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Jedele JM, Curyto K, Ludwin BM, Karel MJ. Addressing Behavioral Symptoms of Dementia Through STAR-VA Implementation: Do Outcomes Vary by Behavior Type? Am J Alzheimers Dis Other Demen 2020; 35:1533317520911577. [PMID: 32237994 PMCID: PMC10623909 DOI: 10.1177/1533317520911577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The STAR-VA program in Veterans Health Administration Community Living Centers (CLCs, nursing home settings) trains teams to implement a psychosocial intervention with residents with behavioral symptoms of dementia (BSD). METHODS Across 71 CLCs, 302 residents selected as training cases had target behaviors categorized into one of 5 types: physically aggressive (PA), physically nonaggressive, verbally aggressive, verbally nonaggressive, and behavior deficit (BD). RESULTS Across all groups, there were significant declines in team-rated behavior frequency (36%) and severity (44%), agitation (10%), distress behaviors (42%), depression (17%), and anxiety (20%). The magnitude of changes varied across behavior category. For example, those with a PA target behavior experienced a greater percentage decline in agitation and distress behavior scores, and those with a BD target behavior experienced a greater percentage decline in depressive and anxiety symptoms. CONCLUSIONS STAR-VA, a multicomponent intervention, is generally effective across various types of behavioral symptoms associated with dementia.
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Affiliation(s)
- Jenefer M. Jedele
- Serious Mental Illness Treatment Resource Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, MI, USA
| | - Kim Curyto
- Center for Integrated Healthcare, VA Western NY Healthcare System, Department of Veterans Affairs, Batavia, NY, USA
| | - Brian M. Ludwin
- New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
- VA Boston Healthcare System, Department of Veterans Affairs, Brockton, MA, USA
| | - Michele J. Karel
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Washington, DC, USA
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Tonga JB, Eilertsen DE, Solem IKL, Arnevik EA, Korsnes MS, Ulstein ID. Effect of Self-Efficacy on Quality of Life in People With Mild Cognitive Impairment and Mild Dementia: The Mediating Roles of Depression and Anxiety. Am J Alzheimers Dis Other Demen 2020; 35:1533317519885264. [PMID: 31916847 PMCID: PMC10623983 DOI: 10.1177/1533317519885264] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the mediating effects of depression and anxiety in the relationship between self-efficacy and quality of life among people with mild cognitive impairment (MCI) or mild dementia. METHOD A total of 196 patients diagnosed with MCI or dementia due to Alzheimer disease completed structured measures of self-efficacy, quality of life, and depressive and anxiety symptoms. We examined direct and mediated effects by fitting structural equation models to data. RESULTS Our analyses supported that the effects of self-efficacy on quality of life may be partially mediated by depression and anxiety. Both anxiety and depression had significant mediating effects, with depression showing a stronger effect. CONCLUSION These results suggest that increased self-efficacy may have a positive effect on quality of life in people with MCI or dementia-partly by reducing depression and anxiety. These findings may have important practical implications for tailoring therapeutic interventions.
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Affiliation(s)
- Johanne B. Tonga
- Department of Old Age Psychiatry, Oslo University Hospital, Gaustad, Norway
- Norwegian Health Association, Oslo, Norway
- Institute of Psychology, University of Oslo, Norway
| | | | - Ingrid K. Ledel Solem
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Espen A. Arnevik
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Maria S. Korsnes
- Department of Old Age Psychiatry, Oslo University Hospital, Gaustad, Norway
- Institute of Psychology, University of Oslo, Norway
| | - Ingun D. Ulstein
- Department of Geriatric Medicine, Oslo University Hospital, Ullevål, Norway
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Noone D, Stott J, Aguirre E, Llanfear K, Spector A. Meta-analysis of psychosocial interventions for people with dementia and anxiety or depression. Aging Ment Health 2019; 23:1282-1291. [PMID: 30328711 DOI: 10.1080/13607863.2018.1495177] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: Assess the effectiveness of psychosocial interventions for depression and anxiety in people with dementia (PWD) or mild cognitive impairment (MCI). Method: OvidMedline, PsychInfo and Embase were searched for studies on the 5th August 2017. The efficacy of the studies was estimated using meta-analyses. Results: Eight RCTs were included. No RCTs were identified for people with MCI. Four RCTs found that psychosocial interventions (multicomponent intervention, Tai Chi, problem adaptation therapy and exercise/walking) were effective at reducing symptoms of depression in PWD who were depressed. One study (Tai Chi) found that these reductions were no longer evident at six-month follow-up. Another study, not included in the meta-analyses, found that pleasant events behaviour therapy and problem solving behaviour therapy improved depression symptoms and this effect remained significant at follow-up. Three RCTs found that psychosocial interventions (music therapy and cognitive behavioural therapy (CBT)) reduced symptoms of anxiety in PWD who were anxious. Evidence from two of these RCTs (music therapy and CBT) showed that these improvements were evident at three to six-month follow-up. Conclusion: The identified psychosocial interventions are effective at reducing symptoms of depression or anxiety in PWD experiencing these symptoms. This review is limited by the quality of studies, small sample sizes and the heterogeneity of the interventions, therefore high quality studies with larger sample sizes are required to test the efficacy of specific interventions such as CBT.
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Affiliation(s)
- Deirdre Noone
- a Department of Clinical, Education and Health Psychology, University College London , London , UK
| | - Josh Stott
- a Department of Clinical, Education and Health Psychology, University College London , London , UK
| | - Elisa Aguirre
- a Department of Clinical, Education and Health Psychology, University College London , London , UK.,b North East London NHS Foundation Trust, Research and development Department, Goodmayes Hospital , Ilford , UK
| | - Kelly Llanfear
- c The Wolfson Neurorehabilitation Centre, St Georges University Hospital NHS Foundation Trust , London , UK
| | - Aimee Spector
- a Department of Clinical, Education and Health Psychology, University College London , London , UK
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Abstract
This article discusses potential adaptations to cognitive behavioral therapy (CBT) needed when working with older adults. Although CBT has been demonstrated to be efficacious in older anxious populations in meta-analyses, more research is needed to better understand the efficacy of CBT for the individual anxiety disorders, for older adults aged 80 years and older, and the efficacy of individual CBT elements. Despite normal age-related reductions in cognitive and physical abilities, most research suggests that only minor adaptations to CBT, if any, are needed for older adults. More significant adaptations relate to therapist attitudes and beliefs rather than the pragmatic CBT delivery, for example, negative attitudes related to aging and the likely benefit of CBT. Despite normal age-related declines in some cognitive domains, research to date suggests that normal cognitive changes do not significantly impact on treatment outcomes over the course of CBT; a case example is presented.
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DiNapoli EA, Cully JA, Mott JM, Hundt NE, Mignogna J, Sansgiry S, Yu HJ, Trahan LH, Kunik ME. Mental health utilization among older Veterans with coexisting depression and dementia. SAGE Open Med 2015; 3:2050312114566488. [PMID: 26770761 PMCID: PMC4679217 DOI: 10.1177/2050312114566488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/28/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We compared mental health service utilization among older, depressed Veterans (60 years or older) with and without coexisting dementia. METHODS This retrospective study examined data from the 2010 Veterans Health Administration National Patient Care Database outpatient treatment files of Veterans with a newly recognized diagnosis of depression (N = 177,710). RESULTS Approximately 48.84% with coexisting depression and dementia and 32.00% with depression only received mental health services within 12 months of diagnosis (p < .0001). Veterans with coexisting depression and dementia were more likely to receive medication-management appointments (33.40% vs 20.62%), individual therapy (13.39% vs 10.91%), and family therapy (3.77% vs 1.19%) than depressed Veterans without dementia. CONCLUSION In general, Veterans with recently diagnosed depression are significantly underusing Veterans Affairs mental health treatment services. Those Veterans who have comorbid dementia are more likely than those with just depression to be enrolled in mental health treatments. Systemic improvements are needed to increase use of mental health services for older, depressed Veterans.
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Affiliation(s)
- Elizabeth A DiNapoli
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey A Cully
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
| | - Juliette M Mott
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, White River Junction, VT, USA
| | - Natalie E Hundt
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
| | - Joseph Mignogna
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
| | - Shubhada Sansgiry
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hong Jen Yu
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
| | - Lisa H Trahan
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Mark E Kunik
- VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
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Gregg JJ, Fiske A, Gatz M. Physicians' detection of late-life depression: the roles of dysphoria and cognitive impairment. Aging Ment Health 2013; 17:1030-6. [PMID: 23767897 PMCID: PMC3797862 DOI: 10.1080/13607863.2013.805403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine factors that impede or facilitate physicians' detection of depression in later life, including cognitive impairment and patients' endorsement of dysphoria. METHODS A population-based sample of 344 adults from the Swedish Adoption/Twin Study of Aging (SATSA) was utilized. Physician detection of depression was determined by (1) outpatient medical records, (2) antidepressant prescription, and/or (3) inpatient hospitalization. Depressive symptoms were measured by highest score on the Center for Epidemiologic Studies - Depression Scale (CES-D), administered on six occasions between 1986 and 1994. Endorsement of dysphoria was examined using two items on the CES-D. The Mini-Mental State Examination (MMSE) was used to indicate cognitive impairment. RESULTS One-hundred thirty-six individuals were above the cut-off on the CES-D on at least one occasion; however, only 14 of these individuals (10%) were detected as depressed by a physician. Higher CES-D total score was significantly related to physician detection. Furthermore, physicians were most likely to detect depression if the individual endorsed the single CES-D item regarding feeling depressed. A significant interaction was found, such that overall CES-D score was only associated with physician detection among those with higher endorsement of the depressed item. The association between total CES-D and physician detection was not affected by presence of cognitive impairment. CONCLUSIONS Depression in later life often goes undetected by physicians. Factors associated with detection include the frequency/severity of symptoms and patients' endorsement specifically of feeling depressed. Results suggest that physicians should routinely assess for other symptoms associated with late-life depression besides dysphoria (e.g., appetite loss, crying spells).
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Affiliation(s)
- Jeffrey J. Gregg
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Amy Fiske
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Margaret Gatz
- Department of Psychology, University of Southern California, Los Angeles, California,Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Vasse E, Vernooij-Dassen M, Cantegreil I, Franco M, Dorenlot P, Woods B, Moniz-Cook E. Guidelines for psychosocial interventions in dementia care: a European survey and comparison. Int J Geriatr Psychiatry 2012; 27:40-8. [PMID: 21370278 DOI: 10.1002/gps.2687] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 12/09/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The effectiveness of psychosocial interventions in treating people with dementia and their carers is increasingly emphasised in the literature. Dementia guidelines should summarise the scientific evidence and best practice that is currently available, therefore, it should include recommendations for psychosocial interventions. The aims of our study were (1) to collate dementia guidelines from countries across Europe and to check whether they included sections about psychosocial interventions, and (2) to compare the methodological quality and the recommendations for specific psychosocial interventions in these guidelines. METHODS The European dementia guidelines were inventoried. The methodological quality of the guideline sections for psychosocial interventions was assessed with the (AGREE) Appraisal of Guidelines Research and Evaluation instrument. The recommendations for specific psychosocial interventions were extracted from each of these guidelines and compared. RESULTS Guidelines for psychosocial interventions were found in five of 12 countries. Guideline developers, methodological quality and appreciation of available evidence influenced the inclusion of psychosocial interventions in dementia guidelines from Germany, Italy, the Netherlands, Spain and the UK. The UK NICE SCIE guideline had the best methodological quality and included the most recommendations for psychosocial interventions. Physical activity and carer interventions were recommended the most across all guidelines. CONCLUSION The inclusion of psychosocial interventions in dementia guidelines is limited across Europe. High-quality guidelines that include psychosocial interventions and are kept up to date with the emerging evidence are needed. Throughout Europe, special attention to the implementation of evidence-based psychosocial care is needed in the next few years.
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Affiliation(s)
- E Vasse
- Scientific Institute for Quality of Healthcare and Nijmegen Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Psychosocial interventions for late-life major depression: evidence-based treatments, predictors of treatment outcomes, and moderators of treatment effects. Psychiatr Clin North Am 2011; 34:377-401, viii. [PMID: 21536164 PMCID: PMC3099466 DOI: 10.1016/j.psc.2011.03.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This systematic review evaluates the efficacy of psychosocial interventions for the acute treatment of late-life depression and identifies predictors of treatment outcomes and moderators of treatment effects. Problem-solving therapy, cognitive behavioral therapy, and treatment initiation and participation program have supportive evidence of efficacy, pending replication. Although the data on predictors of treatment outcomes and moderators of treatment effects are preliminary, it appears that baseline anxiety and stress level, personality disorders, endogenous depression, and reduced self-rated health predict worse depression outcomes. Future research may examine the moderating effects of baseline depression severity and identify other clinical or demographic moderators.
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McCurry SM, Pike KC, Logsdon RG, Vitiello MV, Larson EB, Teri L. Predictors of short- and long-term adherence to a daily walking program in persons with Alzheimer's disease. Am J Alzheimers Dis Other Demen 2010; 25:505-12. [PMID: 20660515 DOI: 10.1177/1533317510376173] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine factors associated with adherence to a walking program in community-dwelling individuals with Alzheimer's disease (AD). METHODS Data were analyzed for 66 participants with AD asked to walk 30 continuous minutes per day. Adherence data (number of days walked, minutes walked, days walked 30+ minutes) were obtained from daily logs. Predictor variables included age, spousal relationship, health limitations, depression, participant dementia severity and behavioral disturbance, and caregiver stress and dementia management style. RESULTS During week 1, participants significantly (P < .0001) increased number of days walked/week compared to baseline. However, walking frequency and duration declined over 6 months. Nonwalkers had higher behavioral disruption scores. Regression analyses indicated that participants who walked more were less depressed. Caregivers of walking participants tended to be spouses, and reported less stress. CONCLUSIONS Both participant and caregiver factors (participant behavioral disruption and depression; caregiver stress and spousal relationship) impacted whether community-dwelling individuals with AD adhered to a walking program.
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Affiliation(s)
- Susan M McCurry
- Department of Psychosocial and Community Health, University of Washington, Seattle, 98115, USA.
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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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Stop Thinking and Start Doing: Switching From Cognitive Therapy to Behavioral Activation in a Case of Chronic Treatment-Resistant Depression. COGNITIVE AND BEHAVIORAL PRACTICE 2008. [DOI: 10.1016/j.cbpra.2008.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Late-life depression rarely occurs in isolation. Thus, screening for and assessment of late-life depression should always involve screening for other psychiatric disorders, including anxiety, personality disorders, and alcohol misuse. Comorbidity often makes treatment to relieve depressive symptoms more complicated, more comprehensive, and longer. Current late-life depression research indicates the strongest support for antidepressant medication and/or cognitive-behavioral therapy for comorbid anxiety, antidepressants and dialectical behavior therapy for comorbid personality disorders, and antidepressants and counseling for alcohol abuse that incorporates specific coping skills training for mood management, based on cognitive-behavioral principles. The clinician should provide sufficient psychoeducation for the older client and involve the client in treatment planning and progress evaluation. Very little research has specifically focused on treating depression and psychiatric comorbidity simultaneously, so additional research in this area is needed.
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Abstract
Dementia and depression are common disorders among elderly populations. Their frequent co-morbidity and similar presentations create a complex clinical scenario for the health care professional. The objective of this study was to determine common characteristics of older adults with dementia that were associated with depression. Data from a retrospective chart review of 242 patients visiting an outpatient geriatric clinic were analyzed to determine the potential relationship between depression and several social- and health-related variables. Results from regression analysis show that taking greater numbers of medications and living in a less independent environment were both associated with greater depression, while using alcohol was associated with less depression. This information could be easily obtained during an office visit and used to help identify patients who suffer from dementia and are at risk for depression and require further evaluation.
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