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Renn BN, Johnson M, Powers DM, Vredevoogd M, Unützer J. Collaborative care for depression yields similar improvement among older and younger rural adults. J Am Geriatr Soc 2021; 70:110-118. [PMID: 34536286 DOI: 10.1111/jgs.17457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depressive disorders are among the most prevalent mental health conditions; however, significant barriers to treatment access persist. This study examined differences in depression outcomes between younger and older adults in a large-scale implementation demonstration of the collaborative care model (CoCM). METHODS Secondary data analysis of a longitudinal, observational implementation demonstration at eight primary care clinics across low-resourced rural or frontier areas of the Western United States. Seven of these clinics were federally qualified health centers. The sample consisted of 3722 younger (18-64 years) and older (65+ years) adult primary care patients diagnosed with unipolar depression. All participants received depression treatment via CoCM, which enhances usual primary care and makes efficient use of specialists by using a behavioral healthcare manager and a psychiatric consultant to support primary care providers. Clinics were followed for up to 27 months. Patients were followed until they completed treatment or dropped out. The Patient Health Questionnaire (PHQ-9) assessed depressive symptoms at baseline (enrollment) and at most follow-up contacts. The primary treatment outcome was a change between a patient's first and last recorded PHQ-9 scores. RESULTS Across both age groups, there was an average overall reduction of 6.9 points on the PHQ-9. Older adults demonstrated a greater decrease in depression scores of 2.06 points (95% CI -2.98 to -1.14, p < 0.001) on the PHQ-9 compared with younger adults. Estimates were robust when adjusting for gender, race, and clinic. CONCLUSIONS CoCM resulted in meaningful improvement in depressive symptoms across age groups.
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Affiliation(s)
- Brenna N Renn
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Diane M Powers
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mindy Vredevoogd
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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2
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Welzel FD, Löbner M, Quittschalle J, Pabst A, Luppa M, Stein J, Riedel-Heller SG. Loss and bereavement in late life (60+): Study protocol for a randomized controlled trial regarding an internet-based self-help intervention. Internet Interv 2021; 26:100451. [PMID: 34540595 PMCID: PMC8437767 DOI: 10.1016/j.invent.2021.100451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The death of a close person is a highly stressful, yet common life event in later life. While most individuals seem to cope well with bereavement, a substantial proportion of older individuals suffer from prolonged grief symptoms. E-mental health interventions have been shown to be efficient for a variety of psychological illnesses. Yet, there is a large research gap of studies with a special focus on older adults. This study protocol describes a randomized controlled trial for an internet-based self-help intervention addressing bereavement and loss in adults aged 60 years and over. The self-management intervention is based on techniques of cognitive behavioral therapy and consists of 8 modules. The objective of the AgE-health study is to evaluate the effectiveness and acceptability of this intervention in comparison to a bibliotherapy control group. METHODS The AgE-health study aims at implementing a randomized controlled trial. Eligible participants aged 60+ years will be randomly allocated to an intervention group (access to the intervention) or to an active control group (access to bibliotherapy). Primary outcome is the reduction in grief symptoms (13-item Prolonged Grief Inventory); secondary outcomes are depression, social activity and network, quality of life, self-efficacy, satisfaction with the intervention/bibliotherapy, loneliness, acceptability, up-take and adherence. Assessments will take place before the intervention (baseline) as well as 4 months (follow-up 1) after the intervention. DISCUSSION This study addresses an under-recognized and understudied mental health burden in later life and may add valuable insight into our knowledge about the effectiveness of eHealth interventions for loss and bereavement in late life. To our knowledge, the AgE-health study will be the first randomized controlled trial to evaluate the effectiveness of an internet-based intervention targeting prolonged grief in adults aged 60 years and over. TRIAL REGISTRATION The study has been registered at the German Clinical Trials Register (Identifier: DRKS00020595, Registered 30th July 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020595).
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Affiliation(s)
- Franziska D. Welzel
- Corresponding author at: Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.
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3
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O’Donnell J, Pybis J, Bacon J. Counselling in the third sector: to what extent are older adults accessing these services and how complete are the data third sector services collect measuring client psychological distress? COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jennifer O’Donnell
- British Association for Counselling and Psychotherapy (BACP) Lutterworth UK
| | - Joanne Pybis
- British Association for Counselling and Psychotherapy (BACP) Lutterworth UK
| | - Jeremy Bacon
- British Association for Counselling and Psychotherapy (BACP) Lutterworth UK
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Rasmussen LR, Videbech P, Mainz J, Johnsen SP. Gender- and age-related differences in the quality of mental health care among inpatients with unipolar depression: a nationwide study. Nord J Psychiatry 2020; 74:569-576. [PMID: 32401125 DOI: 10.1080/08039488.2020.1764619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: The relationship between gender, age and the quality of mental health care among inpatients with depression is unclear. This study examined gender- and age-related differences in the quality of care as reflected by the fulfilment of process performance measures of care among inpatients with unipolar depression in Denmark.Methods: In a nationwide cohort study, 16,858 patients admitted to psychiatric hospital wards for depression between 2011 and 2016 were identified from the Danish Depression Database. Patients were divided according to age (18-39, 40-65, 66-79 and ≥80 years) and stratified by gender. Quality of care was defined as having fulfilled process performance measures of care, reflecting national clinical guideline recommendations. High overall quality of care was defined as having received ≥80% of the processes. The associations were assessed using binomial regressions.Results: With men in the age group 18-39 years serving as the reference, men and women in the age category ≥80 years were more likely to receive higher quality of care with an adjusted relative risk (aRR) of 1.43 [95% confidence interval (CI) = 0.98; 2.10] and 1.30 (95% CI = 0.90; 1.90), respectively. Likewise, for men and women aged 66-79 years, the aRRs as 1.34 (95% CI = 1.07; 1.67) and 1.47 (95% CI = 1.14; 1.90). For men and women aged 40-65, the aRRs was 1.15 (95% CI = 1.00; 1.33) and 1.07 (95% CI = 0.93; 1.24), respectively.Conclusion: Older patients received higher quality of inpatient care for depression, as reflected by a higher proportion of fulfilled guideline supported process measures. In contrast, we found no gender-related differences.
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Affiliation(s)
- Line Ryberg Rasmussen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Aalborg, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Depression Research, Mental Health Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Jan Mainz
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department for Community Mental Health, University of Haifa, Haifa, Israel
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Aalborg, Denmark
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Hovey A, Edick C, Brownlee K. Utilization of social workers in home care: An analysis of service use. Home Health Care Serv Q 2020; 39:80-94. [PMID: 32264771 DOI: 10.1080/01621424.2020.1749920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Social workers are well positioned to address mental health complications impacting home care populations, yet social work has one of the lowest utilization rates of offered home care supports in Ontario. This study analyzed care plan data of frontline in-home social work services. Results identified adjustment to illness as the most common category and that seniors required significantly fewer visits and days on service than non-seniors. Most patients were able to accomplish their social work-based goals. Results highlight a need for further research and for capitalizing on the untapped potential value of social work home care services for patients.
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Affiliation(s)
- Angela Hovey
- School of Social Work, Lakehead University, Orillia, Ontario, Canada
| | - Cole Edick
- School of Social Work, Lakehead University, Orillia, Ontario, Canada
| | - Keith Brownlee
- School of Social Work, Lakehead University, Orillia, Ontario, Canada
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6
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Affiliation(s)
- Jana Hummel
- , Rheingoldstr 41a, D-68199, Mannheim, Deutschland.
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7
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Biering P. Helpful approaches to older people experiencing mental health problems: a critical review of models of mental health care. Eur J Ageing 2019; 16:215-225. [PMID: 31139035 PMCID: PMC6509324 DOI: 10.1007/s10433-018-0490-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Despite growing concerns for the mental health of the older generation most studies focus on mental health care for younger people and there is a lack of knowledge about helpful treatment approaches and models of care for older people. Therefore, the purpose of this review was to answer the question what health care approaches are most helpful for older people experiencing mental health problems. Databases from 2000 to July 2017 were searched with focus on outcome studies, experts' opinions and treatment descriptions. Critical interpretive synthesis was used to analyse and interpret the findings. Four main models of care were found: the medical-psychiatric model which mostly focuses on antipsychotic medication for the treatment of symptoms. Psychotherapeutic and social interventions take into consideration the psychosocial perspectives of mental health problems, but little research has been done on their lasting effect. Research indicates that psychotherapy needs to be adapted to the special needs of older people. Few old people have access to psychotherapy which limits its usefulness. Holistic or integrated models of health care have emerged in recent years. These models focus on both physical and psychosocial well-being and have shown promising outcomes. To reduce antipsychotic medication older people need to be given better access to psychotherapy and social interventions. This presupposes training health care professionals in such treatment methods. The holistic models need to be developed and studied further and given high priority in health care policy.
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Affiliation(s)
- Páll Biering
- University of Iceland, Eiriksgata 34, 101 Reykjavik, Iceland
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Harerimana B, Forchuk C, O'Regan T. The use of technology for mental healthcare delivery among older adults with depressive symptoms: A systematic literature review. Int J Ment Health Nurs 2019; 28:657-670. [PMID: 30666762 DOI: 10.1111/inm.12571] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 12/30/2022]
Abstract
Depression has been identified as the single largest contributor to poor health and functioning worldwide. Global estimates indicate that 4.4% of the world's population lives with depression, equating to about 322 million individuals. Research demonstrates that telehealth interventions (i.e. delivering therapy by phone or videoconferencing) have potential for improving mental health care among community-based older adults. This review analyses scholarly literature on telehealth interventions among older adults with depressive symptoms. Following PRISMA guidelines, a systematic search of peer-reviewed papers was conducted using the following key terms: telemedicine, telepsychogeriatrics, telepsychiatry, eHealth, mental health, depression, and geriatric. The review included nine articles examining telehealth for mental health care, published in English between 1946 and 26 September 2017. Telehealth for mental health care among older adults demonstrates a significant impact on health outcomes, including reduced emergency visits, hospital admissions, and depressive symptoms, as well as improved cognitive functioning. Positive or negative influences on the use of telehealth among older adults are identified. This review highlights keys aspects to consider in using telehealth interventions, including levels of education, cognitive function, and prior technology experience. The review highlights vital factors for designing interventions which aim to capitalize on the benefits of the use of telehealth for mental healthcare service delivery, especially in older adults with depressive symptoms.
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Affiliation(s)
- Boniface Harerimana
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Cheryl Forchuk
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada.,Aging, Mental Health, Rehabilitation and Recovery, Lawson Health Research Institute, London, Ontario, Canada
| | - Tony O'Regan
- Lawson Health Research Institute, London, Ontario, Canada
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Tournier M, Montastruc F. Interest of pharmacoepidemiology for the study of psychotropic drugs. Therapie 2019; 74:239-244. [PMID: 30792080 DOI: 10.1016/j.therap.2019.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 01/21/2023]
Abstract
In psychiatry, drug evaluation using pharmacoepidemiological methods has been of growing interest in recent decades. Studies based on observational databases are particularly useful for psychotropic drugs due to their important prevalence in populations, and their use over long period. The authors discussed the specific interest of pharmacoepidemiological studies in the field of psychiatry through two examples: first, the use of antidepressants, and, second, the risks associated with antipsychotics.
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Affiliation(s)
- M Tournier
- Centre hospitalier Charles-Perrens, 33000 Bordeaux, France; University of Bordeaux, Inserm, Bordeaux population health research center, pharmacoepidemiology research team, UMR 1219, 33000 Bordeaux, France; DRUGS-SAFE National Platform of Pharmacoepidemiology, 33000 Bordeaux, France
| | - F Montastruc
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, centre hospitalier universitaire, faculté de médecine, 31000 Toulouse, France; Unité clinique de pharmacologie psychiatrique, faculté de médecine, centre hospitalier universitaire, 31000 Toulouse, France; UMR 1027 pharmacoepidemiology, assessment of drug utilization and drug safety, Inserm, University Paul-Sabatier-Toulouse III joint research unit, 31000 Toulouse, France; CIC 1436, centre hospitalier universitaire, 31000 Toulouse, France.
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10
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Wongpakaran N, Wongpakaran T, Sirirak T, Jenraumjit R, Jiraniramai S, Lerttrakarnnon P. Predictors of polypharmacy among elderly Thais with depressive and anxiety disorders: findings from the DAS study. BMC Geriatr 2018; 18:309. [PMID: 30541459 PMCID: PMC6292154 DOI: 10.1186/s12877-018-1001-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/30/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Polypharmacy is a geriatric syndrome defined variously as the use of potentially inappropriate drugs and/or the concurrent use of multiple medications including prescription and over-the-counter drugs. An association has been shown between polypharmacy and physical health, increased morbidity and increased mortality. However, there is little information regarding the association between polypharmacy and physical disease, personality trait and mental health problems in elderly. The aim of this study was to investigate potential predictive psychosocial factors related to polypharmacy in elderly Thai people. METHODS The study analysed the secondary data from the Depressive Disorders, Anxiety Disorders, Suicide Risk and Associated Factors Among Elderly Thai People Program (DAS Study) which was funded by National Research Council of Thailand and conducted between January 2012 and April 2013. Demographic and baseline clinical characteristics including sex, age, education, living alone or with others, access to health care privilege and monthly income were described. The number of medication, physical diseases and mental health problems (i.e. depression, anxiety, and personality trait of neuroticism) were analyzed using descriptive statistics, chi-square and proportional odds logistic regression. RESULTS The 803 participants consumed an average of 2.13 prescribed medicines daily (SD 1.46, median = 2). The largest group used 3 medications (18.6%). Predictors found to be associated with polypharmacy in the logistic regression model included hypertension (OR = 1.985, 95% CI = 1.420-2.775), anxiety disorder (OR = 4.402, 95% CI = 2.630-7.367), number of diseases (OR = 2.140, 95% CI = 1.874-2.445), depressive disorder (OR = 1.470, 95% CI = 1.080-2.001), diabetes mellitus (OR = 1.864, 95% CI = 1.122-3.098) and dyslipidemia (OR = 0.511, 95%CI = 0.325-0.803). CONCLUSIONS The prevalence of polypharmacy among Thai elderly was relatively high compared to other related studies. Several aspects should be taken into consideration before starting an additional medication in elderly patients. In addition to the number of physical disease that leads to polypharmacy, general practitioners should be aware of anxiety, depression, and personality trait of neuroticism that may be related to polypharmacy. Early detection for such condition as well as non-pharmacological intervention could be one way to help reduce polypharmacy in the elderly.
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Affiliation(s)
- Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Thanitha Sirirak
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90112, Thailand
| | - Rewadee Jenraumjit
- Department of Pharmaceutical care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Surin Jiraniramai
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Peerasak Lerttrakarnnon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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11
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Bouras AF, Ioos E, Aoudia A, Kaci H, Benaibouche D, Merad-Boudia F. The vision and role of geriatric oncology in surgical treatment of the elderly patient. J Visc Surg 2018; 156:37-44. [PMID: 30416005 DOI: 10.1016/j.jviscsurg.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The phenomenon of population aging is constantly on the rise, as are the medical needs of elderly subjects. Oncological treatment concerns an ever larger number of elderly patients, raising a number of not only practical and medical questions, but also the ethical interrogations associated with therapeutic decision-making, quality of life and therapeutic obstinacy (futile medical care). Surgeons are increasingly preoccupied by elderly patients on account of the cancer rate among them, and they are compelled to cope with challenges such as morbimortality and prolonged hospitalization. Geriatric oncology is a discipline of increasing importance of which the goal consists in comprehensive care of the elderly cancer patient, care taking into full account his physical and psychological aging, his somatic and cognitive comorbidities, and, last but least, his life expectancy. The opinions and recommendations of geriatric oncologists provide increasingly more orientation for the oncological therapeutic decision-making processes. The objective of this attempt at clarification is to discuss the contributions of this discipline to everyday surgical activity, to provide surgeons with some tools facilitating initial evaluation of their patients, and to remind the reader of situations in which oncological assistance is of paramount importance.
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Affiliation(s)
- A F Bouras
- Faculté de médecine d'Alger, Université Benyoucef Benkhedda, Alger 1, Algeria; Chirurgie générale et digestive, CHU Lamine Debaghine, boulevard Saïd Touati, Bab El Oued, Alger, 16000, Algeria.
| | - E Ioos
- Médecine polyvalente et gériatrie, centre hospitalier Germon-et-Gauthier, 62408 Béthune, France
| | - A Aoudia
- Clinique de psychiatrie, hôpital Fontan II, CHRU Lille, 59000 Lille, France
| | - H Kaci
- Faculté de médecine d'Alger, Université Benyoucef Benkhedda, Alger 1, Algeria; Chirurgie générale et digestive, CHU Lamine Debaghine, boulevard Saïd Touati, Bab El Oued, Alger, 16000, Algeria
| | - D Benaibouche
- Faculté de médecine d'Alger, Université Benyoucef Benkhedda, Alger 1, Algeria; Chirurgie générale et digestive, CHU Lamine Debaghine, boulevard Saïd Touati, Bab El Oued, Alger, 16000, Algeria
| | - F Merad-Boudia
- Faculté de médecine d'Alger, Université Benyoucef Benkhedda, Alger 1, Algeria; Chirurgie générale et digestive, CHU Lamine Debaghine, boulevard Saïd Touati, Bab El Oued, Alger, 16000, Algeria
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Yuruyen M, Yavuzer H, Demirdag F, Kara Z, Cengiz M, Yavuzer S, Doventas A, Erdincler DS, Beger T. Is Depression a Predictive Factor for Polypharmacy in Elderly? ACTA ACUST UNITED AC 2017. [DOI: 10.5455/bcp.20160224101558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mehmet Yuruyen
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Hakan Yavuzer
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Filiz Demirdag
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Zehra Kara
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Mahir Cengiz
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of General Medicine, Istanbul - Turkey
| | - Serap Yavuzer
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of General Medicine, Istanbul - Turkey
| | - Alper Doventas
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Deniz Suna Erdincler
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
| | - Tanju Beger
- Istanbul University, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics, Istanbul - Turkey
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13
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Jia H, Lubetkin EI. Incremental decreases in quality-adjusted life years (QALY) associated with higher levels of depressive symptoms for U.S. Adults aged 65 years and older. Health Qual Life Outcomes 2017; 15:9. [PMID: 28077154 PMCID: PMC5225616 DOI: 10.1186/s12955-016-0582-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/19/2016] [Indexed: 01/22/2023] Open
Abstract
Background Quality-adjusted life years (QALY) is a single value index that quantifies the overall burden of disease. It reflects all aspects of heath, including nonfatal illness and mortality outcomes by weighting life-years lived with health-related quality of life (HRQOL) scores. This study examine the burden of disease due to increasing levels of depressive symptoms by examining the association between the 9-item Patient Health Questionnaire (PHQ-9) scores and QALY for U.S. adults aged 65 years and older. Methods We ascertained respondents’ HRQOL scores and mortality status from the 2005–2006, 2007–2008, and 2009–2010 cohorts of the National Health and Nutrition Examination Survey (NHANES) with mortality follow-up data through December 31, 2011. This analysis included respondents aged 65 years and older (n = 3,680). We estimated the mean QALY throughout the remaining lifetime according to participants’ depression severity categories: none or minimal (PHQ-9 score 0–4), mild (5–9), moderate (10–14), and moderately severs and severe (15 or higher). We estimated QALY loss due to major depressive disorder (PHQ-9 score 10 or higher) and to mild depression (5–9). Results The QALY for persons with none/minimal, mild, moderate, and moderately severe/severe depression were 14.0, 7.8, 4.7, and 3.3 years, respectively. Compared to persons without major depressive disorder, persons with major depressive disorder had 8.3 fewer QALY (12.7 vs. 4.4), or a 65% loss. Compared to persons who reported “none” or minimal depressive symptoms, persons who reported mild depressive symptoms had 6.2 fewer QALY (14.0 vs. 7.8), or a 44% loss. The same patterns were noted in demographic and socioeconomic subgroups and according to number of comorbidities. Conclusions This study not only confirmed the significant burden of disease for major depressive disorder among the U.S. elderly, but also showed an incremental decrease in QALY with an increasing severity of depressive symptoms as well as significant QALY loss due to mild depression. Specifically, individuals with higher (or more impaired) PHQ-9 scores had significantly fewer QALYs and our findings of fewer years of QALY for persons with major depressive disorder and mild depression were not only statistically significant but also clinically important.
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Affiliation(s)
- Haomiao Jia
- Department of Biostatistics, Mailman School of Public Health and School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032, USA.
| | - Erica I Lubetkin
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA
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14
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Anderson K, Wickramariyaratne T, Blair A. Help-seeking intentions for anxiety among older adults. Aust J Prim Health 2017; 23:489-495. [DOI: 10.1071/py15185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/06/2017] [Indexed: 11/23/2022]
Abstract
Mental health practices are not working for older people with anxiety in residential care, as there is a persistent lack of recognition and treatment. This suggests that alternative ways of reaching and meeting the needs of this population need to be explored. One possibility involves enabling older adults themselves to seek help. The current work explored various factors impacting on help-seeking behaviours. In total, 105 participants from independent living units in a residential care setting completed a questionnaire focusing on attitudes and stigma towards anxiety, likelihood to seek help, help-seeking barriers and literacy around the symptoms of anxiety. Participants in the main did not hold negative attitudes towards other people with anxiety, despite concerns that other people could view them negatively if they were experiencing anxiety. Barriers to help-seeking included: difficulties recognising physical anxiety symptoms as being indicative of anxiety; the effectiveness of treatments; costs; misdiagnosis; privacy; medication usage and the associated side-effects; and, uneasiness about the skills and knowledge of health professionals. Although concerns were not held by all participants, the fact remains that anxiety is largely undiagnosed and untreated for this population and these stoppages to appropriate care must be addressed.
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15
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Hummel J, Weisbrod C, Boesch L, Himpler K, Hauer K, Hautzinger M, Gaebel A, Zieschang T, Fickelscherer A, Diener S, Dutzi I, Krumm B, Oster P, Kopf D. AIDE-Acute Illness and Depression in Elderly Patients. Cognitive Behavioral Group Psychotherapy in Geriatric Patients With Comorbid Depression: A Randomized, Controlled Trial. J Am Med Dir Assoc 2016; 18:341-349. [PMID: 27956074 DOI: 10.1016/j.jamda.2016.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Comorbid depression is highly prevalent in geriatric patients and associated with functional loss, frequent hospital re-admissions, and a higher mortality rate. Cognitive behavioral psychotherapy (CBT) has shown to be effective in older depressive patients living in the community. To date, CBT has not been applied to older patients with acute physical illness and comorbid depression. OBJECTIVES To evaluate the effectiveness of CBT in depressed geriatric patients, hospitalized for acute somatic illness. DESIGN Randomized controlled trial with waiting list control group. SETTING Postdischarge intervention in a geriatric day clinic; follow-up evaluations at the patients' homes. PARTICIPANTS A total of 155 randomized patients, hospitalized for acute somatic illness, aged 82 ± 6 years and suffering from depression [Hospital Anxiety and Depression Scale (HADS) scores >7]. Exclusion criteria were dementia, delirium, and terminal state of medical illness. INTERVENTION Fifteen, weekly group sessions based on a CBT manual. Commencement of psychotherapy immediately after discharge in the intervention group and a 4-month waiting list interval with usual care in the control group. MEASUREMENTS HADS depression total score after 4 months. Secondary endpoints were functional, cognitive, psychosocial and physical status, resource utilization, caregiver burden, and amount of contact with physician. RESULTS The intervention group improved significantly in depression scores (HADS baseline 18.8; after 4 months 11.4), whereas the control group deteriorated (HADS baseline 18.1; after 4 months 21.6). Significant improvement in the intervention group, but not in the control group, was observed for most secondary outcome parameters such as the Barthel and Karnofsky indexes. Intervention effects were less pronounced in patients with cognitive impairment or acute fractures. CONCLUSIONS CBT is feasible and highly effective in geriatric patients. The benefits extend beyond effective recovery and include improvement in physical and functional parameters. Early diagnosis, good access to psychotherapy, and early intervention could improve care for depressive older patients. CLINICAL TRIAL REGISTRATION www.germanctr.de German Trial Register DRKS 00004728.
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Affiliation(s)
- Jana Hummel
- Geriatric and Gerontopsychotherapeutic Practice, Mannheim, Germany.
| | | | | | | | - Klaus Hauer
- Geriatric Center Bethanien, Heidelberg, Germany
| | | | | | | | | | | | - Ilona Dutzi
- Geriatric Center Bethanien, Heidelberg, Germany
| | - Bertram Krumm
- Central Institute of Mental Health, Mannheim, Germany
| | - Peter Oster
- Geriatric Center Bethanien, Heidelberg, Germany
| | - Daniel Kopf
- Department of Geriatrics, Marien Hospital, Hamburg, Germany
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16
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Enache D, Fereshtehnejad SM, Kåreholt I, Cermakova P, Garcia-Ptacek S, Johnell K, Religa D, Jelic V, Winblad B, Ballard C, Aarsland D, Fastbom J, Eriksdotter M. Antidepressants and mortality risk in a dementia cohort: data from SveDem, the Swedish Dementia Registry. Acta Psychiatr Scand 2016; 134:430-440. [PMID: 27586958 DOI: 10.1111/acps.12630] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND The association between mortality risk and use of antidepressants in people with dementia is unknown. OBJECTIVE To describe the use of antidepressants in people with different dementia diagnoses and to explore mortality risk associated with use of antidepressants 3 years before a dementia diagnosis. METHODS Study population included 20 050 memory clinic patients from the Swedish Dementia Registry (SveDem) diagnosed with incident dementia. Data on antidepressants dispensed at the time of dementia diagnosis and during 3-year period before dementia diagnosis were obtained from the Swedish Prescribed Drug Register. Cox regression models were used. RESULTS During a median follow-up of 2 years from dementia diagnosis, 25.8% of dementia patients died. A quarter (25.0%) of patients were on antidepressants at the time of dementia diagnosis, while 21.6% used antidepressants at some point during a 3-year period before a dementia diagnosis. Use of antidepressant treatment for 3 consecutive years before a dementia diagnosis was associated with a lower mortality risk for all dementia disorders and in Alzheimer's disease. CONCLUSION Antidepressant treatment is common among patients with dementia. Use of antidepressants during prodromal stages may reduce mortality in dementia and specifically in Alzheimer's disease.
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Affiliation(s)
- D Enache
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. .,Southwest Psychiatry, Karolinska University Hospital, Huddinge, Sweden.
| | - S-M Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - I Kåreholt
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Institute of Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - P Cermakova
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,International Clinical Research Center and St. Anne's University Hospital, Brno, Czech Republic
| | - S Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - K Johnell
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - D Religa
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - V Jelic
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - B Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Sweden
| | - C Ballard
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - D Aarsland
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Sweden.,Center for Age-Related Diseases, Psychiatric Clinic, Stavanger University Hospital, Stavanger, Norway
| | - J Fastbom
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - M Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Sweden
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17
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Choi NG, DiNitto DM, Marti CN, Kunik ME. When depression is diagnosed, older adults are as likely as younger adults to be prescribed pharmacotherapy and psychotherapy. Gen Hosp Psychiatry 2016; 43:6-11. [PMID: 27796260 DOI: 10.1016/j.genhosppsych.2016.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examined age group differences in the rates of depression diagnosis and treatment using a national probability sample. METHODS Using data from the 2012 National Ambulatory Medical Care Survey (n=62,723 visits by patients aged 18+ years), we used bivariate and multivariable binary logistic regression analyses to test age group differences in antidepressant medication (ADM) and psychotherapy prescribed/ordered or provided at visits during which depression was diagnosed. RESULTS Visits by older adults were less likely to result in a depression diagnosis than visits by younger individuals: 2.46% and 1.80% in the 65-74 and 75+ age groups, compared to 4.06%, 4.24% and 4.12% in the 18-29, 30-49 and 50-64 age groups, respectively. Of all visits involving diagnosed depression, 65.88% included prescribing/ordering or providing ADM and 19.01% included psychotherapy ordering or providing, without significant age group difference. Prescribing/ordering or providing ADM occurs frequently during visits to physicians regardless of specialty, while psychotherapy was ordered or provided mostly during visits to psychiatrists. CONCLUSIONS During ambulatory care visits in which depression was diagnosed, older adults were as likely as younger adults to be prescribed/provided treatment; however, in more than 30% of visits by depressed older adults neither ADM nor psychotherapy was prescribed.
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Affiliation(s)
- Namkee G Choi
- University of Texas at Austin School of Social Work, Austin, TX, USA.
| | - Diana M DiNitto
- University of Texas at Austin School of Social Work, Austin, TX, USA
| | - C Nathan Marti
- University of Texas at Austin School of Social Work, Austin, TX, USA
| | - Mark E Kunik
- VA Health Services Research and Development Center of Excellence, Baylor College of Medicine, Houston, TX, USA
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18
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Jensen LS, Overgaard C, Garne JP, Carlsen K, Bøggild H, Fonager K. Can registry data be used as a proxy for perceived stress? A cross-sectional study. Ann Epidemiol 2016; 26:493-499. [DOI: 10.1016/j.annepidem.2016.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 05/02/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
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