Physical Comorbidity and its Impact on Symptom Profile of Depression among Elderly Patients Attending Psychiatry Services of a Tertiary Care Hospital

Integrated Care Models for Older Adults with Depression and Physical Comorbidity: A Scoping Review

Objective

Multimorbidity is a growing challenge in the care for older people with mental illness. To address both physical and mental illnesses, integrated care management is required. The purpose of this scoping review is to identify core components of integrated care models for older adults with depression and physical comorbidity, and map reported outcomes and implementation strategies.

Methods

PubMed, EMBASE, CINAHL and Cochrane Library were searched independently by two reviewers for studies concerning integrated care interventions for older adults with depression and physical comorbidity. We used the SELFIE framework to map core components of integrated care models. Clinical and organisational outcomes were mapped.

Results

Thirty-eight studies describing thirteen care models were included. In all care models, a multidisciplinary team was involved. The following core components were mainly described: continuity, person-centredness, tailored holistic assessment, pro-activeness, treatment interaction, individualized care planning, and coordination tailored to complexity of care needs. Twenty-seven different outcomes were evaluated, with more attention given to clinical than to organisational outcomes.

Conclusion

The core components that comprise integrated care models are diverse. Future studies should focus more on implementation aspects of the intervention and describe financial parts, e.g., the cost of the intervention for the healthcare user, more transparently.

Defining Vision and Mission of a Medical Psychiatry Unit (MPU) for Older Adults: A Focus Group Study

This study aims to determine the vision and mission of an academic hospital's medical psychiatry unit (MPU) that exclusively treats geriatric patients. All healthcare providers working at an academic hospital's geriatric MPU were invited to reflect on formulate the vision and mission of this ward. Twenty-two of them took part in the focus group interviews. The interviews focused on defining the MPU's functioning, its objectives, how it will reach these objectives, and where the MPU aspires to go. The interviews were transcribed verbatim and analyzed according to the QUAGOL guide. The themes from the analysis emerged from these group discussions. The participants defined the MPU's vision as to excel in integrated mental and physical geriatric inpatient healthcare, inspiring others to shed the stigma related to this vulnerable patient population. The mission that emerged from the focus group discussions is to provide patient-centered, integrated healthcare for older adults with combined mental and physical disorders. To achieve this, involving the patient's network, interdisciplinarity, shared decision-making, clear communication between all stakeholders, and reintegration of patients into their communities emerged as important themes. This study provides a vision and mission of a geriatric MPU in an academic psychiatric hospital. Since there is no consensus in the literature about the characteristics of MPUs despite the international call for integrated care for older persons with combined mental and physical disorders, these vision and mission statements can feed the discussion on how to install excellent healthcare for this vulnerable patient population.

Future-Proofing Geriatric Mental Health Care Services in India: Training and Policy Directions

BACKGROUND

A burgeoning rise in the elderly subpopulation is being noted in India. This rise has already earned the designation as a shining nation by the United Nations/World Health Organization. This growth will take the elderly subpopulation to 324 million persons above 60 years by 2050. The mental health needs of this subpopulation are varied and nuanced compared to that of the general population. The risk and prevalence of mental health morbidity are also greater. There is an urgent need to gear up the health care systems.

CONSIDERATIONS

Various aspects of the ongoing demographic transitions are considered alongside available health information. Legislative mandates and laws are also reviewed to provide context to qualify the action points and recommendations. Recommendations, India must act urgently to strengthen health care delivery systems in a concurrent multipronged approach. These efforts should focus on developing trained Human Resources and adequate infrastructural resources. Review mechanisms to inform on required updates on best practices and evidence-based medicine must also be incorporated and developed to perform periodically.

Estimation of the prevalence of depression using diagnostic instruments in the elderly population in India, 2000-2019: a systematic review protocol

INTRODUCTION

Depression is a common mental disorder in the elderly population, which significantly impacts their quality of life. However, correct estimates of its magnitude are not available in the elderly in India. The present systematic review and meta-analysis would attempt to estimate the prevalence of depression using diagnostic instruments among elderly persons aged 60 years and above.

METHODS AND ANALYSIS

Searches will be performed in PubMed, Scopus, Embase, Web of Science, CINAHL and PsycINFO. Community-based cross-sectional and cohort studies (2001 to September 2019) reporting the prevalence of depression in the elderly, using diagnostic instruments will be included. Studies conducted among chronic disease patients, in-hospital patients and special groups such as with disaster-stricken populations, and studies reporting the only one or two subcategories of depression, will be excluded. Disagreements in study selection and data abstraction will be resolved by consensus and arbitration by a third reviewer. AXIS critical appraisal tool will be used for quality assessment of individual studies. Findings of eligible studies will be pooled using fixed-effects or random-effects meta-analysis whichever is appropriate. Heterogeneity between studies will be examined by Cochran's Q test and quantified by I² statistic. A cumulative meta-analysis will be used to detect temporal trends in the prevalence of depression and the effect of poor-quality studies on the pooled estimate. Publication bias will be assessed by visual inspection of funnel plots and the Egger test.

ETHICS AND DISSEMINATION

No ethical approval will be needed because it will be a systematic review. Data from previously published studies will be retrieved and analysed. Findings will be disseminated through a peer-reviewed publication in a scientific journal and conferences.

PROSPERO REGISTRATION NUMBER

CRD42019138453.

Anxiety and somatic symptoms among elderly patients with depression

AIM OF THE STUDY

This study aimed to evaluate the symptom profile, including anxiety and somatic symptoms among elderly patients with depression using the Geriatric depression scale (GDS-30), Beck Depression Inventory (BDI), Generalized anxiety Disorder -7 Scale (GAD-7) and Patient Health Questionnaire-15 (PHQ-15) scale. Additional aim was to carry out the factor analysis of symptoms reported on various scales.

METHODOLOGY

83 elderly patients (age ≥60 years) with depression were evaluated on GDS-30, BDI, GAD-7 and PHQ-15.

RESULTS

60 subjects (72.28%) had GAD-7 score of ≥10, which is indicative of significant anxiety. On PHQ-15, 98.8% of patients had moderate to severe somatization. There was no correlation between severity of depressive symptoms (as assessed by GDS-30 and BDI) with anxiety and depressive symptoms except for significant correlation between BDI total score and GAD-7 total score (Pearson correlation coefficient-0.319;p = 0.003).Factor analysis of GDS-30 yielded a five factor solution and when the items of other 3 scales were added, the number of factors/symptoms clusters increased to 7.

CONCLUSION

The present study suggests that there is a higher prevalence of anxiety and somatic symptoms in elderly patients with depression and GDS-30 is unable to capture all the symptoms of depression among elderly in the Indian context. Hence, complete assessment of depression in elderly should include assessment of anxiety and somatic symptoms by using other scales like GAD-7,BDI-II and PHQ-15. There is a need to develop a new scale which will be helpful in capturing the entire symptom profile of depression among elderly.

The suprachiasmatic nucleus; a responsive clock regulating homeostasis by daily changing the setpoints of physiological parameters

The suprachiasmatic nucleus (SCN) is responsible for determining circadian variations in physiological setpoints. The SCN achieves such control through projections to different target structures within and outside the hypothalamus. Thus the SCN prepares the physiology of the body every 24 h via hormones and autonomic nervous system (ANS), to coming changes in behavior. Resulting rhythms in hormones and ANS activity transmit a precise message to selective organs, adapting their sensitivity to coming hormones, metabolites or other essentials. Thus the SCN as autonomous clock gives rhythm to physiological processes. However when the body is challenged by infections, low or high temperature, food shortage or excess: physiological setpoints need to be changed. For example, under fasting conditions, setpoints for body temperature and glucose levels are lowered at the beginning of the sleep (inactive) phase. However, starting the active phase, a normal increase in glucose and temperature levels take place to support activities associated with the acquisition of food. Thus, the SCN adjusts physiological setpoints in agreement with time of the day and according to challenges faced by the body. The SCN is enabled to do this by receiving extensive input from brain areas involved in sensing the condition of the body. Therefore, when the body receives stimuli contradicting normal physiology, such as eating or activity during the inactive period, this information reaches the SCN, adapting its output to correct this disbalance. As consequence frequent violations of the SCN message, such as by shift work or night eating, will result in development of disease.

A naturalistic 1 year follow-up study of the elderly patients with depression visiting the psychiatric outpatient services for the first time

This naturalistic study aimed to assess treatment dropout pattern, course of symptoms and outcome of depression among the elderly. This study aimed to assess the course and outcome of depression and treatment dropout pattern of patients with depression in old age. Additionally an attempt was made to study the predictors of outcome and dropout. 140 elderly patients (≥ 60 years) were followed up at 6 months and 1 year to evaluate the status of their depression and treatment pattern. Out of the 140 patients recruited at the baseline, 58 (41.4%) patients did not return to the clinic after the first visit. 65.7%, 75% and 90% patients dropped out from the clinic by 3 months, 6 months and 1 year after registration with the clinic. At 1 year, about two-third (65%) of patients achieved improvement in symptoms to the extent of 81-100% and only 10% did not show any improvement throughout the study period. To conclude present study suggests that large proportion of the elderly patients with depression attending a mental health service dropout of treatment. Despite the high dropouts rate, more than three-fourth of the patients improve to the extent of 81-100% and very few patients have worsening of symptoms or persistent symptoms.