Good News and Bad News: Depressive Symptoms Decline and Undertreatment Increases With Age in Home Care and Institutional Settings

Szczerbińska, Katarzyna; Hirdes, John P.; Życzkowska, Jolanta

doi:10.1097/jgp.0b013e3182331702

Cited by 56 publications

(52 citation statements)

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“…Of that number, only 22% were adequately treated, a rate consistent with the 20-30% rates observed in other studies [1,8,12]. These findings are noteworthy, given that untreated or under-treated depression is associated with greater morbidity and dependency, functional decline, diminished HRQoL, pain [14], poor adherence to medical treatment, increased demands on family caregivers, premature nursing home admissions [16], increased use of healthcare services [2,3,9,15-18], and increased risk of premature death from suicide and other medical conditions [19]. …”

Section: Discussionsupporting

confidence: 83%

“…Although late-life depression can be successfully treated with antidepressant medications or psychosocial interventions, few older home care clients receive adequate trials of such treatment or use specialized mental health services [1,8-12]. Untreated or under-treated depression in older adults is a serious public health problem [12,13], associated with greater morbidity and dependency, functional decline, diminished health-related quality of life (HRQoL), pain [14], poor adherence to medical treatment [15], increased demands on family caregivers, premature nursing home admissions [16], increased use of healthcare services [2,3,9,17-19], and increased risk of premature death from suicide and other medical conditions [20]. …”

Section: Introductionmentioning

confidence: 99%

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An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms

et al. 2014

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BackgroundDepressive 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.MethodsA 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.ResultsOf 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.ConclusionsOur 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.Trial registrationClinicaltrials.gov identifier: NCT01407926.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms

et al. 2014

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“…Zaburzenia funkcji poznawczych i związana z tym narastająca niesprawność, a w następstwie utrata samodzielności życiowej stanowi ważny problem zdrowotny populacji osób starszych, który nie znajduje dostatecznego zainteresowania wśród organizatorów polskiego systemu opieki zdrowotnej. Wielu autorów szacuje występo-wanie otępienia na poziomie 10-20% populacji po 65. roku życia [12][13][14][15]. Za główną przyczynę otępienia wśród rasy białej uznaje się chorobę Alzheimera.…”

Section: Dyskusjaunclassified

Problemy zdrowia psychicznego pacjentów opieki długoterminowej jako wyzwanie dla pielęgniarek i opiekunów

Wójcik

Czekała

Sienkiewicz

2018

Problemy Pielęgniarstwa

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Społecznego 2 NZOZ Domowa Opieka Medyczna Do-Med roblemy zdrowia psychicznego pacjentów opieki długoterminowej jako wyzwanie dla pielęgniarek i opiekunów Mental health problem among long term care patients as a challange for nurses and caretakers STRESZCZENIEWstęp. Dokonujące się zmiany w strukturze demograficznej i epidemiologicznej polskiego społeczeństwa tworzą zapotrzebowanie na nowe rozwiązania prawne i organizacyjne w systemie usług zdrowotnych realizowanych na rzecz osób w podeszłym wieku. Cel pracy. Głównym celem badań była ocena problemów zdrowia psychicznego u pacjentów objętych pielęgniarską opieką długoterminową domową (PODD). Materiał i metody. Badania przeprowadzono w populacji pacjentów od 60. roku życia objętych świadczeniami PODD, realizowanymi w systemie ubezpieczenia zdrowotnego (NFZ), w wybranych czterech województwach w Polsce. W badaniu wzięło udział 297 pacjentów. Zastosowano międzynarodowe narzędzie badawcze Resident Assessment Instrument-Home Care (RAI/HC), czyli Kwestionariusz Oceny Pacjentów Opieki Domowej (KOP/OD). Wyniki i wnioski. Przeprowadzona ocena wybranych problemów zdrowia psychicznego pacjentów PODD potwierdziła występowanie objawów depresji u 62,6% badanych oraz zaburzeń funkcji poznawczych u 79,2% badanych. Najwyższy wskaźnik objawów depresji zaobserwowano w najniższej grupie wiekowej (60-75 lat), natomiast upośledzenie funkcji poznawczych rosło wraz z wiekiem badanych. Analiza wyników przeprowadzonych badań stała się podstawą do zdefiniowania struktury potrzeb pielęgnacyjnych i opiekuńczych pacjentów długoterminowej opieki domowej, a także do sformułowania propozycji zmian w systemie kwalifikacji i oceny pacjentów PODD.Problemy Pielęgniarstwa 2017; 25 (4): 257-263 Słowa kluczowe: opieka długoterminowa; demencja; depresja; opieka pielęgniarska ABSTRACT Introduction. Changes occurring in demographic and epidemiological structure of the Polish society cause a demand for new legal and organizational solutions in the system of health services provided to elderly persons. Objective. The aim of this study was evaluate mental health problems and care needs among elderly patients receiving long-term nursing care at home. Materials and methods. Survey was carried out on 297 patients receiving long-term nursing care within guaranteed health services in the national health insurance system in 4 Polish voivodships. Selection of the surveyed population was based on two criteria: age 60 or more and receiving long-term home nursing within the health care insurance. The survey was carried out with the use of a standardized questionnaire InterRAI-HC (Resident Assessment Instrument-Home Care) for assessment of health status and health needs of long-term home care patients. Results and conclusions. Assessment of selected mental health problems confirmed occurrence of depression symptoms in 62.6% patients and cognitive function impairment in 79.2% patients. The highest index of depression symptoms was

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“…The Cognitive Performance Scale (CPS) is based on memory impairment, level of consciousness, and executive function, with scores ranging from 0 (intact) to 6 (very severe impairment; Landi et al, 2000;Morris et al, 1994). The Depression Rating Scale (DRS) screens for depressive symptoms with values ranging from 0 (no depressive symptoms) to 14 (severe depressive symptoms; Burrows, Morris, Simon, Hirdes, & Phillips, 2000;Szczerbińska, Hirdes, & Zyczkowska, 2011). The Instrumental ADL capacity (IADL) Scale, which ranges from 0 to 6, considers meal preparation, ordinary housework, and phone use, with higher scores indicating greater difficulty in IADL (Morris, Carpenter, Berg, & Jones, 2000).…”

Section: Data Sourcementioning

confidence: 99%

A Cross-Sectional Study to Compare Caregiver Distress Among Korean Canadian, Chinese Canadian, and Other Canadian Home Care Clients

Chang

Hirdes

2015

Sage Open

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This study examines the health of elderly Korean Canadians in home care and investigates the risk factors for caregiver distress of families caring for their elderly relatives. Korean Canadians, Chinese Canadians, and other Canadian home care clients were compared using the Resident Assessment Instrument-Home Care (RAI-HC). The assessments were done as a part of normal clinical practice between January 2002 and December 2010 within Ontario. A sample of 58,557 home care clients was analyzed using descriptive statistics and chi-square analysis at the bivariate level and multiple logistic regression models. The major finding of the present study is that Korean clients had higher physical impairments and higher prevalence of major chronic diseases, but they were less likely to receive personal support or nursing services. Moreover, the results provide clear evidence of the importance of language barriers for all linguistic minorities, including Korean Canadians.

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Good News and Bad News: Depressive Symptoms Decline and Undertreatment Increases With Age in Home Care and Institutional Settings

Cited by 56 publications

References 54 publications

An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms

An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms

Problemy zdrowia psychicznego pacjentów opieki długoterminowej jako wyzwanie dla pielęgniarek i opiekunów

A Cross-Sectional Study to Compare Caregiver Distress Among Korean Canadian, Chinese Canadian, and Other Canadian Home Care Clients

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