Reducing depression among community-dwelling older adults using life-story review: a pilot study

Effects of life-story review on quality of life, depression, and life satisfaction in older adults in Oman: a randomized controlled study

BACKGROUND

There is a need for healthcare providers to develop life-story review interventions to enhance the mental well-being and quality of life of older adults. The primary aim of this study is to examine the effects of telling their life stories and creating a life-story book intervention on QoL, depressive symptoms, and life satisfaction in a group of older adults in Oman.

METHODS

A repeated-measures randomized controlled design was conducted in Oman. A total of 75 older adults (response rate = 40.1%) were randomly assigned to the intervention (n = 38) or control (n = 37) groups. Demographic data were collected as the baseline. Depression, life satisfaction, and quality of life scores were collected from each participant at weeks 1, 2, 3, 4, and 8.

RESULTS

Their average age is 67.3 ± 5.5 years (range 60-82 years). There are more women (n = 50, 66.7%) than men. Over the 8 weeks, the intervention group exhibited a notable decrease in depression (intervention: 2.5 ± 1.2 vs. control: 5.3 ± 2.1, p < .001) but an increase in life satisfaction (24.6 ± 3.1 vs. 21.9 ± 6.1, p < .001) and quality of life (physical: 76.2 ± 12.7 vs. 53.6 ± 15.5, p < .001; psychological: 76.4 ± 12.1 vs. 59.9 ± 21.5, p < .001; Social relation: 78.3 ± 11.7 vs. 61.8 ± 16.6, p < .001; environment: 70.8 ± 10.2 vs. 58.6 ± 16.1, p < .001) compared to the control group.

CONCLUSION

The life-story review intervention proved effective in diminishing depression and boosting life satisfaction and quality of life among the older sample within the 8-week study. Healthcare providers can apply such interventions to improve older adults' mental health and well-being.

Perceived Physical Health and Cognitive Behavioral Therapy vs Supportive Psychotherapy Outcomes in Adults With Late-Life Depression: A Secondary Analysis of a Randomized Clinical Trial

Importance

Physical diseases co-occur with late-life depression (LLD). The influence of physical diseases and the subjective perception of physical health (PPH) on treatment outcome in LLD, however, is not well understood.

Objective

To assess the association of physical diseases and PPH with the outcomes of 2 different types of psychotherapy in LLD.

Design, Setting, and Participants

This post hoc secondary analysis of a multicenter, observer-blinded, controlled, parallel-group randomized clinical trial assessed participants 60 years or older with moderate to severe depression recruited at 7 psychiatric-psychotherapeutic outpatient trial sites in Germany from October 1, 2018, to November 11, 2020. Data analysis was performed from April 1 to October 31, 2023.

Interventions

Patients received LLD-specific cognitive behavioral therapy (LLD-CBT) or supportive unspecific intervention (SUI).

Main Outcomes and Measures

Depression severity, response, and remission were measured during treatment and at 6-month follow-up by the change in the 30-item Geriatric Depression Scale (GDS) score. Physical health and PPH were assessed by the number of physical diseases, Charlson Comorbidity Index (CCI), and the World Health Organization Quality of Life Brief Version physical health subscale.

Results

A total of 251 patients were randomized to LLD-CBT (n = 126) or SUI (n = 125), of whom 229 (mean [SD] age, 70.2 [7.1] years; 151 [66%] female) were included in the intention-to-treat analysis. Patients with low and moderate PPH at baseline had significantly less reduction in the GDS score across both treatment groups than patients with high PPH (estimated marginal mean difference [EMMD], 2.67; 95% CI, 0.37-4.97; P = .02 for low PPH and EMMD, 1.82; 95% CI, 0.22-3.42; P = .03 for moderate vs high PPH). Higher PPH at baseline was associated with higher likelihood of response (odds ratio [OR], 1.04; 95% CI, 1.00-1.06; P = .009) and remission at the end of treatment (OR, 1.04; 95% CI, 1.02-1.08; P = .002) and response (OR, 1.05; 95% CI, 1.02-1.08; P < .001) and remission at follow-up (OR, 1.06; 95% CI, 1.03-1.10; P < .001) across both treatment groups. However, a significant interaction of PPH with treatment group was observed with low PPH at baseline being associated with significantly larger reduction in GDS scores in SUI compared with LLD-CBT at the end of treatment (EMMD, -6.48; 95% CI, -11.31 to -1.64; P = .009) and follow-up (EMMD, -6.49; 95% CI, -11.51 to -1.47; P = .01). In contrast, patients with high PPH at baseline had a significantly greater reduction in GDS scores in LLD-CBT compared with SUI at all time points (week 5: EMMD, -4.08; 95% CI, -6.49 to -1.67; P = .001; end-of-treatment: EMMD, -3.67; 95% CI, -6.72 to -0.61; P = .02; and follow-up: EMMD, -3.57; 95% CI, -6.63 to -0.51; P = .02). The number of physical diseases or CCI at baseline did not have an effect on the change in GDS score, response, or remission, neither across both groups nor within either group.

Conclusions and Relevance

In this secondary analysis of a randomized clinical trial, subjective PPH was associated with treatment outcome, response, and remission in psychotherapy of LLD. Patients with LLD responded differently to LLD-CBT and SUI, depending on their baseline PPH score. Treatment approaches for patients with LLD should address PPH in personalized interventions.

Trial Registration

ClinicalTrials.gov Identifier: NCT03735576; Deutsches Register Klinischer Studien Identifier: DRKS00013769.

A Qualitative Study to Explore the Life Experiences of Older Adults in Oman

BACKGROUND

Reminiscence studies and life reviews have a number of proven advantages. Future generations gain by learning from elders' life experiences, as do older adults themselves who share their memories. Despite Oman's sizable geriatric population, research on older individuals' life experiences is scarce. Therefore, this study aimed to explore the life experiences of older Omani individuals across their many life stages, from childhood to the present.

METHODS

This was a qualitative study design. Convenience sampling was employed and conducted from December 2021 to October 2022. A total of 13 Omani older adults (9 females and 4 males), with an average age of 68 years, were recruited for this study (response rate = 34%). Socio-demographic and life review information was gathered according to a set of semi-structured guiding questions. The responses were then captured on audio recordings, which underwent transcription and translation. Thematic analysis techniques were applied to the extracted data.

RESULTS

Three main themes were evident in this study's findings: childhood memories, friendships, and relationships, as well as the elders' past. Additionally, older adults passed on a number of gems of wisdom to be shared with the younger generations.

CONCLUSIONS

This study aided in revealing the resiliency, social connections, and life reflections of Omani older adults. These themes can guide the creation of age-inclusive laws, social support initiatives, and healthcare services specifically designed to satisfy the special requirements and ambitions of the elderly population. Based on these themes, this study recommended that the local community or society build a more sympathetic and compassionate atmosphere that honors and respects the accomplishments of this essential group by recognizing and comprehending the complex experiences of older adults. In addition, future studies could explore particular aspects of these older experiences and pinpoint solutions to improve their quality of life and wellbeing.

The biography project: Student learning outcomes in aged care life narrative placements

Australia's Royal Commission into Aged Care Quality and Safety has reported abuses, neglect and a level of systemic apathy and unwillingness to innovate across the nation's aged care sector. Isolation and loneliness stand out as the sector's two most pernicious problems which the current pandemic has only exacerbated. To attempt to ameliorate the situation, the author created a fieldwork intervention that puts undergraduate students into aged care facilities to work with residents on discussing, transcribing, editing and publishing the resident's biography. The "Biography Project" provides much needed contact and connection for residents but also touches on the quality of relationships with family, friends and care staff and supports intergenerational connections for undergraduate students. The article describes the project and its outcomes for students in the hopes of providing a model for geriatric education that could be implemented elsewhere.

An Evaluation of Improving Psychosocial Life Satisfaction among Older Adults in Taiwan Day Care Centers Using Life Review Work

This study examined the effects of life review therapy on the life satisfaction levels of older adults in day care centers in Taiwan. A quasi-experimental design was adopted. A total of 88 adults aged 65 and older were recruited from day care centers through convenience sampling and assigned to two groups based on their level of life satisfaction on Life Satisfaction Index A. The intervention groups participated in a life review therapy for eight weeks in addition to their daily activities. Data were collected at the baseline point and immediately after post-intervention. Generalized estimating equations were used to examine the effect of the intervention on the outcomes. At week eight, the intervention group showed a significantly higher level of life satisfaction than the comparison group. These findings suggest that life review programs may improve general life satisfaction among older adults.

Effectiveness of life review on depression among elderly: a systematic review and meta-analysis

Introduction

depression is considered one of the most common obstacles to daily life activities and quality of life in the elderly. Evidence is accumulating regarding the effectiveness of reminiscence and life review interventions in reducing depression and raising well-being in the elderly. The aim of this review was to determine the effects of life review interventions on depression outcomes among the elderly.

Methods

a search of the literature was performed through 11 electronic databases to identify all randomized controlled trials studies that examine life review effects on depression among the elderly. For each study, the effect size (Cohen's d) between groups (life review vs. control) differences in depression scores for post-intervention and follow-up intervention were computed.

Results

in total, 15 studies were met the inclusion criteria and was evaluated by meta-analysis. Results showed that the life review group has a large effect on reducing depression level than the control group on post-intervention and follow-up. After conducted sensitivity analysis, a moderate effect (effect size=-0.54; 95% CI=-0.71 to -0.36; p<0.05) and small effect (effect size=-0.20; 95% CI=-0.41 to -0.01; p<0.05) were found on post-intervention and follow-up, respectively.

Conclusion

through this systematic review and meta-analysis, the overall results showed a moderate effect to reducing depression levels among the elderly in the life review group after carrying out post-intervention measurements, while in the follow-up the effect was small. This review indicates that life review intervention is one of the options likely to be of benefit for elderly in primary care settings, but further research can be focused on intervention and follow-up durations to obtain long-term effects.

Does life story work improve psychosocial well-being for older adults in the community? A quasi-experimental study

Background

Previous studies have demonstrated that life story work has positive effects when used on older adults. This study aimed to examine the effect of life story work on the general mental well-being, self-esteem, and life satisfaction of older adults by comparing two groups – one with and one without depressive symptoms.

Methods

A quasi-experimental design was adopted in this study. One hundred and twenty-three adults aged 60 or above were recruited from community centers through convenience sampling. They were allocated into two groups based on their level of depressive symptomatology as measured by the Geriatric Depression Scale (GDS). The intervention was to produce a written life story with pictures and memorabilia in four to six semi-structured sessions facilitated by trained volunteers. The outcome measures included general mental well-being (General Health Questionnaire, GHQ), life satisfaction (Life Satisfaction Scale Index A, LSI-A), and self-esteem (Rosenberg’s Self-esteem Scale, RSES). Data were collected at baseline (T0), immediately post-intervention (T1), and at the 3-month follow-up (T2). Generalized estimating equations were used to examine the effect of the intervention on the outcomes.

Results

There was a significant interaction effect between the two groups at T1 (β = 0.244, p < 0.05) with improvements in the GHQ observed in the group with depressive symptomology. No significant time and interaction effects were seen on the LSI-A and RSES. The Friedman test was also used to examine whether the intervention itself would have any effects on the GDS score, with two groups combined. A reduction in the mean GDS score was found to be close to reaching a level of significance (χ² = 5.912, p = 0.052).

Conclusion

The findings of this study provided some preliminary evidence that life story work was effective at improving the general mental well-being of community-dwelling older adults with depressive symptomology. Because older adults with different levels of depressive symptoms might respond differently to life story work interventions, our findings offer interesting directions for future studies – for instance, on what population would benefit the most from Life Story Work and what would be the mechanism that renders Life Story Work effective.

Predictors of treatment outcome in depression in later life: A systematic review and meta-analysis

BACKGROUND

Predictor analyses of late-life depression can be used to identify variables associated with outcomes of treatments, and hence ways of tailoring specific treatments to patients. The aim of this review was to systematically identify, review and meta-analyse predictors of outcomes of any type of treatment for late-life depression.

METHODS

Pubmed, Embase, CINAHL, Web of Science and PsycINFO were searched for studies published up to December 2016. Primary and secondary studies reported treatment predictors from randomised controlled trials of any treatment for patients with major depressive disorder aged over 60 were included. Treatment outcomes included response, remission and change in depression score.

RESULTS

Sixty-seven studies met the inclusion criteria. Of 65 identified statistically significant predictors, only 7 were reported in at least 3 studies. Of these, 5 were included in meta-analyses, and only 3 were statistically significant. Most studies were rated as being of moderate to strong quality and satisfied key quality criteria for predictor analyses.

LIMITATIONS

The searches were limited to randomised controlled trials and most of the included studies were secondary analyses.

CONCLUSIONS

Baseline depression severity, co-morbid anxiety, executive dysfunction, current episode duration, early improvement, physical illnesses and age were reported as statistically significant predictors of treatment outcomes. Only the first three were significant in meta-analyses. Subgroup analyses showed differences in predictor effect between biological and psychosocial treatment. However, high heterogeneity and small study numbers suggest a cautious interpretation of results. These predictors were associated with various mechanisms including brain pathophysiology, perceived social support and proposed distinct types of depressive disorder. Further investigation of the clinical utility of these predictors is suggested.

Psychometric properties of the Ruminative Response Scale-short form in a clinical sample of patients with major depressive disorder

BACKGROUND

The Ruminative Response Scale (RRS)-short form is one of the most widely used measures of rumination, comprising ten items and two components: reflection and brooding. The aim of this study was to investigate RRS validity and reliability in a clinical sample of French patients with major depressive disorder (MDD).

SUBJECTS AND METHODS

Outpatients with a DSM-IV-TR diagnosis of MDD were recruited from a public academic hospital in France. Depressive symptoms were evaluated by the Beck Depression Inventory, anxiety by the State-Trait Anxiety Inventory - state scale, and quality of life by the 36-Item Short Form Health Survey (SF-36) questionnaire. Confirmatory factor analyses, item-dimension correlations, Cronbach's α-coefficients, Rasch statistics, and external validity were tested. Differential item functioning analyses were performed for sex.

RESULTS

A total of 109 patients participated. The final reflection-brooding two-factor model of the RRS showed a good fit (root-mean-square error of approximation 0.041, comparative fit index 0.987, standardized root-mean-square residual 0.048) after removing one item (daily diary writing). Internal item consistency and reliability were satisfactory for the two dimensions. External validity testing confirmed that RRS scores were correlated with Beck Depression Inventory, State-Trait Anxiety Inventory, and SF-36 scores. There was no differential item functioning across sexes.

CONCLUSION

These results demonstrated good scale reliability and validity for assessing rumination in patients with MDD.