Depressive symptoms among older residents at nursing homes in Taiwan

Malnutrition and Depressive Symptoms in Elderly Palliative Care Patients

Objective: The aim of this study is to determine the prevalence of and relationship between malnutrition and depressive symptoms in older palliative care inpatients. Methods: One hundred and thirty-six older adults were included in the study. The Geriatric Depression Scale, Mini Nutritional Assessment Short Form, Mini Mental State Examination, Barthel index, and Lawton & Brody index were used to evaluate the mood, nutrition status, mental status, and activities of daily living of the patients. Results: The mean age of the patients was 74.88 ± 8.82 years, and 63.2% of the patients were female. According to the nutritional assessment, 39.7% of the patients suffered from malnutrition, while 47.1% were at risk for it, and depressive symptoms were detected in 79.4% of the patients. A strong negative correlation was found between the scores for nutritional and depressive symptoms (r = -.750, 95% CI = -.834 to -.668). Conclusion: Malnutrition, risk of malnutrition, and depressive symptoms were found to occur often among the patients, and the relationship between them was statistically significant. Our results highlight that the quality of life of palliative care patients could be improved by providing adequate nutrition and psychological support.

Social Connection in Long-Term Care Homes: A Scoping Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19

Objectives

Good social connection is associated with better health and wellbeing. However, social connection has distinct considerations for people living in long-term care (LTC) homes. The objective of this scoping review was to summarize research literature linking social connection to mental health outcomes, specifically among LTC residents, as well as research to identify strategies to help build and maintain social connection in this population during COVID-19.

Design

Scoping review.

Settings and Participants

Residents of LTC homes, care homes, and nursing homes.

Methods

We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified an aspect of social connection among LTC residents; we limited searches to English-language articles published from database inception to search date (July 2019). For the current analysis, we included studies that reported (1) the association between social connection and a mental health outcome, (2) the association between a modifiable risk factor and social connection, or (3) intervention studies with social connection as an outcome. From studies in (2) and (3), we identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID-19 and included the articles that informed these strategies.

Results

We included 133 studies in our review. We found 61 studies that tested the association between social connection and a mental health outcome. We highlighted 12 strategies, informed by 72 observational and intervention studies, that might help LTC residents, families, and staff build and maintain social connection for LTC residents.

Conclusions and Implications

Published research conducted among LTC residents has linked good social connection to better mental health outcomes. Observational and intervention studies provide some evidence on approaches to address social connection in this population. Although further research is needed, it does not obviate the need to act given the sudden and severe impact of COVID-19 on social connection in LTC residents.

Association between poor sleep quality and depression symptoms among the elderly in nursing homes in Hunan province, China: a cross-sectional study

OBJECTIVES

To examine the association between the prevalence of poor sleep quality and depression symptoms among the elderly in the nursing homes of Hunan province in China.

DESIGN, SETTING AND PARTICIPANTS

This was a cross-sectional study investigating 817 elderly people from 24 nursing homes in China's Hunan province.

MAIN OUTCOME MEASURES

Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) such that poor sleep quality was defined as PSQI Score >5. In addition, depression symptoms were assessed using the Geriatric Depression Scale (GDS). Linear regression models and binary logistic regression models were used to analyse the relationship between the prevalence of poor sleep quality and depression symptoms.

RESULTS

The mean PSQI Score was 8.5±4.9, and the prevalence of poor sleep quality was 67.3%. Additionally, the mean GDS Score was 9.8±7.5, and the prevalence of depression symptoms was 36.0%. Elderly people with poor sleep quality had increased GDS Score (mean difference=2.54, 95% CI 1.66 to 3.42) and increased risk of depression symptoms (OR=3.19, 95% CI 2.04 to 4.98) after controlling for demographics, chronic disease history, lifestyle behaviours, social support, activities of daily living and negative life events.

CONCLUSIONS

The prevalence of poor sleep quality was relatively high, and this was associated with increased depression symptoms. Therefore, poor sleep quality could be speculated as a marker of current depression symptoms in the elderly.

Depression among older adults in Malaysian daycare centres

With the older population increasing worldwide, depressive disorder in this cohort is a serious public health problem that contributes to increased healthcare costs and mortality. This study aimed to determine the prevalence of depression among older adults in Malaysia who attended a daycare centre and to identify the relationship between depression and demographic factors. A cross-sectional study was conducted with 159 older adults recruited following screening for mental capacity. The Malay Geriatric Depression Scale questionnaire was distributed among the participants to obtain descriptive data on the symptoms of depression. Some 59.1% of the participants experienced depression. The most common factors associated with depression were being divorced, low education levels and low income. The findings indicate the need to revise and re-evaluate the activities and programmes in daycare centres for older adults in order to objectively cater to their physical and emotional needs.

Effect of group reminiscence therapy on depression and perceived meaning of life of veterans diagnosed with dementia at veteran homes

Most senior veterans who live in veteran homes in Taiwan have few interpersonal relationships. Aging is often accompanied by solitude and illness, which causes senior veterans to doubt the meaning of life and to lose confidence in the value of life. This study tested the effectiveness of a group reminiscence therapy protocol on the depression and meaning of life among elderly institutionalized veterans. A quasi-experimental design was applied. A convenience sample of older adults was drawn from two veteran homes in southern Taiwan. Participants were assigned to intervention or control groups based on the veterans' homes they attended. The participants in the intervention group carried out group reminiscence therapy for 8 weeks in addition to their daily activities. The participants in the comparison group maintained their daily activities. Both groups were evaluated using the GDS-SF and MLS scale including two aspects of depression mood and meaning of life in weeks 1 and 8. The overall life satisfaction increased significantly over time for the intervention group compared to the comparison group from week 1 to week 8. The group reminiscence therapy programs showed promising effects in improving the depression and meaning of life of older veterans living in veteran homes.

Efficacy of a horticultural activity program for reducing depression and loneliness in older residents of nursing homes in Taiwan

Promoting psychological health in older populations is important. This study evaluated a horticultural activity program for reducing depression and loneliness in older residents of nursing homes in Taiwan. A convenience sample of 150 older residents of three nursing homes were recruited and randomly assigned to either an experimental group or a control group. The experimental group (n = 75) participated in an 8-week horticultural activity program. The control group (n = 75) received routine care. Generalized estimating equations analyses revealed significant time by treatment interaction effects for depression (p < .001) and loneliness (p < .001). This study provides a reference for improving psychological health in older people.

Nurses' confidence in providing and managing care for older persons with depressive symptoms or depression in long-term care facilities: A national survey

The prevalence of depressive symptoms among older residents in long-term care facilities (LTCFs) is high. Nurses are the main healthcare providers in LTCFs and also the persons responsible for detecting changes in residents' mental function and providing subsequent care. Therefore, it is necessary to understand nurses' knowledge, attitudes, and confidence regarding care for older residents with depressive symptoms or depression. This study aimed to understand nurses' level of knowledge of late-life depression, attitudes towards depression, and confidence levels in caring for older adults with depressive symptoms or depression in LTCFs. A cross-sectional descriptive and correlational research design was used. A nationwide self-report survey was conducted in 2016. Ultimately, 556 valid questionnaires were returned. The study found that LTCF nurses' knowledge about late-life depression was poor, and they also lacked confidence in managing and caring for older persons with depressive symptoms or depression, but nurses' attitudes towards depression were neutral or slightly positive. Moreover, nurses who had greater confidence in providing care for older persons with depression were those with more positive attitudes towards depression, a greater interest level in taking care of older adults with depression, less late-life depression knowledge, longer nursing experience in LTCFs, and a greater interest level in late-life depression issues, and who had read late-life depression pamphlets or taken courses or classes in late-life depression. The findings suggest an urgent need to develop strategies to improve nurses' late-life depression knowledge and increase their confidence in providing care to older residents with depressive symptoms or depression.

Prevalence of depressive symptoms in older nursing home residents with intact cognitive function in Taiwan

The investigators aimed to explore the prevalence of depressive symptoms and associated factors among older residents with intact cognitive function in nursing homes in Taiwan. A cross-sectional descriptive and correlational research design was used. A convenience sample of 178 older residents without cognitive impairment was recruited from 36 nursing homes in Southern Taiwan. The questionnaires included demographic data; the Barthel Index, which assesses the ability to perform activities of daily living; and the Geriatric Depression Scale Short Form. Among older residents in nursing homes with intact cognitive function, 39.3% had depressive symptoms. Age, religion, previous living status, previous working status, being totally dependent in physical function, and being severely dependent in physical function were significant predictors of depressive symptoms among cognitively intact older residents. The findings highlight the critical mental healthcare issues among older residents with intact cognitive function in nursing homes. Practical strategies for preventing the occurrence of depressive symptoms and caring for those who have depressive symptoms should be developed, especially for younger or dependent older residents or residents who have never been employed, have no religious beliefs, or have lived alone before they moved into an institution.

Multimorbidity and depression: A systematic review and meta-analysis

BACKGROUND

Multimorbidity, the presence of two or more chronic conditions, is increasingly common and complicates the assessment and management of depression. The aim was to investigate the relationship between multimorbidity and depression.

METHOD

A systematic literature search was conducted using the databases; PsychINFO, Medline, Embase, CINAHL and Cochrane Central. Results were meta-analysed to determine risk for a depressive disorder or depressive symptoms in people with multimorbidity.

RESULTS

Forty articles were identified as eligible (n = 381527). The risk for depressive disorder was twice as great for people with multimorbidity compared to those without multimorbidity [RR: 2.13 (95% CI 1.62-2.80) p<0.001] and three times greater for people with multimorbidity compared to those without any chronic physical condition [RR: 2.97 (95% CI 2.06-4.27) p<0.001]. There was a 45% greater odds of having a depressive disorder with each additional chronic condition compared to the odds of having a depressive disorder with no chronic physical condition [OR: 1.45 (95% CI 1.28-1.64) p<0.001]. A significant but weak association was found between the number of chronic conditions and depressive symptoms [r = 0.26 (95% CI 0.18-0.33) p <0.001].

LIMITATIONS

Although valid measures of depression were used in these studies, the majority assessed the presence or absence of multimorbidity by self-report measures.

CONCLUSIONS

Depression is two to three times more likely in people with multimorbidity compared to people without multimorbidity or those who have no chronic physical condition. Greater knowledge of this risk supports identification and management of depression.

Engaging Experts: Expanding Participation and Enhancing Research in Chinese Eldercare Institutions

Due to the myriad factors straining China's traditional family-based eldercare system, today unprecedented numbers of older adults are turning to institutions for caregiving needs. As researchers and policy makers organize conferences, analyze trends, and allocate resources, the subjective experiences of elders themselves are often forgotten or ignored. While providers recognize that institutionalized elders are at an increased risk for mental health issues, most cite personnel and resource shortages as insurmountable barriers to provision. Using examples from ethnographic research in Chinese eldercare institutions, this article examines the link between participation and mental health for contemporary Chinese elders and makes a case for expanding the role of elders in research in order to improve both the experience and understanding of institutional eldercare.

Seated Tai Chi versus usual activities in older people using wheelchairs: A randomized controlled trial

OBJECTIVE

Compare the effect of seated Tai Chi exercise (intervention) to usual activities on quality of life and depression symptoms in older people using wheelchairs.

DESIGN

Randomized controlled trial.

SETTING

One long-term care facility in Taiwan.

PARTICIPANTS

86 long-term care residents were screened; 60 were eligible and randomized to Tai Chi group (n=30), or usual activity (n=30).

INTERVENTION

One certified trainer provided the intervention group with 40min of seated Tai Chi exercise, three times a week for 26 weeks. Trial registration ACTRN12613000029796.

MAIN OUTCOME MEASURES

Quality of Life (WHOQOL (BREF)); depression symptoms (GDS-SF) RESULTS: Participants in the Tai Chi group (M=3.76, SD=3.65) recorded significantly lower GDS-SF scores than participants in the control (M=7.76, SD=5.15) and the Tai Chi group registered significantly higher scores across overall QOL [p=0.03], general health [p=0.04], and the associated domains: physical health [p=0.00], psychological health [p=0.02], social relations [p=0.00], and environment [p=0.00].

CONCLUSIONS

The findings highlight the importance of Tai Chi in improving QOL and depression in this population.

Sense of coherence among cognitively intact nursing home residents--a five-year longitudinal study

AIM AND OBJECTIVES

To examine how stable the sense of coherence (SOC) is over a five-year period among residents of nursing homes (NH) who are not cognitively impaired and whether components of social support influence SOC.

BACKGROUND

Many studies have investigated the stability of SOC, and the findings have been inconsistent. Social support is a crucial resource in developing SOC. Few researchers have studied the stability of SOC and how various social support dimensions influence changes in SOC among older NH residents who are cognitively intact.

DESIGN

The study was prospective and included baseline assessment and five-year follow-up.

METHODS

The sample comprised 52 cognitively intact NH residents (Clinical Dementia Rating score ≤0.5). We obtained data through direct interviews using the Social Provisions Scale and Sense of Coherence Scale.

RESULTS

SOC increased statistically significantly from baseline to follow-up. The social support subdimension reassurance of worth predicted change in SOC after adjustment for sociodemographic factors. When controlled for baseline SOC, attachment was associated with change in SOC, but reassurance of worth was not.

CONCLUSIONS

The study indicates that the change in SOC over time during the 5 years of follow-up and the social support dimension attachment appear to be important components of change in SOC. Nursing personnel should be aware of the residents' individual needs for attachment and the importance of emotional support for personal strength and ability to cope.

Sleep quality and depression of nursing home older adults in wheelchairs after exercises

BACKGROUND

Sleep disturbances and depression are costly and potentially disabling conditions that affect a considerable proportion of older adults. The purpose of this study was to test the effectiveness of 6 months of elastic band exercises on sleep quality and depression of wheelchair-bound older adults in nursing homes.

METHODS

One hundred twenty-seven older adults from 10 nursing homes participated in this cluster randomized controlled trial, and 114 completed the study. Participants were randomly assigned to two groups: experimental group (five nursing homes, n = 59) and control group (five nursing homes, n = 55). A 40-minute wheelchair-bound senior elastic band exercise program was implemented 3 times per week for 6 months. Sleep quality and depression of the participants were examined at baseline, after 3 months, and at the end of the 6-month study.

DISCUSSION

Participants in the experimental group had longer sleep durations, better habitual sleep efficiencies, and less depression than the control group at 3 months of the study and maintained them throughout the rest of the 6-month study.

CONCLUSIONS

Nursing home directors could recruit volunteers to learn the program and lead the elderly residents in wheelchairs in practicing the wheelchair-bound senior elastic band exercises regularly in the facilities.

Empirical study of the influence of a Laughing Qigong Program on long-term care residents

AIM

To determine the psychological and physiological effects of a Laughing Qigong Program on an elderly population in an institutionalized setting.

METHODS

Participants were recruited from a long-term care institution in northern Taiwan. A total of 99 residents were interviewed and 66 enrolled, there were 33 control participants and 33 experimental participants. The participants were matched according to their abilities as measured by the Barthel Index of Activities for Daily Living. Experimental participants attended the Laughing Qigong Program, twice a week for 4 weeks. Comparisons were made on the Mini-Mental State Examination, Faces Scale, Geriatric Depression Scale and cortisol levels.

RESULTS

Psychometric measures for participants in the experimental group improved, whereas those in the control group decreased. The experimental group showed the following changes: improved Mini-Mental State Examination scores (Z=-2.28; P<0.05), improved mood states (Z=-4.47; P<0.001) and decreased Geriatric Depression Scale scores (Z=3.79; P<0.001). There were no significant changes for the experimental group in cortisol levels. By comparison, the control group showed: decreased mood states (Z=2.53; P<0.011), increased Geriatric Depression Scale scores (Z=4.34; P<0.001) and significant increases in cortisol levels (Z=2.62; P<0.009).

CONCLUSIONS

The Laughing Qigong Program has shown to be an effective, cost-effective non-pharmacological therapy for cognitive impairment, mood states and elderly depression.

The association between participation in social activity and depressive symptoms in institutionalized elders in Taiwan

Depression can be a significant predictor of rapid health decline in institutionalized elders. Non-pharmacologic interventions for depression may include meaningful and enjoyable social activities. This cross-sectional, descriptive correlational study was to examine the associations between three components (frequency, meaningfulness and enjoyment) of nine types of social activities and depressive symptoms in a sample of Taiwanese elders living in long-term care facilities. Results indicated that meaningful and enjoyable activities were associated with fewer depressive symptoms among institutionalized elders. Clinically depressed elders (GDS score ≥ 6) were significantly less likely to report a sense of meaning in 6 of 9 social activities, or to report as enjoyable 7 of 9 social activities investigated. Findings suggest that elders' contemplate assignation of meaning of their subjective experiences with social activities, and it would behoove clinical nurses to pay attention to the essential purpose and perceived benefit of the designed social activities.

Prevalence and factors related to depressive symptoms among family caregivers of nursing home residents in Taiwan

PURPOSE

The purpose of this cross-sectional study was to understand the prevalence and risk factors for depressive symptoms among nursing home residents' family caregivers in Taiwan.

METHODS

Family caregivers (n = 191) of nursing home residents were recruited by stratified random sampling from 16 nursing homes throughout Taiwan. Data were collected from caregivers in face-to-face interviews on depressive status (using the Center for Epidemiologic Studies Depression Scale; CES-D), on meaning ascribed to visiting nursing home residents (using the Family Meaning of Nursing-Home Visits scale), and on demographic data. Factors related to depressive symptoms were analyzed by multiple logistic regression.

RESULTS

The prevalence of depressive status among family caregivers was 29.8 % as determined by the CES-D cutoff score of ≥10. The non-depressed group (CES-D <10) tended to visit residents for emotional maintenance (odds = 0.54), while the depressed group (CES-D ≥10) tended to visit due to sense of responsibility for monitoring care quality (odds = 3.25). These results demonstrate that risk factors for depressive symptoms in family caregivers were their age, self-perceived health status, education level, and being the resident's main caregiver before admission.

CONCLUSION

These results fill a gap in knowledge by providing detailed, evidence-based data on family caregivers' priorities for visiting nursing home residents and it is related to depression. These results also provide useful information for designing intervention protocols to reduce depressive symptoms in family caregivers of nursing home residents, not only in Asian countries, but also in western countries with many Chinese/Asian immigrants.

Factors associated with depressive symptoms in older Taiwanese adults in a long-term care community

BACKGROUND

This study was to examine culturally based factors as potential predictors of depressive symptoms in older Taiwanese adults living in eight long-term care institutions in southern Taiwan.

METHOD

A cross-sectional, exploratory design study was used with a purposive sample of 156 participants with a mean age of 79.80 ± 7.14 years. Measurements included filial responsibility expectation questions, two questions about degrees of acceptance of institutionalization, Perceived Stress Scale, Self-Transcendence Scale, and Geriatric Depression Scale.

RESULTS

An elder's willingness to be institutionalized, an elder's willingness to remain institutionalized, perceived stress, and self-transcendence were significantly associated with depressive symptoms (r = -0.35; -0.49; 0.60; and -0.67, respectively). Although no evidence for the relationship between filial responsibility and depressive symptoms was found in this study, there was evidence that filial responsibility was highly valued. Self-transcendence was the strongest predictor of depressive symptoms, accounting for 45% of the variance.

CONCLUSION

These findings provide insight into the cultural factors associated with depressive symptoms and support the need of timely interventions for institutionalized Taiwanese elderly population.

Health-promoting lifestyle and depression in metabolic syndrome patients in Korea

This cross-sectional study assessed the association between health-promoting lifestyle and depression in metabolic syndrome patients by using a questionnaire survey in Korea. Data were collected from 195 adults (> 20 years old) with hypertension, dyslipidemia and diabetes. The correlation coefficient (r) between health-promoting lifestyle and depression was -0.309 (P < 0.001), and correlation between individual lifestyle dimensions and depression varied from -0.135 to -0.391. The non-depressed group had higher health-promoting lifestyle scores than the depressed group (P = 0.003). Scores for three dimensions of the health-promoting lifestyle profile--self-actualization (P < 0.001), interpersonal support (P = 0.001) and stress management (P = 0.025)--were significantly higher in the non-depressed groups. Logistic regression analysis provided an odds ratio of 2.766 (P = 0.003) for health-promoting lifestyle between the two groups. For patients with metabolic syndrome, depression was negatively associated with health-promoting lifestyle and is an important factor affecting health-promoting behaviour.

Association between obesity and depression: evidence from a longitudinal sample of the elderly in Taiwan

OBJECTIVES

Obesity has been identified as an epidemic worldwide. In Taiwan, the highest prevalence of obesity is observed in adults age ≥65. This article investigates the effects of body weight status on the likelihood of depression among the elderly in Taiwan.

METHOD

A longitudinal sample of the elderly (1351 males and 1165 females) interviewed in both the 1999 and 2003 Surveys of Health and Living Status of the Elderly in Taiwan is used. A random effect logit model is estimated to examine the effects of body weight status, lifestyle, and socio-demographic characteristics on the likelihood of depression.

RESULTS

About 10.4% of the elderly men are overweight and 13.4% are obese in 2003. A higher prevalence of obesity is found among elderly women, with 19.3% being overweight and 26.4% obese. Elderly men who are underweight are more likely to be depressed (odds ratio; OR = 2.36) than those from other weight categories, while overweight and obese women are less likely to be depressed (ORs = 0.72 and 0.61) than elderly women of the normal weight category.

CONCLUSIONS

In contrast to most findings for the Western countries, a negative association between obesity and depression of the elderly is evident in Taiwan. The different findings between Western and Asian countries may be due to the cultural differences. Unlike the Western countries that stigmata are attached to excessive overweight, being overweight is not a symbol of unhealthiness because only the wealthy can afford to eat more and put on more weight in the Chinese society.

The impact of foreign caregiving on depression among older people in Taiwan: model testing

AIM

  This article is a report of a study of predicting the factors that influence depression in the older people in Taiwan. Background.  In 1991, Taiwan opened the labour market to foreign caregivers for the older people who needed long-term care. With the differences in language, culture and lifestyle between foreign caregivers and older people in Taiwan, it was hypothesized that the older people would not be able to relate to them, and therefore become depressed.

METHODS

  The data were collected from 116 Taiwanese older people from July to September, 2005. Path analysis using multiple regression analyses was conducted to estimate the direct and indirect effects of caregiving communication, activities of daily living, income and social support on depression among older people in Taiwan. To evaluate the hypotheses for this research, bi-variate linear regression and multiple regression analyses were used.

RESULTS/FINDINGS

  The results indicated that the level of activities of daily living (β = -0·201, P = 0·010), care-giving communication (β = -0·272, P = 0·002) income (β = -0·305, P = 0·000) and social support (β = -0·276, P = 0·002) were the predictors of depression in older people in Taiwan. Social support was a mediating factor for caregiving communication and depression. Furthermore, foreign caregiver care was not correlated with depression among older people in Taiwan.

CONCLUSIONS

  The findings influence the public awareness of depression in older people, and provide the foundational information to influence the policy makers of Taiwan to evaluate the foreign caregiver policy.

Depression in older people living in residential homes

There is a large body of published research relating to depression in residential homes for older people (also called long-term-care homes, and including both nursing homes and hostels) (Ames 1990; 1993; Seitzet al., 2010; Snowdon and Purandare, 2010; Snowdon, 2010). However, despite increased detection and more frequent treatment in recent years, depression remains a significant problem for many older people living in such settings. This guest editorial summarizes current knowledge about prevalence, etiology, detection and screening, treatment and outcomes of depression in residential homes and concludes with a summary of key issues requiring urgent future action.

Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review

BACKGROUND

The population of older adults in long-term care (LTC) is expected to increase considerably in the near future. An understanding of the prevalence of psychiatric disorders in LTC will help in planning mental health services for this population. This study reviews the prevalence of common psychiatric disorders in LTC populations.

METHODS

We searched electronic databases for studies on the prevalence of major psychiatric disorders in LTC using medical subject headings and key words. We only included studies using validated measures for diagnosing psychiatric disorders or psychiatric symptoms. Our review focused on the following psychiatric disorders: dementia, behavioral and psychological symptoms of dementia (BPSD), major depression, depressive symptoms, bipolar disorder, anxiety disorders, schizophrenia, and alcohol use disorders. We also determined the prevalence of psychiatric disorders in the U.S. LTC population using data from the 2004 National Nursing Home Survey (NNHS).

RESULTS

A total of 74 studies examining the prevalence of psychiatric disorders and psychological symptoms in LTC populations were identified including 30 studies on the prevalence of dementia, 9 studies on behavioral symptoms in dementia, and 26 studies on depression. Most studies involved few LTC facilities and were conducted in developed countries. Dementia had a median prevalence (58%) in studies while the prevalence of BPSD was 78% among individuals with dementia. The median prevalence of major depressive disorder was 10% while the median prevalence of depressive symptoms was 29% among LTC residents. There were few studies on other psychiatric disorders. Results from the 2004 NNHS were consistent with those in the published literature.

CONCLUSIONS

Dementia, depression and anxiety disorders are the most common psychiatric disorders among older adults in LTC. Many psychiatric disorders appear to be more prevalent in LTC settings when compared to those observed in community-dwelling older adults. Policy-makers and clinicians should be aware of the common psychiatric disorders in LTC and further research into effective prevention and treatments are required for this growing population.

Videoconference program enhances social support, loneliness, and depressive status of elderly nursing home residents

OBJECTIVES

The purpose of this quasi-experimental study was to evaluate the effectiveness of a videoconference intervention program in improving nursing home residents' social support, loneliness, and depressive status.

METHODS

Fourteen nursing homes were selected from various areas of Taiwan by purposive sampling. Elderly residents (N = 57) of these nursing homes, who met our inclusion criteria were divided into experimental (n = 24) and control (n = 33) groups. The experimental group received five min/week of videoconference interaction with their family members for three months, and the control group received regular care only. Data were collected through face-to face interviews on social support, loneliness, and depressive status using the Social Supportive Behavior Scale, University of California Los Angeles Loneliness Scale, and Geriatric Depression Scale, respectively, at three points (baseline, one week, and three months after baseline). Data were analyzed using the generalized estimating equation approach.

RESULTS

Subjects in the experimental group had significantly higher mean emotional and appraisal social support scores at one week and three months after baseline than those in the control group. Subjects in the experimental group also had lower mean loneliness scores at one week and three months after baseline than those in the control group, and lower mean depressive status scores at three months after baseline.

CONCLUSION

Our videoconference program alleviated depressive symptoms and loneliness in elderly residents in nursing homes. Our findings suggest that this program could be used for residents of long-term care institutions, particularly those with better ability to perform activities of daily living.

Depression in the first year of stay for elderly long-term nursing home residents in the USA

BACKGROUND

Understanding the prevalence, incidence and cofactors of depression among long-term elderly nursing home (LTNH) residents domiciled for eight months or more may help optimize depression treatment in this vulnerable group. We quantified first year depression in American LTNH residents and the associations between depression and resident/facility characteristics.

METHODS

Data were obtained from the Minimum Data Set and Online Survey Certification and Reporting for 634,060 LTNH residents admitted from 1999 to 2005 in 4,216 facilities. Depression first diagnosed at admission and at subsequent quarterly intervals through the first year of stay was examined. Logistic regressions modeled correlates of newly identified depression in each time-period.

RESULTS

Recorded depression at admission and during the first year increased from 1999 to 2005. By 2005, 54.4% of LTNH residents had depression diagnosed over the first year; 32.8% at admission and a further 21.6% later during the first year. Antidepressant use was reported prior to depression diagnosis for 48% of those first identified depressed after admission. Men, non-Hispanic blacks, never married, and severely-cognitively impaired LTNH residents were less often identified with depression, particularly at admission. Pain and physical comorbidity were positively associated with depression identified throughout the first year. Prior institutionalization was associated with depression at admission, but not new depression after admission. Facility characteristics had weaker associations with depression.

CONCLUSIONS

High depression rates at admission and during the first year indicate a need to monitor and treat large numbers of American LTNH residents for depression. Reduced associations between demographics and depression as stays progress suggest other factors have increased roles in depression etiology.

Effects of yoga on sleep quality and depression in elders in assisted living facilities

BACKGROUND

Being relocated to an assisted living facility can result in sleep disturbances and depression in elders. This may be attributed to or worsened by lack of regular physical activity. Appropriate exercise programs may be an important component of quality of life in this group of transitional frail elders.

PURPOSE

This study aimed to test the effects of a 6-month yoga exercise program in improving sleep quality and decreasing depression in transitional frail elders living in assisted living facilities.

METHODS

A quasi-experimental pretest-and-posttest design was used. A convenience sample of 69 elderly residents of assisted living facilities was divided randomly into a yoga exercise (n = 38) and control group (n = 31) based on residence location. A total of 55 participants completed the study. The intervention was implemented in three small groups, and each practice group was led by two pretrained certified yoga instructors three times per week at 70 min per practice session for 24 weeks. The outcome measures of sleep quality (Pittsburgh Sleep Quality Index) and depression state (Taiwanese Depression Questionnaire) were examined at baseline, at the 12th week, and at the 24th week of the study.

RESULTS

After 6 months of performing yoga exercises, participants' overall sleep quality had significantly improved, whereas depression, sleep disturbances, and daytime dysfunction had decreased significantly (p < .05). In addition, participants in the intervention group had better results on all outcome indicators than those of participants in the control group (p < .05).

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

It is recommended that yoga exercise be incorporated as an activity program in assisted living facilities or in other long-term care facilities to improve sleep quality and decrease depression in institutionalized elders.

Levels and rates of depression among Chinese people living in Chinese ethno-specific and mainstream residential care in Sydney

BACKGROUND

This study aimed to examine the levels and rates of depression in Chinese residents living in ethno-specific nursing homes (NHs), and Chinese residents living in mainstream NHs in Sydney. Australia has a growing aging migrant population and rates of depression in NHs are high, but the prevalence of depression in culturally and linguistically diverse residents has received little attention in the research literature.

METHODS

Older persons from a Chinese background residing in either Chinese-specific or mainstream NHs located in Sydney were invited to participate in a cross-sectional survey. Assessments included the Mini-mental State Examination, the Cornell Scale for Depression in Dementia (CSDD), and interviews with family carers and staff.

RESULTS

Fifty-eight Chinese residents were recruited from three Chinese-specific NHs (n = 31) and 13 mainstream NHs (n = 27). There were no significant differences in resident depression levels or rates between the facility types. Mean CSDD scores were 9.4 (SD = 6.0) and 11.2 (SD = 6.1) in Chinese-specific and mainstream NHs, respectively. Chinese-specific NH residents had lower prescription levels of antipsychotics and more of them received effective antidepressant therapy in comparison to those in mainstream NHs.

CONCLUSIONS

These findings suggest that in comparison to mainstream care Chinese ethno-specific care does not impact on levels or rates of depression but is associated with less antipsychotic use and higher numbers of residents treated effectively with antidepressant therapy. Longitudinal research with larger samples and a range of outcome measures including quality-of-life and social engagement is required to explore further the effects of ethno-specific care.

The impact of social support and sense of coherence on health-related quality of life among nursing home residents--a questionnaire survey in Bergen, Norway

BACKGROUND AND OBJECTIVES

Few studies have examined the association between social support and health-related quality of life (HRQOL) among nursing home residents and whether the sense of coherence (SOC) modifies the effect of social support on health-related quality of life. The main aims of this study were to determine the relationship between social support and HRQOL and to investigate whether the SOC modifies the effect of social support on HRQOL.

DESIGN

A cross-sectional, descriptive, correlational design.

SETTINGS

All 30 nursing homes in Bergen in western Norway.

PARTICIPANTS

Two hundred and twenty-seven mentally intact long-term nursing home residents 65 years and older.

METHODS

Data were obtained through face-to-face interviews using the SF-36 Health Survey, Social Provisions Scale and Sense of Coherence Scale. Possible relationships between the Social Provisions Scale and the eight SF-36 subdimensions were analysed using multiple linear regression while controlling for age, sex, marital status, education and comorbid illness. Interactions between the Sense of Coherence Scale and Social Provisions Scale were investigated.

RESULTS

Attachment affected the mental health subdimension (p=0.001), opportunity for nurturance affected social functioning (p=0.003) and reassurance of worth affected vitality (p=0.001) after adjustment for demographic variables and comorbid illness. After the analysis included the sense of coherence, nurturance still significantly affected social functioning and reassurance of worth still significantly affected vitality. No interaction with sense of coherence was found, and sense of coherence significantly affected all SF-36 subdimensions.

CONCLUSIONS

The opportunity to provide nurturance for others appears to be important for social functioning, and sense of competence and sense of self-esteem appear to be important for vitality. Further, the residents' relationships with significant others comprise an important component of mental health. Finally, independent of the level of sense of coherence, social support is an important resource for better health-related quality of life. Clinical nurses should recognize that social support is associated with health-related quality of life and pay attention to the importance of social support for the residents in daily practice.