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Justo-Henriques SI, Pérez-Sáez E, Carvalho JO, Bobrowicz-Campos E, Apóstolo JLA, Otero P, Vázquez FL. Reliability and Validity of the Geriatric Depression Scale in a Sample of Portuguese Older Adults with Mild-to-Moderate Cognitive Impairment. Brain Sci 2023; 13:1160. [PMID: 37626516 PMCID: PMC10452844 DOI: 10.3390/brainsci13081160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Although the Geriatric Depression Scale (GDS) is a well-established instrument for the assessment of depressive symptoms in older adults, this has not been validated specifically for Portuguese older adults with cognitive impairment. The objective of this study was to analyze the psychometric properties of two Portuguese versions of the GDS (GDS-27 and GDS-15) in a sample of Portuguese older adults with mild-to-moderate cognitive impairment. Clinicians assessed for major depressive disorder and cognitive functioning in 117 participants with mild-to-moderate cognitive decline (76.9% female, Mage = 83.66 years). The internal consistency of GDS-27 and GDS-15 were 0.874 and 0.812, respectively. There was a significant correlation between GDS-27 and GDS-15 with the Beck Depression Inventory-II (GDS-27: rho = 0.738, p < 0.001; GDS-15: rho = 0.760, p < 0.001), suggesting good validity. A cutoff point of 15/16 in GDS-27 and 8/9 in GDS-15 resulted in the identification of persons with depression (GDS-27: sensitivity 100%, specificity 63%; GDS-15: sensitivity 90%, specificity 62%). Overall, the GDS-27 and GDS-15 are reliable and valid instruments for the assessment of depression in Portuguese-speaking older adults with cognitive impairment.
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Affiliation(s)
- Susana I. Justo-Henriques
- Health Sciences Research Unit, Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
| | - Enrique Pérez-Sáez
- National Reference Centre for Alzheimer’s and Dementia Care, Imserso, 37008 Salamanca, Spain
| | - Janessa O. Carvalho
- Department of Psychology, Bridgewater State University, Bridgewater, MA 02325, USA
| | - Elzbieta Bobrowicz-Campos
- Centre for Psychological Research and Social Intervention, Iscte-University Institute of Lisbon, 1649-026 Lisboa, Portugal
| | - João L. Alves Apóstolo
- Health Sciences Research Unit, Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
| | - Patricia Otero
- Department of Psychology, University of A Coruña, 15071 A Coruña, Spain
| | - Fernando L. Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Jilili M, Liu L. Examining the impact of functional disability and cognitive impairment on mental health of Chinese elderly. SOCIAL WORK IN HEALTH CARE 2022; 61:338-352. [PMID: 35792711 DOI: 10.1080/00981389.2022.2091080] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 04/28/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
Depression and anxiety, as the two most prevalent psychiatric disorders, pose a huge challenge to the quality of life of the elderly. Using a sample of 7,721 elderly from the latest Chinese Longitudinal Health and Longevity Survey (CLHLS), the present study intended to explore the association between mental health and socioeconomic status, physical functional disability, and cognitive impairment among Chinese elderly by adopting multivariate logistic regression analyses. The results revealed that depression, anxiety, and their comorbidity are significantly higher in the elderly with instrumental activities of daily living (IADL) disability, cognitive impairment, financial strain, and living alone. Findings of the study will provide implications for policymakers, social workers, and individual caregivers to develop necessary intervention measures to improve the mental health of the elderly and promote successful aging.
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Affiliation(s)
- Maitixirepu Jilili
- School of Social and Behavioral Sciences, Nanjing University, Nanjing, Jiangsu Province, China
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3
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Park SH. Which of the Cornell Scale for Depression in Dementia or the Geriatric Depression Scale is more useful to screen for depression in older adults? Asian J Psychiatr 2022; 72:103147. [PMID: 35533539 DOI: 10.1016/j.ajp.2022.103147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression in older adults is a major disorder that can be triggering, exacerbating, or co-occurring with dementia symptoms. AIM This study compared the diagnostic accuracy of the Cornell Scale for Depression in Dementia (CSDD) and the Geriatric Depression Scale (GDS), a depression screening tool developed for older adults. METHODS Electronic searches were performed on the MEDLINE, EMBASE, CINAHL, and PsycINFO databases using the following keywords: dementia, depression, and CSDD. RESULTS The pooled sensitivity of the CSDD and the GDS was 0.89 and 0.82, the pooled specificity was 0.88 and 0.85, and the summary receiver operating characteristic (SROC) curve was 0.94 and 0.91, respectively. In the subgroup analysis, the CSDD had the highest accuracy in the pooled sensitivity of 0.91, the pooled specificity of 0.87, and the sROC curve of 0.95 in the dementia group, and the GDS was the best in the non-dementia group at 0.88, 0.82, and 0.93, respectively. CONCLUSIONS The CSDD showed high diagnostic accuracy in older adults with dementia, and the GDS in older adults without dementia.
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Affiliation(s)
- Seong-Hi Park
- School of Nursing, Soonchunhyang University, 22 Soonchunhyang-ro, Sinchang-myen, Asan-si, Chungcheongnam-do 31538, Republic of Korea.
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Detecting depression in persons living with mild cognitive impairment: a systematic review. Int Psychogeriatr 2022; 34:453-465. [PMID: 35357300 DOI: 10.1017/s1041610222000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Depression is common in persons experiencing mild cognitive impairment (MCI), with 32% (95% Cl 27, 37) overall experiencing depression. Persons with MCI who have depression have more cognitive changes compared to those without depression. To understand how we can detect depressive symptoms in persons with MCI, we undertook a systematic review to identify tools that were validated compared with a reference standard. DESIGN We searched MEDLINE, EMBASE, PsycINFO, and Cochrane from inception to April 25, 2021, and conducted a gray literature search. Title/abstract and full-text screening were completed in duplicate. Demographic information, reference standards, prevalence, and diagnostic accuracy measures were then extracted from included articles (PROSPERO CRD: CRD42016052120). RESULTS Across databases, 8,748 abstracts were generated after removing duplicates. Six hundred and sixty-five records underwent full-text screening, with six articles included for data extraction. Nine tools were identified compared to a reference standard, with multiple demonstrating a sensitivity of 100% (Brief Assessment Schedule Depression Cards, Beck Depression Inventory-II, Cornell Scale for Depression in Dementia, Zung Self-Rated Depression Scale, and the Neuropsychiatric Inventory). The second highest sensitivity reported was 89% (Patient Health Questionnaire-9). Too few studies were available for a meta-analysis. CONCLUSIONS Multiple depression detection tools have been examined amongst MCI outpatients, with several showing high sensitivity. However, this evidence is only present in single studies, with little demonstration of how differing MCI types affect accuracy. More research is needed to confirm the accuracy of these tools amongst persons with MCI. At this time, several tools could be suitable for use in cognitive clinics.
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Clinical considerations when using assessment tools to identify depression in older adults with mild cognitive impairment. Int Psychogeriatr 2022; 34:413-416. [PMID: 35465861 DOI: 10.1017/s1041610222000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sugiyama T, Carver A, Sugiyama M, Lorenzon A, Davison TE. Views of Greenery and Psychological Well-Being in Residential Aged Care Facilities: Longitudinal Associations. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 15:219-232. [PMID: 34809476 DOI: 10.1177/19375867211059757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study examined associations of objectively measured views of greenery in residential aged care facilities (RACFs) with changes in multiple psychological well-being measures among residents who were newly admitted to RACFs. METHODS Data were collected from 52 residents (mean age: 84, 73% women) of 13 RACFs, located in Melbourne, Australia. The outcomes were changes in depression, stress, anxiety, and quality of life (QoL) between baseline and 8-week follow-up. The exposure measures were the amount and presence of greenery visible from participant's bedroom and common areas (lounge, dining). Greenery was categorized as being either within or beyond the RACF perimeter. RESULTS Regression analyses found that greenery visible from participant's bedroom was not associated with any outcomes. The amount of greenery visible from common areas within the RACF perimeter was adversely related to stress, unexpectedly: Each additional 1 m2 of greenery was associated with a greater increase in stress (b = 0.05; 95% CI [0.07, 0.94]). However, greenery visible from common areas beyond the perimeter contributed favorably to stress and QoL. The presence of such greenery was associated with a lower increase in stress (b = -3.99; 95% CI [-7.75, -0.23]; reference: no greenery), and a 1 m2 increment was associated with a greater increase in QoL (b = 0.07; 95% CI [0.02, 0.11]). CONCLUSION Views of greenery outside of the RACF from lounge and dining areas may be protective against residents' stress increase and improve their QoL. Locating residents in areas with such outdoor views may prevent their psychological condition from worsening.
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Affiliation(s)
- Takemi Sugiyama
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Alison Carver
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Masaaki Sugiyama
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.,Graduate School of Human Life Science, Osaka City University, Japan
| | - Alanna Lorenzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Tanya E Davison
- Health and Ageing Research Group, Swinburne University of Technology, Melbourne, Australia
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Park SH, Kwak MJ. Performance of the Geriatric Depression Scale-15 with Older Adults Aged over 65 Years: An Updated Review 2000-2019. Clin Gerontol 2021; 44:83-96. [PMID: 33164674 DOI: 10.1080/07317115.2020.1839992] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This up-to-date systematic review and meta-analysis aimed to examine the predictive validity of the Geriatric Depression Scale-15 (GDS-15) for screening depression in older adults aged over 65 years. METHODS Electronic searches were performed on the MEDLINE, EMBASE, CINAHL, and PsycINFO database using the following keywords: depression, depressive disorder, major, geriatric depression scale, and geriatric depression scale short. The Quality Assessment of Diagnostic Accuracy Studies-2 was applied to assess the risk of bias in diagnostic studies. RESULTS Thirty-one studies that included 8,897 older adults were analyzed. The pooled sensitivity of the GDS-15 was 0.80 (95% CI:0.78 to 0.82), its pooled specificity was 0.79 (95% CI:0.78 to 0.80), the area under the curve (AUC) was 0.89 (SE = 0.01) and the Q* value was 0.82 (SE = 0.01). The subgroup analysis revealed that the pooled sensitivity and specificity of the GDS-15 were higher in older adults with normal cognitive function than in those with cognitive impairment. CONCLUSIONS These finding suggest that the GDS-15 may be more accurate for screening depression in older adults with normal cognitive function. CLINICAL IMPLICATIONS The utility the GDS-15 may be restricted because its diagnostic accuracy is slightly lower among older adults with cognitive impairment.
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Affiliation(s)
- Seong-Hi Park
- School of Nursing, Soonchunhyang University , Asan, South Korea
| | - Mi-Jeong Kwak
- Quality Improvement Team, Korea University Anam Hospital , Seoul, South Korea
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Davison TE, McCabe MP, Busija L, Graham A, Camões-Costa V, Kelly J, Byers J. The effectiveness of the Program to Enhance Adjustment to Residential Living (PEARL) in reducing depression in newly admitted nursing home residents. J Affect Disord 2021; 282:1067-1075. [PMID: 33601679 DOI: 10.1016/j.jad.2020.12.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/23/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Depression is common in nursing homes, particularly among newly admitted residents. This cluster randomised controlled trial evaluated the effectiveness of the Program to Enhance Adjustment to Residential Living (PEARL) in reducing depression in this group. METHODS Participants were 219 newly-admitted residents (mean of 4.4 weeks since admission) in 42 nursing homes in Melbourne, Australia, with a mean age of 85.5 years (SD = 7.3). Nursing homes were randomly allocated to the intervention or standard care condition. Level of depressive symptoms was evaluated at baseline (T1), one week post- intervention (T2), 2 months post-intervention (T3, primary end point), and 6 months post-intervention (T4). Changes in depressive symptoms in the intervention and control groups over time were compared using a multilevel model, with nursing homes modelled as random intercept. RESULTS In intention to treat analyses, depressive symptoms reduced from T1 to T3 to a greater degree in the intervention condition (Mchange=2.56, SDchange=5.71) than in the control (Mchange=0.63, SDchange=5.25), with a significant, small-medium treatment effect size (p=.035; Cohen's d=0.36). The reduction in depressive symptoms from T1 to T4 was not significant (p=.369; Cohen's d=0.32). LIMITATIONS The findings require replication, particularly comparing PEARL with an active control condition. CONCLUSIONS PEARL is a simple, brief program that was effective in reducing symptoms of depression in newly admitted nursing home residents.
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Affiliation(s)
- Tanya E Davison
- Swinburne University of Technology, Hawthorn, VIC, Australia.
| | - Marita P McCabe
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | - Annette Graham
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | - Julie Kelly
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jessica Byers
- Swinburne University of Technology, Hawthorn, VIC, Australia
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9
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Davison TE, McCabe MP, Busija L, O'Connor DW, Costa VC, Byers J. A cluster randomised trial of the program to enhance adjustment to residential living (PEARL): a novel psychological intervention to reduce depression in newly admitted aged care residents. BMC Geriatr 2020; 20:98. [PMID: 32164587 PMCID: PMC7068981 DOI: 10.1186/s12877-020-1492-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Depression rates are high in residential aged care (RAC) facilities, with newly admitted residents at particular risk. New approaches to address depression in this population are urgently required, particularly psychological interventions suitable for widespread use across the RAC sector. The Program to Enhance Adjustment to Residential Living (PEARL) is a brief intervention, designed to provide individually tailored care approaches to meet the psychological needs of newly admitted residents, delivered in collaboration with facility staff. Methods PEARL will be evaluated using a cluster randomised controlled design, comparing outcomes for residents who participate in the intervention with those residing in care as usual control facilities. Participants are RAC residents aged 60 years or above, with normal cognition or mild-moderate cognitive impairment, who relocated to the facility within the previous 4 weeks. The primary outcomes are depressive symptoms and disorders, with secondary outcomes including anxiety, stress, quality of life, adjustment to RAC, and functional dependence, analysed on an intention to treat basis using multilevel modelling. Discussion PEARL is an intervention based on self-determination theory, designed to reduce depression in newly admitted residents by tailoring day to day care to meet their psychological needs. This simple psychological approach offers an alternative care model to the current over-reliance of antidepressant medications. Trial registration ACTRN12616001726448; Registered 16 December 2016 with the Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Tanya E Davison
- Health and Ageing Research Group, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, H95 PO Box 218, Hawthorn, VIC, 3122, Australia.
| | - Marita P McCabe
- Health and Ageing Research Group, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, H95 PO Box 218, Hawthorn, VIC, 3122, Australia
| | - Lucy Busija
- Biostatistics Consulting Platform, Research Methodology Division, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | - Vera Camões Costa
- Health and Ageing Research Group, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, H95 PO Box 218, Hawthorn, VIC, 3122, Australia
| | - Jessica Byers
- Health and Ageing Research Group, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, H95 PO Box 218, Hawthorn, VIC, 3122, Australia
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10
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Verdaguer ES, Stafford J, Tuijt R, Orgeta V. Minor and subthreshold depressive disorders in Alzheimer's disease: A systematic review and meta-analysis of prevalence studies. J Affect Disord 2020; 263:728-734. [PMID: 31787425 DOI: 10.1016/j.jad.2019.11.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 10/02/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Depressive symptoms are common in Alzheimer's disease (AD) and negatively impact patient well-being. The main aim of the present study was to establish summary estimates for the prevalence of minor depressive disorder (MinD) and subthreshold depression in AD and synthesise evidence on prognosis and management of these symptoms in order to inform clinical guidelines. METHODS Systematic review and meta-analysis of cross-sectional and longitudinal studies of prevalence, prognosis, and treatments for minor and subthreshold depression in AD. We searched MEDLINE, Embase, PsycINFO and CINAHL. We included studies that reported prevalence of subthreshold depressive disorders and those reporting data on validity of diagnostic criteria, mechanisms, or randomised controlled clinical trials (RCTs) testing effectiveness of interventions. Estimates of prevalence were pooled using random-effects meta-analyses. Two authors screened articles and independently extracted data on study characteristics. RESULTS We reviewed 5671 abstracts, retrieved 621 full text articles and included a total of 15 studies. Pooling data from 10 studies showed that prevalence for MinD in AD was 22.0% (95% CI 16.0 to 28.0). Prevalence for a clinical diagnosis of MinD (DSM-III-R and DSM-IV) was 26.0% (95% CI 20.0 to 32.0; 6 studies). People with MinD experienced higher levels of neuropsychiatric symptoms, functional and cognitive decline, although studies remain cross-sectional. Neither sertraline nor a carer intervention were effective in reducing symptoms. CONCLUSION This review finds that MinD is prevalent in people with a diagnosis of AD and requires clinical attention. Research is warranted to develop effective interventions to treat and prevent these symptoms.
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Gillitzer M. Implementing a depression screening algorithm in a memory clinic. Arch Psychiatr Nurs 2019; 33:123-128. [PMID: 31753217 DOI: 10.1016/j.apnu.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/25/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE AND RATIONALE Improved and appropriate utilization of depression screening will increase the quality of life for those individuals with dementia who may have undetected or untreated depression. SYNTHESIS OF EVIDENCE Depressive symptoms may be an early sign of dementia or occur at any stage. PROPOSED CHANGE AND IMPLEMENTATION STRATEGIES An algorithm was piloted in which initial cognitive screenings were administered prior to using either the Cornell Scale for Depression in Dementia (CSDD) screen or Geriatric Depression Scale Short Form (GDS-SF) screen. EVALUATION Findings included an increase in depression screening and an improvement of clinician knowledge of screening tools. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This project enhanced knowledge among the clinicians, however, only one provider improved practices.
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Affiliation(s)
- Michelle Gillitzer
- University of Iowa, College of Nursing, 101 College of Nursing Building, 50 Newton Road, Iowa City, IA 52242, United States of America.
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Davison TE, Eppingstall B, Runci S, O'Connor DW. A pilot trial of acceptance and commitment therapy for symptoms of depression and anxiety in older adults residing in long-term care facilities. Aging Ment Health 2017; 21:766-773. [PMID: 26942691 DOI: 10.1080/13607863.2016.1156051] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy and acceptability of a psychological intervention based on acceptance and commitment therapy (ACT) to improve symptoms of depression and anxiety among older adults living in long-term care. METHOD Forty one residents aged between 63 and 97 years (M = 85.3 years) participated in this study. Residents were allocated to receive either a 12 session ACT intervention implemented by trainee psychology therapists or a wait-list control group. Measures of depression and anxiety were collected at baseline and 8 week post-intervention, and residents who received the intervention were tracked for three months. A treatment satisfaction questionnaire was administered to residents who received the intervention and a sample of 10 facility staff members. RESULTS Using an intention to treat approach and controlling for baseline scores, scores on depression measures were significantly lower after the ACT intervention than after the wait-list control. These outcomes were maintained at three-month follow-up. Treatment satisfaction was rated highly by both residents and their care staff. CONCLUSION This preliminary trial suggests that ACT shows promise as a therapeutic approach to address symptoms of depression in long-term care.
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Affiliation(s)
- Tanya E Davison
- a Department of Psychiatry , Monash University , Clayton , Australia
| | | | - Susannah Runci
- a Department of Psychiatry , Monash University , Clayton , Australia
| | - Daniel W O'Connor
- a Department of Psychiatry , Monash University , Clayton , Australia
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13
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ST-elevation myocardial infarction risk in the very elderly. BBA CLINICAL 2016; 6:108-12. [PMID: 27635386 PMCID: PMC5024138 DOI: 10.1016/j.bbacli.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 08/24/2016] [Accepted: 09/01/2016] [Indexed: 12/31/2022]
Abstract
Background Despite the high incidence and mortality of ST-segment elevation myocardial infarction (STEMI) among the very elderly, risk markers for this condition remain poorly defined. This study was designed to identify independent markers of STEMI among individuals carefully selected for being healthy or manifesting STEMI in < 24 h. Methods We enrolled participants aged 80 years or older of whom 50 were STEMI patients and 207 had never manifested cardiovascular diseases. Blood tests, medical and psychological evaluations were obtained at study admission. Odds Ratio (OR) and attributed risk (AR) were obtained by multivariate regression models using STEMI as dependent variable. Results Low glomerular filtration rate (GFR) [OR:4.41 (1.78–10.95); p = 0.001], reduced levels of HDL-C [OR:10.70 (3.88–29.46); p = 0.001], male gender [OR:12.08 (5.82–25.08); p = 0.001], moderate to severe depressive symptoms [OR:10.00 (2.82–35.50); p = 0.001], prior smoking [OR:2.00 (1.05–3.80); p = 0.034] and current smoking [OR:6.58 (1.99–21.70); p = 0.002] were significantly associated with STEMI. No association was found between STEMI and age, diabetes, hypertension, mild depressive symptoms, triglyceride or LDL-C. Conclusions This is the first case–control study carried out with very elderlies to assess STEMI risk. Our findings indicate that reduced HDL-C, GFR, male gender, smoking habits and moderate to severe depressive symptoms are markers of STEMI in this age group. General Significance In Individuals aged 80 or more years, a greater attention must be paid to low HDL-C and GFR at the expense of conventional STEMI risk factors for younger adults such as diabetes mellitus, hypertension and high LDL-C or triglyceride. Population aging are rapidly increasing worldwide, especially in developing countries. Incidence and mortality due to cardiovascular diseases is extremely high in the very elderly population. There is no specific algorithm for cardiovascular disease risk estimation for very elderly individuals. Among the very elderly, markers of cardiovascular risk are distinct from younger adults.
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Key Words
- ANCOVA, analysis of covariance
- AR, attributable risk
- Aged
- Aged, 80 and over
- BDI-II, Beck Depression Inventory version II
- BHS, Brasília Heart Study
- BSHA, Brasília Study on Healthy Aging
- CK-MB, MB fraction of creatine kinase
- CRP, C-reactive protein
- CVD, cardiovascular disease
- DBP, diastolic blood pressure
- EDTA, ethylenediamine tetraacetic acid
- GDS, Geriatric Depression Scale
- GFR, glomerular filtration rate
- HDL-C, high-density lipoprotein cholesterol
- HDL-cholesterol
- HbA1c, glycated hemoglobin
- IQR, interquartile range
- LDL-C, low-density lipoprotein cholesterol
- MI, myocardial infarction
- Myocardial infarction
- OR, odds ratio
- SBP, systolic blood pressure
- SD, standard deviation
- STEMI, ST-segment elevation myocardial infarction
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Rashedi V, Rezaei M, Foroughan M, Delbari A. Validity and reliability of the depression in old age scale (DIA-S) in Iranian older adults. Arch Gerontol Geriatr 2016; 66:193-7. [PMID: 27351463 DOI: 10.1016/j.archger.2016.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 04/11/2016] [Accepted: 06/10/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Vahid Rashedi
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Mohammad Rezaei
- Faculty of Rehabilitation Sciences, Hamadan University of Medical Sciences & Health Services, Hamadan, Iran
| | - Mahshid Foroughan
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
| | - Ahmad Delbari
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
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Pocklington C, Gilbody S, Manea L, McMillan D. The diagnostic accuracy of brief versions of the Geriatric Depression Scale: a systematic review and meta-analysis. Int J Geriatr Psychiatry 2016; 31:837-57. [PMID: 26890937 DOI: 10.1002/gps.4407] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 11/09/2015] [Accepted: 11/25/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depression in older adults is often under recognised despite it being the most common mental health illness in this age group. An increasing older adult population highlights the need for improved diagnostic rates. Brief versions (15 items or less) of the Geriatric Depression Scale (GDS), which are suitable for busy clinical practice, could improve detection rates. OBJECTIVE Our aim is to establish the diagnostic accuracy of brief versions of the GDS. METHODS Twelve electronic databases of published and unpublished literature were searched. Study selection was in accordance with predefined inclusion and exclusion criteria. A recognised gold-standard diagnostic instrument was used as a comparator against data pertaining to the use of a brief version of the GDS in an older adult population. The QUADAS-II was utilised for quality assessment. Narrative analysis and, where possible, meta-analysis were performed. RESULTS Thirty-two studies were identified that provided diagnostic data regarding seven brief versions of the GDS (1, 4, 5, 7 8, 10 and 15-item versions). Pooled sensitivity was 0.89 (95% confidence interval (CI) 0.80-0.94), and specificity was 0.77 (95% CI 0.65-0.86) for the GDS-15 at the recommended cut-off score of 5. Meta-analysis of other brief versions was not possible because of an insufficient number of studies with standardised items. CONCLUSIONS Results suggest the possibility of selective reporting of cut-off scores, and therefore, findings should be approached cautiously. Studies should report all cut-off scores, and all brief GDS versions should be compiled of standardised items. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, University of York, Heslington, York, UK
| | - Laura Manea
- Hull York Medical School and Department of Health Sciences, University of York, Heslington, York, UK
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, University of York, Heslington, York, UK
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Brown EL, Raue PJ, Halpert K. Evidence-Based Practice Guideline: Depression Detection in Older Adults With Dementia. J Gerontol Nurs 2015; 41:15-21. [DOI: 10.3928/00989134-20151015-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Review of the effect of music interventions on symptoms of anxiety and depression in older adults with mild dementia. Int Psychogeriatr 2015; 27:1661-70. [PMID: 25921299 DOI: 10.1017/s1041610215000393] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Treatment of anxiety and depression, the most common psychiatric symptoms in older adults with mild dementia, requires innovative approaches due to the high cost and significant side effects associated with traditional pharmacological interventions. Alternative non-pharmacological therapies, such as music, when used in conjunction with pharmacological treatment, have the potential to alleviate symptoms of anxiety and depression in older adults diagnosed with mild dementia. The purpose of this review was to examine the evidence of music's efficacy in improving symptoms of anxiety and depression in older adults with mild dementia. METHODS Four databases (Medline, CINAHL, PsychInfo, PubMed) were searched using the terms "music," "music therapy," "music intervention," "singing," "dementia," "anxiety," and/or "depression," identifying ten studies that met the inclusion and exclusion criteria. RESULTS The poor methodological rigor of the studies precluded reaching consensus on the efficacy of a music intervention in alleviating symptoms of anxiety and depression in older adults with mild dementia. CONCLUSIONS There was inconclusive evidence as to whether music interventions are effective in alleviating symptoms of anxiety and depression in older adults with mild dementia due to the poor methodological rigor. However, with improved designs guided by a deeper understanding of how music engages the aging brain, music may emerge as an important adjunct therapy to improving the lives of older adults with mild dementia.
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A personalized multimedia device to treat agitated behavior and improve mood in people with dementia: A pilot study. Geriatr Nurs 2015; 37:25-9. [PMID: 26412509 DOI: 10.1016/j.gerinurse.2015.08.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 11/21/2022]
Abstract
Agitated behaviors and dysphoric moods in nursing home residents with dementia may be a response to a lack of personalized, meaningful activity and stimulation. To address this deficiency, a personal computer was adapted to play favorite music and display photographs, movies and messages that were selected or made by family members. The system (called Memory Box) is accompanied by a simplified interface to help people with dementia access material independently. The system's ability to reduce agitation, and improve symptoms of depression and anxiety, was tested by means of an eight-week randomized, single-blinded, cross-over trial comparing Memory Box with a control condition that offered equivalent contact with research staff. Eleven nursing home residents with mild to severe dementia and persistent, daily agitated behaviors completed the study. Outcome measures included ratings of anxiety, depression and agitated behavior made by knowledgeable staff members in collaboration with researchers. Memory Box was well utilized and highly rated by residents, families and staff members. There were significant reductions in depressive and anxiety symptoms during the course of the intervention. The system shows promise as a tool to assist families and nursing home staff to improve the wellbeing of cognitively impaired older people with agitated behaviors.
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Jeon YH, Li Z, Low LF, Chenoweth L, O'Connor D, Beattie E, Liu Z, Brodaty H. The clinical utility of the Cornell Scale for Depression in Dementia as a routine assessment in nursing homes. Am J Geriatr Psychiatry 2015; 23:784-93. [PMID: 25256214 DOI: 10.1016/j.jagp.2014.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/26/2014] [Accepted: 08/29/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the clinical utility of the Cornell Scale for Depression in Dementia (CSDD) in nursing homes. SETTING 14 nursing homes in Sydney and Brisbane, Australia. PARTICIPANTS 92 residents with a mean age of 85 years. MEASUREMENTS Consenting residents were assessed by care staff for depression using the CSDD as part of their routine assessment. Specialist clinicians conducted assessment of depression using the Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders for residents without dementia or the Provisional Diagnostic Criteria for Depression in Alzheimer Disease for residents with dementia to establish expert clinical diagnoses of depression. The diagnostic performance of the staff completed CSDD was analyzed against expert diagnosis using receiver operating characteristic (ROC) curves. RESULTS The CSDD showed low diagnostic accuracy, with areas under the ROC curve being 0.69, 0.68 and 0.70 for the total sample, residents with dementia and residents without dementia, respectively. At the standard CSDD cutoff score, the sensitivity and specificity were 71% and 59% for the total sample, 69% and 57% for residents with dementia, and 75% and 61% for residents without dementia. The Youden index (for optimizing cut-points) suggested different depression cutoff scores for residents with and without dementia. CONCLUSION When administered by nursing home staff the clinical utility of the CSDD is highly questionable in identifying depression. The complexity of the scale, the time required for collecting relevant information, and staff skills and knowledge of assessing depression in older people must be considered when using the CSDD in nursing homes.
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Affiliation(s)
- Yun-Hee Jeon
- Sydney Nursing School, the University of Sydney, Sydney, Australia.
| | - Zhicheng Li
- Sydney Nursing School, the University of Sydney, Sydney, Australia
| | - Lee-Fay Low
- Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Lynn Chenoweth
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Daniel O'Connor
- Southern Clinical School, Monash University, Clayton, Australia
| | - Elizabeth Beattie
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Zhixin Liu
- Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
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Olagunju AT, Olutoki MO, Ogunnubi OP, Adeyemi JD. Late-life depression: Burden, severity and relationship with social support dimensions in a West African community. Arch Gerontol Geriatr 2015; 61:240-6. [PMID: 26003904 DOI: 10.1016/j.archger.2015.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The occurrence of depression in old age is often linked with grave consequences. The purpose of this study is to investigate the burden of depression and its relationship with perceived social support among the elderly in a West African community setting. METHODS In this cross-sectional study, participants made up of 350 elders aged 60 years and above were selected through multi-stage random sampling technique. All participants were interviewed with designed questionnaire, multidimensional scale of perceived social support (MSPSS) and Geriatric Depression Scale (GDS) to elicit socio-demographic profile, social support and depressive psychopathology respectively. RESULTS The participants were largely females (52.9%) and their mean age was 68.8±7.3 years. A little above one-quarter (26.4%) had depressive episode, and mild severity was preponderant. Low level of social support was associated with depression (χ(2)=8.418, p=0.004); especially low social supports from significant others (χ(2)=3.989, p=0.046) and family members (χ(2)=4.434, p=0.035). Similarly, severity of depression in the elderly correlated negatively with availability of social support from significant others (χ(2)=5.495, p=0.019) and family members (χ(2)=5.149, p=0.023). CONCLUSION Considering the burden of depression in this elderly population and the influential roles of social support especially from family and significant others on depression; strengthening of informal social support and formal social support for the elders is advocated. In addition, design of community based geriatric mental health with social services and articulation of public policy to address old age needs are implied.
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Affiliation(s)
- Andrew Toyin Olagunju
- Department of Psychiatry, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria; Department of Psychiatry, Lagos University Teaching Hospital, PMB 12003, Lagos, Nigeria.
| | - Michael Olasunkanmi Olutoki
- Federal Neuropsychiatric Hospital, Yaba, PMB 2008, Lagos, Nigeria; Federal Neuropsychiatric Hospital, Calabar, PMB 1052, Calabar, Cross River State, Nigeria
| | | | - Joseph Dada Adeyemi
- Department of Psychiatry, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria; Department of Psychiatry, Lagos University Teaching Hospital, PMB 12003, Lagos, Nigeria
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Azulai A, Walsh CA. Screening for geriatric depression in residential care facilities: a systematic narrative review. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 58:20-45. [PMID: 24926811 DOI: 10.1080/01634372.2014.904469] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Studies in residential care facilities suggest that routine screening can assist in the early detection of geriatric depression. However, the effectiveness of screening instruments in residential care in the US and Canada has not been adequately evaluated. We conducted a systematic narrative review of the English-language literature published between 2000 and 2010 on screening instruments used for depression detection in older adults living in residential care facilities. The review yielded nine scales and their modifications tested in residential care, which we evaluated. We provide specific recommendations for the use of effective scales and discuss implications for practice, policy and research.
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Affiliation(s)
- Anna Azulai
- a Faculty of Social Work , University of Calgary , Calgary , Canada
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McKenna B, Furness T, Dhital D, Ireland S. Recovery-Oriented Care in Older-Adult Acute Inpatient Mental Health Settings in Australia: An Exploratory Study. J Am Geriatr Soc 2014; 62:1938-42. [DOI: 10.1111/jgs.13028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Brian McKenna
- School of Nursing; Midwifery and Paramedicine; Australian Catholic University; Fitzroy Vic. Australia
- NorthWestern Mental Health; Royal Melbourne Hospital; Parkville Vic. Australia
| | - Trentham Furness
- School of Nursing; Midwifery and Paramedicine; Australian Catholic University; Fitzroy Vic. Australia
- NorthWestern Mental Health; Royal Melbourne Hospital; Parkville Vic. Australia
| | - Deepa Dhital
- School of Nursing; Midwifery and Paramedicine; Australian Catholic University; Fitzroy Vic. Australia
- NorthWestern Mental Health; Royal Melbourne Hospital; Parkville Vic. Australia
| | - Susan Ireland
- NorthWestern Mental Health; Royal Melbourne Hospital; Parkville Vic. Australia
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Abstract
Depression is related to disability and affects rehabilitation participation, outcomes, and compliance with treatment. Improving older adult depression detection and referral requires knowledge, skills, supportive organizational policies, and access to mental health experts. This review provides a selected overview of evidence-based approaches for screening of suspected cases of depression in older adults by physical therapists and other non-mental health professionals and discusses procedures to refer suspected cases to primary care providers and/or mental health specialists for evaluation, including resources and a tool to assist in communicating depression-related information to the primary care provider or mental health specialist. We hope that this review will promote the incorporation of evidence-based screening and referral of suspected cases of depression in older adults into routine practice.
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Affiliation(s)
- Edgar Ramos Vieira
- 1College of Nursing and Health Sciences, Florida International University, Miami. 2Weill Cornell Medical College, Cornell University, White Plains, New York
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Olutoki MO, Olagunju AT, Adeyemi JD. Correlates of depressive illness among the elderly in a mixed urban community in Lagos, Nigeria. Aging Ment Health 2014; 18:561-9. [PMID: 24102150 DOI: 10.1080/13607863.2013.843156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Little is known about the factors associated with depression among elderly Nigerians despite research evidence suggesting that some correlates of depression may be important in early detection, treatment and prognosis. This study aimed to determine the correlates of depression among a community based elderly population. METHODS The study population made up of 350 consenting participants was selected using multistage stratified random sampling technique. Face-to-face interviews were conducted among the participants using a research instrument consisting of two parts: a self-designed questionnaire to elicit their socio-demographic profile, level of social support as well as their health status and the 30-item Geriatric Depression Scale to diagnose depression using cut-off score ≥11. Both the English and Yoruba versions of the study instruments were used depending on the level of education of the participants. RESULTS Depression was found to be associated with being younger old (χ(2) = 6.19, p = 0.045), prolonged stay in current residence (χ(2) = 6.62, p = 0.01), living in less developed area of the community and not having children (χ(2) = 0.03, p = 0.01), while higher social support (χ(2) = 4.19, p = 0.041) seems protective. However, only low social support (odds ratio [OR] = 0.573; 95% confidence interval [CI], 0.330-0.994; p = 0.048), living in less developed area (OR = 5.342; 95% CI = 1.027, 27.776; p = 0.046) and prolonged stay in current residence (OR = 0.407; 95% CI = 0.205, 0.806; p = 0.01) independently predicted depression in participants. CONCLUSION To enhance early detection and treatment of depressive disorders in the elderly, physicians should be alert to the diagnosis of depression in late life, especially among the younger old, elderly not having children, those with low social support as well as prolonged stay in a residence and living in less developed parts of the community. Further research is needed to shed light on the intriguing link between depression and associated factors in geriatric population.
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Knight T, Skouteris H, Townsend M, Hooley M. The act of giving: a pilot and feasibility study of theMy Life Storyprogramme designed to foster positive mental health and well-being in adolescents and older adults. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2014. [DOI: 10.1080/02673843.2014.881297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Curran EM, Loi S. Depression and dementia. Med J Aust 2013; 199:S40-4. [DOI: 10.5694/mja12.10567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 08/29/2012] [Indexed: 11/17/2022]
Affiliation(s)
| | - Samantha Loi
- St Vincent's Hospital, Melbourne, VIC
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, VIC
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McCabe MP, Mellor D, Davison TE, Karantzas G, von Treuer K, O’Connor DW. A study protocol to investigate the management of depression and challenging behaviors associated with dementia in aged care settings. BMC Geriatr 2013; 13:95. [PMID: 24047236 PMCID: PMC3848459 DOI: 10.1186/1471-2318-13-95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The high occurrence and under-treatment of clinical depression and behavioral and psychological symptoms of dementia (BPSD) within aged care settings is concerning, yet training programs aimed at improving the detection and management of these problems have generally been ineffective. This article presents a study protocol to evaluate a training intervention for facility managers/registered nurses working in aged care facilities that focuses on organisational processes and culture as well as knowledge, skills and self-efficacy. METHODS A Randomised Control Trial (RCT) will be implemented across 18 aged care facilities (divided into three conditions). Participants will be senior registered nurses and personal care attendants employed in the aged care facility. The first condition will receive the training program (Staff as Change Agents - Enhancing and Sustaining Mental Health in Aged Care), the second condition will receive the training program and clinical support, and the third condition will receive no intervention. RESULTS Pre-, post-, 6-month and 12-month follow-up measures of staff and residents will be used to demonstrate how upskilling clinical leaders using our transformational training approach, as well as the use of a structured screening, referral and monitoring protocol, can address the mental health needs of older people in residential care. CONCLUSIONS The expected outcome of this study is the validation of an evidence-based training program to improve the management of depression and BPSD among older people in residential care settings by establishing routine practices related to mental health. This relatively brief but highly focussed training package will be readily rolled out to a larger number of residential care facilities at a relatively low cost. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): The Universal Trial Number (UTN) is U1111-1141-0109.
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Affiliation(s)
- Marita P McCabe
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Melbourne 3125, Victoria, Australia
| | - David Mellor
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Melbourne 3125, Victoria, Australia
| | - Tanya E Davison
- School of Psychology and Psychiatry, Monash University, Melbourne, Australia
| | - Gery Karantzas
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Melbourne 3125, Victoria, Australia
| | - Kathryn von Treuer
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Melbourne 3125, Victoria, Australia
| | - Daniel W O’Connor
- School of Psychology and Psychiatry, Monash University, Melbourne, Australia
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McSweeney K, Jeffreys A, Griffith J, Plakiotis C, Kharsas R, O'Connor DW. Specialist mental health consultation for depression in Australian aged care residents with dementia: a cluster randomized trial. Int J Geriatr Psychiatry 2012; 27:1163-71. [PMID: 22344753 DOI: 10.1002/gps.3762] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 11/10/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This cluster randomized controlled trial sought to determine whether multidisciplinary specialist mental health consultation was more effective than care as usual in treating the depression of aged care residents with dementia. METHODS Three hundred and eighty nine aged care residents were screened for dementia and major depression. Forty four were ultimately included in the intervention sample, selected from 20 aged care facilities located in Melbourne, Australia. Facilities were randomly allocated to an intervention condition involving the provision of multidisciplinary specialist consultation regarding the best-practice management of depression in dementia, or to a care as usual condition. Consultations involved individually tailored medical and psychosocial recommendations provided to care staff and general practitioners. All residents participated in a comprehensive pre-intervention diagnostic assessment, including the administration of the Cornell Scale for Depression in Dementia. This assessment was repeated approximately 15 weeks post-intervention by a rater blind to study condition. RESULTS Multidisciplinary specialist mental health consultation was significantly more effective than care as usual in treating the clinical depression of aged care residents with dementia (p < 0.05, partial η(2) = 0.16). At follow-up, the mean Cornell Scale for Depression in Dementia score for the intervention group was 9.47, compared with 14.23 for the control group. In addition, 77% of the intervention group no longer met criteria for major depression. CONCLUSIONS The results of this study suggest that the psychosocial and medical management of depressed aged care residents can be improved by increasing access to specialist mental health consultation.
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Affiliation(s)
- Kate McSweeney
- Aged Mental Health Research Unit, School of Psychology and Psychiatry, Monash University, Melbourne, Australia.
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An evaluation of a national program to implement the Cornell Scale for Depression in Dementia into routine practice in aged care facilities. Int Psychogeriatr 2012; 24:631-41. [PMID: 22137149 DOI: 10.1017/s1041610211002146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Screening tools have been recommended for use in aged care to improve the detection and treatment of depression. This study aimed to evaluate the impact of a program for the routine implementation of the Cornell Scale for Depression in Dementia in Australian facilities, to determine whether use of the instrument by nurses led to further monitoring of depressive symptoms, medical referral, and changes in treatments prescribed for depression. METHODS A file review was completed for 412 participants out of a total of 867 older people (47.5%) who resided in ten aged care facilities. The review examined Cornell Scale assessment data, medication charts, medical history, nursing progress notes, and resident care plans. Nursing staff who administered the Cornell Scale to each participant were also interviewed, and ten facility managers took part in an interview to determine barriers to the effective implementation of the instrument. RESULTS The Cornell Scale had been administered to 46.8% of the sample in the previous 12 months, with 25% of these participants scoring 9-13 and 27% scoring 14 and above. Less than one third of the residents with high scores were monitored by the staff following the assessment. Only 18% of residents with high scores were referred for further assessment of depression, while 10% received a treatment change. CONCLUSIONS The absence of a protocol for responding to high Cornell Scale scores limited the potential of this program to result in widespread improved treatment of depressed older people. The use of the Cornell Scale by aged care nurses with limited training raised concern.
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Abstract
The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.
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Affiliation(s)
- Roschelle A Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt. Pleasant, Michigan 48859, USA.
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Head D, Singh T, Bugg JM. The moderating role of exercise on stress-related effects on the hippocampus and memory in later adulthood. Neuropsychology 2012; 26:133-43. [PMID: 22288406 DOI: 10.1037/a0027108] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Chronic stress has well-documented negative effects on hippocampal structure and function, and has been suggested to contribute to age-related declines. In contrast, there is evidence that exercise has beneficial effects in older adults. The current investigation examined effects of lifetime stress on hippocampal volume and memory, the moderating role of stress on age effects, and the moderating role of exercise on stress-related effects. METHOD Measures of lifetime stress, exercise engagement, magnetic-resonance-imaging-based volumes, and cognitive performance were obtained in a sample of healthy middle-aged and older adults. RESULTS There was a significant negative influence of stress on hippocampal volume. In addition, exercise engagement moderated effects of lifetime stress on both hippocampal volume and memory. Specifically, lower exercise engagement individuals evidenced greater stress-related declines compared with high exercise engagement individuals. CONCLUSIONS These novel findings suggest that benefits of exercise in later adulthood may extend to minimizing detrimental effects of stress on the hippocampus and memory.
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Affiliation(s)
- Denise Head
- Washington University, Department of Psychology, Campus Box 1125, One Brookings Drive, St. Louis, MO 63130, USA.
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Social engagement and depressive symptoms of elderly residents with dementia: a cross-sectional study of 37 long-term care units. Int Psychogeriatr 2011; 23:625-33. [PMID: 21073769 DOI: 10.1017/s1041610210002061] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Social engagement and depression are important outcomes for residents with dementia in long-term care. However, it is still largely unclear which differences in social engagement and depression exist in residents of various long-term care settings and how these differences may be explained. This study investigated the relationship between social engagement and depressive symptoms in long-term care dementia units, and studied whether differences in social engagement and depressive symptoms between units can be ascribed to the composition of the resident population or to differences in type of care setting. METHODS Thirty-seven long-term care units for residents with dementia in nursing- and residential homes in the Netherlands participated in the study. Social engagement and depressive symptoms were measured for 502 residents with the Minimum Data Set of the Resident Assessment Instrument. Results were analyzed using multilevel analysis. RESULTS Residents of psychogeriatric units in nursing homes experienced low social engagement. Depressive symptoms were most often found in residents of psychogeriatric units in residential homes. Multilevel analyses showed that social engagement and depressive symptoms correlated moderately on the level of the units. This correlation disappeared when the characteristics of residents were taken into account. CONCLUSIONS Social engagement and depressive symptoms are influenced not only by individual characteristics but also by the type of care setting in which residents live. However, in this study social engagement and depressive symptoms were not strongly related to each other, implying that separate interventions are needed to improve both outcomes.
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Abstract
BACKGROUND We assessed the relationship between cognitive impairment (including mild cognitive impairment with no signs of dementia, and dementia) and risk for depression in old age (60 years and older). METHODS MEDLINE, EMBASE and the Cochrane Library database were used to identify potential studies. All of the clinical studies that produced data on the association between cognitive function and risk of depression among individuals aged 55 years or older were identified and included in this review. The studies were classified into cross-sectional and longitudinal subsets. The quantitative meta-analysis of cross-sectional and longitudinal studies were performed. For prevalence and incidence rates of depression, odds risk (OR) and relative risk (RR) were calculated, respectively. RESULTS Since all but two studies found in the search were for individuals aged 60 years or over, we assessed and reported on results for this larger group only. In this review we included 13 cross-sectional and four prospective longitudinal studies. The quantitative meta-analysis showed that, in old age, individuals with non-dementia cognitive impairment had neither significant higher prevalence nor incidence rates of depression than those without (odds risk (OR): 1.48, 95% confidence intervals (95% CI): 0.87-2.52; relative risk (RR): 1.12, 95% CI: 0.62-2.01). In old age, individuals with dementia had both significant higher prevalence and incidence rates of depression than those without (OR: 1.82, 95% CI: 1.15-2.89; RR: 3.92, 95% CI: 1.93-7.99). CONCLUSIONS Despite the methodological limitations of this meta-analysis, we found that in old age, there was no association between depression and cognitive impairment with no dementia; however, there was a definite association between depression and dementia and thus dementia might be a risk for depression.
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Abstract
ABSTRACTThis study investigated the association between environmental mastery and depression in a sample of 96 older adults (aged 64–98 years) in residential care. The participants completed a scale that assessed depression along with measures for risk factors for depression such as functional capacity, self-evaluated physical health, bereavement experiences and environmental mastery. The results showed that 49 per cent of the variance in participants' scores in depression could be attributed to their self-reported level of environmental mastery. Given the complexity of depression and the likelihood of reduced environmental mastery among older adults in residential care, the construct was further assessed as a mediating variable between the risk factors and depression. With environmental mastery taken as such, the explained variance in depression increased to 56 per cent. It was concluded that environmental mastery may be one of the more important factors affecting the mental health of older adults living in residential care and that strategies for increasing the residents' environmental mastery are important to their psychological wellbeing. The discussion notes that among the questions needing further investigation are whether older adults who experience high environmental mastery make the transition from community living to residential nursing home care more successfully than others, and whether perceived mastery diminishes over time or occurs at the point of transition from community independent living to dependent supported living.
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Baller M, Boorsma M, Frijters DHM, van Marwijk HWJ, Nijpels G, van Hout HPJ. Depression in Dutch homes for the elderly: under-diagnosis in demented residents? Int J Geriatr Psychiatry 2010; 25:712-8. [PMID: 19806603 DOI: 10.1002/gps.2412] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Although community-based studies reported an increased incidence of depression among demented persons compared with non-demented persons, it is not clear whether this relationship also exists among institutionalised elderly persons. The aim of this study was to compare the prevalence of diagnosed depressive disorders and mood symptoms between demented and non-demented residents living in Dutch homes for the elderly. METHODS Cross-sectional analysis in 16 homes for the elderly of routine outcome measurements by trained nurse assistants using the Resident Assessment Instrument (RAI) between January 2007 and April 2008. Nurse assistants recorded all known medical diagnoses including dementia and depression, as well as a structured observation of the presence or absence of 11 mood symptoms over the last 3 days. RESULTS 313 demented and 463 non-demented residents with complete data were included (99% of all residents, mean age 84 years). 24.6% of participants were diagnosed with a depressive disorder, with no statistically significant difference between demented and non-demented persons (p = 0.237). Mood symptoms were more prevalent in demented residents (p < 0.001, OR 2.14, 95%CI 1.56-2.93). Among residents with mood symptoms, demented residents were less likely to be diagnosed with a depressive disorder than non-demented residents (p = 0.039, OR 0.61, 95%CI 0.38-0.98). CONCLUSIONS The prevalence of diagnosed depressive disorders was comparable between demented and non-demented residents. However, demented residents suffered more from mood symptoms and may be at risk of under-diagnosis of depression.
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Affiliation(s)
- Menke Baller
- Department of General Practice, EMGO-Institute, VU University Medical Center, Amsterdam, The Netherlands
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Torres SJ, McCabe M, Nowson CA. Depression, nutritional risk and eating behaviour in older caregivers. J Nutr Health Aging 2010; 14:442-8. [PMID: 20617286 DOI: 10.1007/s12603-010-0041-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study investigated the relationship between depression, nutritional risk and dietary intake in a population of older caregivers. DESIGN Mailed questionnaire with sub group participating in a home-based interview. PARTICIPANTS AND SETTING Seventy-six community dwelling caregivers aged 50 y or over from Victoria, Australia. MEASUREMENTS Questionnaires provided information on weight, height, hours of care, depressive symptoms, nutritional risk and appetite. The home-based interview assessed dietary intake and shopping, cooking and meal consumption habits. RESULTS The sample had a mean +/- SD age of 70.3 +/- 12.8 y, BMI of 27.2 +/- 4.8 kg/m2 and the time spent caring was 101.8 +/- 68.1 h/wk. Overall, 32% of caregivers had depressive symptoms, 21% were at risk of malnutrition and 21% reported their appetite was fair/bad/very bad. Caregivers with depressive symptoms (32%) compared to those with no depressive symptoms (53%) had a poorer appetite (p < 0.05). Of the 20 caregivers who participated in the home interview, 25% reported they ate their meals alone. CONCLUSION A significant proportion of community dwelling older caregivers had depressive symptoms, were at risk of malnutrition and had poor appetites, although the majority were overweight or obese.
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Affiliation(s)
- S J Torres
- Centre for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia
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Abstract
PURPOSE In this study, we explored the association between cognitive impairment and depression in the very elderly using a sample aged 90-108 years. METHODS A cross-sectional study. RESULTS The sample included 682 unrelated Chinese nonagenarians/centenarians (67.25% women, mean age of 93.49 years). The mean depression score (measured with the brief 23-item Geriatrics Depression Scale-Chinese Edition was 8.45 (standard deviation [SD] = 3.30). The mean of cognitive function scores (measured with the 30-item Mini-Mental State Examination) was 15.54 (SD = 5.38). There was no significant difference in cognitive function scores between subjects with and without depression, and there was also no significant difference in depression scores between subjects with and without cognitive impairment. There was also no significant difference in the frequency of depression between subjects with and without cognitive impairment or in the frequency of cognitive impairment between subjects with and without depression. Both the odds ratio (OR) of depression (as a function of increased cognitive impairment) and the OR of cognitive impairment (as a function of increased depression) were found to be insignificant. Pearson Correlation also showed no significant correlation between depression scores and cognitive function scores. CONCLUSIONS In summary, we found that depression was not directly correlated with cognitive impairment in Chinese nonagenarians and centenarians.
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Abstract
OBJECTIVES Individual clinical interviews are typically viewed as the "gold standard" when diagnosing major depressive disorder (MDD) and when examining the validity of self-rated questionnaires. However, this approach may be problematic with older people, who are known to underreport depressive symptomatology. This study examined the effect of including an informant interview on prevalence estimations of MDD in an aged-care sample. DESIGN The results of an individual clinical interview for MDD were compared with those obtained when an informant interview was incorporated into the assessment. Results from each diagnostic approach were compared with scores on a self-rated depression instrument. SETTING Low-level aged-care residential facilities in Melbourne (equivalent to "residential homes," "homes for the elderly," or "assisted living facilities" in other countries). PARTICIPANTS One hundred and sixty-eight aged-care residents (mean age: 84.68 years; SD: 6.16 years) with normal cognitive functioning. MEASUREMENTS Individual clinical interviews were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders. This interview was modified for use with staff informants. Self-reported depression was measured using the Geriatric Depression Scale-15 (GDS-15). RESULTS The estimated point prevalence of MDD rose from 16% to 22% by including an informant clinical interview in the diagnostic procedure. Overall, 27% of depressed residents failed to disclose symptoms in the clinical interview. The concordance of the GDS-15 with a diagnosis of MDD was substantially lower when an informant source was included in the diagnostic procedure. CONCLUSION Individual interviews and self-report questionnaires may be insufficient to detect depression among older adults. This study supports the use of an informant interview as an adjunct when diagnosing MDD among cognitively intact aged-care residents.
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Blessing A, Fritsche-Fäh L, Schänzle-Geiger H, Jäncke L. Bedeutung der emotionalen Valenz beim emotionalen Gedächtniseffekt bei Demenzpatienten. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2009. [DOI: 10.1024/1016-264x.20.2.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Die Verbesserung der Gedächtnisleistung für emotional erregende gegenüber neutralen Informationen wird als „emotionaler Gedächtniseffekt“ bezeichnet. Inwiefern die emotionale Valenz des Materials die Erinnerungsleistung bei Demenzpatienten beeinflußt, ist bislang unklar und wurde in der vorliegenden Studie untersucht. Allen Versuchsteilnehmern wurden ein Text (emotional positiv, negativ und neutral beurteilter Abschnitt) und mehrere Bilder (emotional positiv, negativ und neutral beurteilte Bilder) präsentiert, es erfolgte ein unmittelbarer und ein verzögerter freier Abruf (30 min.). Während beim non-verbalen Material die Kontrollgruppe emotional positive und negative Informationen in gleichem Masse erinnerte, zeigte sich bei der Gruppe der Alzheimer Patienten eine verbesserte Abrufleistung für emotional negatives Material. Die vermehrte Erinnerung von emotional negativem Material trat nicht nur bei depressiven Patienten auf und ist folglich nicht durch einen „Stimmungskongruenzeffekt“ zu erklären. Beim verbalen Gedächtnistest wiesen beide Stichproben eine Tendenz zur vermehrten Erinnerung von emotional negativen Informationen auf. Die Studie zeigt, daß die emotionale Valenz des Materials die explizite Gedächtnisleistung von Demenzpatienten beeinflusst. Die Ergebnisse sind für die Therapie von und den Umgang mit Demenzpatienten von besonderer Bedeutung.
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Onega LL, Pixley JL. Psychometric properties of the Depressive Symptom Assessment for Older Adults in individuals with moderate or severe dementia. Issues Ment Health Nurs 2008; 29:942-58. [PMID: 18770100 DOI: 10.1080/01612840802274602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Many older adults with moderate or severe dementia also have depression, but identifying depressive symptoms in these individuals can be challenging. The Depressive Symptom Assessment for Older Adults (DSA), a newly developed instrument designed to evaluate older adults for depression, regardless of their cognitive status, facilitates longitudinal evaluation. This investigation examined the psychometric properties of the DSA in older adults (n = 68) with moderate or severe dementia. Internal consistency for the overall instrument and three of the six subscales, inter-rater reliability, and concurrent validity were established. Preliminary factor analysis yielded two strong factors; however, the other four factors were conceptually unclear. Although the DSA performed well statistically, the instrument may have over-identified depressive symptoms related to disagreeable behavior and lethargy and may have under-identified other depressive symptoms.
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Affiliation(s)
- Lisa L Onega
- School of Nursing, Radford University, Radford, Virginia 24142, USA.
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Abstract
BACKGROUND This research concerns the prevalence and course of depression in newly admitted nursing home residents. We attempted to recruit consecutive admissions into the study, irrespective of cognitive status, enabling a comparison of the prevalence and course of depression experienced by cognitively intact residents and those exhibiting all levels of cognitive impairment. METHOD Depression was assessed at one month, three months and six months post-admission. The assessment of mood in this study entailed the conduct of a semi-structured clinical interview, which encompassed DSM-IV criteria and Cornell Scale for Depression in Dementia (CSDD) items. RESULTS Recruitment difficulties resulted in a sample of 51 newly admitted residents, drawn from six nursing homes located in Victoria, Australia. Of particular interest, throughout the duration of the study, only the cognitively impaired were diagnosed with major depression (MD). One month post-admission, 24% of the sample were diagnosed with MD, and a further 20% evidenced a non-major depressive disorder. At the second and third assessments, MD was observed in 14% and 15% of residents, respectively. For residents who completed all three assessments, there was no appreciable change in the proportion diagnosed with a depressive disorder, nor was there a change in the levels of depressive symptomatology. CONCLUSION Although subject to limitations, the current study indicated that clinical depression in nursing home facilities most often occurs in residents who also exhibit pronounced cognitive impairment. These depressions are unlikely to remit spontaneously. Accordingly, care staff and general practitioners must be trained in the identification of depression in dementia, and any interventions implemented in these facilities should be tailored to meet the unique needs of this group.
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McCabe MP, Davison T, Mellor D, George K. Knowledge and skills of professional carers working with older people with depression. Aging Ment Health 2008; 12:228-35. [PMID: 18389403 DOI: 10.1080/13607860701797166] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The current study was designed to evaluate the knowledge, skills and self-efficacy of care providers from the perspective of professionals working in the aged-care industry. METHOD Participants were 21 professional carers, 10 General Practitioners and 7 aged-care managers. Focus groups, which involved the completion of a semi-structured interview related to knowledge, recognition, confidence, referral procedures and use of screening tools for the detection of depression, were conducted. RESULTS The results showed that all groups of respondents recognised significant gap in the knowledge and awareness of depression among professional care staff working with older people in both the community and residential care-settings. Skills in the detection and monitoring of depression and the self-efficacy of these care staff were also seen to be a problem. DISCUSSION The implications of these findings in terms of training programmes for professional carers working in the aged health care sector are discussed.
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Affiliation(s)
- Marita P McCabe
- School of Psychology, Deakin University, Victoria, Australia.
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Moniz-Cook E, Vernooij-Dassen M, Woods R, Verhey F, Chattat R, De Vugt M, Mountain G, O'Connell M, Harrison J, Vasse E, Dröes RM, Orrell M. A European consensus on outcome measures for psychosocial intervention research in dementia care. Aging Ment Health 2008; 12:14-29. [PMID: 18297476 DOI: 10.1080/13607860801919850] [Citation(s) in RCA: 264] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Psychosocial intervention makes a vital contribution to dementia care. However, the lack of consensus about which outcome measures to use to evaluate effectiveness prevents meaningful comparisons between different studies and interventions. This study used an iterative collaborative, evidence-based approach to identify the best of currently available outcome measures for European psychosocial intervention research. This included consensus workshops, a web-based pan-European consultation and a systematic literature review and a rigorous evaluation against agreed criteria looking at utility across Europe, feasibility and psychometric properties. For people with dementia the measures covered the domains of quality of life, mood, global function, behaviour and daily living skills. Family carer domains included mood and burden, which incorporated coping with behaviour and quality of life. The only specific staff domain identified was morale, but this included satisfaction and coping with behaviour. In conclusion twenty-two measures across nine domains were recommended in order to improve the comparability of intervention studies in Europe. Areas were identified where improved outcome measures for psychosocial intervention research studies are required.
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Affiliation(s)
- E Moniz-Cook
- Institute of Rehabilitation, University of Hull & Humber Mental Health Teaching NHS Trust, Hull, UK.
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Abstract
PURPOSE OF REVIEW An increasing proportion of the world's population is over the age of 65 years. Specialist mental health services for older people have been developed in many countries. The way services develop depends partly on how healthcare arrangements have evolved in that jurisdiction, as well as on finances, culture and attitudes towards elderly and disabled individuals. Health planners in developing countries recognize that considerable increases in their elderly populations and numbers of individuals with disability are imminent. It will be important to ensure that older people with mental disorders receive appropriate treatment. This review discusses recent findings and observations about psychogeriatric services in the community and in long-term care facilities, and aims to suggest how to improve or develop such services. RECENT FINDINGS The prevalence of mental disorders in long-term care facilities is high, but services to deal with them are usually not optimal. When appropriately staffed and organized, community psychogeriatric services, day care and collaborative care can be effective in reducing mental health problems and preventing admissions. SUMMARY Recent reviews and research have provided useful guidance regarding aspects of current psychogeriatric services that work well and those that need to be improved. A person-centred approach is favoured.
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Sun C, Tikellis G, Klein R, Steffens DC, Larsen EKM, Wong TY. Depressive symptoms and age-related macular degeneration in older people: the cardiovascular health study. Ophthalmic Epidemiol 2007; 14:127-33. [PMID: 17613847 DOI: 10.1080/09286580601186742] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To examine the association between age-related macular degeneration (AMD) and depressive symptoms. METHODS Population-based, cross-sectional study. A total of 2,194 persons aged 69-97 years were included in the current analyses. During the 1997-1998 examination, retinal photography from one randomly selected eye was graded for presence of early and late AMD using a modified Wisconsin AMD by Grading System. Depressive symptoms were assessed via a modified version of the Centers for Epidemiologic Studies Depression (CES-D) scale annually from 1989 through 1997-1998. Depressive symptoms were defined as a CES-D score of >9 (top quartile of CES-D score) at the 1997-1998 examination. RESULTS There were 338 (15.6%) individuals with early AMD and 29 (1.3%) with late AMD. Among them, 368 (16.8%) persons had depressive symptoms at the 1997-1998 examination. Depressive symptoms were not associated with early AMD (multivariable adjusted odds ratio [OR]: 0.97; 95% confidence intervals [CI]: 0.69-1.36) or late AMD (OR: 1.15; 95% CI: 0.38-3.46). Including persons using anti-depressive medications did not alter these associations (OR: 0.98; 95% CI: 0.74-1.32 for early AMD and OR: 0.97; 95% CI: 0.35-2.67 for late AMD). There was no association in multinomial logistic regression models of increasing quartiles of the CES-D scores with early or late AMD status. CONCLUSIONS Our study did not find an association between early AMD and depressive symptoms in older people.
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Affiliation(s)
- Cong Sun
- Centre for Eye Research Australia, University of Melbourne, Australia
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