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Inoue M, Hasegawa M, Tompkins CJ, Donnelly CM. Culturally Responsive Companion Program for a Japanese Woman with Dementia in a U.S. Nursing Home. J Cross Cult Gerontol 2021; 36:309-320. [PMID: 34324047 DOI: 10.1007/s10823-021-09434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/26/2022]
Abstract
The older foreign-born population is predicted to increase in the United States. As a whole, this population in the long-term care setting is more likely to face greater challenges associated with loneliness and social isolation due to their smaller social networks, language and cultural differences. The benefits of person-centered care have been widely recognized and may be a potential remedy for such challenges felt by older immigrants. Using a qualitative case study approach, this study explored the staff perceptions of a culturally responsive companion program provided to an older Japanese woman with advanced dementia in the long-term care setting to understand the potential benefits of such a program. The first theme that emerged was that the client benefitted from the program in regard to her physical wellbeing, emotional wellbeing, language communication and cultural support. Given the support of Japanese companions, the client was able to express her needs and health symptoms effectively and the staff were subsequently able to provide culturally-sensitive care. The second theme that emerged was the perceived benefits received by the staff. The companion program improved the staff's ability to provide quality care for the resident. This study implies that culturally responsive companion programs may benefit foreign-born older individuals in improving their wellbeing in long-term care settings.
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Affiliation(s)
- Megumi Inoue
- Department of Social Work, George Mason University, 4400 University Drive, MSN: 1F8, Fairfax, VA, 22181, USA.
| | | | - Catherine J Tompkins
- Department of Social Work, George Mason University, 4400 University Drive, MSN: 1F8, Fairfax, VA, 22181, USA
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Gellert P, Beyer AK, Tegeler C, Vathke C, Nordheim J, Kuhlmey A, Kessler EM. Outpatient psychotherapy for home-living vulnerable older adults with depression: study protocol of the PSY-CARE trial. BMC Geriatr 2020; 20:271. [PMID: 32758135 PMCID: PMC7409457 DOI: 10.1186/s12877-020-01661-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/22/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is a need to improve psychotherapeutic approaches to treatment for vulnerable older adults with depression in terms of both clinical practice and health care supply. Against this background, PSY-CARE is testing the feasibility and effectiveness of outpatient psychotherapy for home-living older adults in need of care with depression in Berlin, Germany, and neighboring suburban areas. METHODS In a two-arm single-center pragmatic randomized controlled trial (RCT), manual-guided outpatient psychotherapy will be compared to brief psychosocial counseling. The study population will be compromised of older adults with clinically significant depressive symptoms who have a long-term care grade, as assessed by the German compulsory state nursing care insurance. In the intervention group, individual cognitive-behavioral psychotherapy tailored to the specific needs of this population will be offered by residential psychotherapists as part of the regular healthcare service. In the active control group, participants will receive individual psychosocial telephone counselling and a self-help guide. The planned sample size is N = 130 (n = 65 participants per group). The reduction of depressive symptoms (primary outcome) as well as the maintaining of activities of daily living, quality of life, and functioning will be assessed with questionnaires provided at baseline, after the end of the intervention and after three months. Feasibility and process evaluation will be conducted qualitatively based on documentation and interviews with psychotherapists, gatekeepers and the participants. DISCUSSION PSY-CARE investigates the potentials and limitations of providing outpatient psychotherapeutic treatment meeting the demands of vulnerable home-living older adults with depression under the real conditions of the health care system. The study will provide practical implications to improve access to and quality of outpatient psychotherapy for this poorly supplied population. TRIAL REGISTRATION The trial is registered at ISRCTN55646265 ; February 15, 2019.
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Affiliation(s)
- Paul Gellert
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Ann-Kristin Beyer
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christina Tegeler
- MSB Medical School Berlin, Department of Psychology, Rüdesheimer Str. 50, 14197, Berlin, Germany
| | - Claudia Vathke
- MSB Medical School Berlin, Department of Psychology, Rüdesheimer Str. 50, 14197, Berlin, Germany
| | - Johanna Nordheim
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Adelheid Kuhlmey
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Eva-Marie Kessler
- MSB Medical School Berlin, Department of Psychology, Rüdesheimer Str. 50, 14197, Berlin, Germany
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Tesky VA, Schall A, Schulze U, Stangier U, Oswald F, Knopf M, König J, Blettner M, Arens E, Pantel J. Depression in the nursing home: a cluster-randomized stepped-wedge study to probe the effectiveness of a novel case management approach to improve treatment (the DAVOS project). Trials 2019; 20:424. [PMID: 31296264 PMCID: PMC6625077 DOI: 10.1186/s13063-019-3534-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Depression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents have minor or major depression. Although depressive disorders in old age can be improved and even cured with adequate therapy, they often go unnoticed in nursing home residents and remain untreated. This highlights a striking deficit in health care and might result not only in lower quality of life among those concerned but also in poor physical functioning, premature mortality, and increased hospitalization rates. Methods The aims of the interdisciplinary research project DAVOS are to implement an innovative and stepped structural case management program to improve depression treatment for nursing home residents by a modularized intervention and to assess it in terms of its effectiveness. Intervention modules are in line with recommendations given by the German national treatment guidelines for depression (S3 guidelines). Ten nursing homes in Frankfurt, Germany, will participate in the project, which aims to recruit a study population of 380. The recruitment will continue throughout the trial (open cohort). Persons (>60 years) who live in a nursing home, have no medical diagnosis of dementia, and can provide their informed consent to participate are eligible for inclusion in the study. Residents with a clinical diagnosis of dementia, alcohol or substance-related disorders, or other serious psychiatric illnesses will be excluded. DAVOS is a controlled cluster-randomized study that employs a stepped-wedge design. Discussion Our main hypothesis is that the implementation of the intervention will lead to a decline in the prevalence of depression and a reduction in depression symptoms among the home residents. In addition, we expect the intervention to have a positive impact on secondary outcomes such as level of functioning, quality of life, and social participation. The project’s results can make an important contribution toward improving the health care of nursing home residents who have late-life depression. Trial registration DRKS, DRKS00015686, Oct. 10, 2018.
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Affiliation(s)
- Valentina A Tesky
- Department of Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. .,Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany.
| | - Arthur Schall
- Department of Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany
| | - Ulrike Schulze
- Hessian Institute of Nursing Research (HessIP), Frankfurt University of Applied Sciences (Frankfurt UAS), Nibelungenplatz 3, Frankfurt am Main, 60318, Germany
| | - Ulrich Stangier
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, Frankfurt am Main, 60486, Germany
| | - Frank Oswald
- Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany.,Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany
| | - Monika Knopf
- Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University of Mainz, Langenbeckstraße 1, Mainz, 55131, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University of Mainz, Langenbeckstraße 1, Mainz, 55131, Germany
| | - Elisabeth Arens
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, Frankfurt am Main, 60486, Germany
| | - Johannes Pantel
- Department of Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Comparative validation of proxy-based Montgomery-Åsberg depression rating scale and cornell scale for depression in dementia in nursing home residents with dementia. Am J Geriatr Psychiatry 2012; 20:985-93. [PMID: 21989316 DOI: 10.1097/jgp.0b013e318233152b] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To 1) compare the accuracy of the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Cornell Scale for Depression in Dementia (CSDD) in nursing home residents with dementia when professional caregivers are the only available source of information and 2) explore different methods to account for missing items. DESIGN Cross-sectional design. SETTING Nursing home (NH). PARTICIPANTS One hundred one residents with dementia. MEASUREMENTS NH residents with dementia were assessed on the presence of clinical depression using Provisional Diagnostic Criteria for Depression of Alzheimer's Disease. The MADRS and CSDD were administered in a structured interview with professional primary caregivers. RESULTS Receiver operating characteristic analyses revealed no significant differences between areas under the empirical curve for MADRS and CSDD. Imputation of a lowest possible item score for missing items revealed larger areas than three other methods (significant result only for CSDD). A MADRS cutoff score of ">13" yielded the highest sum of sensitivity (78%) and specificity (66%). A CSDD cutoff score of ">6" yielded the highest sum of sensitivity (94%) and specificity (49%). Both scales showed high negative predictive values up to 100% and low positive predictive values not exceeding 50%. CONCLUSION The proxy-based MADRS and CSDD did not differ in distinguishing depressed from nondepressed NH residents and may be used for screening purposes. For missing items, imputation of a lowest possib le item score may be applied. The MADRS and CSDD may be better used for ruling out rather than for ruling in depression.
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Mitchell AJ, Kakkadasam V. Ability of nurses to identify depression in primary care, secondary care and nursing homes--a meta-analysis of routine clinical accuracy. Int J Nurs Stud 2010; 48:359-68. [PMID: 20580001 DOI: 10.1016/j.ijnurstu.2010.05.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 05/15/2010] [Accepted: 05/17/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE To clarify the ability of nurses and nursing assistants working in primary care, secondary care and nursing homes to identify depressed individuals using their clinical skills using meta-analysis of published studies. METHODS Literature search, appraisal and meta-analysis. We located 22 studies reporting on the detection of depression, 4 involving primary care or community nurses; 7 involving hospital nurses and 11 from nursing homes.17 of 22 studies had specificity data. RESULTS Across all 22 studies involving 7061 individuals, and a prevalence of 28.1% (95% CI=22.6-33.9%), practice and community nurses correctly identified 26.3% (95% CI=16.2-37.8%) of people with depression. They also correctly identified 94.8% (95% CI=91.3-97.4%) of the non-depressed. Nurses working in hospital settings correctly identified 43.1% (95% CI=31.9-54.8%) of people with depression and 79.6% (95% CI=71.5-86.7%) of the non-depressed. Those working in nursing homes correctly identified 45.8% (95% CI=38.1-53.6%) of people with depression and 80.0% (95% CI=68.6-88.7%) of the non-depressed. CONCLUSIONS Nurses have considerable difficulty accurately identifying depression but are probably at least as accurate as medical staff.
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Affiliation(s)
- Alex J Mitchell
- Liaison Psychiatry, Leicester General Hospital, Leicester LE5 4PW, United Kingdom.
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Abstract
OBJECTIVES Individual clinical interviews are typically viewed as the "gold standard" when diagnosing major depressive disorder (MDD) and when examining the validity of self-rated questionnaires. However, this approach may be problematic with older people, who are known to underreport depressive symptomatology. This study examined the effect of including an informant interview on prevalence estimations of MDD in an aged-care sample. DESIGN The results of an individual clinical interview for MDD were compared with those obtained when an informant interview was incorporated into the assessment. Results from each diagnostic approach were compared with scores on a self-rated depression instrument. SETTING Low-level aged-care residential facilities in Melbourne (equivalent to "residential homes," "homes for the elderly," or "assisted living facilities" in other countries). PARTICIPANTS One hundred and sixty-eight aged-care residents (mean age: 84.68 years; SD: 6.16 years) with normal cognitive functioning. MEASUREMENTS Individual clinical interviews were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders. This interview was modified for use with staff informants. Self-reported depression was measured using the Geriatric Depression Scale-15 (GDS-15). RESULTS The estimated point prevalence of MDD rose from 16% to 22% by including an informant clinical interview in the diagnostic procedure. Overall, 27% of depressed residents failed to disclose symptoms in the clinical interview. The concordance of the GDS-15 with a diagnosis of MDD was substantially lower when an informant source was included in the diagnostic procedure. CONCLUSION Individual interviews and self-report questionnaires may be insufficient to detect depression among older adults. This study supports the use of an informant interview as an adjunct when diagnosing MDD among cognitively intact aged-care residents.
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Hyer L, Yeager CA, Hilton N, Sacks A. Group, individual, and staff therapy: an efficient and effective cognitive behavioral therapy in long-term care. Am J Alzheimers Dis Other Demen 2008; 23:528-39. [PMID: 19001352 PMCID: PMC10846160 DOI: 10.1177/1533317508323571] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Depression is a major problem in long-term care (LTC) as is the lack of related empirically supported psychological treatments. This small study addressed a variant of cognitive behavioral therapy, GIST (group, individual, and staff therapy), against treatment as usual (TAU) in long-term care. METHOD 25 residents with depression were randomized to GIST (n = 13) or TAU (n = 12). Outcome measures included geriatric depression scale-short form (GDS-S), life satisfaction index Z (LSI-Z), and subjective ratings of treatment satisfaction. The GIST group participated in 15 group sessions. TAU crossed over to GIST at the end of the treatment trial. RESULTS There were significant differences between GIST and TAU in favor of GIST on the GDS-S and LSI-Z. The GIST group maintained improvements over another 14 sessions. After crossover to GIST, TAU members showed significant improvement from baseline. Participants also reported high subjective ratings of treatment satisfaction. DISCUSSION This trial demonstrated GIST to be more effective for depression in LTC than standard treatments.
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Affiliation(s)
- Lee Hyer
- Georgia Neurosurgical Institute, Macon, Georgia, USA
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