strength and balance training programs may be promoted more effectively by maximizing and emphasizing their multiple positive benefits for health and well-being. A personal invitation from a health professional to participate is important, and it also may be helpful to provide home-based programs for those who dislike or find it difficult to attend groups.
Collaborating on early detection of frailty; a multifaceted challenge
- Authors:
- BUIST Yvette, et al
- Journal article citation:
- International Journal of Integrated Care, 19(2), 2019, Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: In several countries, initiatives to detect frailty among older citizens at an early stage are being implemented to enable proactive intervention and, consequently, to support independent living for as long as possible. Alignment and collaboration between the various actors are crucial. This study aimed to provide insight in factors that impede or facilitate collaboration at a local level as perceived by the different actors and their experiences were explored. Methods: Semi-structured interviews were conducted with 37 representatives of three groups active in proactive elderly care in the Netherlands: (i) commissioners, (ii) service providers, and (iii) other stakeholders (e.g. public health advisors, academics). The Framework Method was used to analyse data. Results: Interviewees perceived many factors hampering or facilitating collaboration. Overall, the factors mentioned were quite similar for the different groups. Facilitators and barriers were related to culture and professionals (e.g. knowledge of early detection approaches, mutual trust), organizations (e.g. shared vision or patient information system) and context (e.g. financing). Discussion and conclusion: Collaborating on early detection appears to be a multifaceted challenge. However, as different stakeholders hold similar views, there seem to be several starting-points to improve collaboration. First steps shall include getting to know each other and developing a shared vision on early detection. (Edited publisher abstract)
Awareness of risk factors for loneliness among third agers
- Authors:
- SCHOENMAKKERS Eric C., van TILBURG Theo G., FOKKEMA Tineke
- Journal article citation:
- Ageing and Society, 34(6), 2014, pp.1035-1051.
- Publisher:
- Cambridge University Press
Awareness of risk factors for loneliness is a prerequisite for preventive action. Many risk factors for loneliness have been identified. This paper focuses on two: poor health and widowhood. Preventive action by developing a satisfying social network requires time and effort and thus seems appropriate for people unexposed to risk factors, i.e. third agers and non-lonely persons. The third age is the period in old age after retirement, before people's social relationships deteriorate. This paper addresses three questions: Are older adults aware of poor health and widowhood as risk factors for loneliness? Are there differences in awareness between third and fourth agers? Are there differences in awareness between lonely and non-lonely older adults? After being introduced to four vignette persons, 920 respondents from the Longitudinal Aging Study Amsterdam were asked whether they expected these persons to be lonely. Older adults, especially third agers, expected peers exposed to the risk factors to be lonely more often than peers who were unexposed. The results indicate that awareness of loneliness-provoking factors is high among third agers, which is a first step towards taking actions to avoid loneliness. Compared to lonely older adults, non-lonely ones expected peers to be lonely less often, suggesting the latter's lower awareness of the risk factors. The results provide evidence for policy makers and practitioners that combating loneliness might require early action. (Publisher abstract)
Qualitative study on the impact of falling in frail older persons and family caregivers: foundations for an intervention to prevent falls
- Authors:
- FAES Miriam C., et al
- Journal article citation:
- Aging and Mental Health, 14(7), September 2010, pp.834-842.
- Publisher:
- Taylor and Francis
The main aim of this study was to explore the impact of falling for frail community-dwelling older persons with and without cognitive impairments who have experienced a recent fall and their primary family caregivers. In addition, the study aimed to define components for a future fall prevention programme. Interviews based on grounded theory were undertaken with 10 patients and 10 caregivers. Three of the patients were cognitively unimpaired, four had mild cognitive impairment and three had dementia. All the patients described a fear of falling and social withdrawal. Caregivers reported a fear of their care recipient falling. Most patients were unable to name a cause for the falls. The patients rejected the ideas that falling is preventable and that the fear of falling can be reduced. Some caregivers believed that a prevention programme would not be useful because of the care recipients' cognitive impairment, physical problems, age and personalities. The article concludes that a fall prevention programme should focus on reducing the consequences of falling and on promoting self-efficacy and activity. The causes of falls should be discussed. The programme should include dyads of patients and caregivers. Before beginning such a programme, providers should transform negative expectations about the programme into positive ones. Finally, caregivers must learn how to deal with the consequences of their care recipients’ falling as well as their cognitive impairment.
Secondary prevention of depressive symptoms in elderly inhabitants of residential homes
- Authors:
- CUIJPERS Pim, van LAMMEREN Paula
- Journal article citation:
- International Journal of Geriatric Psychiatry, 16(7), July 2001, pp.702-708.
- Publisher:
- Wiley
The effects of a multifaceted secondary prevention intervention in residential homes in the Netherlands were examined, using a quasi-experimental design. In five experimental residential homes, the caregivers received three training sessions on detecting depression and on supporting depressed residents. Furthermore, an information session was organised for all personnel, a further session was organised for residents and their relatives, and several group interventions were offered. 213 residents participated in the study. The results suggest that general approaches aimed at a residential home are capable of influencing depressive symptoms in inhabitants.