1
|
Sakai T, Jadczak AD, Khalid A, Piovezan RD, Leemaqz S, Visvanathan R. The prevalence of, and factors associated with, a risk of depression in residential aged care services residents: Findings from the FIRST study. Australas J Ageing 2024. [PMID: 39073245 DOI: 10.1111/ajag.13358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 06/01/2024] [Accepted: 06/18/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES Depression is common amongst Australian residential aged care services (RACS) residents. This study aimed to estimate the risk of depression amongst residents and identify factors associated with this risk. In care settings such as RACS, time-efficient screening tools to identify depression risk may be a preferred tool. METHODS The two-item Patient Health Questionnaire (PHQ-2), derived from the nine-item PHQ-9 used commonly in the United States (US), was employed in this study. A resident was identified as being at risk of depression where the score was ≥3. Multivariable logistic regression analysis was used to identify independent factors associated with being at risk of depression. RESULTS Residents' mean age was 87.7 (standard deviation: 7.3) years and 73% were female. One-fifth of residents (n = 108 or 20%) were at risk of depression. Age (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.93-0.99); Pain Assessment in Advanced Dementia (PAINAD) score (OR 1.55, 95% CI 1.11-2.16); Epworth Sleepiness Scale (ESS) score (OR 1.08, 95% CI 1.03-1.13); and 38-item Frailty Index (FI) score (OR 1.07, 95% CI 1.03-1.10) were significantly associated with being at risk of depression, whilst sex, urinary incontinence, polypharmacy, Dementia Severity Rating Scale (DSRS) and Nursing Home Life Space Diameter (NHLSD) score were not. CONCLUSIONS One in five residents were at risk of depression. Younger age, higher pain, higher daytime sleepiness and higher frailty status were associated with depressive risk. Future studies focusing on interventions targeting these factors may contribute to improved health outcomes.
Collapse
Affiliation(s)
- Tomomichi Sakai
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Agathe Daria Jadczak
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ashna Khalid
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Ronaldo D Piovezan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Shalem Leemaqz
- South Australian Health and Medical Research Institute (SAHMRI) Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| |
Collapse
|
2
|
Knippenberg IAH, Leontjevas R, Stoyanov S, Persoon A, Verboon P, Vermeulen H, van Lankveld JJDM, Gerritsen DL. Informal antidepressant strategies for nursing home residents: two group concept mapping studies. Aging Ment Health 2023; 27:251-262. [PMID: 35369803 DOI: 10.1080/13607863.2022.2057427] [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: 01/18/2023]
Abstract
OBJECTIVES To identify and structure potential informal antidepressant strategies that can be used in daily practice for nursing home residents alongside formal treatments. METHODS In a first Group Concept Mapping study, residents, relatives, and professional caregivers (N = 124) brainstormed on strategies residents could use to prevent or alleviate depression. In a second study, the same participants (N = 110) reported strategies for use by others. Furthermore, participants rated the expected effectiveness and feasibility of the suggested strategies. Simultaneously, all strategies were sorted by experts and clustered using multidimensional scaling and hierarchical cluster analysis. RESULTS Six clusters emerged for strategies by residents themselves and five clusters for strategies by others. For residents' strategies, the clusters Being socially connected and Participating in activities were perceived as most effective, as was the cluster Offering personal attention for strategies by others. Participants perceived Creating a healthy living environment as the most feasible cluster executed by residents. Within strategies by others, the clusters Offering personal attention, Using positive treatment/approach, and Using or adapting the physical environment were perceived as the most feasible. CONCLUSION The results indicated the importance of social connectedness, a personalized and positive approach by significant others, and tailored activity programs. The results also suggest that adaptations to the physical environment within nursing homes may be an easy applicable strategy to prevent or alleviate depression in residents. Although more research is needed, these findings may guide daily practice and the development of interventions that include informal strategies. UNLABELLED Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2022.2057427 .
Collapse
Affiliation(s)
- Inge A H Knippenberg
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Radboudumc Alzheimer Center, Nijmegen, The Netherlands.,Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Ruslan Leontjevas
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Radboudumc Alzheimer Center, Nijmegen, The Netherlands.,Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Slavi Stoyanov
- Faculty of Educational Sciences, Department of Technology Enhanced Learning and Innovation, Open University of the Netherlands, Heerlen, The Netherlands
| | - Anke Persoon
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Peter Verboon
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Hester Vermeulen
- IQ healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| |
Collapse
|
3
|
Hara K, Nakabe T, Tanaka M, Imanaka Y. Measuring the quality of life of long-term care service users in Japan: a cross-sectional questionnaire study. BMC Geriatr 2022; 22:955. [PMID: 36510174 PMCID: PMC9746158 DOI: 10.1186/s12877-022-03662-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In Japan's super-aging society, the number of long-term care service providers is increasing, and the quality of care is a matter of concern. One aspect of the quality of care is the user's quality of life. The questionnaires EQ-5D and WHO-5 are representative indicators of quality of life. Herein, we aimed to measure the quality of life in long-term care service users in Japan and to clarify the relationship between quality of life and the level of care required. METHODS A questionnaire study was conducted in 106 facilities of 22 corporations. In addition to the EQ-5D and WHO-5, sex, age, and the level of care required were assessed by descriptive statistics. Bonferroni's multiple comparison test was used to analyze each quality of life score, and the differences by sex and age were analyzed multiple regression analyses, with each quality of life score as the objective variable. RESULTS Of 4647 cases collected, 2830 were analyzed, with no missing data. Both indicators tended to be lower than the general older population. Those scores tended to be higher in females than males (EQ-5D: males, 0.58 ± 0.26; females, 0.60 ± 0.24; P = 0.06 and WHO-5: males, 13.8 ± 5.92; females 14.9 ± 5.70; P < 0.001). In terms of age, those under 65 years old with specific diseases had lower EQ-5D scores than those in other age groups (P < 0.001); however, WHO-5 scores did not differ by age. Multiple regression analysis showed a significant association between the EQ-5D score and level of care required, except for support-required level 1, which tended to worsen as the level of care required increased. Conversely, the WHO-5 score was significantly lower for care need levels 2, 4, and 5. CONCLUSIONS The quality of life of long-term care service users was worse than that of the general older population, it tended to be low among males and those under 65 years old with specific diseases. Furthermore, it gradually decreased as the level of care required increased. It is important to monitor users' quality of life as a quality indicator of care, to improve and manage it.
Collapse
Affiliation(s)
- Koji Hara
- grid.258799.80000 0004 0372 2033Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto City, 606-8501 Japan ,grid.268441.d0000 0001 1033 6139School of Economics and Business Administration, Yokohama City University, 22-2 Seto, Kanazawa, Yokohama, 236-0027 Japan
| | - Takayo Nakabe
- grid.258799.80000 0004 0372 2033Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto City, 606-8501 Japan ,grid.412708.80000 0004 1764 7572The Database Center of the National University Hospitals, Tokyo Central Hospital North F8, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655 Japan
| | - Masayuki Tanaka
- grid.258799.80000 0004 0372 2033Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto City, 606-8501 Japan
| | - Yuichi Imanaka
- grid.258799.80000 0004 0372 2033Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto City, 606-8501 Japan
| |
Collapse
|
4
|
Rinnan E, André B, Espnes GA, Drageset J, Garåsen H, Haugan G. Despite Symptom Severity, do Nursing Home Residents Experience Joy-of-Life? The Associations Between Joy-of-Life and Symptom Severity in Norwegian Nursing Home Residents. J Holist Nurs 2021; 40:84-96. [PMID: 34213960 PMCID: PMC9121523 DOI: 10.1177/08980101211021219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Finding new approaches to increase health and well-being among nursing home (NH) residents is highly warranted. From a holistic perspective, several Norwegian municipalities have implemented the certification scheme framed "Joy-of-Life Nursing Home" Aims: In a holistic perspective on NH care, this study investigated if NH residents despite potential symptom severity experience joy-of-life (JoL). Therefore, we examined the frequency of common symptoms and the association between common symptoms and JoL in cognitively intact NH residents. Methods: A cross-sectional design was employed. Using the QLQ-C15-PAL quality-of-life questionnaire, hospital anxiety and depression scale, and JoL scale, a total of 188 cognitively intact NH residents participated. Results: Symptom severity was high; 54% reported fatigue, 52% reported constipation, 45% reported pain, 43% reported dyspnea, 32% reported insomnia, 22% reported appetite loss, and 20% reported nausea, while 20% reported anxiety and 23% reported depressive symptoms. Nevertheless, 59% of the NH residents reported high JoL, which was significantly positively related to the quality of life and negatively associated with anxiety and depression.
Collapse
Affiliation(s)
- Eva Rinnan
- 8018NTNU Norwegian University of Science and Technology.,25574Trondheim Municipality
| | - Beate André
- NTNU Norwegian University of Science and Technology
| | | | - Jorun Drageset
- 1657Western Norway University of Applied Sciences.,1658University of Bergen
| | | | - Gørill Haugan
- 8018NTNU Norwegian University of Science and Technology.,1786Nord University
| |
Collapse
|
5
|
Goyal AR, Engedal K, Benth JŠ, Strøm BS. Effects of the Sonas Program on Anxiety and Depression in Nursing Home Residents with Dementia: A 6-Month Randomized Controlled Trial. Dement Geriatr Cogn Dis Extra 2021; 11:151-158. [PMID: 34178020 DOI: 10.1159/000516804] [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: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction There is a dearth of evidence about the effects of Sonas, a multisensory stimulation on people with dementia (PWD). The main aim of this study was to examine the effects of the Sonas program on anxiety and depression in nursing home (NH) residents with dementia. Methods In all, 120 PWD ≥65 years of age from 6 NHs were included in a randomized control trial and were allocated to 1 of 3 groups for 24 weeks: a Sonas program group (n = 48), a reading group (n = 32), and a control group (n = 40). One hundred and five participants completed follow-up assessments. Anxiety and depression were assessed by the Rating Anxiety in Dementia (RAID) scale and the Cornell Scale for Depression in Dementia (CSDD), respectively. Generalized linear mixed models were estimated to assess trends in the proportion of participants with anxiety (a RAID score ≥11) and depression (a CSDD score ≥10). Results No significant reduction in anxiety from baseline to follow-up was observed in any of the groups. Participants in the Sonas group showed a significant reduction in depression from baseline to 12 weeks (p = 0.001) and from baseline to 24 weeks (p = 0.009). Conclusion The Sonas program had no effect on severity of anxiety but a reduction in depressive symptoms was found in PWD.
Collapse
Affiliation(s)
- Alka R Goyal
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Knut Engedal
- Norwegian Advisory Unit for Aging and Health, Vestfold Hospital HF, Tønsberg, Norway.,Department of Geriatrics, Oslo University Hospital, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | | |
Collapse
|
6
|
Stensvik GT, Helvik AS, Nakrem S, Haugan G. Cornell's Depression for Dementia Scale: A psychometric study among Norwegian nursing home residents. Arch Gerontol Geriatr 2020; 93:104325. [PMID: 33383356 DOI: 10.1016/j.archger.2020.104325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Depression is common among residents in long term-care facilities. Therefore, access to a valid and reliable measure of depressive symptoms among nursing home (NH) residents is highly warranted. AIM The aim of this study was to test the psychometrical properties of the Norwegian version of the Cornell Scale for Depression in Dementia (CSDD). METHODS A sample of 309 NH residents were assessed for depressive symptoms using the CSDD in 2015-2016. Data on CSDD were missing for 64 residents, giving an effective sample of 245 (79.3%). Principal component and confirmatory factor analysis were used. RESULTS A five-dimensional solution yielded the best fit with the data (χ2=174.927, df=94, χ2/df=1.86, p=0.0001, RMSEA=0.058, p-value for test of close fit=0.152, CFI=0.94, TLI=0.92 and SRMR=0.056). As expected, higher depressive symptoms correlated positively with higher scores on the Minimum Data Set Depression Rating Scale (MDSDRS) and correlated negatively with Quality of life assessed with the Quality of Life in Late Stage-Dementia Scale. LIMITATIONS The excluded residents (n=64, 20.7%) had lower cognitive function, which may limit the generalizability of the study results. CONCLUSION This study suggests a five-dimensional solution of the CSDD scale. Sixteen of the 19 original items showed highly significant loadings, explaining a notable amount of the variation in the CSDD-construct. Further development and testing of a well-adapted scale assessing depression in the nursing home population with and without dementia is required.
Collapse
Affiliation(s)
- Geir-Tore Stensvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway..
| | - Anne-Sofie Helvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.; Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Sigrid Nakrem
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway..
| | - Gørill Haugan
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.; Nord University, Faculty of Nursing and Health Sciences, Levanger, Norway..
| |
Collapse
|
7
|
Halse I, Bjørkløf GH, Engedal K, Rokstad AMM, Persson K, Eldholm RS, Selbaek G, Barca ML. Applicability of the locus of control of behaviour scale for people with dementia. Aging Ment Health 2020; 24:2111-2116. [PMID: 31402698 DOI: 10.1080/13607863.2019.1652244] [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: 10/26/2022]
Abstract
OBJECTIVE To investigate the applicability of the Locus of Control of Behaviour scale (LoCB) for people with dementia. METHOD A sample of 534 participants with dementia (78.4 mean age, 58% female) were included. Assessment included the LoCB, the Montgomery-Aasberg Depression Rating Scale (MADRS), the Mini-Mental Status Examination Norwegian revised (MMSE-NR) and the Instrumental Activities of Daily Living (I-ADL). Completion percentages and internal reliability of LoCB were examined for predefined MMSE-NR groups (0-4, 5-9, 10-14, 15-19, 20-24, 25-27, and 28-30). Factors associated with completion were analysed, and a principal component analysis (PCA) of the LoCB was performed. Sum score and component subscale scores were compared to MADRS and MMSE-NR scores. RESULTS In total, 234 participants completed the LoCB. Completion percentages ranged from 74% (MMSE-NR 28-30) to 0% (MMSE-NR 0-9). Internal reliability was between 0.80 and 0.72 in groups with MMSE-NR > 9, except in MMSE-NR 20-24 (0.52). Age, MMSE-NR and education were associated with completion. The PCA yielded three components - powerful others, internal, and luck/fate - with explained variance of 41.3%. Participants with MADRS > 7 scored higher on the LoCB sum score, powerful others and internal subscale scores. No difference was found regarding the luck/fate subscale score. MMSE-NR did not affect LoCB scores. CONCLUSION Older age, less education, and more cognitive impairment decreased the likelihood of completion. However, psychometric test results indicate that those who completed the LoCB understood the questions, even with severe cognitive impairment. We conclude, therefore, that the LoCB is applicable for investigating control orientation among people with dementia.
Collapse
Affiliation(s)
- Ingeborg Halse
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital-Ullevål, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital-Ullevål, Oslo, Norway
| | - Anne Marie Mork Rokstad
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Karin Persson
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital-Ullevål, Oslo, Norway
| | - Rannveig Sakshaug Eldholm
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St. Olavs Hospital, Trondheim, Norway
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital-Ullevål, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maria Lage Barca
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital-Ullevål, Oslo, Norway
| |
Collapse
|
8
|
Haugan G, Kuven BM, Eide WM, Taasen SE, Rinnan E, Xi Wu V, Drageset J, André B. Nurse-patient interaction and self-transcendence: assets for a meaningful life in nursing home residents? BMC Geriatr 2020; 20:168. [PMID: 32381032 PMCID: PMC7203905 DOI: 10.1186/s12877-020-01555-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Due to the shift to an older population worldwide and an increased need for 24-h care, finding new and alternative approaches to increase wellbeing among nursing home (NH) residents is highly warranted. To guide clinical practice in boosting wellbeing among NH residents, knowledge about nurse-patient interaction (NPI), inter- (ST1) and intra-personal (ST2) self-transcendence and meaning-in-life (PIL) seems vital. This study tests six hypotheses of the relationships between NPI, ST1, ST2 and PIL among cognitively intact NH residents. Methods In a cross-sectional design, 188 (92% response rate) out of 204 long-term NH residents representing 27 NHs responded to NPI, ST, and the PIL scales. Inclusion criteria were: (1) municipality authority’s decision of long-term NH care; (2) residential time 3 months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. The hypothesized relations between the latent constructs were tested through structural equation modeling (SEM) using Stata 15.1. Results The SEM-model yielded a good fit (χ2 = 146.824, p = 0.021, df = 114, χ2/df = 1.29 RMSEA = 0.040, p-close 0.811, CFI = 0.97, TLI = 0.96, and SRMR = 0.063), supporting five of the six hypothesized relationships between the constructs of NPI, ST1, ST2 and PIL. Conclusion NPI significantly relates to both ST1, ST2 and PIL in NH residents. ST revealed a fundamental influence on perceived PIL, while NPI demonstrated a significant indirect influence on PIL, mediated by ST.
Collapse
Affiliation(s)
- Gørill Haugan
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway. .,NORD University, Faculty of Nursing and Health Science, Levanger, Norway.
| | - Britt Moene Kuven
- Faculty of Health and Social Science, Western University of Applied Science, Bergen, Norway
| | - Wenche Mjanger Eide
- Faculty of Health and Social Science, Western University of Applied Science, Bergen, Norway
| | - Siv Eriksen Taasen
- Faculty of Health and Social Science, Western University of Applied Science, Bergen, Norway
| | - Eva Rinnan
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Trondheim Municiaplity, Trondheim, Norway
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, The National University of Singapore, Singapore, Singapore
| | - Jorunn Drageset
- Faculty of Health and Social Science, Western University of Applied Science, Bergen, Norway.,Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - Beate André
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
9
|
Haugan G, Eide WM, André B, Wu VX, Rinnan E, Taasen SE, Kuven BM, Drageset J. Joy-of-life in cognitively intact nursing home residents: the impact of the nurse-patient interaction. Scand J Caring Sci 2020; 35:208-219. [PMID: 32200564 DOI: 10.1111/scs.12836] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/12/2020] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The nursing-home population is at a high risk of declined well-being and quality of life. Finding approaches to increase well-being among older adults in nursing-homes is highly warranted. Responding to this need, the approach framed 'Joy-of-Life-Nursing-Homes' (JoLNH) was developed in Norway. AIM To investigate the association between nurse-patient interaction and joy-of-life in the nursing-home population. METHODS Cross-sectional data were collected in 2017 and 2018 using the Nurse-Patient Interaction Scale and the Joy-of-Life Scale. A total of 204 cognitively intact nursing-home residents met the inclusion criteria and 188 (92%) participated. A structural equation model (SEM) of the relationship between nurse-patient interaction and joy-of-life was tested by means of STATA/MP 15.1. Ethical approval was given and each participant provided voluntarily written informed consent. RESULTS The SEM-model yielded a good fit with the data (χ2 = 162.418, p = 0.004, df = 118, χ2 /df = 1.38, RMSEA = 0.046, p-close 0.652, CFI = 0.97, TLI = 0.96, and SRMR = 0.054). As hypothesised, nurse-patient interaction related significantly with joy-of-life (γ1,1 = 0.61, t = 7.07**). LIMITATIONS The cross-sectional design does not allow for conclusions on causality. The fact that the researchers visited the participants to help fill in the questionnaire might have introduced some bias into the respondents' reporting. CONCLUSION Relational qualities of the nurse-patient interaction should be essential integral aspects of nursing-home care. Consequently, such qualities should be emphasised in clinical practice, and research and education should pay more attention to nurse-patient interaction as an important, integral part of the caring process promoting joy-of-life and thereby well-being.
Collapse
Affiliation(s)
- Gørill Haugan
- NTNU Center for Health Promotion Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Wenche Mjanger Eide
- Faculty of Health and Social Sciences, Western University of Applied Sciences, Bergen, Norway
| | - Beate André
- NTNU Center for Health Promotion Research, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Eva Rinnan
- Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Siv Eriksen Taasen
- Faculty of Health and Social Sciences, Western University of Applied Sciences, Bergen, Norway
| | - Britt Moene Kuven
- Faculty of Health and Social Sciences, Western University of Applied Sciences, Bergen, Norway
| | - Jorunn Drageset
- Faculty of Health and Social Sciences, Western University of Applied Sciences, Bergen, Norway.,University of Bergen, Department of Global Public Health and Primary Care, Bergen, Norway
| |
Collapse
|
10
|
Fu H, Xu Z, Zhang XL, Zheng GQ. Kaixinsan, a Well-Known Chinese Herbal Prescription, for Alzheimer's Disease and Depression: A Preclinical Systematic Review. Front Neurosci 2020; 13:1421. [PMID: 32009890 PMCID: PMC6971218 DOI: 10.3389/fnins.2019.01421] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 12/16/2019] [Indexed: 01/30/2023] Open
Abstract
Alzheimer's disease (AD), the most common cause of dementia, is highly prevalent worldwide with no modifying therapy. Behavioral and psychological symptoms of dementia (BPSD) occur in most patients with AD, and depression is one of the most common AD-related BPSD. Kaixinsan (KXS) is an ancient Chinese herbal prescription widely used to treat dementia and forgetfulness. In this systematic review, we conducted a meta-analysis to assess preclinical evidence for the effects of KXS on cognitive impairment and depression. Thirty-eight articles involving 1,050 animals were included after searching from six databases from the inception up to June 2019. The primary outcome measures were behavioral outcome. Indicators of cognitive function in AD included escape latency, time spent on the target quadrant, and the number of target platform crossings in the Morris water maze (MWM) test. Indicators of depression included number of rearing events and total distance in the open-field test, duration of immobility in the forced swim test, and sucrose consumption or sucrose preference index in the sucrose preference test. The secondary outcomes were mechanisms of KXS for treatment of AD and depression. The results showed that KXS significantly reduced escape latency (P < 0.01), increased time spent in the target quadrant (P < 0.01), and increased the number of target platform crossings (P < 0.01) in the MWM test in AD models compared with control. The possible mechanisms for KXS-mediated improvements in cognitive function were antioxidant activity, anti-inflammatory activity, antiapoptotic activity, neuroprotection, and synapse protection. In addition, the results demonstrated that KXS significantly increased the number of rearing instances (P < 0.01) in the open-field test, decreased the duration of immobility (P < 0.01) in forced swim test, and increased sucrose consumption or sucrose preference index (P < 0.01) in the sucrose preference test in depression models compared with control. The mechanisms of KXS-mediated anti-depressive effects were HPA axis regulation, antioxidant activity, anti-inflammatory activity, synapse protection, and neuroprotection. The results of this study suggested that KXS can be used to effectively treat AD and depression through multiple mechanisms, extrapolating the therapeutic potential of KXS for treating AD-related BPSD.
Collapse
Affiliation(s)
| | | | | | - Guo-qing Zheng
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
11
|
Haugan G, Drageset J, André B, Kukulu K, Mugisha J, Utvær BKS. Assessing quality of life in older adults: psychometric properties of the OPQoL-brief questionnaire in a nursing home population. Health Qual Life Outcomes 2020; 18:1. [PMID: 31898546 PMCID: PMC6941243 DOI: 10.1186/s12955-019-1245-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/14/2019] [Indexed: 12/02/2022] Open
Abstract
Background Well-adapted and validated quality-of-life measurement models for the nursing home population are scarce. Therefore, the aim of this study was to test the psychometrical properties of the OPQoL-brief questionnaire among cognitively intact nursing home residents. The research question addressed evidence related to the dimensionality, reliability and construct validity, all of which considered interrelated measurement properties. Methods Cross-sectional data were collected during 2017–2018, in 27 nursing homes representing four different Norwegian municipalities, located in Western and Mid-Norway. The total sample comprised 188 of 204 (92% response rate) long-term nursing home residents who met the inclusion criteria: (1) municipality authority’s decision of long-term nursing home care; (2) residential time 3 months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. Results Principal component analysis and confirmative factor analyses indicated a unidimensional solution. Five of the original 13 items showed low reliability and validity; excluding these items revealed a good model fit for the one-dimensional 8-items measurement model, showing good internal consistency and validity for these 8 items. Conclusion Five out of the 13 original items were not high-quality indicators of quality-of-life showing low reliability and validity in this nursing home population. Significant factor loadings, goodness-of-fit indices and significant correlations in the expected directions with the selected constructs (anxiety, depression, self-transcendence, meaning-in-life, nurse-patient interaction, and joy-of-life) supported the psychometric properties of the OPQoL-brief questionnaire. Exploring the essence of quality-of-life when residing in a nursing home is highly warranted, followed by development and validation of new tools assessing quality-of-life in this population. Such knowledge and well-adapted scales for the nursing home population are beneficial and important for the further development of care quality in nursing homes, and consequently for quality-of-life and wellbeing in this population.
Collapse
Affiliation(s)
- Gørill Haugan
- NTNU Center for health promotion research, Norwegian University of Science and Technology, Trondheim, Norway. .,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
| | - Jorunn Drageset
- Faculty of Health and Social Science, Western University of Applied Science, Bergen, Norway.,University of Bergen, Bergen, Norway
| | - Beate André
- NTNU Center for health promotion research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kamile Kukulu
- Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - James Mugisha
- Social Worker, Kyambogo University and Butabika National Referral and Teaching Hospital, Kampala, Uganda
| | - Britt Karin S Utvær
- Department of Teacher Education, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
12
|
Hoben M, Heninger A, Holroyd-Leduc J, Knopp-Sihota J, Estabrooks C, Goodarzi Z. Depressive symptoms in long term care facilities in Western Canada: a cross sectional study. BMC Geriatr 2019; 19:335. [PMID: 31791250 PMCID: PMC6889648 DOI: 10.1186/s12877-019-1298-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The main objective is to better understand the prevalence of depressive symptoms, in long-term care (LTC) residents with or without cognitive impairment across Western Canada. Secondary objectives are to examine comorbidities and other factors associated with of depressive symptoms, and treatments used in LTC. METHODS 11,445 residents across a random sample of 91 LTC facilities, from 09/2014 to 05/2015, were stratified by owner-operator model (private for-profit, public or voluntary not-for-profit), size (small: < 80 beds, medium: 80-120 beds, large > 120 beds), location (Calgary and Edmonton Health Zones, Alberta; Fraser and Interior Health Regions, British Columbia; Winnipeg Health Region, Manitoba). Random intercept generalized linear mixed models with depressive symptoms as the dependent variable, cognitive impairment as primary independent variable, and resident, care unit and facility characteristics as covariates were used. Resident variables came from the Resident Assessment Instrument - Minimum Data Set (RAI-MDS) 2.0 records (the RAI-MDS version routinely collected in Western Canadian LTC). Care unit and facility variables came from surveys completed with care unit or facility managers. RESULTS Depressive symptoms affects 27.1% of all LTC residents and 23.3% of LTC resident have both, depressive symptoms and cognitive impairment. Hypertension, urinary and fecal incontinence were the most common comorbidities. Cognitive impairment increases the risk for depressive symptoms (adjusted odds ratio 1.65 [95% confidence interval 1.43; 1.90]). Pain, anxiety and pulmonary disorders were also significantly associated with depressive symptoms. Pharmacologic therapies were commonly used in those with depressive symptoms, however there was minimal use of non-pharmacologic management. CONCLUSIONS Depressive symptoms are common in LTC residents -particularly in those with cognitive impairment. Depressive symptoms are an important target for clinical intervention and further research to reduce the burden of these illnesses.
Collapse
Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Abigail Heninger
- Faculty of Science, University of British Columbia, Vancouver, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Zahra Goodarzi
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute of Public Health, Calgary, AB, Canada.
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
13
|
Haugan G, Rinnan E, Espnes GA, Drageset J, Rannestad T, André B. Development and psychometric properties of the Joy-of-Life Scale in cognitively intact nursing home patients. Scand J Caring Sci 2019; 33:801-814. [PMID: 30866075 DOI: 10.1111/scs.12676] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 02/10/2019] [Indexed: 11/26/2022]
Abstract
AIM To develop and psychometrically test the Joy-of-Life Scale. The research question addressed evidence related to the dimensionality, reliability and construct validity, all of which considered inter-related measurement properties. METHODS Cross-sectional data were collected during 2017-2018, in 27 nursing homes representing four different Norwegian municipalities, located in Western and Mid-Norway. The total sample comprised 188 of 204 (92% response rate) long-term nursing home patients who met the inclusion criteria: (i) local authority's decision of long-term nursing home care; (ii) residential time 3 months or longer; (iii) informed consent competency recognised by responsible doctor and nurse; and (iv) capable of being interviewed. RESULTS Exploratory and confirmative factor analyses clearly suggested a unidimensional solution. Five of the original 18 items showed low reliability and validity; excluding these items revealed an acceptable model fit for the one-dimensional 13-item measurement model. Reliability and construct validity were acceptable, indicating good internal consistency. CONCLUSION Significant factor loadings, several goodness-of-fit indices and significant correlations in the expected directions with the selected constructs (anxiety, depression, self-transcendence, meaning-in-life, sense of coherence, nurse-patient interaction and quality of life) supported the psychometric properties of the Joy-of-Life Scale. IMPACT The 'Joy-of-Life-Nursing-Home' is a national strategy for promoting quality of life, meaning and quality of life among nursing home patients in Norway. Therefore, exploring the essence of the Joy-of-Life phenomenon and developing a measurement scale assessing joy-of-life in this population is important for the further development of care quality in nursing homes.
Collapse
Affiliation(s)
- Gørill Haugan
- NTNU Center for health promotion research, Trondheim, Norway
| | - Eva Rinnan
- NTNU Center for health promotion research, Trondheim, Norway.,NTNU Department of public health and nursing, Trondheim, Norway.,Trondheim municipality, Bergen, Norway
| | - Geir Arild Espnes
- NTNU Center for health promotion research, Trondheim, Norway.,NTNU Department of public health and nursing, Trondheim, Norway
| | - Jorunn Drageset
- University of Bergen, Bergen, Norway.,Western University of Applied Sciences, Bergen, Norway
| | - Toril Rannestad
- NTNU Center for health promotion research, Trondheim, Norway.,NTNU Department of public health and nursing, Trondheim, Norway
| | - Beate André
- NTNU Center for health promotion research, Trondheim, Norway.,NTNU Department of public health and nursing, Trondheim, Norway
| |
Collapse
|
14
|
Rinnan E, André B, Drageset J, Garåsen H, Espnes GA, Haugan G. Joy of life in nursing homes: A qualitative study of what constitutes the essence of Joy of life in elderly individuals living in Norwegian nursing homes. Scand J Caring Sci 2018; 32:1468-1476. [PMID: 30070384 DOI: 10.1111/scs.12598] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/11/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Finding new approaches to increase positive health and well-being of elderly individuals living in nursing homes (NH) is highly warranted. Several Norwegian municipalities have implemented the certification scheme framed 'Joy of Life Nursing Home' (JOLNH). JOLNH is based on a health-promoting perspective directing elderly individuals' resources. Through health promotion, preventive and social activities across generations, NH care promotes respect, well-being, health and cultural experiences among elderly individuals. AIMS The aims of this study were to explore the phenomenon of Joy of life (JOL) among elderly individuals living in NHs and to provide a deeper understanding of which dimensions constitute JOL in this population. METHODS The present study explored the JOL phenomenon using qualitative methodology. Data were collected between December 2015 and May 2016 by individual qualitative research interviews of 29 elderly individuals who met the inclusion criteria. The informants were living in ten different NHs in two large municipalities in Norway. Prior approval was obtained from all regulatory institutions dealing with research issues and the management in both municipalities. RESULTS The results showed that (i) positive relations, (ii) a sense of belonging, (iii) sources of meaning, (iv) moments of feeling well, and (v) acceptance constituted the conceptualisation of the JOL phenomenon. CONCLUSION The dimensions constituting the JOL concept correspond to the concepts of well-being and flourishing. Knowledge of the JOL phenomenon may help professionals to target elderly individuals' health and well-being more precisely and thereby increase flourishing, JOL and well-being among them.
Collapse
Affiliation(s)
- Eva Rinnan
- Faculty of Medicine and Health Science, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Chief Executive Office, Trondheim Municipality, Trondheim, Norway
| | - Beate André
- Faculty of Medicine and Health Science, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Jorunn Drageset
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Faculty of Health and Social Sciences, Department of Nursing, Western Norway University of Applied Sciences, Bergen, Norway
| | - Helge Garåsen
- Faculty of Medicine and Health Science, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Chief Executive Office, Trondheim Municipality, Trondheim, Norway
| | - Geir Arild Espnes
- Faculty of Medicine and Health Science, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Gørill Haugan
- Faculty of Medicine and Health Science, Department of Public Health and Nursing, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
15
|
Kvæl LAH, Bergland A, Telenius EW. Associations between physical function and depression in nursing home residents with mild and moderate dementia: a cross-sectional study. BMJ Open 2017; 7:e016875. [PMID: 28729326 PMCID: PMC5541615 DOI: 10.1136/bmjopen-2017-016875] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The primary aim of this study is to describe depression and physical function in nursing home residents with dementia, as well as to examine the associations between depression and balance function, lower limb muscle strength, mobility and activities of daily living. The secondary aim is to examine the differences in physical function between the groups classified as depressed and not depressed. DESIGN The study has a cross-sectional design. SETTING A convenience sample of 18 nursing homes in, and around, Oslo, Norway, participated. PARTICIPANTS We included 170 nursing home residents aged 60-100 years with mild or moderate degree of dementia defined by a score of 1 or 2 on the Clinical Dementia Rating Scale (CDR). OUTCOME MEASURES Assessments used were Cornell Scale for Depression in Dementia (CSDD), Berg Balance Scale (BBS), 'the 6-metre walking test' (walking speed), 30 s Chair Stand Test (CST) and the Barthel Index (BI). RESULTS Nursing home residents with dementia are a heterogeneous group in terms of physical function and depression. By applying the recommended cut-off of ≥8 on CSDD, 23.5% of the participants were classified as being depressed. The results revealed significant associations between higher scores on CSDD (indicating more symptoms of depression) and lower scores on BBS (95% CI -0.12 to -0.02, p=0.006), 30 s CST (95% CI -0.54 to -0.07, p=0.001) as well as maximum walking speed (95% CI -4.56 to -0.20, p=0.003) (indicating lower level of physical function). CONCLUSION Better muscle strength, balance and higher walking speed were significantly associated with less depressive symptoms. The potential interaction of dementia with poor physical function and depression indicates an area to explore in future epidemiological studies with a prospective design. TRIAL REGISTRATION NUMBER NCT02262104.
Collapse
Affiliation(s)
- Linda Aimée Hartford Kvæl
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
- Ryen Helsehus/Short-term Rehabilitation, Nursing Home Agency, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Elisabeth Wiken Telenius
- Department of Physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| |
Collapse
|
16
|
Abstract
Depression is among the most frequent psychiatric comorbid conditions in dementia. There is no strong consensus as to what criteria should be used to diagnose depression in AD. This is at least partially explained by the overlap between symptoms of depression and symptoms of AD. Recent studies using latent class analysis provided clarification to this diagnostic dilemma. All nine DSM-IV symptoms of major depression were found to characterize a class with a high chance (96% ) of having a clinical diagnosis of major depression, and symptoms of anxiety were also frequent. Other psychiatric symptoms may also be included under the construct of depression in AD, since both apathy and anxiety are among the most frequent comorbid conditions for major depression in AD. Subtypes of depression should also be validated in this condition. For instance, increased awareness of cognitive and functional deficits is significantly associated with dysthymia but not with major depression, suggesting that different depressive syndromes in AD may have different etiology.
Collapse
Affiliation(s)
- Filipa Novais
- Serviço de Psiquiatria e Saúde Mental, Departamento de Neurociências, Hospital de Santa Maria, Lisboa, Portugal
| | - Sergio Starkstein
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia, and Fremantle Hospital, Fremantle, Western Australia
| |
Collapse
|
17
|
Vitorino LM, Lucchetti G, Santos AEO, Lucchetti ALG, Ferreira EB, Adami NP, Vianna LAC. Spiritual Religious Coping is Associated with Quality of Life in Institutionalized Older Adults. JOURNAL OF RELIGION AND HEALTH 2016; 55:549-559. [PMID: 26649565 DOI: 10.1007/s10943-015-0148-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to investigate the relationship between spiritual/religious coping (SRCOPE) strategies and quality of life (QoL) in institutionalized older adults. This is a cross-sectional, correlational study, with a sample of 77 older adults in Brazil. The present study found long-term care patients use religious and spiritual coping strategies to deal with their chronic health conditions. Positive SRCOPE and Total SRCOPE have positive correlations with most QoL domains from the WHOQOL-OLD and WHOQOL-BREF. On the other hand, Negative SRCOPE strategies correlated negatively with the facets of "death and dying" from the WHOQOL-OLD. These results suggest the need for an integrative approach for long-term care patients, considering the positive and negative aspects of coping.
Collapse
Affiliation(s)
| | | | | | | | - Eric Batista Ferreira
- Institute of Exact Sciences, Federal University of Alfenas - UNIFAL, Alfenas, Brazil
| | - Nilce Piva Adami
- Paulista School of Nursing, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | | |
Collapse
|
18
|
Helvik AS, Engedal K, Benth JŠ, Selbæk G. Prevalence and Severity of Dementia in Nursing Home Residents. Dement Geriatr Cogn Disord 2016; 40:166-77. [PMID: 26138271 DOI: 10.1159/000433525] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to compare the presence and severity of dementia in two large cross-sectional samples of nursing home residents from 2004/2005 and 2010/2011. METHODS Demographic information as well as data on the type of nursing home unit, length of stay before assessment, physical health, regularly used prescribed drugs and Clinical Dementia Rating scale scores were used in the analyses. Logistic and linear regression models for hierarchical data were estimated. RESULTS The odds of the occurrence and of a greater severity of dementia were higher in 2010/2011 than in 2004/2005. Independent of the time of study, married men had more severe dementia than single men, and single women had more severe dementia than single men. CONCLUSION The findings may reflect the increase in the need for more nursing home beds designed for people with dementia between 2004/2005 and 2010/2011.
Collapse
Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | | | | |
Collapse
|
19
|
Lee J, Lee B, Park Y, Kim Y. Effects of combined fine motor skill and cognitive therapy to cognition, degree of dementia, depression, and activities of daily living in the elderly with Alzheimer's disease. J Phys Ther Sci 2015; 27:3151-4. [PMID: 26644663 PMCID: PMC4668154 DOI: 10.1589/jpts.27.3151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/10/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study evaluated the effects of combined fine motor skill and cognitive therapies on cognition, depression, and activities of daily living in elderly patients with Alzheimer's disease (AD). [Subjects and Methods] Twenty-six participants comprised 2 groups. The experimental group (n=13) received combined fine motor skill and cognitive therapy, and the control group (n=13) received only general medical care. [Results] The experimental group showed improvements in cognition, degree of dementia, depression, and activities of daily living compared to the control group. However, there were no significant differences between the two groups. [Conclusion] These results suggest that combined fine motor skill and cognitive therapy improves cognition, degree of dementia, depression, and daily living in elderly patients with AD. These therapies would therefore be effective as general medical care strategies.
Collapse
Affiliation(s)
- Jin Lee
- Graduate School of Physical Therapy, Sahmyook University, Republic of Korea
| | - ByoungHee Lee
- Deptartment of Physical Therapy, Sahmyook University, Republic of Korea
| | - YuHyung Park
- Graduate School of Physical Therapy, Sahmyook University, Republic of Korea
| | - Yumi Kim
- Graduate School of Physical Therapy, Sahmyook University, Republic of Korea
| |
Collapse
|
20
|
Mjørud M, Kirkevold M, Røsvik J, Selbæk G, Engedal K. Variables associated to quality of life among nursing home patients with dementia. Aging Ment Health 2015; 18:1013-21. [PMID: 24911813 DOI: 10.1080/13607863.2014.903468] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study which variables are associated with quality of life (QOL) in persons with dementia (PWD) living in nursing homes (NHs). METHODS A cross-sectional study included 661 PWD living in NH. To measure QOL the quality of life in late-stage dementia scale (QUALID) was applied. Other scales were: the clinical dementia rating scale (CDR), physical self-maintenance scale (PSMS), and neuropsychiatric inventory questionnaire (NPI-Q). RESULTS The patients' mean age was: 86.9 (SD 7.7), 472 (71.4%) were women. Of all, 22.5% had CDR 1, 33.6% had CDR 2, and 43.9% had CDR 3. The mean PSMS score was 18.2 (SD 5.0), 43.1% lived in special care units, 56.9% in regular units. In a linear regression analysis NPI-affective score (β = 0.360, p-value < 0.001), NPI-agitation score (β = 0.268, p-value < 0.001), PSMS total score (β = 0.181, p-value < 0.001), NPI-apathy (β = 0.144, p-value < 0.001), NPI psychosis (β = 0.085, p-value 0.009), CDR sum of boxes score (β = 0.081, p-value 0.026) were significantly associated with QUALID total score (explained variance 44.5%). CONCLUSION Neuropsychiatric symptoms, apathy, severity of dementia, and impairment in activities in daily living are associated with reduced QOL in NH patients with dementia.
Collapse
Affiliation(s)
- Marit Mjørud
- a Norwegian Centre for Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway
| | | | | | | | | |
Collapse
|
21
|
Borza T, Engedal K, Bergh S, Barca ML, Benth JŠ, Selbæk G. The course of depressive symptoms as measured by the Cornell scale for depression in dementia over 74 months in 1158 nursing home residents. J Affect Disord 2015; 175:209-16. [PMID: 25638794 DOI: 10.1016/j.jad.2014.12.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/21/2014] [Accepted: 12/24/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depressive symptoms and depression are common in nursing home residents. However, longitudinal studies of depression in nursing home residents are scarce and the sample sizes are small. This study aimed to investigate the course of depressive symptoms as measured by the Cornell Scale for Depression in Dementia (CSDD) and associated explanatory demographic and clinical variables. METHODS A longitudinal study over 74 months of 1158 nursing home residents aged 50 years and older from twenty six nursing homes in Norway where data was collected at five time points. RESULTS "Irritability" was the most prevalent, incident and persistent CSDD symptom. Compared with the baseline assessment, the likelihood of the mood symptoms "suicidal ideation," "pessimism" and "delusions" being present was lower at all subsequent assessments. This persisted after adjusting for the severity of dementia. The severity of depression as measured by CSDD decreased over 74 months when adjusting for relevant resident variables. Poorer physical health, higher number of medications, more severe dementia and use of antidepressants were associated with higher depression score. LIMITATIONS Depression and dementia were not diagnosed according to standardized diagnostic criteria. The use of CSDD did not include a clinician׳s interview with the patient. This could have implications for the generalization of the results. CONCLUSION This study adds important knowledge about the long-term course of depressive symptoms and depression for residents in nursing homes, and underlines the importance to pay close attention to the overlap between depression and dementia symptoms when evaluating depression in this setting.
Collapse
Affiliation(s)
- Tom Borza
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Knut Engedal
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Sverre Bergh
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Maria Lage Barca
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Jūratė Šaltytė Benth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Institute of Clinical Medicine, Campus AHUS, University of Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Norway
| | - Geir Selbæk
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway; Institute of Clinical Medicine, Campus AHUS, University of Oslo, Norway
| |
Collapse
|
22
|
Iden KR, Ruths S, Hjørleifsson S. Residents' perceptions of their own sadness--a qualitative study in Norwegian nursing homes. BMC Geriatr 2015; 15:21. [PMID: 25888453 PMCID: PMC4356108 DOI: 10.1186/s12877-015-0019-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mood symptoms are highly prevalent among frail old people residing in nursing homes. Systematic diagnostics of depression is scarce, and treatment is not always in accordance with best evidence. The distinction between non-pathological sadness and depression may be challenging, and we know little of the older peoples' perspectives. The aim of this qualitative interview study was to explore residents' perceptions of their own sadness. METHODS We performed individual, semi-structured interviews with twelve older people residing in nursing homes with no dementia. The interview guide comprised questions on what made the informants sad and what prevented sadness. We recorded, transcribed verbatim and analysed the interviews using systematic text condensation. RESULTS The interviews revealed three main themes. I. Decay and loss of agency. The informants perceived their sadness to be caused by loss of health and functional ability, reliance on long-term care, dysfunctional technical aids and poor care. II. Loneliness in the middle of the crowd. Loss of family and friends, and lack of conversations with staff members and fellow patients were also sources of sadness. III. Relating and identity. The informants kept sadness at bay through: acceptance and re-orientation to their current life situation, maintaining narratives about their identity and belonging, and religiosity. CONCLUSIONS Nursing home nurses and doctors should identify and respond to sadness that is a rational response to manageable causes. Further, identifying and supporting residents' resources and coping strategies is a salutogenetic approach that may alleviate sadness.
Collapse
Affiliation(s)
- Kristina Riis Iden
- Research Unit for General Practice, Uni Research Health, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Sabine Ruths
- Research Unit for General Practice, Uni Research Health, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Stefan Hjørleifsson
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| |
Collapse
|
23
|
Iden KR, Engedal K, Hjorleifsson S, Ruths S. Prevalence of depression among recently admitted long-term care patients in Norwegian nursing homes: associations with diagnostic workup and use of antidepressants. Dement Geriatr Cogn Disord 2014; 37:154-62. [PMID: 24157730 DOI: 10.1159/000355427] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2013] [Indexed: 11/19/2022] Open
Abstract
AIMS We aimed to establish the prevalence of depression among recently admitted long-term care patients and to examine associations with diagnostic initiatives and treatment as recorded in patients' medical records. MATERIALS AND METHODS Eighty-eight long-term care patients were included. Depression was diagnosed according to the ICD-10 criteria; patients were screened for depression using the Cornell Scale for Depression in Dementia (CSDD) and for dementia with the Clinical Dementia Rating (CDR) scale. RESULTS Depression was found in 25% of the patients according to the ICD-10 criteria and in 31% according to a CSDD sum score of ≥ 8. Diagnostic initiatives were documented in the medical records of half of the patients with depression. Forty-four percent of the patients were prescribed antidepressants and 23% actually received them for the treatment of depression. CONCLUSION Depression was prevalent among recently admitted long-term care patients, but diagnostic initiatives were too rarely used. Antidepressants were commonly prescribed, but depression was the indication for treatment in only half of the cases. Screening for depression should be mandatory on admission.
Collapse
Affiliation(s)
- Kristina Riis Iden
- Research Unit for General Practice, Uni Health/Uni Research, Bergen, Norway
| | | | | | | |
Collapse
|
24
|
Haugan G, Drageset J. The hospital anxiety and depression scale--dimensionality, reliability and construct validity among cognitively intact nursing home patients. J Affect Disord 2014; 165:8-15. [PMID: 24882171 DOI: 10.1016/j.jad.2014.04.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depression and anxiety are particularly common among individuals living in long-term care facilities. Therefore, access to a valid and reliable measure of anxiety and depression among nursing home patients is highly warranted. AIM To investigate the dimensionality, reliability and construct validity of the Hospital Anxiety and Depression scale (HADS) in a cognitively intact nursing home population. METHODS Cross-sectional data were collected from two samples; 429 cognitively intact nursing home patients participated, representing 74 different Norwegian nursing homes. Confirmative factor analyses and correlations with selected constructs were used. RESULTS The two-factor model provided a good fit in Sample1, revealing a poorer fit in Sample2. Good-acceptable measurement reliability was demonstrated, and construct validity was supported. LIMITATIONS Using listwise deletion the sample sizes were 227 and 187, for Sample1 and Sample2, respectively. Greater sample sizes would have strengthen the statistical power in the tests. The researchers visited the participants to help fill in the questionnaires; this might have introduced some bias into the respondents׳ reporting. The 14 HADS items were part of greater questionnaires. Thus, frail, older NH patients might have tired during the interview causing a possible bias. CONCLUSION Low reliability for depression was disclosed, mainly resulting from three items appearing to be inappropriate indicators for depression in this population. Further research is needed exploring which items might perform as more reliably indicators for depression among nursing home patients.
Collapse
Affiliation(s)
- Gørill Haugan
- Sør-Trøndelag University College, Faculty of Nursing and Research Centre for Health Promotion and Resources, HIST, Norway.
| | | |
Collapse
|
25
|
Knapskog AB, Barca ML, Engedal K. A comparison of the cornell scale for depression in dementia and the Montgomery-Aasberg depression rating scale in a memory clinic population. Dement Geriatr Cogn Disord 2013; 35:256-65. [PMID: 23594823 DOI: 10.1159/000348345] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this study was to explore the correlation between the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) among memory clinic patients. METHODS The CSDD (based on an interview with the caregiver) and the MADRS (based on the patient's opinion) were filled in independently of each other among 520 patients. Principal component and correlation analyses were performed. RESULTS The mean score of the CSDD was 7.6 (SD: 6.0), and the mean MADRS score was 9.7 (SD: 6.7). The correlation between the two scales was 0.36 for the whole group, 0.22 in the group with dementia and 0.48 for those without dementia, respectively. Principal component analyses revealed four factors for the CSDD and two factors for the MADRS. CONCLUSIONS Using two different sources of information, we found a poor correlation between the two scales. We suggest that evaluation of depression among memory clinic patients should be done by interviewing both the patient and the caregiver.
Collapse
Affiliation(s)
- Anne-Brita Knapskog
- Department of Geriatric Medicine, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | | | | |
Collapse
|
26
|
Bjørkløf GH, Engedal K, Selbæk G, Kouwenhoven SE, Helvik AS. Coping and depression in old age: a literature review. Dement Geriatr Cogn Disord 2013; 35:121-54. [PMID: 23392253 DOI: 10.1159/000346633] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The interest in the relation between coping and depression in older persons is growing, but research on the concepts and instruments of coping in relation to depression among older persons is scarce and systematic reviews are lacking. With this background, we wanted to gain a systematic overview of this field by performing a systematic literature search. METHODS A computer-aided search in MEDLINE, CINAHL, PsycINFO, Embase, PubMed and www.salutogenesis.fi was conducted. We systematically searched for studies including coping and depression among persons 60 years of age and above. The included studies were evaluated according to predefined quality criteria. RESULTS Seventy-five studies, 38 clinical and 37 community settings, were included. Of these, 44 were evaluated to be of higher quality. Studies recruiting samples of older persons with a major depressive disorder, moderate or severe cognitive impairment or those who were dependent on care were scarce, thus the research is not representative of such samples. We found a huge variety of instruments assessing resources and strategies of coping (55 inventories). Although we found the relation between resources and strategies of coping and depression to be strong in the majority of studies, i.e. a higher sense of control and internal locus of control, more active strategies and positive religious coping were significantly associated with fewer symptoms of depression both in longitudinal and cross-sectional studies in clinical and community settings. CONCLUSION Resources and strategies of coping are significantly associated with depressive symptoms in late life, but more research to systematize the field of coping and to validate the instruments of resources and strategies of coping in older populations is required, especially among older persons suffering from major depression and cognitive decline.
Collapse
Affiliation(s)
- Guro Hanevold Bjørkløf
- Department of Psychiatry, Vestre Viken Hospital Trust, Lier Norway. guhane @ vestreviken.no
| | | | | | | | | |
Collapse
|
27
|
Affiliation(s)
- Robert Stewart
- Institute of Psychiatry, King's College London, London SE5 8AF, UK.
| |
Collapse
|
28
|
Residents with mental-physical multimorbidity living in long-term care facilities: prevalence and characteristics. A systematic review. Int Psychogeriatr 2013. [PMID: 23206307 DOI: 10.1017/s1041610212002025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Aging societies will be confronted with increased numbers of long-term care (LTC) residents with multimorbidity of physical and mental disorders other than dementia. Knowledge about the prevalence rates, medical and psychosocial characteristics, and care needs of this particular group of residents is mandatory for providing high-quality and evidence-based care. The purpose of this paper was to review the literature regarding these features. METHODS A systematic literature search was conducted in PubMed, EMBASE, PsycINFO, and CINAHL from January 1, 1988 to August 16, 2011. Two reviewers independently assessed eligibility of studies on pre-established inclusion criteria as well as methodological quality using standardized checklists. RESULTS Seventeen articles were included. Only one small study describes multimorbidity of a wide range of chronic psychiatric and somatic conditions in LTC residents and suggests that physical-mental multimorbidity is rather rule than exception. All other studies show prevalence rates of comorbid physical and mental illnesses (range, 0.5%-64.7%), roughly in line with reported prevalence rates among community-dwelling older people. LTC residents with mental-physical multimorbidity were younger than other LTC residents and had more cognitive impairment, no dementia, and problem behaviors. Care needs of these residents were not described. CONCLUSIONS Although exact figures are lacking, mental-physical multimorbidity is common in LTC residents. Given the specific characteristics of the pertaining residents, more knowledge of their specific care needs is essential. The first step now should be to perform research on symptoms and behavior, which seem more informative than diagnostic labels as well as care needs of LTC residents with mental-physical multimorbidity.
Collapse
|
29
|
Haugan G, Innstrand ST, Moksnes UK. The effect of nurse-patient interaction on anxiety and depression in cognitively intact nursing home patients. J Clin Nurs 2013; 22:2192-205. [DOI: 10.1111/jocn.12072] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Gørill Haugan
- Faculty of Nursing; Research Centre for Health Promotion and Resources; Sør-Trøndelag University College, HIST; Trondheim Norway
| | - Siw T Innstrand
- Research Centre for Health Promotion and Resources ; Norwegian University of Science and Technology, NTNU; Trondheim Norway
| | - Unni K Moksnes
- Faculty of Nursing; Research Centre for Health Promotion and Resources; Sør-Trøndelag University College, HIST; Trondheim Norway
| |
Collapse
|
30
|
Helvik AS, Engedal K, Selbæk G. Change in sense of coherence (SOC) and symptoms of depression among old non-demented persons 12 months after hospitalization. Arch Gerontol Geriatr 2013; 56:314-20. [DOI: 10.1016/j.archger.2012.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 10/16/2012] [Accepted: 10/17/2012] [Indexed: 11/29/2022]
|
31
|
Helvik AS, Engedal K, Selbaek G. Depressive symptoms among the medically hospitalized older individuals -- a 1-year follow-up study. Int J Geriatr Psychiatry 2013; 28:199-207. [PMID: 22505371 DOI: 10.1002/gps.3811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 03/14/2012] [Indexed: 11/07/2022]
Abstract
AIM The present follow-up study of older medically hospitalized patients from a rural area in Norway assessed the prevalence of depressive symptoms at 1-year follow-up and furthermore explored whether depressive symptoms at follow-up was associated with change in the medical, functional or emotional situation between baseline and follow-up. METHODS A 1-year follow-up study included 363 (175 men) older medical inpatients with age range 65-98 (mean = 80.2; standard deviation (SD) = 7.5) years. Information was collected at baseline and follow-up using the Hospital Anxiety and Depression scale (HAD), the Mini-Mental State Examination, Lawton and Brody's scales for physical self-maintenance and performance of the instrumental activities of daily living. RESULTS The prevalence of depressive symptoms, as defined by a score ≥ 8 at HAD-D, was 10% at baseline and 7% at follow-up. Of those with depressive symptoms at baseline, 78% had experienced remission. The incidence of depressive symptoms at follow-up was 5%. In logistic regression analyses adjusted for age, gender, and depressive symptoms at baseline, becoming or being in need of assistance from nursing or social services (odds ratio (OR) = 8.1, 95% CI: 1.9-34.2 and OR = 4.4, 95% CI: 1.1-17.4, respectively), having a cognitive decline (OR = 1.1, 95% CI: 1.0-1.3), and exhibiting poorer physical self-maintenance (OR = 1.2, 95% CI: 1.0-1.3), becoming vision impaired (OR = 8.3, 95% CI: 2.8-25.0), and with increased anxiety (OR = 1.2, 95% CI: 1.0-1.3) during follow-up was associated with depressive symptoms at follow-up. CONCLUSION The 1-year follow-up study of older medical inpatients contributes to the research body regarding risk factors of depression in older people.
Collapse
Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | | | | |
Collapse
|
32
|
Knapskog AB, Portugal MDG, Barca ML, Coutinho ESF, Laks J, Engedal K. A cross-cultural comparison of the phenotype of depression as measured by the Cornell Scale and the MADRS in two elderly outpatient populations. J Affect Disord 2013; 144:34-41. [PMID: 22858259 DOI: 10.1016/j.jad.2012.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 06/01/2012] [Accepted: 06/02/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Different cutoff points for a depressive disorder on depression scales exist in different countries. The reasons could be that the presence or the intensity of the various symptoms on the scales differ. We wanted to explore differences in scores on depression scales among patients in Brazil and Norway. METHODS The Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) were completed independently among 211 elderly outpatients in Brazil and Norway. A psychiatrist, blind to the results, diagnosed depression using the ICD-10 and DSM-IV criteria. RESULTS According to the ICD-10 criteria, 29 (33.7%) Brazilian and 51 (40.8%) Norwegian patients had depression (p=0.3). Mean CSDD score was 14.4 (SD 8.9) in Brazil and 6.8 (SD 4.9) in Norway (p<0.001). Mean MADRS score was 13.2 (SD 12.1) in Brazil and 8.4 (SD 6.8) in Norway (p=0.02). We analyzed the scores for the depressed and the non-depressed patients separately. In both groups the Brazilian patients had significantly higher scores on both scales compared to the Norwegian patients. In an adjusted linear regression analysis the variable "country" was associated with the CSDD score (beta=-0.29, p=0.01). LIMITATIONS The protocols in the two countries were not exactly the same. Only one psychiatrist evaluated the patients. CONCLUSIONS The scores on the MADRS and the CSDD were higher in patients in Brazil than in Norway. In an adjusted linear regression analysis, "country" was the only variable associated with the higher CSDD score.
Collapse
Affiliation(s)
- Anne-Brita Knapskog
- Department of Geriatric Medicine, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, P.B. 4950, Nydalen, 0424 Oslo, Norway.
| | | | | | | | | | | |
Collapse
|
33
|
Wyller TB, Watne LO, Torbergsen A, Engedal K, Frihagen F, Juliebø V, Saltvedt I, Skovlund E, Ræder J, Conroy S. The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial. BMC Geriatr 2012; 12:36. [PMID: 22817102 PMCID: PMC3583172 DOI: 10.1186/1471-2318-12-36] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 07/09/2012] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hip fractures mainly affect older people. It is associated with high morbidity and mortality, and in particular a high frequency of delirium. Incident delirium following hip fracture is associated with an increased risk of dementia in the following months, but it is still not firmly established whether this is an association or a causal relationship. Orthogeriatric units vary with respect to content and timing of the intervention. One main effect of orthogeriatric care may be the prevention of delirium, especially if preoperative and postoperative care are provided. Thus, the aim of Oslo Orthogeriatric Trial, is to assess whether combined preoperative and postoperative orthogeriatric care can reduce the incidence of delirium and improve cognition following hip fracture. METHODS/DESIGN Inclusion and randomisation will take place in the Emergency Department, as soon as possible after admission. All patients with proximal femur fractures are eligible, irrespective of age, pre-fracture function and accommodation, except if the fracture is caused by a high energy trauma or the patient is terminally ill. The intervention is pre-and post-operative orthogeriatric care delivered on a dedicated acute geriatric ward. The primary outcome measure is a composite endpoint combining the Clinical Dementia Rating Scale (CDR) and the 10 word memory task at four months after surgery. Secondary outcomes comprise incident delirium, length of stay, cognition, mobility, place of residence, activities of daily living and mortality, measured at 4 and 12 months after surgery. We have included 332 patients in the period 17th September 2009 to 5th January 2012. DISCUSSION Our choice of outcome measures and our emphasis of orthogeriatric care in the preoperative as well as the postoperative phase will enable us to provide new knowledge on the impact of orthogeriatric care on cognition. TRIALS REGISTRATION ClinicalTrials.gov NCT01009268.
Collapse
|
34
|
Volicer L, Frijters DHM, Van der Steen JT. Relationship between symptoms of depression and agitation in nursing home residents with dementia. Int J Geriatr Psychiatry 2012; 27:749-54. [PMID: 21956820 DOI: 10.1002/gps.2800] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 08/12/2011] [Accepted: 08/15/2011] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this study is to analyze modifiable factors related to agitation of nursing home residents with dementia. METHODS Relationship of agitation with three modifiable factors (depression, psychosis, and pain) was explored using longitudinal Minimum Data Set (MDS) information from 2032 residents of Dutch nursing homes. Presence of agitation and depression was ascertained using validated scales based on MDS information. Presence of psychosis and pain was ascertained from the individual MDS items. RESULTS There was a significant correlation between MDS depression and agitation scores. Depression scores increased in residents whose agitation worsened and decreased in residents whose agitation improved. Psychosis scores (combination of delusions and hallucinations) also correlated with MDS depression scores, and psychosis scores increased in residents whose agitation worsened. Pain scores correlated with agitation scores, but the pain scores did not change with changes in agitation. Depression symptoms were present in 51% of residents, while psychotic symptoms were present only in 15% of residents, and two-thirds of these residents were also depressed. CONCLUSION These results indicate that depression may be the most common factor associated with agitation in nursing home residents with dementia.
Collapse
Affiliation(s)
- Ladislav Volicer
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | | | | |
Collapse
|
35
|
Knapskog AB, Barca ML, Engedal K. A comparison of the validity of the Cornell Scale and the MADRS in detecting depression among memory clinic patients. Dement Geriatr Cogn Disord 2012; 32:287-94. [PMID: 22262043 DOI: 10.1159/000334983] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of the study was to compare the validity of the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Aasberg Depression Rating Scale (MADRS) among memory clinic patients. METHODS The scales were independently completed for 125 patients. The diagnosis of depression was made by psychiatrists blinded to the depression scores. RESULTS The mean score of the Mini-Mental State Examination was 25.5 (SD: 4.6), of the CSDD 6.8 (SD: 4.9), and of the MADRS 8.5 (SD: 6.8). In receiver operation characteristics (ROC) analyses, the AUC for the CSDD was 0.73 (95% CI: 0.63-0.82) using the International Classification of Diseases-10 (ICD-10) criteria for depression, and 0.68 (95% CI: 0.57-0.79) using the DSM-IV criteria. The AUC was 0.88 (95% CI: 0.81-0.95) for the MADRS using the ICD-10 criteria, and 0.84 (95% CI: 0.76-0.92) using the DSM-IV criteria. CONCLUSION Both scales are suitable as screening tools. According to the ROC analyses, the MADRS seems better at distinguishing depressed from nondepressed patients.
Collapse
Affiliation(s)
- Anne-Brita Knapskog
- Department of Geriatric Medicine, Institute of Clinical Medicine, University of Oslo, Ullevaal, Norway
| | | | | |
Collapse
|
36
|
Haugan G, Innstrand ST. The effect of self-transcendence on depression in cognitively intact nursing home patients. ISRN PSYCHIATRY 2012; 2012:301325. [PMID: 23738199 PMCID: PMC3658806 DOI: 10.5402/2012/301325] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 02/28/2012] [Indexed: 11/23/2022]
Abstract
Aims. This study's aim was to test the effects of self-transcendence on depression among cognitively intact nursing home patients. Background. Depression is considered the most frequent mental disorder among the elderly population. Specifically, the depression rate among nursing home patients is three to four times higher than that among community-dwelling elderly. Therefore, finding new and alternative ways to prevent and decrease depression is of great importance for nursing home patients' well-being. Self-transcendence is related to spiritual as well as nonspiritual factors, and it is described as a correlate and resource for well-being among vulnerable populations and at the end of life. Methods. A two-factor construct of the self-transcendence scale (interpersonal and intrapersonal) and the hospital anxiety and depression scale (HADS) was applied. A sample of 202 cognitively intact nursing home patients in central Norway was selected to respond to the questionnaires in 2008/2009. Results. A hypothesized SEM model demonstrated significant direct relationships and total effects of self-transcendence on depression. Conclusion and Implication for Practice. Facilitating patients' self-transcendence, both interpersonally and intrapersonally, might decrease depression among cognitively intact nursing home patients.
Collapse
Affiliation(s)
- Gørill Haugan
- Research Centre for Health Promotion and Resources HiST/NTNU, Faculty of Nursing, Sør-Trøndelag University College, 7004 Trondheim, Norway
| | - Siw Tone Innstrand
- Research Centre for Health Promotion and Resources HiST/NTNU, Department of Social Work and Health Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| |
Collapse
|
37
|
Leontjevas R, Gerritsen DL, Koopmans RT, Smalbrugge M, Vernooij-Dassen MJ. Process Evaluation to Explore Internal and External Validity of the “Act in Case of Depression” Care Program in Nursing Homes. J Am Med Dir Assoc 2012; 13:488.e1-8. [DOI: 10.1016/j.jamda.2012.03.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 02/07/2012] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
|
38
|
Barca ML, Engedal K, Laks J, Selbaek G. Factors associated with a depressive disorder in Alzheimer's disease are different from those found for other dementia disorders. Dement Geriatr Cogn Dis Extra 2012; 2:19-28. [PMID: 22479262 PMCID: PMC3318937 DOI: 10.1159/000335775] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background This study explores factors associated with depression in Alzheimer's disease (AD) compared with mild cognitive impairment (MCI) and other dementia disorders. Method In a prospective study we included 195 patients: 31 with MCI, 112 with AD and 52 with other dementias. Results According to the ICD-10 and the DSM-IV criteria, 88 (44.1%) and 59 (30.3%), respectively, had a depressive disorder. An adjusted multiple regression analysis showed that previous depression (p < 0.05) was significantly associated with depression in AD patients. Severity of dementia (p < 0.05) was significantly associated with a depressive disorder in a group of patients with frontotemporal dementia, vascular dementia, or dementia due to Lewy Body disease or Parkinson's disease. Conclusion We found different factors associated with a depressive disorder in AD compared to those found for other dementia disorders.
Collapse
Affiliation(s)
- Maria Lage Barca
- Norwegian Centre for Dementia Research, Centre for Ageing and Health, Department of Geriatric Medicine, Oslo University Hospital, Ullevål, Norway
| | | | | | | |
Collapse
|
39
|
Barca ML, Engedal K, Laks J, Selbæk G. Quality of life among elderly patients with dementia in institutions. Dement Geriatr Cogn Disord 2011; 31:435-42. [PMID: 21757909 DOI: 10.1159/000328969] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2011] [Indexed: 11/19/2022] Open
Abstract
AIM To study quality of life among the elderly with dementia in institutions. METHODS Patients above 60 years with dementia, 82 in nursing home and 74 in departments of geriatric psychiatry, were included. They were assessed with the Quality of Life in Late-Stage Dementia (QUALID); the Self-Maintenance scale, Mini Mental State Examination (MMSE) and Clinical Dementia Rating scale. Patient's age, gender, previous medical and psychiatric history were recorded. Dementia was diagnosed according to ICD-10 criteria for research. Based on information in an interview with the patient and a carer and information in the patient's record, a geriatric psychiatrist made a diagnosis of major depression according to DSM-IV, if present. RESULTS The patients' mean (± SD) age was 82.9 ± 7.7 years, 103 (66%) were women. A factor analysis of the QUALID scale resulted in two factors: 'discomfort' and 'comfort'. Three linear regression analyses were performed. Variables associated with lower quality of life (total QUALID score) were: a diagnosis of major depression (p < 0.001), lower score on MMSE (p = 0.032), impaired function in activities of daily living (p = 0.007) and female gender (p = 0.046). Variables associated with the 'discomfort' subscale score were: major depression (p < 0.001), lower score on MMSE (p = 0.006) and living in a department of geriatric psychiatry (p = 0.041). The 'comfort' subscale score was associated with impaired function in activities of daily living (p < 0.001). Explained variance for the three models was 34, 33 and 23%, respectively. CONCLUSION Quality of life is diminished among elderly patients in institutions and the most marked correlates were a diagnosis of major depression, worse performance in activities of daily living and worse cognitive function.
Collapse
Affiliation(s)
- Maria L Barca
- Norwegian Centre for Dementia Research, Centre for Aging and Health, Oslo University Hospital, Ullevaal, Oslo, Norway.
| | | | | | | |
Collapse
|
40
|
Volicer L, Frijters D, van der Steen J. Underdiagnosis and undertreatment of depression in nursing home residents. Eur Geriatr Med 2011. [DOI: 10.1016/j.eurger.2011.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
41
|
Iden KR, Hjørleifsson S, Ruths S. Treatment decisions on antidepressants in nursing homes: a qualitative study. Scand J Prim Health Care 2011; 29:252-6. [PMID: 22126226 PMCID: PMC3308458 DOI: 10.3109/02813432.2011.628240] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore decision-making on treatment with antidepressants among doctors and nurses in nursing homes. DESIGN AND SUBJECTS A qualitative study based on interviews with three focus groups comprising eight physicians engaged full time, eight physicians engaged part time, and eight registered nurses, respectively. The interview guide comprised questions on initiating, evaluating, and withdrawing treatment with antidepressants. The interviews were audio-recorded, transcribed, and analysed by systematic text condensation. RESULTS The first theme was the diagnostic process. The informants expressed difficulty in differentiating between depression and sorrow resulting from loss in old age. Further, the doctors reported that they relied on nurses' observations and rarely carried out systematic diagnostic work and follow-up of patients with depression. The second theme was treatment. Antidepressants were usually the only type of treatment provided, and patients were kept on medication even though staff felt uncertain whether this was effective. The third theme was who really determines the treatment. Registered nurses reported that unskilled and auxiliary nursing staff requested drug treatment, and doctors felt some pressure from the nurses to prescribe antidepressants. CONCLUSIONS This study suggests that the quality of diagnosis and treatment for depression in nursing homes needs to be improved in Norway. Doctors should be more available and take responsibility and leadership in medical decisions.
Collapse
|
42
|
Patterns of psychotropic medication use in nursing homes: surveys in Sydney, allowing comparisons over time and between countries. Int Psychogeriatr 2011; 23:1520-5. [PMID: 21429281 DOI: 10.1017/s1041610211000445] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study aimed to explore changes in patterns of use of psychotropic medication in Sydney nursing homes over recent years, and to compare current usage rates with those reported from other countries. METHODS Data were obtained from 44 of the 48 nursing homes in a central Sydney health area. Researchers noted details from medication cards concerning residents' age, gender and all currently prescribed drugs, checking whether medication had been given as prescribed. Frequency of administration of "as required" drugs in the previous four weeks was noted. RESULTS The pattern of use of psychotropic medication changed considerably between 1993 and 2009. The number of residents taking regularly administered antipsychotics increased by 24% during 1998-2009, though mean dosages decreased. In 2009, fewer residents took hypnotic and/or anxiolytic medications than in the 1990s, and fewer than in countries from which equivalent data have been reported. Antidepressant use increased over the 16 years but only to 25.6%. Only 3% of residents in Sydney nursing homes in 2009 took cognition-enhancing drugs. CONCLUSIONS Compared to other countries, rates of use of hypnotic, anxiolytic and antidepressant medication in Sydney nursing homes are low. Benefits and disadvantages of these differences merit analysis. Antipsychotic medications were administered to similar percentages of survey residents in 1993 and 2009, but at lower mean dosages in 2009 compared to previous surveys, and with a change to using mainly atypical antipsychotic drugs. Compared to various other countries, cognition-enhancing and antidepressant medications are administered to proportionally fewer residents in Sydney nursing homes. Outcome analysis regarding the use and benefits of such drugs in nursing homes is desirable.
Collapse
|
43
|
Engedal K, Barca ML, Laks J, Selbaek G. Depression in Alzheimer's disease: specificity of depressive symptoms using three different clinical criteria. Int J Geriatr Psychiatry 2011; 26:944-51. [PMID: 21845597 DOI: 10.1002/gps.2631] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Accepted: 08/03/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous studies report contradictory results on whether the symptoms of depression in Alzheimer's disease patients are the same as in cognitively normal persons. Thus, provisional criteria for depression in Alzheimer's disease (PDC-dAD) have been developed. AIM To examine which symptoms in AD patients are significant in diagnosing depression according to PDC-dAD compared to those for the DSM-IV-TR and ICD-10 criteria. METHODS We included 112 patients with Alzheimer's disease. They were interviewed by a psychiatrist who diagnosed depression according to PDC-dAD, DSM-IV-TR and ICD-10. Without knowledge of that diagnosis, trained nurses interviewed the caregivers of the patients using the Cornell scale for depression in dementia (CSDD). RESULTS Mean age of the patients was 83.0 (s.d. 7.9), 77 (69.6%) were female. The proportion with depression according to each set of criteria was: PDC-dAD 53.5%, ICD-10, 47.3% and DSM-IV-TR, 34.8%. Sadness, loss of interest and agitation/retardation were the most prevalent symptoms in depressed subjects as evaluated by the psychiatrists. According to CSDD sadness, anxiety, suicidal thoughts, poor self-esteem, multiple physical complaints and pessimism best distinguished the depressed patients from the non-depressed. In multiple logistic regression analyses poor self-esteem, delusion and multiple physical complaints best predicted depression using PDC-dAD criteria, whereas sadness, suicidal thoughts and poor self-esteem best predicted depression using ICD-10 and DSM-IV-TR. CONCLUSION The most significant symptoms for a depressive disorder in AD are pretty much the same as for patients without dementia using the DSM-IV-TR and ICD-10 criteria, whereas they differ using the PDC-dAD criteria.
Collapse
Affiliation(s)
- Knut Engedal
- Norwegian Centre for Dementia Research, Centre for Ageing and Health, Department of Geriatric Medicine, Oslo University Hospital, Ullevaal, Norway.
| | | | | | | |
Collapse
|
44
|
Farner L, Wagle J, Engedal K, Flekkøy KM, Wyller TB, Fure B. Depressive symptoms in stroke patients: a 13 month follow-up study of patients referred to a rehabilitation unit. J Affect Disord 2010; 127:211-8. [PMID: 20933286 DOI: 10.1016/j.jad.2010.05.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 05/25/2010] [Accepted: 05/29/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although depression is known to be frequently associated with stroke, it is nonetheless underdiagnosed and under-treated in this patient population. Its effect on outcome for stroke patients is thought to be substantial, but prediction is complicated by other pre- and post stroke factors. The aims of this study was to describe changes in depressive symptoms in elderly stroke patients across a timespan of one year, to examine risk factor for such changes and to explore whether depressive symptoms have any independent impact upon one year mortality and nursing home placement. METHODS 194 patients diagnosed with an ischaemic or hemorrhagic stroke was recruited from the Stroke Rehabilitation Unit, Ullevaal University Hospital, Oslo, Norway during the period between March 2005 and August 2006 and followed up for a period of 13 months. Pre-stroke assessment was accomplished by means of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Frenchay Activities Index (FAI), the Barthel ADL Index and patient's medical history. Post-stroke assessment at inclusion and follow-up examination was performed with the Mini Mental State Examination (MMSE), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Star Cancellation Test, the Barthel ADL Index, the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale (NIHSS). Information was collected from the patients' records. RESULTS Institutionalization at 13 months was predicted by more depression (MADRS) and cognitive impairment (RBANS) at baseline, together with lower pre-stroke social activity levels (FAI). Two factors predicted death at 13 months: Cognitive impairment (MMSE) and greater age. The prevalence of depression was relatively unchanged from baseline (56%) to 13 month follow-up (48%). Among the patients who were depressed at baseline 55% still had MADRS score above six (persistent depression) at 13 months, while 35% in the non-depressed group at baseline had developed depression (incident depression). Persistent depression was significantly predicted by lower pre-stroke social activity levels (FAI) together with a more severe stroke (NIHSS) and worse overall function (mRS) at baseline. Incident depression was predicted by receipt of municipal home help before the stroke and a lower score on the delayed memory tasks on RBANS at baseline.
Collapse
Affiliation(s)
- Lasse Farner
- Norwegian Centre for Ageing and Health, Vestfold Mental Health Care Trust, Norway.
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
BACKGROUND Although studies have shown the prevalence of depression in nursing homes to be high, under-recognition of depression in these facilities is widespread. Use of screening tests to enhance detection of depressive symptoms has been recommended. METHODS This paper aims to provoke discussion about optimal management of depression in nursing homes. The utility of the Cornell Scale for Depression in Dementia (CSDD) is considered. CSDD data relating to residents assessed in 2008-2009 were collected from three Sydney nursing homes. RESULTS CSDD scores were available from 162 residents, though raters stated they were unable to score participants on at least one item in 47 cases. Scores of 13 or more were recorded for 23% of residents in these facilities, but in most of these cases little was documented in case files to show that the results had been discussed by staff, or that they led to interventions, or that follow-up testing was arranged. CONCLUSIONS Results of CSDD testing should prompt care staff (including doctors) to consider causation of depression in cases where residents are identified as possibly depressed. In particular, there needs to be discussion of how to help residents to cope with disability, losses, and feelings of powerlessness. Research is needed, examining factors that might predict response to antidepressants, and what else helps. Accreditation of nursing homes could be made to depend partly on evidence that staff regularly search for, and (if found) ensure appropriate responses to, depression.
Collapse
|
46
|
Laks J, Engelhardt E. Peculiarities of geriatric psychiatry: a focus on aging and depression. CNS Neurosci Ther 2010; 16:374-9. [PMID: 20875046 DOI: 10.1111/j.1755-5949.2010.00196.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
There is a debate on whether Geriatric Psychiatry stands for itself as a discrete specialty or whether it is an extension of clinical Geriatrics, Neurology, and Psychiatry. This review aims to outline some recent data and possible approaches to define peculiarities of Geriatric Psychiatry, focusing on certain characteristics that define the aging brain. Geriatric depression is discussed taking into consideration some data from translational research. The brain aging process is not uniform. Frontal areas show marked impairment in inhibiting irrelevant information in working memory as they age, and the recruitment of these areas occur differently than in young subjects. Executive functions also change in normal elderly. Geriatric depression is a general definition of a multidimensional disorder with multiple risk factors. Dysexecutive syndrome is considered as a key to the neuropsychology of geriatric depression, correlated with functional impairment in late life. Late-onset depression has a higher load of comordibity, of cerebrovascular disease, and of some genetic factors that may be different from early onset depression. Also, there are at least four clusters of treatment outcomes that are common in geriatric depression, which mirror the neuropsychological and clinical profiles. Research and practice in Geriatric Psychiatry should focus on the interaction of various dimensions and risk factors rather than on attempting to find a single cause to the disorders. Some answers may be found in comorbidity issues, in white matter lesions, which are more common in the elderly, and in genetic factors that impact on the aging process.
Collapse
Affiliation(s)
- Jerson Laks
- Institute of Psychiatry of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | |
Collapse
|
47
|
Nishtala PS, McLachlan AJ, Bell JS, Chen TF. Determinants of antidepressant medication prescribing in elderly residents of aged care homes in Australia: A retrospective study. ACTA ACUST UNITED AC 2009; 7:210-9. [DOI: 10.1016/j.amjopharm.2009.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2009] [Indexed: 11/26/2022]
|