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Ding Z, Wang M, Chen J, Mei Z, Li W, Xu G. Long-term care for community-dwelling older adults: A systematic review of clinical practice guidelines and consensus statements. Geriatr Nurs 2024; 58:135-143. [PMID: 38810290 DOI: 10.1016/j.gerinurse.2024.05.016] [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: 03/05/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
This review identified clinical practice guidelines (CPGs) and consensus statements (CSs) that include recommendations on long-term care for community-dwelling older adults. Additionally, it assessed their quality using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool to determine high-quality guidelines and synthesis recommendations from high-quality guidelines and evaluate the quality of these guidelines using the AGREE-Recommendation Excellence (AGREE-REX) tool. A systematic search was performed (November 2023) in MEDLINE, PubMed, Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Registered Nurses' Association of Ontario (RNAO), National Guideline Clearinghouse (NGC), and Scottish Intercollegiate Guidelines Network (SIGN). Two reviewers independently selected and assessed the articles using AGREE II. A meeting was held to appraise the quality of the guidelines (AGREE II mean score >70 %) using AGREE-REX. The analysis included 14 CPGs and 2 CSs. Of these, 7 CPGs reached the standard of >70 %, the 'Scope and purpose' domain obtained the highest score with 85.43 (± 17.87), and the 'Applicability' domain scored lowest with 46.93 (± 26.74). Regarding the score of AGREE-REX, the seven CPGs were considered as 'moderate', with the 'Clinical Applicability' domain having the highest score of 61.29 % (±10.80) and the 'Values and Preferences' domain having the lowest score of 38.14 % (±9.26). Four themes were synthesised from the seven high-quality CPGs: planning and delivering person-centred home care, cognitive impairment, and screening for impaired vision and falls. The quality of CPGs and CSs on long-term care for community-dwelling older adults has room for improvement, and higher-quality guidelines are required to meet the long-term care needs of community-dwelling older adults.
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Affiliation(s)
- Zichun Ding
- School of nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Meng Wang
- School of nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Junyu Chen
- School of nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ziqi Mei
- School of nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Weitong Li
- School of nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Guihua Xu
- School of nursing, Nanjing University of Chinese Medicine, Nanjing, China.
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Lu Y, Qi Y, Du J, Liu Y, Dong S, Ge H, Yu Y, Wang J, Zhang N, Wang B, Ma G. Classification of high-risk depressed mood groups in cancer patients based on Health Ecology Model. J Affect Disord 2024; 347:327-334. [PMID: 37992777 DOI: 10.1016/j.jad.2023.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 10/28/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Depressed mood affects a significant number of patients with cancer, and can impair their quality of life and interfere with successful treatment. Our study aims to create a predictive model for identifying high-risk groups of depressed mood in cancer patients, offering a theoretical support for preventing depressed mood in these individuals. METHODS The China Health and Retirement Longitudinal Study (CHARLS) provided the data for this research, which used CES-D as a tool to identify individuals with depressed mood. Influencing factors of depressed mood in cancer patients was analyzed using a binary logistic regression model. Using the Harvard Cancer Index, we classified the high-risk patients for depressed mood. RESULTS In present study, 52.96 % of cancer patients met criteria for depressed mood based on the CES-D. Significant correlations were found between depressed mood and factors such as gender, self-rated health, sleep duration, exercise, satisfaction with family, residence, education, life satisfaction, and medical insurance. Utilizing the Harvard Cancer Index, we classified patients into five risk levels for depressed mood, revealing a significant variation in the number of depressive patients across these levels (x2=99.82, P < 0.05). Notably, the incidence of depressed mood increased with the risk level among cancer patients (x2=103.40, P < 0.05). LIMITATIONS Lack of data on tumor typing and subgroups makes it unlikely to explore the specifics of depressed mood in patients with various types of cancer. CONCLUSION The determinants of depressed mood in cancer patients are multi-dimensional. The Harvard Cancer Index may be helpful in identifying high-risk populations.
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Affiliation(s)
- Youhua Lu
- School of Public Health, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, China; Office of the President, Shandong Cancer Prevention and Treatment Institute (Shandong Cancer Hospital), Cancer Hospital Affiliated to Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, Shandong 250117, China
| | - Yuantao Qi
- Office of the President, Shandong Cancer Prevention and Treatment Institute (Shandong Cancer Hospital), Cancer Hospital Affiliated to Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, Shandong 250117, China
| | - Jin Du
- School of Public Health, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, China
| | - Yan Liu
- School of Public Health, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, China
| | - Shihong Dong
- School of Public Health, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, China
| | - Huaiju Ge
- School of Public Health, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, China
| | - Yuan Yu
- School of Public Health, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, China
| | - Jialin Wang
- Human Resource Department, Shandong Cancer Prevention and Treatment Institute (Shandong Cancer Hospital), Cancer Hospital Affiliated to Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, Shandong 250117, China
| | - Nan Zhang
- Office of the President, Shandong Cancer Prevention and Treatment Institute (Shandong Cancer Hospital), Cancer Hospital Affiliated to Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, Shandong 250117, China
| | - Bingxiang Wang
- Human Resource Department, Shandong Cancer Prevention and Treatment Institute (Shandong Cancer Hospital), Cancer Hospital Affiliated to Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, Shandong 250117, China
| | - Guifeng Ma
- School of Public Health, Weifang Medical University, 7166# Baotong West Street, Weifang, Shandong 261053, China.
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Smith ML, Steinman LE, Montoya CN, Thompson M, Zhong L, Merianos AL. Effectiveness of the Program to Encourage Active, Rewarding Lives (PEARLS) to reduce depression: a multi-state evaluation. Front Public Health 2023; 11:1169257. [PMID: 37361168 PMCID: PMC10289834 DOI: 10.3389/fpubh.2023.1169257] [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: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction An estimated 15% of community-dwelling older adults have depressive symptoms in the U.S. The Program to Encourage Active, Rewarding Lives (PEARLS) is an evidence-based program for managing late-life depression. PEARLS is a home/community-based collaborative care model delivered by community-based organizations to improve access to quality depression care. Trained staff actively screen for depression to improve recognition, teach problem-solving and activity planning skills for self-management, and connect participants to other supports and services as needed. Methods This study examined 2015-2021 data from 1,155 PEARLS participants across four states to assess PEARLS effectiveness to reduce depressive symptoms. The clinical outcomes were measured by the self-reported PHQ-9 instrument to assess changes in depressive symptoms scored as depression-related severity, clinical remission, and clinical response. A generalized estimating equation (GEE) model was fitted to examine changes in composite PHQ-9 scores from baseline to the final session. The model adjusted for participants' age, gender, race/ethnicity, education level, income level, marital status, number of chronic conditions, and number of PEARLS sessions attended. Cox proportional hazards regression models were conducted to estimate the hazard ratio for improvement of depressive symptoms (i.e., remission or response), while adjusting for the covariates. Results PHQ-9 scale scores significantly improved from baseline to their final sessions (mean difference = -5.67, SEM = 0.16, p < 0.001). About 35% of participants achieved remission with PHQ-9 score < 5. Compared to participants with mild depression, patients with moderate depression (HR = 0.43, 95%CI = 0.35-0.55), moderately severe depression (HR = 0.28, 95%CI = 0.21-0.38), and severe depression (HR = 0.22 95%CI = 0.14-0.34) were less likely to experience clinical remission with PHQ-9 score < 5, while adjusting for the covariates. About 73% achieved remission based on no longer having one or both cardinal symptoms. Compared to participants with mild depression, patients with moderate depression (HR = 0.66, 95%CI = 0.56-0.78), moderately severe depression (HR = 0.46, 95%CI = 0.38-0.56), and severe depression (HR = 0.38, 95%CI = 0.29-0.51) were less likely to experience clinical remission, while adjusting for the covariates. Nearly 49% of participants had a clinical response or a ≥ 50% decrease in PHQ-9 scores over time. There were no differences between the severity of depression groups based on the time to clinical response. Discussion Findings confirm that PEARLS is an effective program to improve depressive symptoms among older adults in diverse real-world community settings and can be a more accessible option for depressive older adults who are traditionally underserved by clinical care.
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Affiliation(s)
- Matthew Lee Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, United States
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
- Center for Health Equity and Evaluation Research, Texas A&M University, College Station, TX, United States
| | - Lesley E. Steinman
- Department of Health Systems and Population Health, Health Promotion Research Center, School of Public Health, University of Washington, Seattle, WA, United States
| | | | | | - Lixian Zhong
- School of Pharmacy, Texas A&M University, College Station, TX, United States
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, United States
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Ohta R, Weiss E, Mekky M, Sano C. Relationship between Dysphagia and Home Discharge among Older Patients Receiving Hospital Rehabilitation in Rural Japan: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10125. [PMID: 36011757 PMCID: PMC9408141 DOI: 10.3390/ijerph191610125] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Dysphagia refers to swallowing difficulty, which impacts patients' quality of life. Dysphagia influences clinical outcomes, including mortality rates and length of hospital stay of older hospitalized patients. Dysphagia may affect the current and future quality of life of these patients. However, its exact impact remains unclear. We aimed to clarify the impact of dysphagia on discharge to home in older patients in a rural rehabilitation unit. We conducted a secondary analysis using data from a retrospective cohort study including patients aged over 65 years who had been discharged from a community hospital rehabilitation unit in rural Japan. Data from the participants had been previously collected from April 2016 to March 2020. The primary outcome was home discharge. The average participant age was 82.1 (standard deviation, 10.8) years; 34.5% were men. Among medical conditions, brain stroke (44.3%) was the most frequent reason for admission; the most frequent orthopedic condition was femoral fracture (42.9%). The presence of dysphagia (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.20-0.73), polypharmacy (OR = 0.5, 95% CI: 0.32-0.90), and admission for internal medicine diseases (OR = 0.44, 95% CI: 0.26-0.77) were negatively associated with home discharge. High motor domain scores of the Functional Independence Measure were positively associated with home discharge (OR = 1.07, 95% CI: 1.05-1.08). Dysphagia was negatively associated with home discharge as were polypharmacy and admission for internal medicine diseases and conditions. By clarifying effective interventions through interventional studies, including approaches to managing multimorbidity and polypharmacy through interprofessional collaboration, the health conditions of older patients in rural areas may be improved.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Japan
| | - Emily Weiss
- Department of Public Health, Old College, University of Edinburgh, South Bridge, Edinburgh EH8 9YL, UK
| | - Magda Mekky
- Department of Public Health, Old College, University of Edinburgh, South Bridge, Edinburgh EH8 9YL, UK
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo 693-8501, Japan
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The Moderating Effect of Social Support between Loneliness and Depression: Differences between the Young-Old and the Old-Old. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042322. [PMID: 35206508 PMCID: PMC8871923 DOI: 10.3390/ijerph19042322] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/19/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023]
Abstract
This study aimed to investigate the moderation of social support in the association between loneliness and depression in different age groups of older adults. The sample consisted of 1532 community-dwelling adults aged 65 years or older, based on the data from the National Social Life, Health, and Aging Project (NSHAP), Wave 3 (2015–2016). Eleven items of the Center for Epidemiologic Studies Depression Scale (CES-D) were used to measure depressive symptoms. Similarly, a four-item scale was used to measure social support (each from spouse and family), and a three-item scale for loneliness. The results were as follows. Loneliness was associated with depression in both the young-old and the old-old groups. Spousal support and family support were associated with reduced depression in the young-old group, whereas only spousal support was associated with relieving depression in the old-old group. Social support had a significant moderating effect on the relationship between loneliness and depression in the old-old group, whereas it had no significant effect in the young-old group. From these results, it can be concluded that spousal support plays a significant role in seniors’ mental health. The role of caregivers for a person’s well-being grows later in life, so practitioners could help couples communicate with this consideration. In addition, regular contacts with family members and spousal support are recommended to prevent older old adults’ depression.
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Venditti EM, Steinman LE, Lewis MA, Weiner BJ, Ma J. Seeking a pot of gold with integrated behavior therapy and research to improve health equity: insights from the RAINBOW trial for obesity and depression. Transl Behav Med 2021; 11:1691-1698. [PMID: 34244787 PMCID: PMC8344914 DOI: 10.1093/tbm/ibab069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
More than one third of adults in the United States (U.S.) live with multiple chronic conditions that affect their physical and mental health, functional outcomes, independence, and mortality. The COVID-19 pandemic has exposed not only an increased risk for infection, morbidity, and mortality among those with chronic conditions but long-standing health inequities by age, race, sex, and other social determinants. Obesity plus depression represent one such prevalent comorbidity for which few effective integrated interventions exist, prompting concern about the potential for secondary physical and mental health pandemics post COVID-19. Translational behavioral medicine research can play an important role in studying integrated collaborative healthcare approaches and advancing scientific understanding on how to engage and more effectively treat diverse populations with physical and mental health comorbidities. The RAINBOW (Research Aimed at Improving Both Mood and Weight) clinical trial experience offers a wealth of insights into the potential of collaborative care interventions to advance behavior therapy research and practice. Primary care patients with co-occurring obesity and depression were assigned to either Integrated Coaching for Mood and Weight (I-CARE), which blended Group Lifestyle Balance (GLB) for weight management and the Program to Encourage Active Rewarding Lives (PEARLS) for depression, or usual care, to examine clinical, cost-effectiveness, and implementation outcomes. This commentary highlights the empirical findings of eight RAINBOW research papers and discusses implications for future studies, including their relevance in the U.S. COVID-19 context. Organized by key principles of translational behavioral medicine research, the commentary aims to examine and embrace the heterogeneity of baseline and intervention response differences among those living with multiple chronic conditions. We conclude that to prevent health and healthcare disparities from widening further, tailored engagement, dissemination, and implementation strategies and flexible delivery formats are essential to improve treatment access and outcomes among underrepresented populations.
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Affiliation(s)
- Elizabeth M Venditti
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lesley E Steinman
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | | | - Bryan J Weiner
- Departments of Global Health and Health Services, University of Washington, Seattle, WA, USA
| | - Jun Ma
- Department of Medicine and Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
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Richard-Devantoy S, Badillo-Amberg I, Greenway KT, Tomasso MD, Turecki G, Bertrand JA. Low MoCA performances correlate with suicidal ideation in late-life depression. Psychiatry Res 2021; 301:113957. [PMID: 33962353 DOI: 10.1016/j.psychres.2021.113957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
Late-life depression remains an underdiagnosed clinical entity, mainly because the presence of cognitive impairment in the elderly leads clinicians to suspect dementia rather than depression. Our objective was to analyze the cognitive abilities of elderly depressed patients using the Montreal Cognitive Assessment (MoCA) in relation to the presence or absence of suicidal ideation. The MoCA, Beck Scale of Suicidal Ideation, Hamilton Anxiety Scale, and Hamilton Depression Scale were administered to 72 patients with a recent history of late life depression: 43 with suicidal ideation and 29 non-suicidal controls. The results show that suicidal patients demonstrated significantly worse performance on the MoCA total score and the delayed recall subtest in comparison to non-suicidal controls. In addition, after adjusting for age and depression, poorer performance on the MoCA total score correlated to the presence of suicidal ideation. We found that the MoCA total score is able to predict the presence of suicidal ideation in depressed elderly patients in a fair-to-good manner. As late-life depression is already established as a potential prodrome of dementia, longitudinal follow-up may determine whether depressed individuals with suicidal ideation are at higher risk of converting to dementia.
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Affiliation(s)
- Stéphane Richard-Devantoy
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada; CISSS des Laurentides, Department of Psychiatry, Saint-Jérôme, Canada.
| | - Icoquih Badillo-Amberg
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Kyle T Greenway
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Maria Di Tomasso
- CISSS des Laurentides, Department of Psychiatry, Saint-Jérôme, Canada
| | - Gustavo Turecki
- McGill University & Douglas Mental Health Research Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - J A Bertrand
- CISSS des Laurentides, Department of Psychiatry, Saint-Jérôme, Canada; Douglas Research Center, Douglas Mental Health Research Institute, Montréal, Québec, Canada; Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
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Abstract
After participating in this activity, learners should be better able to:• Identify risk factors for late-life depression• Evaluate strategies to prevent late-life depression ABSTRACT: Late-life depression (LLD) is one of the major sources of morbidity and mortality in the world. Because LLD is related to increased public health burden, excess health care costs and utilization, reduced quality of life, and increased mortality, prevention is a priority. Older adults differ from younger adults with respect to key features, such as their chronicity and lifetime burden of depression and their constellation of comorbidities and risk factors. LLD likely arises from a complex interplay of risk factors, including medical, physiologic, psychosocial, behavioral, and environmental factors. Thus, a comprehensive understanding of LLD risk factors is necessary to inform prevention strategies. In this narrative literature review, we address both the risk architecture of LLD and several potential strategies for prevention. Our description of LLD risk factors and prevention approaches is informed by the framework developed by the National Academy of Medicine (formerly, Institute of Medicine), which includes indicated, selective, and universal approaches to prevention.
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Davison TE, Koder D, Helmes E, Doyle C, Bhar S, Mitchell L, Hunter C, Knight B, Pachana N. Brief on the Role of Psychologists in Residential and Home Care Services for Older Adults. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12209] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Deborah Koder
- Specialist Mental Health Services for Older People, Royal Prince Alfred Hospital,
| | | | - Colleen Doyle
- Australian Catholic University, Villa Maria Catholic Homes,
| | - Sunil Bhar
- Department of Psychological Sciences, Swinburne University of Technology,
| | | | | | - Bob Knight
- School of Psychology and Counselling, University of Southern Queensland,
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De Nobrega AK, Luz KV, Lyons LC. Resetting the Aging Clock: Implications for Managing Age-Related Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1260:193-265. [PMID: 32304036 DOI: 10.1007/978-3-030-42667-5_9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Worldwide, individuals are living longer due to medical and scientific advances, increased availability of medical care and changes in public health policies. Consequently, increasing attention has been focused on managing chronic conditions and age-related diseases to ensure healthy aging. The endogenous circadian system regulates molecular, physiological and behavioral rhythms orchestrating functional coordination and processes across tissues and organs. Circadian disruption or desynchronization of circadian oscillators increases disease risk and appears to accelerate aging. Reciprocally, aging weakens circadian function aggravating age-related diseases and pathologies. In this review, we summarize the molecular composition and structural organization of the circadian system in mammals and humans, and evaluate the technological and societal factors contributing to the increasing incidence of circadian disorders. Furthermore, we discuss the adverse effects of circadian dysfunction on aging and longevity and the bidirectional interactions through which aging affects circadian function using examples from mammalian research models and humans. Additionally, we review promising methods for managing healthy aging through behavioral and pharmacological reinforcement of the circadian system. Understanding age-related changes in the circadian clock and minimizing circadian dysfunction may be crucial components to promote healthy aging.
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Affiliation(s)
- Aliza K De Nobrega
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL, USA
| | - Kristine V Luz
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL, USA
| | - Lisa C Lyons
- Department of Biological Science, Program in Neuroscience, Florida State University, Tallahassee, FL, USA.
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Heisel MJ, Moore SL, Flett GL, Norman RMG, Links PS, Eynan R, O'Rourke N, Sarma S, Fairlie P, Wilson K, Farrell B, Grunau M, Olson R, Conn D. Meaning-Centered Men's Groups: Initial Findings of an Intervention to Enhance Resiliency and Reduce Suicide Risk in Men Facing Retirement. Clin Gerontol 2020; 43:76-94. [PMID: 31671031 DOI: 10.1080/07317115.2019.1666443] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: To assess the preliminary effectiveness of Meaning-Centered Men's Groups (MCMG), a 12-session existentially-oriented, community-based, psychological group intervention designed to enhance psychological resiliency and prevent the onset or exacerbation of suicide ideation among men who are concerned about or struggling with the transition to retirement.Methods: We recruited 30 men (n= 10 per group), 55 years and older (M= 63.7, SD= 4.1) from community settings to participate in a course of MCMG to be delivered in a community center. Participants completed eligibility, pre-, mid-, and post-group assessments of suicide ideation and psychological risk and resiliency factors.Results: Participants experienced significant increases in attitudinal sources of meaning in life, psychological well-being, life satisfaction, retirement satisfaction, and general health, and decreases in depression, hopelessness, loneliness, and suicide ideation.Conclusions: Preliminary findings suggest that MCMG is a novel men's mental health intervention that may help to enhance psychological well-being and potentially reduce the severity or prevent the onset of symptoms of depression, hopelessness, and suicide ideation.Clinical Implications: Upstream psychological interventions may serve an important role in mental health promotion and suicide prevention with potentially vulnerable individuals facing challenging life transitions.
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Affiliation(s)
- Marnin J Heisel
- Department of Psychiatry, The University of Western Ontario (UWO).,Lawson Health Research Institute, London, ON, Canada.,Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY, USA.,Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Canada
| | | | | | - Ross M G Norman
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Canada
| | - Paul S Links
- Department of Psychiatry, The University of Western Ontario (UWO).,Lawson Health Research Institute, London, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University
| | - Rahel Eynan
- Department of Psychiatry, The University of Western Ontario (UWO).,Lawson Health Research Institute, London, ON, Canada
| | - Norm O'Rourke
- Department of Public Health and Multidisciplinary Research Center on Aging, Ben-Gurion University of the Negev
| | - Sisira Sarma
- Department of Epidemiology & Biostatistics, The University of Western Ontario, London, Canada
| | | | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph
| | | | | | | | - David Conn
- Canadian Coalition for Seniors' Mental Health, Baycrest Health Sciences, Department of Psychiatry, University of Toronto
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12
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Gendered patterns of depression and its determinants in older Europeans. Arch Gerontol Geriatr 2019; 82:207-216. [DOI: 10.1016/j.archger.2019.02.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 02/07/2023]
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Haedtke C, Smith M, VanBuren J, Klein D, Turvey C. The Relationships Among Pain, Depression, and Physical Activity in Patients With Heart Failure. J Cardiovasc Nurs 2018; 32:E21-E25. [PMID: 28306701 PMCID: PMC5555784 DOI: 10.1097/jcn.0000000000000399] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Increasing patients' physical activity levels holds many opportunities to facilitate health and well-being among those with heart failure (HF) by improving HF symptoms and decreasing depression and pain. Given low exercise participation rates, an essential first step to increase exercise rates is to evaluate how pain and depression may further influence engagement in exercise programs. AIMS The aims of this study were to describe the level of physical activity and exercise that patients with HF with depression achieve and to investigate the relationships among pain, depression, total activity time, and sitting time. METHODS In this correlational cross-sectional study, we analyzed data from 61 participants with depression and New York Heart Association class II to IV HF. RESULTS AND CONCLUSIONS The total time spent being active was less than 1 hour per day. Depressed patients with HF have much lower physical activity levels than the general public. Decreasing sitting time and increasing light activity levels hold promise to improve pain and depression symptoms.
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Affiliation(s)
- Christine Haedtke
- Post-Doctoral Clinical Scholar in Cardiovascular Science, The University of Kentucky, College of Nursing, 2201 Regency Road, Suite 403 Lexington, KY 40503 USA, , Phone: 1(859)323-4883, Fax: 1(859)257-0554
| | - Marianne Smith
- Associate Professor and the Education Director for the Hartford Center of Geriatric Nursing Excellence, University of Iowa, College of Nursing, Iowa City, IA, 52242, USA,
| | - John VanBuren
- Assistant Professor, Department of Pediatrics - Division of Critical Care, University of Utah School of Medicine, Salt Lake City, Utah 84132 USA,
| | - Dawn Klein
- Research Manager, University of Iowa, Psychiatry Research, Research Coordinator (Affiliate), Iowa City VA Health Care System, Iowa City, IA, 52242 USA,
| | - Carolyn Turvey
- Professor of Psychiatry and of Epidemiology, The University of Iowa Carver College of Medicine; Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City, IA, 52242, USA,
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Chang KJ, Hong CH, Roh HW, Lee KS, Lee EH, Kim J, Lim HK, Son SJ. A 12-Week Multi-Domain Lifestyle Modification to Reduce Depressive Symptoms in Older Adults: A Preliminary Report. Psychiatry Investig 2018; 15:279-284. [PMID: 29475242 PMCID: PMC5900365 DOI: 10.30773/pi.2017.08.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/10/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the effectiveness of usual care management (UCM) and a newly-developed lifestyle modification with contingency management (LMCM) for geriatric depressive symptoms in the community. METHODS A randomized controlled trial was conducted in 93 older adults with major depressive disorder at community mental health centers. A 12 week multi-domain LMCM was developed by providing positive reinforcement using 'gold medal stickers' as a symbolic incentive to motivate their participation and adherence. Participants were allocated to LMCM (n=47) and UCM (n=46) groups. They were then subjected to the 12 week treatment. Effects of the two intervention methods on Geriatric Depression Scale were determined using mixed model analysis. RESULTS Participants in the LMCM group had greater decline in GDS score per month than participants in the UCM group after adjusting for age, sex, years of education, living alone, and MMSE scores at baseline examination [coefficient for GDS score (95% CI): -1.08 (-1.51, -0.65), p<0.001, reference: UCM group]. CONCLUSION LMCM is safe and easy to use with a low cost. LMCM is suitable as psychosocial intervention for older adults with depressive symptoms in the community.
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Affiliation(s)
- Ki Jung Chang
- Department of Psychiatry, Ajou Good Hospital, Suwon, Republic of Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Woong Roh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kang Soo Lee
- Department of Psychiatry, CHA University School of Medicine, CHA Hospital, Seongnam, Republic of Korea
| | - Eun Hee Lee
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jinju Kim
- Department of Psychiatry, Ajou Danam Hospital, Suwon, Republic of Korea
| | - Hyun Kook Lim
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
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MacQueen G, Santaguida P, Keshavarz H, Jaworska N, Levine M, Beyene J, Raina P. Systematic Review of Clinical Practice Guidelines for Failed Antidepressant Treatment Response in Major Depressive Disorder, Dysthymia, and Subthreshold Depression in Adults. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:11-23. [PMID: 27554483 PMCID: PMC5302110 DOI: 10.1177/0706743716664885] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This systematic review critically evaluated clinical practice guidelines (CPGs) for treating adults with major depressive disorder, dysthymia, or subthreshold or minor depression for recommendations following inadequate response to first-line treatment with selective serotonin reuptake inhibitors (SSRIs). METHOD Searches for CPGs (January 2004 to November 2014) in English included 7 bibliographic databases and grey literature sources using CPG and depression as the keywords. Two raters selected CPGs on depression with a national scope. Data extraction included definitions of adequate response and recommended treatment options. Two raters assessed quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. RESULTS From 46,908 citations, 3167 were screened at full text. From these 21 CPG were applicable to adults in primary care and outpatient settings. Five CPGs consider patients with dysthymia or subthreshold or minor depression. None provides recommendations for those who do not respond to first-line SSRI treatment. For adults with MDD, most CPGs do not define an "inadequate response" or provide specific suggestions regarding how to choose alternative medications when switching to an alternative antidepressant. There is variability between CPGs in recommending combination strategies. AGREE II ratings for stakeholder involvement in CPG development, editorial independence, and rigor of development are domains in which depression guidelines are often less robust. CONCLUSIONS About half of patients with depression require second-line treatment to achieve remission. Consistency and clarity in guidelines for second-line treatment of depression are therefore important for clinicians but lacking in most current guidelines. This may reflect a paucity of primary studies upon which to base conclusions.
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Affiliation(s)
- Glenda MacQueen
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| | - Pasqualina Santaguida
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
| | - Homa Keshavarz
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
| | | | - Mitchell Levine
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
| | - Joseph Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
| | - Parminder Raina
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
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Saracino RM, Rosenfeld B, Nelson CJ. Towards a new conceptualization of depression in older adult cancer patients: a review of the literature. Aging Ment Health 2016; 20:1230-1242. [PMID: 26312455 PMCID: PMC4925309 DOI: 10.1080/13607863.2015.1078278] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Identifying depression in older adults with cancer presents a set of unique challenges, as it combines the confounding influences of cancer and its treatment with the developmental changes associated with aging. This paper reviews the phenomenology of depression in older adults, and individuals diagnosed with cancer. METHOD PsychInfo, PubMed, Web of Science, and Google Scholar databases were searched for English-language studies addressing the phenomenology, symptoms, or assessment of depression in older adults and those with cancer. RESULTS The Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria that appear to be relevant to both older adults and cancer patients are anhedonia, concentration difficulties, sleep disturbances, psychomotor retardation/agitation, and loss of energy. Possible alternative criteria that may be important considerations included constructs such as loss of purpose, loneliness, and irritability in older adults. Among cancer patients, tearfulness, social withdrawal, and not participating in treatment despite ability to do so were identified as potentially important symptoms. CONCLUSIONS Current DSM criteria may not adequately assess depression in older cancer patients and alternative criteria may be important to inform the understanding and identification of depression in this population. Enhancing diagnostic accuracy of depression is important as both the over-diagnosis and under-diagnosis is accompanied with significant costs. Thus, continued research exploring the phenomenology and identifying effective indicators of depression in older cancer patients is needed.
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Affiliation(s)
- Rebecca M. Saracino
- Department of Psychology, Fordham University, Bronx, NY 10458, USA,Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA,Corresponding author.
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, Bronx, NY 10458, USA,Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
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17
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Brewster GS, Peterson L, Roker R, Ellis ML, Edwards JD. Depressive Symptoms, Cognition, and Everyday Function Among Community-Residing Older Adults. J Aging Health 2016; 29:367-388. [PMID: 26951519 DOI: 10.1177/0898264316635587] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to understand the relationships among depressive symptoms, cognition, and functional performance in a community-based sample of older adults. METHOD Older adults ( N = 885) from the Staying Keen in Later Life study completed tests of executive function, speed of processing, and memory. The Center for Epidemiologic Depression Scale assessed depressive symptoms. The Timed Instrumental Activities of Daily Living Test assessed participants' everyday functional performance. RESULTS Depressive symptoms had significant associations with measures of executive function, speed of processing, memory, and everyday functional performance. Cognitive performance completely mediated the association between depressive symptoms and everyday function. DISCUSSION Among community-dwelling older adults, depressive symptoms were associated with impaired cognition across multiple domains, which detrimentally affected everyday function. Health care providers should be aware of these associations to monitor and manage changes in depressive symptoms and cognitive performance and thereby potentially mitigate functional decline.
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18
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Okereke OI, Singh A. The role of vitamin D in the prevention of late-life depression. J Affect Disord 2016; 198:1-14. [PMID: 26998791 PMCID: PMC4844780 DOI: 10.1016/j.jad.2016.03.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/15/2016] [Accepted: 03/07/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND In this article, we review current evidence regarding potential benefits of vitamin D for improving mood and reducing depression risk in older adults. We summarize gaps in knowledge and describe future efforts that may clarify the role of vitamin D in late-life depression prevention. METHODS MEDLINE and PsychINFO databases were searched for all articles on vitamin D and mood that had been published up to and including May 2015. Observational studies and randomized trials with 50 or more participants were included. We excluded studies that involved only younger adults and/or exclusively involved persons with current depression. RESULTS Twenty observational (cross-sectional and prospective) studies and 10 randomized trials (nine were randomized placebo-controlled trials [RCTs]; one was a randomized blinded comparison trial) were reviewed. Inverse associations of vitamin D blood level or vitamin D intake with depression were found in 13 observational studies; three identified prospective relations. Results from all but one of the RCTs showed no statistically significant differences in depression outcomes between vitamin D and placebo groups. LIMITATIONS Observational studies were mostly cross-sectional and frequently lacked adequate control of confounding. RCTs often featured low treatment doses, suboptimal post-intervention changes in biochemical levels of vitamin D, and/or short trial durations. CONCLUSION Vitamin D level-mood associations were observed in most, but not all, observational studies; results indicated that vitamin D deficiency may be a risk factor for late-life depression. However, additional data from well-designed RCTs are required to determine the impact of vitamin D in late-life depression prevention.
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Affiliation(s)
- Olivia I. Okereke
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 02115,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, 02115,Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston MA, 02115
| | - Ankura Singh
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 02115
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19
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Wright PP, Thorpe CW. Triple Threat Among the Elderly: Depression, Suicide Risk, and Handguns. J Emerg Nurs 2016; 42:14-8. [DOI: 10.1016/j.jen.2015.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/23/2015] [Accepted: 01/24/2015] [Indexed: 12/17/2022]
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20
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Gum AM, Dautovich ND, Greene J, Hirsch A, Schonfeld L. Improving home-based providers' communication to primary care providers to enhance care coordination. Aging Ment Health 2015; 19:921-31. [PMID: 25401276 DOI: 10.1080/13607863.2014.977772] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Health care system fragmentation is a pervasive problem. Research has not delineated concrete behavioral strategies to guide providers to communicate with personnel in other organizations to coordinate care. We addressed this gap within a particular context: home-based providers delivering depression care management (DCM) to older adults requiring coordination with primary care personnel. Our objective was to pilot test a communication protocol ('BRIDGE - BRinging Inter-Disciplinary Guidelines to Elders') in conjunction with DCM. METHOD In an open pilot trial (N = 7), home-based providers delivered DCM to participants. Following the BRIDGE protocol, home-based providers made scripted telephone calls and sent structured progress reports to personnel in participants' primary care practices with concise information and requests for assistance. Home-based providers documented visits with participants, contacts to and responses from primary care personnel. A research interviewer assessed participant outcomes [Symptom Checklist-20 (depressive symptoms), World Health Organization Disability Assessment Schedule-12, satisfaction] at baseline, three months, and six months. RESULTS Over 12 months, home-based providers made 2.4 telephone calls and sent 6.3 faxes to other personnel, on average per participant. Primary care personnel responded to 18 of 22 requests (81.8%; 2 requests dropped, 2 ongoing), with at least one response per participant. Participants' depressive symptoms and disability improved significantly at both post-tests with large effect sizes (d ranged 0.73-2.3). Participants were satisfied. CONCLUSION Using BRIDGE, home-based providers expended a small amount of effort to communicate with primary care personnel, who responded to almost all requests. Larger scale research is needed to confirm findings and potentially extend BRIDGE to other client problems, professions, and service sectors.
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Affiliation(s)
- Amber M Gum
- a Department of Mental Health Law and Policy, Louis de la Parte Florida Mental Health Institute , University of South Florida , Tampa , FL , USA
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21
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Van Orden KA, Yan L, Podgorski CA, Conwell Y. The association between higher social support and lower depressive symptoms among aging services clients is attenuated at higher levels of functional impairment. Int J Geriatr Psychiatry 2015; 30:1085-92. [PMID: 25663607 PMCID: PMC4527957 DOI: 10.1002/gps.4266] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/18/2014] [Accepted: 01/08/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Adults seeking services from the Aging Services Provider Network (ASPN) are at risk for depression. ASPN clients also have high prevalence of both functional impairments and social morbidities. Study of the relationships between these factors may inform the development of interventions for depression in this service setting. METHODS We interviewed 373 older adults accessing ASPN services and assessed depression symptom severity, functional impairment (instrumental activities of daily living and activities of daily living), and social support. RESULTS Lower social support and greater functional impairment were associated with greater depressive symptoms. At a high level of functional impairment, the inverse associations between indices of social support and depressive symptoms were attenuated. CONCLUSIONS Results suggest that older adults with more severe functional impairment may benefit somewhat less from increased social support with respect to depression symptom severity.
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Affiliation(s)
| | - Li Yan
- University of Rochester School of Medicine
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22
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Olgiati P, Serretti A. Persistent benefits of slow titration of paroxetine in a six-month follow-up. Hum Psychopharmacol 2015; 30:329-33. [PMID: 25900268 DOI: 10.1002/hup.2478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Paroxetine titration may be difficult in older individuals as they are more sensitive to side effects. The current study extends to 6 months our previously published report in which paroxetine was started at 2.5 mg/day and slowly increased by 2.5 mg on alternate days (slow titration) or rapidly titrated to target dose from 10 mg/day (standard titration) in a naturalistic setting. METHODS Here, the follow-up period was extended to 26 weeks. We performed an intent-to-treat analysis of 47 subjects from the original sample (major depressive disorder and/or generalized anxiety disorder (GAD); >60 years of age). Missing evaluations were replaced by last observations carried forward. GAD was included as a stratification factor. RESULTS Patients in whom paroxetine was slowly up-titrated were more likely to remit (84.0% vs 54.5%; p = 0.028) and had lower core depression (p = 0.0015) and psychic anxiety levels (p = 0.006) after 26 weeks. Dropout rate was 20% in the slow titration group compared with 77.3% in the standard titration arm (p < 0.001). Patients with GAD accounted for all significant associations. No substantial differences were reported between slow and standard titration groups in the subsample without GAD. CONCLUSIONS Despite some limitations, these findings suggest that paroxetine treatment should be started at lower doses in older depressed patients and slowly up-titrated. This strategy would allow to increase antidepressant response and the likelihood of completing treatment cycle in patients with high anxiety levels and GAD comorbidity.
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Affiliation(s)
- Paolo Olgiati
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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23
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Examining functional and social determinants of depression in community-dwelling older adults: implications for practice. Geriatr Nurs 2015; 35:236-40. [PMID: 24942525 DOI: 10.1016/j.gerinurse.2014.04.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Coping with declining health, physical illnesses and complex medical regimens, which are all too common among many older adults, requires significant lifestyle changes and causes increasing self-management demands. Depression occurs in community-dwelling older adults as both demands and losses increase, but this problem is drastically underestimated and under-recognized. Depressive symptoms are often attributed to physical illnesses and thus overlooked, resulting in lack of appropriate treatment and diminished quality of life. The purpose of this study is to assess prevalence of depressive symptoms in community-dwelling older adults with high levels of co-morbidity and to identify correlates of depression. In this sample of 533 homebound older adults screened (76.1% female, 71.8% white, mean age 78.5 years) who were screened using the Geriatric Depression Scale (SF), 35.9% scored greater than 5. Decreased satisfaction with family support (p << 0.001) and functional status (p ≤ 0.001) and increased loneliness (p < 0.001) were significant independent predictors of depression status in this sample; thus, these factors should be considered when planning care.
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24
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Belza B, Altpeter M, Hooker SP, Moni G. The CDC Healthy Aging Research Network: Advancing Science toward Action and Policy for the Evidence-Based Health Promotion Movement. Front Public Health 2015; 2:261. [PMID: 25964935 PMCID: PMC4410341 DOI: 10.3389/fpubh.2014.00261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 11/12/2014] [Indexed: 12/02/2022] Open
Affiliation(s)
- Basia Belza
- Department of Health Services, Health Promotion Research Center, University of Washington , Seattle, WA , USA ; Department of Biobehavioral Nursing and Health Systems, Health Promotion Research Center, University of Washington , Seattle, WA , USA
| | - Mary Altpeter
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill , Chapel Hill, NC , USA
| | - Steven P Hooker
- School of Nutrition and Health Promotion, Arizona State University , Phoenix, AZ , USA
| | - Gwen Moni
- Department of Health Services, Health Promotion Research Center, University of Washington , Seattle, WA , USA
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25
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Alamo C, López-Muñoz F, García-García P, García-Ramos S. Risk-benefit analysis of antidepressant drug treatment in the elderly. Psychogeriatrics 2014; 14:261-8. [PMID: 25495088 DOI: 10.1111/psyg.12057] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/18/2014] [Indexed: 01/01/2023]
Abstract
Depression in the elderly is a significant health issue that has the potential to seriously affect physical and emotional well-being. Therefore, the treatment of geriatric depression is necessary. Antidepressant treatment in older depressed patients is efficacious, but differences in the effectiveness of different classes of antidepressants have not been demonstrated. However, differences in tolerability profile are most recognizable in the elderly. With ageing, a series of changes occur in the elderly that modify both the pharmacokinetics and pharmacodynamics of antidepressants and may influence the efficacy, tolerability and safety of treatment in the elderly. Comorbidities require the use of other drugs, which increases the possibility of drug-drug interactions. Given these aspects, individualized therapy for each elderly patient is needed to achieve acceptable risk-benefit ratio. Effective treatment of depression in the elderly, which may require combined pharmacological with psychosocial treatment, can decrease both morbidity and mortality; it also may lead to reduced demands on family members and on health-care and social services.
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Affiliation(s)
- Cecilio Alamo
- Department of Biomedical Sciences (Pharmacology Area), Faculty of Medicine and Health Sciences, University of Alcalá, Madrid, Spain
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26
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Olgiati P, Bajo E, Serretti A. Benefit of slow titration of paroxetine to treat depression in the elderly. Hum Psychopharmacol 2014; 29:544-51. [PMID: 25363240 DOI: 10.1002/hup.2433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 05/13/2014] [Accepted: 07/07/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Paroxetine is commonly used to treat depression in the elderly; however, titration issues have been raised. Rapid titration may lead to increased anxiety and early dropout. The aim of this cost-utility analysis was to compare the potential benefit of standard (10 mg the first day) versus slow titration (2.5 mg gradually increased). METHODS Clinical analysis was based on a naturalistic trial integrated with a decision-analytic model representing second treatments for those who initially did not respond and for dropout cases. Treatment setting was a public outpatient center for mental disorders in Italy. Service use data were estimated from best practice guidelines, whereas costs (Euros; 2012) were retrieved from Italian official sources. RESULTS Slow titration approach produced 0.031 more quality-adjusted life years (remission rate: 57% vs 44% in standard titration group) at an incremental cost of €5.53 (generic paroxetine) and €54.54 (brand paroxetine syrup). Incremental cost-effectiveness ratio (ICER) values were €159 and €1768, respectively, in favor of slow titration approach. Cost-effectiveness threshold, defined as ICER < 1 GDP per capita according to World Health Organization criteria, is about €25 000 in Italy. CONCLUSIONS Our results are consistent with a superiority of slow titration of paroxetine in older depressed patients. However, these findings, in part based on simulated data, need to be replicated in clinical trials.
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Affiliation(s)
- Paolo Olgiati
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
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27
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The association between depression and widowhood and nutritional status in older adults. Geriatr Nurs 2014; 35:428-33. [PMID: 25085716 DOI: 10.1016/j.gerinurse.2014.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 06/18/2014] [Accepted: 06/23/2014] [Indexed: 11/24/2022]
Abstract
This study aimed to investigate the association of depression and widowhood on the nutritional status of older adults. A cross-sectional study of community-dwelling older adults in the rural United States was conducted. Dietary intake was measured via questionnaires. Depression status was classified by asking participants if they have ever been diagnosed with the condition, or by review of medical records. The final sample consisted of 1065 participants with 141 (13.2%) depressed, 384 (36.1%) widowed, and 67 (6.3%) both depressed and widowed. Mean caloric intake for total study population was low; widows and widowers had the lowest energy consumption among all groups. Greater intake of several nutrients was observed in depressed and/or widowed subjects. Nutritional services, such as congregate and home delivered meal programs, were not identified as significant contributors to the nutritional intake in older adults who were depressed, widowed, or both. Health care professionals may contribute to meal-based nutrition programs by offering their assistance in aspects of nutritional education and counseling for the promotion of healthy aging.
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28
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Markle-Reid M, McAiney C, Forbes D, Thabane L, Gibson M, Browne G, Hoch JS, Peirce T, Busing B. An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms. BMC Geriatr 2014; 14:62. [PMID: 24886344 PMCID: PMC4019952 DOI: 10.1186/1471-2318-14-62] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services. Methods A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation. Results Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period. Conclusions Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms. Trial registration Clinicaltrials.gov identifier: NCT01407926.
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Prevalence of depression and its associated factors among patients attending primary care settings in the post-conflict Northern Province in Sri Lanka: a cross-sectional study. BMC Psychiatry 2014; 14:85. [PMID: 24661436 PMCID: PMC3987835 DOI: 10.1186/1471-244x-14-85] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/12/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In Sri Lanka, civilians in the Northern Province were affected by a long-term armed conflict that ended in 2009. This study aims to describe the prevalence of depression and its associated factors among adult patients attending primary care settings in the Northern Province in Sri Lanka. METHODS We report data from a cross-sectional patient morbidity registry established in 16 primary care facilities (12 Divisional Hospitals and 4 Primary Medical Care Units) in four districts of the Northern Province. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression among all patients aged ≥ 18 years, between March and May 2013. A sample of 12,841 patient records was included in the analysis. A total score of ≥ 10 in the PHQ-9 was considered as major depression. Factors associated with major depression were tested using multivariable logistic regression analysis. RESULTS The prevalence of major depression was 4.5% (95% CI: 4.1-4.9) and mild depression was 13.3% (95% CI: 12.7-13.9). The major depression was significantly higher in females than males (5.1% vs. 3.6%) and among unpaid family workers (6.0%) than any other category who earned an income (varied between 1.2% and 3.2%). The prevalence was rising significantly with advancing age, and ranged from 0.3% in the youngest to 11.6% in the elderly.Multivariable regression analysis revealed that the females have a higher risk for major depression than males (OR = 1.4; 95% CI: 1.1-1.7). Older patients were more likely to be depressed than younger patients, OR (95% CI) were 4.9 (1.9-12.5), 5.6 (2.2-14.0), 5.7 (2.3-14.2) and 4.7 (1.8-11.9) for the age groups 25-34, 35-49, 50-64, and ≥ 65 years respectively, in contrast to 18-24 year group. Disability in walking (OR = 7.5; 95% CI: 5.8-9.8), cognition (OR = 4.5; 95% CI: 3.6-5.6), self-care (OR = 2.6; 95% CI: 1.7-4.0), seeing (OR = 2.3; 95% CI: 1.8-3.0), and hearing (OR = 2.0; 95% CI: 1.5-2.5) showed significant associations with depression. CONCLUSIONS Depression is a common issue at primary care settings in a post-conflict population, and the elders, women and persons with disability are at a greater risk. Strengthening capacity of primary care facilities and community mental health services is necessary for early detection and management.
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Lysack C, Leach C, Russo T, Paulson D, Lichtenberg PA. DVD Training for Depression Identification and Treatment in Older Adults: A Two-Group, Randomized, Wait-List Control Study. Am J Occup Ther 2013; 67:584-93. [DOI: 10.5014/ajot.2013.008060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. To test the effectiveness of an educational intervention aimed at improving mental health knowledge and skills in occupational therapists working with older rehabilitation patients.
METHOD. The DVD-format educational intervention was evaluated using a two-group randomized wait-list control design. Occupational therapists (n = 75) completed a 32-item knowledge questionnaire at three time points. Patient charts were reviewed (n = 960) at 3 months before and 3 and 6 months after DVD training to evaluate clinical practice change.
RESULTS. A two-way analysis of variance showed knowledge scores increased significantly for both groups after DVD training. A significant Group × Time interaction and significant main effects for time and group were found. Chart review data also showed significant increases in desired clinical behaviors in both groups after training. The greatest single item of clinical practice change was use of a standardized depression screen.
CONCLUSION. DVD-based training can significantly improve mental health practice.
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Affiliation(s)
- Cathy Lysack
- Cathy Lysack, PhD, OT(C), is Deputy Director and Professor of Occupational Therapy, Institute of Gerontology, Wayne State University, Room 231, Knapp Building, 87 East Ferry Street, Detroit, MI 48202;
| | - Carrie Leach
- Carrie Leach, MPA, is Manager, Community Based Research and Engagement, Institute of Gerontology, Wayne State University, Detroit
| | - Theresa Russo
- Theresa Russo is Education Program Coordinator, Alzheimer’s Association–Greater Michigan Chapter, Southfield
| | - Daniel Paulson
- Daniel Paulson, MA, is Doctoral Candidate, Department of Psychology, Wayne State University, Detroit, and Clinical Psychology Intern, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Peter A. Lichtenberg
- Peter A. Lichtenberg, PhD, ABPP, is Director, Institute of Gerontology, and Professor of Psychology, Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit
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Gitlin LN, Harris LF, McCoy MC, Chernett NL, Pizzi LT, Jutkowitz E, Hess E, Hauck WW. A home-based intervention to reduce depressive symptoms and improve quality of life in older African Americans: a randomized trial. Ann Intern Med 2013; 159:243-52. [PMID: 24026257 PMCID: PMC4091662 DOI: 10.7326/0003-4819-159-4-201308200-00005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Effective care models for treating older African Americans with depressive symptoms are needed. OBJECTIVE To determine whether a home-based intervention alleviates depressive symptoms and improves quality of life in older African Americans. DESIGN Parallel, randomized trial stratified by recruitment site. Interviewers assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov: NCT00511680). SETTING A senior center and participants' homes from 2008 to 2010. PATIENTS African Americans aged 55 years or older with depressive symptoms. INTERVENTION A multicomponent, home-based intervention delivered by social workers or a wait-list control group that received the intervention at 4 months. MEASUREMENTS Self-reported depression severity at 4 months (primary outcome) and depression knowledge, quality of life, behavioral activation, anxiety, function, and remission at 4 and 8 months. RESULTS Of 208 participants (106 and 102 in the intervention and wait-list groups, respectively), 182 (89 and 93, respectively) completed 4 months and 160 (79 and 81, respectively) completed 8 months. At 4 months, participants in the intervention group showed reduced depression severity (difference in mean change in Patient Health Questionnaire-9 score from baseline, -2.9 [95% CI, -4.6 to -1.2]; difference in mean change in Center for Epidemiologic Studies Depression Scale score from baseline, -3.7 [CI, -5.4 to -2.1]); improved depression knowledge, quality of life, behavioral activation, and anxiety (P < 0.001); and improved function (P = 0.014) compared with wait-list participants. More intervention than wait-list participants entered remission at 4 months (43.8% vs. 26.9%). After treatment, control participants showed benefits similar in magnitude to those of participants in the initial intervention group. Those in the initial intervention group maintained benefits at 8 months. LIMITATION The study had a small sample, short duration, and differential withdrawal rate. CONCLUSION A home-based intervention delivered by social workers could reduce depressive symptoms and enhance quality of life in most older African Americans. PRIMARY FUNDING SOURCE National Institute of Mental Health.
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Houle J, Gascon-Depatie M, Bélanger-Dumontier G, Cardinal C. Depression self-management support: a systematic review. PATIENT EDUCATION AND COUNSELING 2013; 91:271-279. [PMID: 23414831 DOI: 10.1016/j.pec.2013.01.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/14/2013] [Accepted: 01/17/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To systematically review empirical evidence regarding the efficacy of depression self-management support (SMS) interventions for improving depression symptomatology and preventing relapse. METHODS Pubmed and PsycINFO databases were searched for relevant articles on depression SMS interventions. Scanning of references in the articles and relevant reviews and communications with field experts yielded additional articles. Two independent reviewers analyzed the articles for inclusion and data was extracted from the selected articles. RESULTS 13 papers met the inclusion criteria and reported the results of six separate studies, including three pilot studies. The results were mostly positive. A majority of the trials assessing depression severity changes found SMS to be superior to care as usual. SMS interventions were found to improve self-management behaviors and self-efficacy. Mixed results were found concerning relapse rates. Promising results were found on assessments of functional status. Based on the findings, cost-effectiveness remains unclear. CONCLUSION SMS has been mostly examined through pilot studies with insufficient power. The results are promising, but larger randomized controlled trials are needed. PRACTICE IMPLICATIONS SMS interventions can be administered by non-physician professionals and are well accepted by patients, but more research is needed before we can recommend implementing specific depression SMS approaches in primary care.
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Affiliation(s)
- Janie Houle
- Department of Psychology, Université du Québec à Montréal, Canada.
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Gum AM, Greene J, DeMuth A, Dautovich ND. Primary Care Physicians’ Attitudes Regarding Collaborating With Home-Based Depression Care Managers. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2013. [DOI: 10.1177/1084822313480178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Home-based case managers face many challenges to collaborating with primary care physicians, including for management of depression. To obtain physicians’ perspectives regarding optimal collaboration strategies, we conducted a mail survey of randomly selected primary care physicians ( N = 74). The survey described a home-based depression care management program to be delivered by case managers and assessed physicians’ preferred collaboration strategies. Most respondents perceived the services described as useful, including having the case manager send a list of medications and send psychotropic medication recommendations per consulting psychiatrist. Most physicians reported being likely to read a written summary sent by the case manager, reply, and send it back to the case manager. Preferred communication procedures varied widely. By considering physicians’ preferences, case managers may enhance collaboration.
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Byma EA, Given CW, Given BA. Associations among indicators of depression in Medicaid-eligible community-dwelling older adults. THE GERONTOLOGIST 2012; 53:608-17. [PMID: 23103523 DOI: 10.1093/geront/gns130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The purpose of this research was to examine associations among 2 separate Minimum Data Set-Home Care (MDS-HC) depression measures (the Depression Rating Scale [DRS] and medical diagnosis of depression) with billed antidepressant medications in Medicaid paid claim files. DESIGN AND METHODS The sample for this cross-sectional research included 3,041 Medicaid-eligible older adult participants in a Home and Community Based Waiver Program and used data from the MDS-HC, Version 1 and Medicaid Paid Claim Files. Sensitivity and specificity analyses, receiver operating characteristic (ROC) curve analysis, and t tests were utilized. RESULTS DRS scoring indicated that 15.4% of participants had behaviors indicative of depression, whereas 42% had a medical diagnosis of depression noted in the MDS-HC. Of those with a medical diagnosis of depression, 51% had a prescribed antidepressant medication. ROC analysis suggested that the DRS was a poor distinguisher of participants with and without a medical diagnosis of depression or prescribed antidepressant medications. IMPLICATIONS Approximately half of Medicaid-eligible older adults medically diagnosed with depression were treated pharmacologically. Longitudinal research is recommended to assess responsiveness of the DRS over time to pharmacological and psychotherapeutic interventions for depression.
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Affiliation(s)
- Elizabeth A Byma
- Department of Nursing, Calvin College, Science Building, 1734 Knollcrest Circle SE, Grand Rapids, MI 49546-4403, USA.
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Implementing evidence-based guidelines for managing depression in elderly patients: a Norwegian perspective. Epidemiol Psychiatr Sci 2012; 21:237-40. [PMID: 22793810 DOI: 10.1017/s204579601200025x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Depression in the elderly is common and exhibits a distinctive phenomenology, due to neurobiological, physiological, psychological and social changes related to ageing. Most elderly with depression are managed in primary health care. Although the number of scientific publications related to geriatric psychiatry has increased, there are still important gaps. Implementation of evidence-based guidelines for managing depression in primary care has had limited success, but has led to improvements compared to standard care. It is logical that the determinants (barriers and enablers) of implementing depression guidelines can be identified and can guide the selection of more effective implementation strategies that are tailored to address those determinants. We are testing that logic as part of a multinational implementation research project called 'Tailored Implementation for Chronic Diseases' (TICD). Our focus in Norway is on the management of depression in the elderly in primary care. We will identify the determinants of implementing evidence-based recommendations using various methods and comparing those methods. We will then use different methods to match the implementation interventions to the identified determinants and compare those methods. Finally, we will evaluate the resulting tailored implementation strategy in a randomized trial.
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Arean PA, Raue PJ, Sirey JA, Snowden M. Implementing evidence-based psychotherapies in settings serving older adults: challenges and solutions. Psychiatr Serv 2012; 63:605-7. [PMID: 22638006 PMCID: PMC3643294 DOI: 10.1176/appi.ps.201100078] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This Open Forum addresses challenges--insurance limitations, staff and setting limitations, and training and sustainability issues--in the implementation of psychotherapy interventions in settings serving older adults and provides solutions for ensuring that they have access to effective mental health services. There is considerable movement toward developing the geriatric mental health workforce, and it is important that these efforts include a discussion of implementation issues with regard to evidence-based psychotherapies as they are provided in services for aging populations.
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Affiliation(s)
- Patricia A Arean
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., Box F-0984, San Francisco, CA 94143, USA.
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Abstract
AbstractObjective:Depression is a frequent problem in cancer patients, which is known to reduce quality of life; however, many cancer patients with depression are not treated because of the difficulties in assessing depression in this population. Our aim was to evaluate and improve the depression assessment strategies of palliative care (PC) physicians and oncologists.Method:We invited all medical oncologists and PC physicians from three cancer centers to participate in this multicenter prospective study. They were asked to classify 22 symptoms (related and specific to depression in cancer patients, related but not specific, and unrelated) as “very important,” “important,” “less important,” or “not important” for the diagnosis of depression in cancer patients, at three different time points (at baseline, after a video education program, and after 4 weeks). They were also asked to complete a questionnaire exploring physicians' perceptions of depression and of their role in its systematic screening.Results:All 34 eligible physicians participated. Baseline performance was good, with >70% of participants correctly classifying at least seven of nine related and specific symptoms. We found no significant improvement in scores in the immediate and 4-week follow-up tests. Additionally, 24 (83%) and 23 (79%) participants expressed support for systematic depression screening and a role for oncologists in screening, respectively.Significance of results:Oncologists had good baseline knowledge about depression's main symptoms in cancer patients and a positive attitude toward being involved in screening. Underdiagnosis of depression is probably related to problems associated with the oncology working environment rather than the physicians' knowledge.
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Lenze S, Hasche L, Brown T, Lawrence L, Proctor E, Morrow-Howell N. Implementing collaborative care for late-life depression in community long-term care. Int J Geriatr Psychiatry 2012; 27:545-6. [PMID: 22508474 DOI: 10.1002/gps.2765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Shannon Lenze
- School of Medicine-Psychiatry; Washington University; St. Louis; MO; USA
| | - Leslie Hasche
- School of Social Welfare; University of Kansas; Lawrence; KS; USA
| | - Teresa Brown
- School of Medicine-Internal Medicine; Washington University; St. Louis; MO; USA
| | - Lisa Lawrence
- Washington University in St. Louis; St. Louis; MO; USA
| | - Enola Proctor
- George Warren Brown School of Social Work; Washington University in St. Louis; St. Louis; MO; USA
| | - Nancy Morrow-Howell
- George Warren Brown School of Social Work; Washington University in St. Louis; St. Louis; MO; USA
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Cassie KM, Cassie WE. Organizational and Individual Conditions Associated With Depressive Symptoms Among Nursing Home Residents Over Time. THE GERONTOLOGIST 2012; 52:812-21. [DOI: 10.1093/geront/gns059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Evaluation of the Mental Healthiness Aging Initiative: community program to promote awareness about mental health and aging issues. Community Ment Health J 2012; 48:193-201. [PMID: 21234684 DOI: 10.1007/s10597-011-9373-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 01/03/2011] [Indexed: 10/18/2022]
Abstract
The objective of this study is to evaluate the Mental Healthiness Aging Initiative, designed to promote community awareness and knowledge about mental health and aging issues. This study occurred during 2007-2009 in 67 of 120 counties in Kentucky. A rural region (11 counties) received the intervention, consisting of focus groups, Extension Agent training, and television-based social marketing campaign. Partial-intervention counties (29 counties) received only the television-based social marketing campaign. The control counties (27 counties) received no intervention activities. Results indicated that the intervention counties agreed more with being able to assist elder adults with a potential mental illness. Also, the intervention counties understood the risk of consuming alcohol and medications better, but had a poorer recognition of drinking problems in elder adults. These findings need to be considered within study limitations, such as measurement error, degree of intervention exposure, and regional differences across intervention groups. The study demonstrates that community interventions on mental health awareness and knowledge are feasible within majority rural regions, with Extension Agents being gatekeepers, for promoting positive messages about mental health and aging issues.
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Physical activity and depressive symptoms in older adults: 11-year follow-up. Am J Prev Med 2012; 42:355-62. [PMID: 22424248 DOI: 10.1016/j.amepre.2011.11.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 10/26/2011] [Accepted: 11/30/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Few studies have explored the reciprocal relationships between naturally occurring changes in physical activity and depressive symptoms in later life. PURPOSE This study examined the reciprocal associations between changes in physical activity and depressive symptoms in a population-based sample of Taiwanese older adults over an 11-year period. METHODS Analyses were based on nationally representative data from the Taiwan's Health and Living Status of the Elderly Survey collected in 1996, 1999, 2003, and 2007. Data from the fixed cohort of 1160 participants aged ≥67 years in 1996 with 11 years of follow-up were studied. Depressive symptoms were assessed using the ten-item Chinese version of the Center for Epidemiologic Studies-Depression Scale. Physical activity was self-reported as the number of sessions per week. Latent growth modeling was used to examine the bidirectional associations between changes in physical activity and depressive symptoms when controlling for sociodemographic variables, lifestyle behaviors, and health status. Data analyses were completed in 2011. RESULTS With multivariate adjustment, initial levels of physical activity were negatively associated with changes in depressive symptoms (β=-0.34, p<0.05). In contrast, early depressive symptoms were not related to change in physical activity (β=-0.17, p>0.05). CONCLUSIONS Physical activity engagement in later life is associated with a lower risk of subsequent depressive symptoms, but the reverse association is not supported. The finding has underlying implications for future physical activity and mental health promotion in aged populations.
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Abstract
OBJECTIVES : To define the prevalence and correlates of depression among older adults receiving assessments by nonmedical community-based care managers at the point of entry to care and thus prior to provision of aging services. Our long-term goal is to inform development of collaborative care models for late life depression that incorporate Aging Services Providers. METHODS : Aging Services Provider Network (ASPN) clients receiving in-home assessments were administered the Structured Clinical Interview for DSM-IV-TR (SCID) module for affective disorders and measures of depression symptom severity, alcohol use, physical health, functional status, social support, stressful life events, and religiosity. Engagement in mental healthcare was documented. RESULTS : Subjects (N = 378) were primarily white (84%) and women (69%) with household incomes under $1,750/month (62%). Half lived alone (48%). Their mean age was 77 years. Thirty-one percent had clinically significant depressive symptoms and 27% met criteria for a current major depressive episode, of which 61% were being treated with medication and 25% by a mental health provider. Nearly half (47%) had experienced one or more episodes of major depression during their lives. Disability, number of medical conditions, number and severity of recent stressful life events, low social support, and low religiosity were independently associated with current major depression. CONCLUSION : Depressive illness was common among this sample of ASPN clients. Because ASPN care managers have expertise in managing many of the problems correlated with depression, they may play a significant role in identifying, preventing, and collaborating in the treatment of depressive illnesses among community-dwelling older adults.
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Wiesmann U, Hannich HJ. A Salutogenic Analysis of Developmental Tasks and Ego Integrity vs. Despair. Int J Aging Hum Dev 2012; 73:351-69. [DOI: 10.2190/ag.73.4.e] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examines the hypothesis that the outcome of the Eriksonian crisis of integrity vs. despair is dependent on successful coping with four developmental tasks: maintenance of active involvement, reevaluation of life satisfaction, developing a sense of health maintenance, and reevaluation of the sense of coherence (SOC). A selective sample of 170 rather healthy individuals at the mean age of 67 years filled out a questionnaire assessing everyday activities, satisfaction with past, present, and future life, healthy habits, SOC, and depression. In our final path-analytical model, the SOC had a significant direct effect on all endogenous variables; it also attenuated depression indirectly via activity and via satisfaction with present and future life. Satisfaction with present life showed the strongest mitigating direct effect on depression. The SOC is an important antecedent for successfully resolving the integrity vs. despair crisis, in that a strong SOC is a guiding force behind mastering the other three tasks.
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A community-integrated home based depression intervention for older African Americans: [corrected] description of the Beat the Blues randomized trial and intervention costs. BMC Geriatr 2012; 12:4. [PMID: 22325065 PMCID: PMC3293778 DOI: 10.1186/1471-2318-12-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 02/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary care is the principle setting for depression treatment; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended standard of care. Older African Americans are at high risk for depression due to elevated rates of chronic illness, disability and socioeconomic distress. There is an urgent need to develop and test new depression treatments that resonate with minority populations that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness. METHODS/DESIGN Beat the Blues (BTB) is a single-blind parallel randomized trial to assess efficacy of a non-pharmacological intervention to reduce depressive symptoms and improve quality of life in 208 African Americans 55+ years old. It involves a collaboration with a senior center whose care management staff screen for depressive symptoms (telephone or in-person) using the Patient Health Questionnaire (PHQ-9). Individuals screened positive (PHQ-9 ≥ 5) on two separate occasions over 2 weeks are referred to local mental health resources and BTB. Interested and eligible participants who consent receive a baseline home interview and then are randomly assigned to receive BTB immediately or 4 months later (wait-list control). All participants are interviewed at 4 (main study endpoint) and 8 months at home by assessors masked to study assignment. Licensed senior center social workers trained in BTB meet with participants at home for up to 10 sessions over 4 months to assess care needs, make referrals/linkages, provide depression education, instruct in stress reduction techniques, and use behavioral activation to identify goals and steps to achieve them. Key outcomes include reduced depressive symptoms (primary), reduced anxiety and functional disability, improved quality of life, and enhanced depression knowledge and behavioral activation (secondary). Fidelity is enhanced through procedure manuals and staff training and monitored by face-to-face supervision and review of taped sessions. Cost and cost effectiveness is being evaluated. DISCUSSION BTB is designed to bridge gaps in mental health service access and treatments for older African Americans. Treatment components are tailored to specific care needs, depression knowledge, preference for stress reduction techniques, and personal activity goals. Total costs are $584.64/4 months; or $146.16 per participant/per month. TRIAL REGISTRATION ClinicalTrials.gov #NCT00511680.
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Lysack C, Lichtenberg P, Schneider B. Effect of a DVD intervention on therapists' mental health practices with older adults. Am J Occup Ther 2011; 65:297-305. [PMID: 21675335 DOI: 10.5014/ajot.2011.001354] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE We tested the effectiveness of an educational intervention in DVD format aimed at strengthening the mental health practices of occupational therapists working with older adults. METHOD The DVD intervention was tested in a pretest-posttest design. Occupational therapists (n = 30) completed a brief knowledge and attitude questionnaire; a chart review (n = 383) of therapists' (n = 20) patients at 3 mo before and 3 mo after DVD training was also conducted. RESULTS Questionnaire data showed that the percentage of therapists with correct answers increased 20%-30% for 5 of the 11 knowledge items. Chart review data showed therapists spoke more often with their older patients about mood, depression, and cognitive impairment; screened more often for depression and cognitive impairment; and reported findings more often to the treatment team after training. CONCLUSION Educational interventions can significantly improve therapists' mental health practice with older adults.
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Affiliation(s)
- Cathy Lysack
- Gerontology and Occupational Therapy, Institute of Gerontology, Wayne State University, Room 231, Knapp Building, 87 East Ferry Street, Detroit, MI 48202, USA.
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Depression indicators in a national sample of older community and care home patients: applying the Quality and Outcomes Framework. Br J Gen Pract 2011; 61:135-8. [PMID: 21276341 DOI: 10.3399/bjgp11x556281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
In a national primary care database sample of older people (≥65 years), 81% (83 588/103 821) of community and 58% (1702/2940) of care home residents with diabetes or heart disease had depression case finding recently recorded; 66% (1418/2145) of community and 22% (26/118) of care home residents with a new depression episode had a depression-severity assessment recorded. Age, sex, and higher care home dementia prevalence did not explain these differences. Case finding and assessment of depression need to be improved in older people, particularly care home residents.
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Rébola CB, Jones B. Sympathetic Devices: Communication Technologies for Inclusion. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2011. [DOI: 10.3109/02703181.2011.555060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van der Weele GM, de Waal MW, van den Hout WB, van der Mast RC, de Craen AJM, Assendelft WJJ, Gussekloo J. Yield and costs of direct and stepped screening for depressive symptoms in subjects aged 75 years and over in general practice. Int J Geriatr Psychiatry 2011; 26:229-38. [PMID: 20665554 DOI: 10.1002/gps.2518] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine yield and costs of two screening methods for depressive symptoms in subjects ≥75 years in general practice. METHODS In 73 general practices of 12.144 registered subjects ≥75 years 10.681 could be invited for screening. In the first 31 practices we invited 3797 subjects for direct screening which implied an invitation by letter followed by a home visit to administer the 15-item Geriatric Depression Scale (GDS-15). In the remaining 42 practices 6884 subjects were invited for stepped screening which implied that the GDS-15 was sent by post, followed by a home visit only if the self-administered GDS-15-score was ≥4 points. Being screen-positive for depressive symptoms was defined as an interviewer-administered GDS-15-score ≥5 points. Screening costs were estimated based on results in this study. RESULTS Of all registered subjects 707 (5.8%) were already being treated for depression. The yield of direct screening was higher than of stepped screening (2.6% versus 1.9%, p = 0.009), with similar yields for subjects aged 75-79 years and for subjects aged ≥80 years. In a standard GP-practice with 160 subjects ≥75 years estimated total screening costs are about twice as high for direct screening than for stepped screening. Estimated costs per screen positive subject are €350 for direct screening and €250 for stepped screening. CONCLUSION Direct screening has a higher yield, but is also more time consuming and more expensive. Whether the extra yield is clinically relevant and worth the extra costs, will depend on the subsequent treatment effect. TRIAL REGISTRATION www.controlled-trials.com/ISRCTN 71142851
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Affiliation(s)
- Gerda M van der Weele
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
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McCaffrey R, Liehr P, Gregersen T, Nishioka R. Garden walking and art therapy for depression in older adults: a pilot study. Res Gerontol Nurs 2011; 4:237-42. [PMID: 21323299 DOI: 10.3928/19404921-20110201-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 07/26/2010] [Indexed: 11/20/2022]
Abstract
The purpose of this pilot study was to compare garden walking (either alone or guided) with art therapy in older adults with depression. Depression was measured using the Geriatric Depression Scale (GDS) and stories of sadness/joy. Prior to the intervention, 47% of participants had depression scores in the severe range and 53% in the mild range. At the end of the intervention, none of the participants had scores in the severe range, 89% had scores in the mild range, and 11% had scores in the normal range. Results of the GDS data using repeated measures analysis of variance indicated significant decreases in depression for all three groups from pretest to posttest. All participants, regardless of group assignment, had a lower percentage of negative-emotion word use and a higher percentage of positive-emotion word use over time. This study provides evidence for nurses wishing to guide older adults in safe, easy, and inexpensive ways to reduce depression.
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