To present findings from an expert panel-informed literature review on community-based treatment of late-life depression.
A systematic literature review was conducted to appraise publications on community-based interventions for depression in older adults. The search was conducted between March and October 2005. An expert panel of mental health, aging, health services, and epidemiology researchers guided the review and voted on quality and effectiveness of these interventions.
A total of 3,543 articles were found with publication dates from 1967 to October 2005; of these, 116 were eligible for inclusion. Adequate data existed to determine effectiveness for the following interventions: depression care management, group and individual psychotherapy for depression, psychotherapy targeting mental health, psychotherapy for caregivers, education and skills training (to manage health problems besides depression; and for caregivers), geriatric health evaluation and management, exercise, and physical rehabilitation and occupational therapy. After reviewing the data, panelists rated the depression care management interventions as effective. Education and skills training, geriatric health evaluation and management, and physical rehabilitation and occupational therapy received ineffective ratings. Other interventions received mixed effectiveness ratings. Insufficient data availability and poor study quality prevented the panelists from rating several reviewed interventions.
While several well-described interventions were found to treat depression effectively in community-dwelling older adults, significant gaps still exist. Interventions that did not target depression specifically may be of benefit to older adults, but they should not be presumed to treat depression by themselves. Treating depressed elders may require a multifaceted approach to ensure effectiveness. More research in this area is needed.
"The benefit is even greater if the program targets individuals at risk of, suffering from, or recovering from depression ; incorporates clinician education [26,45,47]; and involves an enhanced role for the nurse [45,48], proactive follow-up and outcomes monitored by a care manager, enhanced IP communication, and integration between primary and specialist mental healthcare services [48-50]. These conclusions have been substantiated by systematic reviews and meta-analyses of many randomized controlled trials (RCTs) [32,45,51-53] and by consensus panels of experts who have developed evidence-based practice guidelines for the prevention, detection, and management of depression [9,26,54-56]. "
[Show abstract][Hide abstract] ABSTRACT: Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services.
A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation.
Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period.
Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms.
Clinicaltrials.gov identifier: NCT01407926.
"Living with untreated depression presents a serious public health problem since it may complicate chronic conditions such as heart disease, diabetes, and stroke; often accompanies functional impairment and disability and leads to increased health care costs
[41,42]. Depression among older adults can be addressed through better community-based approaches for identifying and treating depression, and through more public awareness programmes
[Show abstract][Hide abstract] ABSTRACT: In Sri Lanka, civilians in the Northern Province were affected by a long-term armed conflict that ended in 2009. This study aims to describe the prevalence of depression and its associated factors among adult patients attending primary care settings in the Northern Province in Sri Lanka.
We report data from a cross-sectional patient morbidity registry established in 16 primary care facilities (12 Divisional Hospitals and 4 Primary Medical Care Units) in four districts of the Northern Province. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression among all patients aged >=18 years, between March and May 2013. A sample of 12,841 patient records was included in the analysis. A total score of >=10 in the PHQ-9 was considered as major depression. Factors associated with major depression were tested using multivariable logistic regression analysis.
The prevalence of major depression was 4.5% (95% CI: 4.1-4.9) and mild depression was 13.3% (95% CI: 12.7-13.9). The major depression was significantly higher in females than males (5.1% vs. 3.6%) and among unpaid family workers (6.0%) than any other category who earned an income (varied between 1.2% and 3.2%). The prevalence was rising significantly with advancing age, and ranged from 0.3% in the youngest to 11.6% in the elderly.Multivariable regression analysis revealed that the females have a higher risk for major depression than males (OR = 1.4; 95% CI: 1.1-1.7). Older patients were more likely to be depressed than younger patients, OR (95% CI) were 4.9 (1.9-12.5), 5.6 (2.2-14.0), 5.7 (2.3-14.2) and 4.7 (1.8-11.9) for the age groups 25-34, 35-49, 50-64, and >=65 years respectively, in contrast to 18-24 year group. Disability in walking (OR = 7.5; 95% CI: 5.8-9.8), cognition (OR = 4.5; 95% CI: 3.6-5.6), self-care (OR = 2.6; 95% CI: 1.7-4.0), seeing (OR = 2.3; 95% CI: 1.8-3.0), and hearing (OR = 2.0; 95% CI: 1.5-2.5) showed significant associations with depression.
Depression is a common issue at primary care settings in a post-conflict population, and the elders, women and persons with disability are at a greater risk. Strengthening capacity of primary care facilities and community mental health services is necessary for early detection and management.
"Depression care management was determined to be an effective intervention. The Program to Encourage Active Rewarding Lives for Seniors (PEARLS) was one of the interventions determined to be effective (Frederick et al., 2007). Subsequently , fi ndings on a subset of interventions from this review were presented to the Task Force on Community Preventive Services. "
[Show abstract][Hide abstract] ABSTRACT: There has been considerable advancement in our understanding of the im-pact of lifestyle and behavioral risk factors on the health and well-being of older adults. Early longitudinal evidence from the Alameda County Popula-tion Study demonstrated the association between behavioral risk factors such as smoking and physical activity and mortality and change in physical func-tioning in older adults (Kaplan, Seeman, Cohen, Knudsen, and Guralnik, 1987; Kaplan, Strawbridge, Camacho, and Cohen, 1993). More recent reviews of epidemiological, clinical, and longitudinal studies continue to confi rm the impact of behavioral risk factors, especially the use of tobacco, poor diet, physical inactivity, and alcohol consumption, not only on the major causes of death and disability, but also on health and well-being (Mokdad, Marks, Stroup, and Gerberding, 2004). We also have considerable surveillance data on the prevalence of these risk factors and the demographic distribution of these risk factors among subgroups of older adults (see chap. 7). Given the known impact of behavioral risk factors on health, the translation of effi ca-cious interventions on these and other behavioral risk factors into programs JHUP_prohaska.indd 161 10/12/11 2:12 PM
Public Health for an Aging Society, Edited by T. Prohaska, L. Anderson, R. Binstock, 01/2012: chapter Translation: Dissemination and Implementation Issues; Johns Hopkins Press.
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