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Feasibility of a family‐centered intervention for depressed older men in primary care
- Authors:
- HINTON Ladson, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 34(12), 2019, pp.1808-1814.
- Publisher:
- Wiley
Objective: Families provide considerable support to many older adults with depression, yet few intervention studies have sought to include them. Family participation in depression treatment aligns with the preferences of older men, a group at high risk for depression under treatment. This study examined the feasibility of a family‐centred depression intervention for older men in a primary care setting. Methods: A clinical trial was conducted in a Federally Qualified Health Center (FQHC) in California's Central Valley. Depressed older men (age 50 and older) were allocated to usual care enhanced by depression psychoeducation or a family‐centred depression intervention delivered by a licensed clinical social worker. Intervention feasibility was assessed in terms of recruitment, retention, and extent of family engagement. The PHQ‐9 was administered at baseline, 1, 3, and 6 months. Results: For more than 6 months, 45 men were referred to the study; 31 met the inclusion criteria, 23 were successfully enrolled, and 20 (88%) participated in more than or equal to one treatment sessions. Overall, 85% (11 of 13) of men allocated to the intervention engaged a family member in more than or equal to one session and 54% (7 of 13) engaged the family member in more than or equal to three sessions. While men in both groups showed evidence of a significant decline in PHQ‐9 scores early on, which attenuated over time, there were no significant between group differences. Conclusions: The family‐centred depression intervention showed acceptable feasibility on the basis of a variety of parameters. Future research on family‐based approaches may benefit from longer duration and more intensive treatment as well as additional strategies to overcome recruitment barriers. (Edited publisher abstract)
A descriptive qualitative study of the roles of family members in older men's depression treatment from the perspectives of older men and primary care providers
- Authors:
- HINTON Ladson, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 30(5), 2015, pp.514-522.
- Publisher:
- Wiley
Objective: The aim of this study is to describe the roles of family members in older men's depression treatment from the perspectives of older men and primary care physicians (PCPs). Methods: Cross-sectional, descriptive qualitative study conducted from 2008–2011 in primary care clinics in an academic medical centre and a safety-net county teaching hospital in California's Central Valley. Participants in this study were the following: (1) 77 age ≥ 60, noninstitutionalised men with a 1-year history of clinical depression and/or depression treatment who were identified through screening in primary care clinics and (2) a convenience sample of 15 PCPs from the same recruitment sites. Semi-structured and in-depth qualitative interviews were conducted and audiotaped then transcribed and analysed thematically. Results: Treatment-promoting roles of family included providing an emotionally supportive home environment, promoting depression self-management and facilitating communication about depression during primary care visits. Treatment-impeding roles of family included triggering or worsening men's depression, hindering depression care during primary care visits, discouraging depression treatment and being unavailable to assist men with their depression care. Overall, more than 90% of the men and the PCPs described one or more treatment-promoting roles of family and over 75% of men and PCPs described one or more treatment-impeding roles of family. Conclusions: Families play important roles in older men's depression treatment with the potential to promote as well as impede care. Interventions and services need to carefully assess the ongoing roles and attitudes of family members and to tailor treatment approaches to build on the positive aspects and mitigate the negative aspects of family support. (Edited publisher abstract)
Using mixed methods to evaluate the use of a caregiver strain measure to assess outcomes of a caregiver support program for caregivers of older adults
- Authors:
- HYUCK Magaret Hellie, AYALON Liat, YODER Judy
- Journal article citation:
- International Journal of Geriatric Psychiatry, 22(2), February 2007, pp.160-165.
- Publisher:
- Wiley
Many assessment tools have been developed for evaluating caregiving programs, but the majority are too cumbersome for ongoing use. This study reports on a brief assessment tool used to monitor strain among family members caring for an impaired elder. Participants were enrolled in the SeniorCare program, a program funded by the Administration on Aging to provide care to family caregivers. The Caregiver Risk Screen (CRS) is a 12-item measure of strain, initially developed as part of an in-home assessment procedure. Its utility for use in practice settings over time was assessed using both quantitative and qualitative methodology. Chronbach alpha levels for the CRS were 0.85 at intake and 0.84 at first follow-up. At the first follow-up, the overall index score and five of the 12 items showed statistically significant lessened strain. In subsequent follow-up evaluations, the average improvements were maintained but there was no additional decrease in strain. Individual variations in changes over time were identified by combining quantitative and qualitative information. Themes that emerged in qualitative data served to modify the measure for future use. The brief Caregiver Risk Screen tool appears to be a reliable and valid tool for use in practice settings. It is acceptable to clients and professional staff. Modifications have been made that may further enhance the suitability of this measure for other settings.
What do general practitioners tell people with dementia and their families about the condition? A survey of experiences in Scotland
- Authors:
- DOWNS Murna, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 1(1), February 2002, pp.47-58.
- Publisher:
- Sage
Reports on a study which examined what GPs tell people with dementia and their families about the condition. The study relied on data gathered from an opportunistic sample of 114 GPs who were attending a training course in care of people with dementia. Findings reveal a disparity between what GPs tell the family and the person. People with dementia tend to be given information about the symptoms and the cause is described predominantly as part of ageing. Family members are given information about symptoms, cause, prognosis and available supports. Argues that best practice regarding diagnosis disclosure to people with dementia needs to be established. This includes what people with dementia are told, how they are told and what supports are made available to those who have been told.
Informal carers and the primary care teams
- Author:
- SIMON Chantal
- Journal article citation:
- British Journal of General Practice, November 2001, pp.920-923.
- Publisher:
- Royal College of General Practitioners
The number of carers in the community is rising, and the importance of general practice in providing support for them has been highlighted. Caring for a disabled friend or relative has been shown to be harmful to the health of the caregiver and changes in social and family structure have led carers to become isolated and more reliant on the formal support services. The shift from hospital to community-based care and the blurring of social roles of responsibility puts additional pressure on the cares and community services. Argues that, general practice is in the best position to help and there are many things that can be done by primary care teams, such as providing information about available support, benefits and local services, which would be appreciated by informal carers.
Caring for patients with dementia: the GP perspective
- Authors:
- DOWNS M., et al
- Journal article citation:
- Aging and Mental Health, 4(4), November 2000, pp.301-304.
- Publisher:
- Taylor and Francis
While general practitioners (GPs) have a central role to play in the effective primary care response to people with dementia and their families, concern has been raised as to the adequacy with which they fulfil this role. The purpose of this study was to assess GPs' views and practices regarding dementia diagnosis and management. . Results suggest that GPs perceive considerable difficulties with some aspects of their care for their patients with dementia. In general, their self-reported approach to diagnosis and management of dementia was not consistent with recommended practice. The study confirms findings of earlier studies as to the adequacy with which GPs respond to people with dementia and their families.
Families that care: a qualitative study of families engaged in the provision of elder care
- Author:
- BREWER Loretta
- Journal article citation:
- Journal of Gerontological Social Work, 39(3), 2002, pp.41-55.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The purpose of this study was to identify family caregiving approaches that preserve the well being of caregivers while maintaining an acceptable quality of care for older adults. The goal was to determine whether there is a difference in the quality of elder care provided by family caregiving teams as compared to the primary caregiving approach. Semi-structured interviews were used to explore the caregiving approaches utilized by twenty-two families actively engaged in the provision of elder care. The findings of this study hold implications for every level of service to aging families, including the micro, mezzo, and macro levels of practice. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Optimal healthcare delivery to care homes in the UK: a realist evaluation of what supports effective working to improve healthcare outcomes
- Authors:
- GORDON Adam L., et al
- Journal article citation:
- Age and Ageing, 47(4), 2018, p.595–603.
- Publisher:
- Oxford University Press
Introduction: care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. Methods: a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. Results: context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which ‘wraps around’ care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites. Conclusion: activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise. (Edited publisher abstract)
Community care in a rural setting: challenging the myth
- Authors:
- COPE Richard, PALFREY Colin
- Journal article citation:
- Social Services Research, 1, 1997, pp.33-45.
- Publisher:
- Social Services Research Group
This study explores the impact of the NHS and Community Care Act (1990) upon a rural community in South West England. The research draws on the views of service users and practitioners with regard to the provision of support services. Results of the research found a marked degree of reliance on family carers and indicates that vulnerable people and their carers hold pessimistic views about the prospects for their continued support by medical and social services agencies.