Depressive symptoms in long term care facilities in Western Canada: a cross sectional study

Living environment, service quality satisfaction and depression among Chinese older adults in elderly caring social organizations

BACKGROUND

Older adults living in elderly caring social organizations (SOs) are prone to suffer from depression. Many studies have found correlations between environmental and quality-of-life factors and depression; however, evidence from elderly caring SOs is rare, particularly in China.

METHODS

A cross-sectional study was conducted among service recipients in elderly caring SOs in Anhui and Chongqing, China. Data on demographic and health-related characteristics, living environment factors, and service quality satisfaction factors in 2171 older adults were used for analysis. The binary logistic regression model was conducted to estimate the association between living environment and service quality satisfaction factors and depression.

RESULTS

Our results indicated that living environment factors in terms of exposure to suitable temperature and humidity (OR = 0.655; 95 % CI: 0.446, 0.963), green coverage >30 % (OR = 0.432; 95 % CI: 0.337, 0.553) were associated with lower odds of developing depression. Also, an opposite relationship was found in the noise factor (OR = 1.985; 95 % CI: 1.395, 2.823). Higher satisfaction with admission and discharge services, dietary services, entertainment services, and psychological support services were also found to be associated with a lower risk of depression.

LIMITATIONS

A cross-sectional design precluded determining whether living environment, service quality satisfaction, and depression are causally related. Measurement of living environment factors and service quality satisfaction factors needs to be further clarified comprehensively.

CONCLUSIONS

Enhancing the living environment and the quality of the services provided to seniors in the elderly caring SOs is conducive to the reduction of the likelihood of depression.

Effects of A meaning in life enhancement program on depression among older adult residents of assisted living facilities

Older adults residing in assisted living facilities often experience higher rates of depression. This study aimed to examine the effects of a program to enhance meaning in life on depression among older adult residents. The samples included 60 older adults living in two assisted living facilities. The experimental group participated in the meaning in life enhancement program, while the control group received routine nursing care only. The program was developed based on Frankl's theory of meaning in life within the Thai context. The Thai Geriatric Depression Scale was used to collect data. Descriptive statistics and t-test were used for data analysis. The results were as follows: 1) The mean depression scores after participating in the program were statistically and significantly lower than before; 2) There was a statistically significant difference in depression scores between the experimental and control groups, with the experimental group exhibiting lower depression scores. The findings suggest that the meaning in life enhancement program decreased the depression of older adults residing in assisted living facilities.

Depression detection in dementia: A diagnostic accuracy systematic review and meta analysis update

Background

Depression is common in persons with dementia and is often under-detected and under-treated. It is critical to understand which available tools accurately detect depression in the context of dementia.

Methods

We updated our systematic review completed in 2015. The search strategy of our original review was replicated in Medline, Embase, and PsycINFO. Studies describing the use of a tool to identify depression in persons with dementia, compared to a criterion standard, and reporting diagnostic accuracy outcomes were included in the review update. Pooled prevalence estimates of major depression and pooled estimates of diagnostic accuracy outcomes (i.e., sensitivity [SN], specificity [SP]) for tools were calculated.

Results

Three studies were included of the 8980 returned from the database search and were added to the prior 20 articles from the 2015 review. The Cornell Scale for Depression in Dementia (CSDD), Geriatric Depression Scale (GDS)-15 item, Neuropsychiatric Inventory-Depression items (NPI-D), and Depression in Old Age Scale (DIA-S) were evaluated in the three studies. Two new studies were added to the existing pooled prevalence estimate of major depression (29%, 95% confidence interval [CI] = 21.6%-36.5%, n = 17) and pooled diagnostic accuracy estimate for the CSDD at the best cut-off (SN = 0.83, 95% CI = 0.74-0.90; SP = 0.81, 95% CI = 0.69-0.89). New pooled diagnostic accuracy estimates were completed for the CSDD (cut-off ≥12) (SN = 0.61, 95% CI = 0.42-0.77; SP = 0.83, 95% CI = 0.76-0.88), GDS-15 (best cut-off) (SN = 0.65, 95% CI = 0.40-0.83; SP = 0.72, 95% CI = 0.55-0.85), and Montgomery Asberg Depression Rating Scale (MADRS) (best cut-off) (SN = 0.77, 95% CI = 0.67-0.85; SP = 0.68, 95% CI = 0.60-0.75).

Conclusions

The CSDD continues to have the most evidence for depression case finding in persons living with dementia. The CSDD and Hamilton Depression Rating Scale have the highest sensitivities and may be recommended for use over other common tools like the GDS-15 and MADRS. Newly identified tools like the NPI-D and DIA-S require further study before they can be recommended for use in practice.

Long-term care home residents' experiences with socially assistive technologies and the effectiveness of these technologies: a mixed methods systematic review

OBJECTIVE

The objectives of this review were to determine the effectiveness of socially assistive technologies for improving depression, loneliness, and social interaction among residents of long-term care (LTC) homes, and to explore the experiences of residents of LTC homes with socially assistive technologies.

INTRODUCTION

Globally, the number of older adults (≥ 65 years) and the demand for LTC services are expected to increase over the next 30 years. Individuals within this population are at increased risk of experiencing depression, loneliness, and social isolation. The exploration of the extent to which socially assistive technologies may aid in improving loneliness and depression while supporting social interactions is essential to supporting a sustainable LTC sector.

INCLUSION CRITERIA

This mixed methods systematic review included studies on the experiences of older adults in LTC homes using socially assistive technologies, as well as studies on the effectiveness of these technologies for improving depression, loneliness, and social interaction. Older adults were defined as people 65 years of age and older. We considered studies examining socially assistive technologies, such as computers, smart phones, tablets, and associated applications.

METHODS

A JBI mixed methods convergent, segregated approach was used. CINAHL (EBSCOhost), MEDLINE (Ovid), Embase, APA PsycINFO (EBSCOhost), and Scopus databases were searched on January 18, 2022, to identify published studies. The search for unpublished studies and gray literature included ProQuest Dissertations and Theses Global, Open Access Theses and Dissertations, Google, and the websites of professional organizations associated with LTC. No language or geographical restrictions were placed on the search. Titles, abstracts, and full texts of included studies were screened by 2 reviewers independently. Included studies underwent quality appraisal and data extraction. Quantitative and qualitative data findings were analyzed separately and then integrated. Where possible, quantitative data were synthesized using comparative meta-analyses with a fixed-effects model.

RESULTS

From 12,536 records identified through the search, 14 studies were included. Quantitative (n=8), mixed methods (n=3), and qualitative (n=3) approaches were used in the included studies, with half (n=7) using quasi-experimental designs. All studies received moderate to high-quality appraisal scores. Comparative meta-analyses for depression and loneliness scores did not find any significant differences, and narrative findings were mixed. Qualitative meta-aggregation identified 1 synthesized finding (Matching technology functionality to user for enhanced well-being) derived from 2 categories (Enhanced sense of well-being, and Mismatch between technology and resident ability).

CONCLUSIONS

Residents' experiences with socially assistive technologies, such as videoconferencing, encourage a sense of well-being, although quantitative findings related to depression and loneliness reported mixed impact. Residents experienced physical and cognitive challenges in learning to use the technology and required assistance. Future work should consider the unique needs of older adults and LTC home residents in the design and use of socially assistive technologies.

REVIEW REGISTRATION

PROSPERO CRD42021279015.

The Effect of Social Robots on Depression and Loneliness for Older Residents in Long-Term Care Facilities: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVES

Depression and loneliness are challenges facing older residents living in long-term care facilities. Social robots might be a solution as nonpharmacologic interventions. The purpose of this study was to explore the effects of concrete forms of social robots on depression and loneliness in older residents in long-term care facilities by a systematic review and meta-analysis of randomized controlled trials.

DESIGN

This is a systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Older residents in long-term care facilities.

METHODS

Six electronic databases of PubMed, Embase, Scopus, Web of Science, MEDLINE, and CINAHL plus were searched in August 2023. Random effect models of meta-analyses, subgroup analyses, and meta-regressions were performed for statistical analyses.

RESULTS

After evaluation, 8 studies were selected for both qualitative and quantitative synthesis. Social robot interventions had significant positive effects on decreasing depression and loneliness with large effect sizes. Group-based robot activities had a better effect on improving depression than individual-based robot activities. Longer durations of interventions produced significantly more improvement in depression.

CONCLUSION AND IMPLICATION

Social robots with physical manifestation provide the opportunity for older adults' social engagement and interactions with robots and others. Social robot interventions are recommended for older residents in long-term care facilities to promote psychosocial well-being in daily care routines.

Counting what counts: assessing quality of life and its social determinants among nursing home residents with dementia

BACKGROUND

Maximizing quality of life (QoL) is a major goal of care for people with dementia in nursing homes (NHs). Social determinants are critical for residents' QoL. However, similar to the United States and other countries, most Canadian NHs routinely monitor and publicly report quality of care, but not resident QoL and its social determinants. Therefore, we lack robust, quantitative studies evaluating the association of multiple intersecting social determinants with NH residents' QoL. The goal of this study is to address this critical knowledge gap.

METHODS

We will recruit a random sample of 80 NHs from 5 Canadian provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario). We will stratify facilities by urban/rural location, for-profit/not-for-profit ownership, and size (above/below median number of beds among urban versus rural facilities in each province). In video-based structured interviews with care staff, we will complete QoL assessments for each of ~ 4,320 residents, using the DEMQOL-CH, a validated, feasible tool for this purpose. We will also assess resident's social determinants of QoL, using items from validated Canadian population surveys. Health and quality of care data will come from routinely collected Resident Assessment Instrument - Minimum Data Set 2.0 records. Knowledge users (health system decision makers, Alzheimer Societies, NH managers, care staff, people with dementia and their family/friend caregivers) have been involved in the design of this study, and we will partner with them throughout the study. We will share and discuss study findings with knowledge users in web-based summits with embedded focus groups. This will provide much needed data on knowledge users' interpretations, usefulness and intended use of data on NH residents' QoL and its health and social determinants.

DISCUSSION

This large-scale, robust, quantitative study will address a major knowledge gap by assessing QoL and multiple intersecting social determinants of QoL among NH residents with dementia. We will also generate evidence on clusters of intersecting social determinants of QoL. This study will be a prerequisite for future studies to investigate in depth the mechanisms leading to QoL inequities in LTC, longitudinal studies to identify trajectories in QoL, and robust intervention studies aiming to reduce these inequities.

Association between use of different long-term care services and risks of mental disorder and mortality as well as medical utilization

Objective

This study sought to investigate mental disorder and mortality risks and medical utilization among various long-term care (LTC) services and examine the associated factors.

Methods

This retrospective cohort study used data from the National Health Insurance Research Database of the entire population of Taiwan recorded between 2006 and 2017. A total of 41,407 patients using LTC (study group) were identified and propensity score-matched with 41,407 LTC nonusers (control group) at a ratio of 1:1 according to sex, age, salary-based premium, comorbidity index score, and urbanization level. Patients were divided into four groups according to LTC service type. The age distribution was as follows: 50-60 years (10.47%), 61-70 years (14.48%), 71-80 years (35.59%), and 81 years and older (39.45%). The mean age was 70.18 years and 53.57% of female participants were included. The major statistical methods were the Cox proportional hazards model and the general linear model (GLM).

Results

Users of both institutional and inhome LTC services had the highest risk of mental disorder [adjusted hazard ratio (aHR) = 3.2]. The mean mortality rate in LTC nonusers was 46.2%, whereas that in LTC users was 90.4%, with the highest found among the users of both institutional and inhome LTC (90.6%). The institutional LTC users had the shortest survival time (4.1 years). According to the adjusted Cox model analysis, the odds of mortality was significantly higher among institutional LTC users than among inhome LTC users (aHR = 1.02). After the adjustment of covariates, adjusted GLM model results revealed that the annual medical expenditure per capita of LTC nonusers was NT$46,551, which was 1.6 times higher that of LTC users.

Conclusion

Users of both institutional and inhome LTC services have higher risk of mental disorder, shorter survival time, and lower medical utilization.

Depression within the First Year of Relocation to Residential Care/Assisted Living: Where You Come From Matters

Depression is common within the first year of relocation to residential care/assisted living (RC/AL). Yet, few studies investigate the relationship between depression and relocation factors that might help identify at-risk residents, such as previous location. This study analyzed cross-sectional resident data (n = 2651) from the National Survey of Residential Care Facilities to test: (1) group differences between residents relocating from acute/post-acute facilities (e.g., hospital, rehabilitation facility) and community-based residences, and (2) the relationship between previous location and depression within the first year of relocation. The 921 (35%) residents relocating directly from acute/post-acute facilities were more likely to have depression (p < .001) and poorer outcomes on select health and psychosocial variables. After controlling for covariates, relocating directly from an acute/post-acute facility significantly related to depression (OR = 1.22). Findings highlight opportunities to improve routine screening and transitional care for this subpopulation of RC/AL residents at heightened risk for depression.

Loss, Unresolved Trauma and Gaps in Staff Knowledge: A Qualitative Study on Older Adults Living in Residential Aged Care

Despite the prevalence of mental health concerns among those who live in residential aged care, many residential aged care facilities (RACFs) provide little by way of psychological support. Drawing on qualitative data obtained from interviews with residents from across 15 RACFs in Victoria, Australia, this article adds to understandings about the diversity and impact of mental health challenges experienced by residents, and gaps in the knowledge of staff about how to address such. Thus, it also offers evidence of the urgent need for RACFs to provide residents both better access to specialist mental health practitioners and training to care staff on mental health issues.

Detecting depression in persons living in long-term care: a systematic review and meta-analysis of diagnostic test accuracy studies

OBJECTIVE

Depressive disorders are common in long-term care (LTC), however, there is no one process used to detect depressive disorders in this setting. Our goal was to describe the diagnostic accuracy of depression detection tools used in LTC settings.

METHODS

We conducted a systematic review and meta-analysis of diagnostic accuracy measures. The databases PubMed, EMBASE, PsycINFO and CINAHL were searched from inception to 10 September 2021. Studies involving persons living in LTC, assisted living residences or facilities, comparing diagnostic accuracy of depression tools with a reference standard, were included. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess risk of bias.

RESULTS

We identified 8,463 citations, of which 20 studies were included in qualitative synthesis and 19 in meta-analysis. We identified 23 depression detection tools (including different versions) that were validated against a reference standard. At a cut-off point of 6 on the Geriatric Depression Scale-15 (GDS-15), the pooled sensitivity was 73.6% (95% confidence interval (CI) 43.9%-76.5%), specificity was 76.5% (95% CI 62.9%-86.7%), and an area under the curve was 0.83. There was significant heterogeneity in these analyses. There was insufficient data to conduct meta-analysis of other screening tools. The Nursing Homes Short Depression Inventory (NH-SDI) had a sensitivity ranging from 40.0% to 98.0%. The 4-item Cornell Scale for Depression in Dementia (CSDD) had the highest sensitivity (67.0%-90.0%) for persons in LTC living with dementia.

CONCLUSIONS

There are 23 tools validated for detection of depressive disorders in LTC, with the GDS-15 being the most studied. Tools developed specifically for use in LTC settings include the NH-SDI and CSDD-4, which provide briefer options to screen for depression. However, more studies of both are needed to examine tool accuracy using meta-analyses.

Real-time location systems technology in the care of older adults with cognitive impairment living in residential care: A scoping review

INTRODUCTION

There has been growing interest in using real-time location systems (RTLS) in residential care settings. This technology has clinical applications for locating residents within a care unit and as a nurse call system, and can also be used to gather information about movement, location, and activity over time. RTLS thus provides health data to track markers of health and wellbeing and augment healthcare decisions. To date, no reviews have examined the potential use of RTLS data in caring for older adults with cognitive impairment living in a residential care setting.

OBJECTIVE

This scoping review aims to explore the use of data from real-time locating systems (RTLS) technology to inform clinical measures and augment healthcare decision-making in the care of older adults with cognitive impairment who live in residential care settings.

METHODS

Embase (Ovid), CINAHL (EBSCO), APA PsycINFO (Ovid) and IEEE Xplore databases were searched for published English-language articles that reported the results of studies that investigated RTLS technologies in persons aged 50 years or older with cognitive impairment who were living in a residential care setting. Included studies were summarized, compared and synthesized according to the study outcomes.

RESULTS

A total of 27 studies were included. RTLS data were used to assess activity levels, characterization of wandering, cognition, social interaction, and to monitor a resident's health and wellbeing. These RTLS-based measures were not consistently validated against clinical measurements or clinically important outcomes, and no studies have examined their effectiveness or impact on decision-making.

CONCLUSION

This scoping review describes how data from RTLS technology has been used to support clinical care of older adults with dementia. Research efforts have progressed from using the data to track activity levels to, most recently, using the data to inform clinical decision-making and as a predictor of delirium. Future studies are needed to validate RTLS-based health indices and examine how these indices can be used to inform decision-making.

Social participation and depressive symptoms among older adults during the Covid-19 pandemic in Serbia: A cross-sectional study

Objectives

To determine the predictors and level of social participation and depressive symptoms within the context of isolation during the COVID-19 pandemic and investigate if the residence and type of housing had a moderating role in the relationship between social participation and depressive symptoms.

Methods

This cross-sectional, comparative, and correlational study was conducted on a sample of 299 participants. Research instruments used in this study included: socio-demographic questionnaire, the Geriatric Depression Scale, the Maastricht Social Participation Profile, and Mini-Mental State Exam.

Results

Social participation was found to contribute negatively to symptoms of depression (β = -0.245, p < .01), with a higher level of depression being found in older adults living in nursing homes (β = -0.152, p < .05).

Conclusions

The study confirmed a strong relationship between social participation and depressive symptoms in the COVID-19 pandemic.

Influence of Attachment Anxiety on the Relationship between Loneliness and Depression among Long-Term Care Residents

BACKGROUND

Attachment styles influence an individual's ability to maintain relationships throughout their lifespan. Insecure attachment has been associated with many aspects of mental health. The study aimed to explore the influence of attachment on loneliness and depression among old-age residents in long-term care facilities.

METHODS

A survey was conducted among residents from long term care facilities (LTC) in Thailand during the COVID-19 pandemic; 221 older people participated in the study. The mean aged was 73.60 ± 7.45 years old, and 57.5% female. All participants completed the Geriatric Depression Scale, the six-item revised version of the University of California Los Angeles Loneliness Scale, and the Revised Experience of Close Relationships questionnaire to measure depressive symptoms, loneliness, and attachment style. Hierarchical multiple regression analysis was performed to find the predictors for depressive symptoms.

RESULTS

In all, 40.7% of residents in LTC facilities experienced depression. Male sex, education, loneliness, and attachment anxiety predicted the increased level of depressive symptoms.

CONCLUSION

Loneliness was confirmed to be significantly associated with depressive symptoms, and attachment anxiety was found to be a strong predicting factor of depressive symptoms. Intervention and research regarding reducing loneliness and attachment anxiety should be promoted in LTC settings.

'It makes life worthwhile!' Peer mentoring in long-term care-a feasibility study

Objectives: Loneliness and depression are of increasing concern in long-term care homes made more urgent by viral outbreak isolation protocols. An innovative program called Java Mentorship was developed that engaged community volunteers and resident volunteers (mentors) as a team. The team met weekly, received education, and provided visits and guidance in pairs to socially disengaged residents (mentees). The purpose of this study was to assess the feasibility of conducting a larger study.Method: We conducted a mixed-methods pre-post study to evaluate the program. We collected feasibility data associated with the program implementation, including assessment of the sample and ability to recruit; procedures for data collection; retention, program adherence and acceptability; and residents' responses including loneliness, depression, purpose in life, social identity and sense of belonging outcomes. We enrolled community mentors (n = 65), resident mentors (n = 48) staff facilitators (n = 24) and mentees (n = 74) in 10 Canadian sites.Results: Most feasibility objectives were met, and adherence and acceptability were high. Some resource challenges and low retention rates among resident mentors were noted. We found a 29% reduction in depression scores (p = .048; d = .30) and 15% reduction in loneliness scores (p = .014; d = .23). Purpose in life, social identity and sense of belonging were unchanged. Interviews among participants indicated high acceptability and positive perceptions of the program.Conclusion: The study findings reveal a potential role for mentorship as a viable approach to reducing loneliness and depression in long-term care settings and lay the groundwork for future research.

Restoring trust: COVID-19 and the future of long-term care in Canada

The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the characteristics of older adults living in nursing homes, their caregivers, and the physical environment of nursing homes as important contributors to the COVID-19 crisis. Finally, the report articulates principles for action and nine recommendations for action to help solve the workforce crisis in nursing homes.