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A systematic review of community-based health interventions on depression for older adults with heart disease
- Authors:
- KANG-YI Christina D., GELLIS Zvi D.
- Journal article citation:
- Aging and Mental Health, 14(1), January 2010, pp.1-19.
- Publisher:
- Taylor and Francis
This systematic review examines the effectiveness of community-based heart-health interventions on depression outcomes among homebound elderly (64 years and older) with heart disease. People with heart disease who are depressed have an increased risk of death after a heart attack, and therefore treatment for depression in conjunction with heart disease may help patients to manage both diseases. A comprehensive literature search and meta-analysis was performed to evaluate randomised controlled trials examining outpatient or home-based interventions. The methodological quality was assessed by standard criteria developed by the Cochrane Collaborative Initiative. This identified 15 studies which met the inclusion criteria and all measured depression outcomes. The studies differed in scope and methodological rigor and sample sizes varied widely. Problems in treatment fidelity and masking of group assignment were noted. Great variability was found in depression outcomes due to the differences in methodology and intervention. Five studies reported significant treatment effect on depression; three of those employed home-based interventions and two were outpatient-clinic interventions. Ten studies were included in the meta-analysis and the mean weighted effect size was 0.11, with 6 studies showing a positive effect size. The article concludes that mixed evidence for community-based heart disease interventions on depression outcomes was found. Future intervention studies should conduct more rigorous trials over longer time periods and consider using the Consolidated Standards of Reporting Trials (CONSORT).
Randomised controlled trial of problem-solving therapy for minor depression in home care
- Authors:
- GELLIS Zvi D., et al
- Journal article citation:
- Research on Social Work Practice, 18(6), November 2008, pp.596-606.
- Publisher:
- Sage
Data are presented from a pilot research program initiated to develop, refine, and test the outcomes of problem-solving therapy that targets the needs of older adults with minor depression in home care settings. A pilot randomized clinical trial compares the impact of problem-solving therapy for home care to treatment as usual in a sample of older, medically ill home care patients. Compared with 32 older home care participants randomized to the treatment as usual condition, 30 older home care participants in an intervention condition received brief problem-solving therapy. Outcome data suggest significant improvements in depression symptomatology and problem-solving abilities after problem-solving therapy for home care, relative to treatment as usual. The experimental group was also more satisfied with treatment as compared to the control condition. Authors discuss results in terms of the "real-world" social work applicability of this psychosocial treatment for late-life depression.
Psychological treatment of late-life depression: a meta-analysis of randomized controlled trials
- Authors:
- CUIJPERS Pim, VAN STRATEN Annemieke, SMIT Filip
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(12), December 2006, pp.1139-1149.
- Publisher:
- Wiley
Older meta-analyses of the effects of psychological treatments for depression in older adults have found that these treatments have large effects. However, these earlier meta-analyses also included non-randomized studies, and did not include newer high-quality randomized controlled trials. The authors conducted a meta-analysis of randomized studies on psychological treatments for depression in older adults. Twenty-five studies were included, of which 17 compared a psychological intervention to a control condition (mainly waiting list and care-as-usual control groups). The quality of the included studies varied. Psychological treatments have moderate to large effects on depression in older adults (standardized mean effect size d = 0.72). Heterogeneity was very low. No differences were found between individual, group or bibliotherapy format, or between cognitive behavioural therapy and other types of psychological treatment. The effects were comparable in studies where depression was defined according to diagnostic criteria, and those in which depression was measured with self rating questionnaires. Although the quality of many studies was not optimal, the results of this meta-analysis support.
The effects of an expanded cognitive stimulation therapy model on the improvement of cognitive ability of elderly with mild stage Dementia living in a community - a randomized waitlist controlled trial
- Authors:
- YOUNG Daniel Kim-Wan, et al
- Journal article citation:
- Aging and Mental Health, 23(7), 2019, pp.855-862.
- Publisher:
- Taylor and Francis
Objective: This research study aims to evaluate the effectiveness of an expanded cognitive stimulation therapy (CST) model that combines a CST group and tai chi on improving the cognitive ability of community-dwelling Chinese elderly with mild stage dementia (EwMD). Method: A randomized waitlist controlled trial design was adopted in this study. The treatment group participated in a structured CST group followed by tai chi twice a week, with a total of 14 sessions throughout the study period. The waitlist control group received treatment as usual at the initial stage and expanded CST model at a later stage. The Chinese Mattis Dementia Rating Scale (DRS) and the Chinese Mini Mental State Examination (MMSE) were used to assess the cognitive ability of EwMD in the pre- and post- treatment periods. Results: At baseline, the treatment group (n = 51) and control group (n = 50) did not differ significantly in any demographic or clinical variables. Overall, the participants had a mean baseline MMSE score of 20.67 (SD = 2.30). The 2 × 2 repeated measures ANCOVA demonstrated that the treatment group was significantly more effective than the control group in improving the MMSE score (F = 12.31, p< .01) with a moderate effect size (partial eta square = .11) after controlling for group difference in age, gender, education, and having a diagnosis of dementia. Conclusion: The present study demonstrates the effectiveness of the expanded CST model on the improvement of cognitive ability of community-dwelling EwMD. More research is needed to further investigate this intervention model across cultures and societies.
Effectiveness of home treatment for elderly people with depression: randomised controlled trial
- Authors:
- KLUG Gunter, et al
- Journal article citation:
- British Journal of Psychiatry, 197(6), December 2010, pp.463-467.
- Publisher:
- Cambridge University Press
This study tested the effectiveness of home treatment for elderly people with depression living independently in Austria. Sixty out-patients aged 65 and over with major depression were either allocated to a home treatment model over a 1-year period or to conventional psychiatric out-patient care. Home treatment was delivered by a multidisciplinary team consisting of one psychiatrist, two psychologists and one social worker who was also qualified as a psychiatric nurse. Treatment included talks about self-esteem, coping resources and medication adherence; encouragement to establish and maintain social networks, increase social and leisure activities and cope with tasks of daily living; support of carers; and crisis interventions when required. The primary outcome was the level of depressive symptoms after 3 and 12 months. The secondary outcomes were global functioning, subjective quality of life, admissions to nursing homes, duration of psychiatric hospital treatments and the cost of care. Findings revealed that the individuals receiving home treatment had significantly fewer symptoms of depression, better global functioning and a higher quality of life at 3 months and at 12 months. In the 1 year period there were fewer admissions to nursing homes, they spent less time in psychiatric in-patient care and the overall cost of care was lower. The study concluded that home treatment appeared to be an effective and cost-effective service model for elderly people with depression.
A randomised controlled trail of the effects of multi-sensory stimulation (MSS) for older people with dementia
- Authors:
- BAKER Roger, et al
- Journal article citation:
- British Journal of Clinical Psychology, 40(1), March 2001, pp.81-96.
- Publisher:
- Wiley
Article investigates short-term effects of Multi-Sensory Stimulation (MSS) on behaviour, mood and cognition of older adults with dementia. Through a randomised controlled trial comparing MSS with a credible control of one-to-one activities. Fifty patients with diagnoses of moderate to severe dementia were randomised to either MSS or Activity groups. Immediately after MSS and Activity sessions patients talked more spontaneously, related better to others, did more from their own initiative, were less bored/inactive, and were more happy, active or alert. Both groups were more attentive to their environment than before, with a significantly greater improvement from the MSS group. At a day hospital, patients in the Activity group improved on their 'speech skills' where as the MSS group remained unchanged during the trial. The MSS group showed a significant improvement in mood and behaviour at home compared to the Activity group behaviour deteriorated. No longer-term benefits were shown; , behaviour declined sharply during the month follow-up period. Concludes that both MSS and Activity sessions appear to be effective and appropriate therapies for people with dementia.
Light therapy for behavioural and psychological symptoms of dementia
- Authors:
- SKJERVEArvid, BJORBATN Bjorn, HOLSTEN Fred
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(6), June 2004, pp.516-522.
- Publisher:
- Wiley
Reviews the literature concerning the efficacy, clinical practicability and safety of light treatment for behavioural and psychological symptoms of dementia (BPSD). Data collection included computer literature searches (MEDLINE, PsycINFO and Cochrane) and checks of references, covering the period of January 1980-September 2003. Trials were searched for evidence for treatment efficacy and for their consideration of the treatment's clinical practicability and evidence of adverse effects. Results from randomised controlled trials (RCT) indicated some evidence of improvement in aspects of sleep disturbances and circadian activity rhythmicity. One RCT study indicated better response in patients with vascular dementia compared to Alzheimer's disease. By and large, non-RCT studies reported improvement in BPSD including sleep disturbances, agitation and activity rhythm disturbances. Few studies commented on the treatment's practicability and safety. Although there is some evidence for influence of light therapy on sleep and circadian activity rhythmicity, it is not possible to draw any conclusion about efficacy of light therapy for BPSD, or about practicability in clinical settings and safety. There are still too few well designed studies. Suggestions for further research are presented.
Reality orientation for dementia: a systematic review of the evidence of effectiveness from randomised controlled trials
- Authors:
- SPECTOR Aimee, et al
- Journal article citation:
- Gerontologist, 40(2), April 2000, pp.206-212.
- Publisher:
- Oxford University Press
The effectiveness of classroom reality orientation (RO) in dementia was evaluated by conducting a systematic literature review. The evidence indicates that RO has benefits on both cognition and behaviour for dementia sufferers. However, a continued programme may be needed to sustain potential benefits. Future research should evaluate RO in well-designed multicentre trials.
Randomised controlled trial of effect of intervention by psychogeriatric team on depression in frail elderly people at home
- Authors:
- BANERJEE Sube, et al
- Journal article citation:
- British Medical Journal, 26.10.96, 1996, pp.1058-1061.
- Publisher:
- British Medical Association
Investigates the efficacy of intervention by a psychogeriatric team in the treatment of depression in elderly disabled people receiving home care from their local authority.