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Mental health first aid for the elderly: a pilot study of a training program adapted for helping elderly people
- Authors:
- SVENSSON Bengt, HANSSON Lars
- Journal article citation:
- Aging and Mental Health, 21(6), 2017, pp.595-601.
- Publisher:
- Taylor and Francis
Objectives: Epidemiological studies have shown a high prevalence of mental illness among the elderly. Clinical data however indicate both insufficient detection and treatment of illnesses. Suggested barriers to treatment include conceptions that mental health symptoms belong to normal ageing and lack of competence among staff in elderly care in detecting mental illness. A Mental Health First Aid (MHFA) training programme for the elderly was developed and provided to staff in elderly care. The aim of this study was to investigate changes in knowledge in mental illness, confidence in helping a person, readiness to give help and attitudes towards persons with mental illness. Method: Single group pre-test–post-test design. Results: The study group included staff in elderly care from different places in Sweden (n = 139). Significant improvements in knowledge, confidence in helping an elderly person with mental illness and attitudes towards persons with mental illness are shown. Skills acquired during the course have been practiced during the follow-up. Conclusions: The adaption of MHFA training for staff working in elderly care gives promising results. Improvements in self-reported confidence in giving help, attitudes towards persons with mental illness and actual help given to persons with mental illness are shown. However, the study design allows no firm conclusions and a randomised controlled trail is needed to investigate the effectiveness of the programme. Outcomes should include if the detection and treatment of mental illness among the elderly actually improved. (Edited publisher abstract)
Vascular depression: overrepresented among African Americans?
- Authors:
- REINLIEB Michelle E., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 29(5), 2014, pp.470-477.
- Publisher:
- Wiley
Objective: Our primary aim was to compare the rate of vascular depression among a clinical sample of African American and Caucasian depressed older adults. Secondary aims included characterizing the clinical and neuropsychological profile of vascular depression and comparing antidepressant response rates between patients with vascular and nonvascular depression. Methods: This was a two-site, multi-ethnic, open 8-week trial of antidepressant medication in older adults with depression. Men and women 50 years or older meeting DSM-IV criteria for nonpsychotic unipolar depression participated in this trial. Each participant underwent a comprehensive psychiatric and neuropsychological evaluation and a brain MRI, which were performed at baseline. Results: Forty-six patients met inclusion and exclusion criteria. Forty-two of those patients received an MRI at baseline. Sixteen patients met criteria for vascular depression. Patients with vascular depression were significantly more likely to be African American and have a higher likelihood of being female, a higher rate of hypertension and psychomotor retardation, a lower rate of family history of affective illness, and frontal systems dysfunction on neuropsychological testing. The difference in response rates between patients with vascular and nonvascular depression did not reach statistical significance. Conclusions: This is the first study to document high rates of vascular depression in a clinical sample of African Americans and Caucasians. Our findings suggest that vascular depression may be overrepresented among African Americans, which is consistent with the high rates of cardiovascular disease, hypertension, and stroke in this population. (Publisher abstract)
Crisis resolution and home treatment teams for older people with mental illness
- Authors:
- DIBBEN Claire, et al
- Journal article citation:
- Psychiatric Bulletin, 32(7), July 2008, pp.268-270.
- Publisher:
- Royal College of Psychiatrists
Examined the impact of a crisis resolution and home treatment teams (CRHTT) on hospital admission rates, bed days and treatment satisfaction among older people with mental illness and their carers. The authors compared these factors in the 6 months before the service started and 6 months after its introduction. The CRHTT significantly reduced admissions, but there was no significant difference in the length of hospital stay as compared before and after the introduction of this service. There was a trend towards carers, but not patients, being more satisfied with treatment after the introduction of the CRHTT. Admissions for older people were up by 31% and carers preferred the service. Further research on crisis teams in older people with mental illness is needed using randomised controlled methodology.
The Dysfunctional Attitudes Scale: factor structure, reliability, and validity with older adults
- Authors:
- FLOYD M., SCOGIN F., CHAPLIN W. F.
- Journal article citation:
- Aging and Mental Health, 8(2), March 2004, pp.153-160.
- Publisher:
- Taylor and Francis
The Dysfunctional Attitudes Scale Form A (DAS-A), a self-report measure of depression-related attitudes, has been used in numerous depression studies. The DAS-A has a two-factor structure that has been found consistently with college student samples and clinically depressed samples of middle-aged adults, but it has not been validated with older adults. The present study examined the factor structure with a sample of 100 depressed older adults (average age = 68.19; average initial Hamilton Rating Scale for Depression [HRSD] score = 16.72) who participated in a depression treatment study. Results indicated the factor structure established with younger adults was not replicated with older adults. Furthermore, the factor structure with older adults was uncertain: a single factor structure, two-factor structure, and three-factor structure were essentially of equal validity. The uncertainty of the latent structure of the DAS-A suggests that it should be interpreted with caution whenever used with older adults.
Psychosocial and clinical predictors of unipolar depression outcome in older adults
- Authors:
- BOSWORTH Hayden B., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 17(3), March 2002, pp.238-246.
- Publisher:
- Wiley
Depression in old age is widespread, affecting at least one in six patients' in general medical practice and even higher percentage in nursing homes and hospitals. Impairment and disability associated with depression is equal to that attribute to cardiovascular disease, and greater than that due to other chronic physical disorders such as hypertension, diabetes, and arthritis. Response to treatment among depressed individuals may vary greatly. While some of the treatment variation can be explained in terms of differences in the severity of the depression, much of it remains to be explained. Because of the significant personal, clinical, and societal implications associated with depression, it is important to understand what factors, especially those amenable to clinical intervention, are associated with better outcomes. This article focuses on a variety of psychosocial, demographic, and clinical factors to identify those that predict better depression outcome among initially depressed elderly adults.
Subjective health measures and acute treatment outcomes in geriatric depression
- Authors:
- LENZE Eric J., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 16(12), December 2001, pp.1149-1155.
- Publisher:
- Wiley
This study examines measures of self-rated health, physical disability, and social function as predictors of treatment response in late life- depression, and to assess these same health measures as treatment outcomes. Results found subjects with poorer self-rated health as baseline were more likely both to drop out of treatment and to not respond to adequate treatment. This relationship was independent of demographic measures, severity of depression, physical and social functioning, medical illness, personality, hopelessness, overall medication use, and side effects or non-compliance with treatment. Although this finding is preliminary it suggests that lower self-rated health may independently predict premature discontinuation of treatment for depression. Additionally, subjects who recovered from depression showed significantly improvements in self-rated health, physical disability, and social functioning.
The relevance of guidelines for treatment mania in old age
- Author:
- SNOWDON John
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(9), September 2000, pp.779-783.
- Publisher:
- Wiley
Reviews three sets of guidelines for the treatment of patients with bipolar disorder, in order to assess their adequacy in relation to treatment of older persons with mania. One of the three referred to differences encountered when treating elderly people, but none gave adequate attention to age-related changes in pharmacokinetics and whether it is appropriate to prescribe lithium as a first-line mood stabiliser for older persons. Concludes that the guidelines do not give clear guidance on initial management of acutely manic patients who refuse medication. Nor do they give consideration to secondary mania. Recommended that evidence be gathered in order to develop guidelines specifically for management of mental disorders presenting in old age.
A comparison of self-reported function assessed before and after depression treatment among depressed geriatric inpatients
- Authors:
- CASTEN Robin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(9), September 2000, pp.813-818.
- Publisher:
- Wiley
The purpose of this study was to determine whether self-perceptions of function among depressed, geriatric psychiatry inpatients improved as their depression resolved. Self-perceptions of function improved over time, while caregivers' perceptions remained stable, suggesting that patients' perceptions of function is in part influenced by their depression. Further, correlations between patient and caregiver perceptions of function were higher at 3 months post discharge (when patients were not depressed) than they were at admission. The implication is that self-perceptions of function are more accurate when not depressed.
Factors predicting the relapse of depression in old age
- Authors:
- KIVELA Sirkka-Liisa, VIRAMO Petteri, PAHKULA Kimmo
- Journal article citation:
- International Journal of Geriatric Psychiatry, 15(2), February 2000, pp.112-119.
- Publisher:
- Wiley
Studies in mixed-aged populations show differences between the predictors of a relapse and those of a long term course of depression, supporting the hypothesis about similar differences among the aged. The aim of this study was to identify the factors predicting or related to a relapse of depression among the Finnish elderly having recovered from depression during treatment. The logistic regression model showed major depression and psychomotor retardation to be independent predictors. Relapses were not related to stressors in life or psychical illnesses occurring the follow up. Major depressive elderly patients have a high risk for relapses without the occurrence of the stressors or the physical illnesses. Concludes that in clinical practice, major depressive elderly patients should be followed up in order to detect and treat potential relapses as soon as possible.
Psychopharmacological treatment of dementia
- Author:
- CALLAWAY Janice T.
- Journal article citation:
- Research on Social Work Practice, 8(4), July 1998, pp.452-474.
- Publisher:
- Sage
This article provides an overview and description of dementia, explores current and investigational agents used in the treatment of accompanying cognitive and noncognitive symptoms, and suggests considerations for assessing certain aspects of pharmacological management.