Psychosocial Treatment Options for Major Depressive Disorder in Older Adults

Renn, Brenna N.; Areán, Patricia A.

doi:10.1007/s40501-017-0100-6

Cited by 33 publications

(20 citation statements)

References 76 publications

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“…Care staff working in mental health facilities had significantly higher self-efficacy in end-of-life communication compared to care staff working in facilities for older people. This may be due to the experience of mental health staff with psychosocial interventions [42, 43]. Care staff in mental healthcare are also often trained in and accustomed to discussing complex and sensitive topics such as a wish to die [14].…”

Section: Discussionmentioning

confidence: 99%

Are care staff equipped for end-of-life communication? A cross-sectional study in long-term care facilities to identify determinants of self-efficacy

et al. 2019

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BackgroundEnd-of-life conversations are rarely initiated by care staff in long-term care facilities. A possible explanation is care staff’s lack of self-efficacy in such conversations. Research into the determinants of self-efficacy for nurses and care assistants in end-of-life communication is scarce and self-efficacy might differ between care staff of mental health facilities, nursing homes, and care homes. This study aimed to explore differences between care staff in mental health facilities, nursing homes, and care homes with regard to knowledge about palliative care, time pressure, and self-efficacy in end-of-life communication, as well as aiming to identify determinants of high self-efficacy in end-of-life communication.MethodsTwo cross-sectional Dutch studies, one in mental health facilities and one in nursing and care homes (PACE study). Nurses and care assistants were invited to complete a questionnaire in 2015. Multivariable logistic regression analyses were performed to identify determinants of high self-efficacy.ResultsFive hundred forty one nurses and care assistants completed a survey; 137 worked in mental health facilities, 172 in nursing homes, and 232 in care homes. Care staff at mental health facilities were the most knowledgeable about the World Health Organization’s definition of palliative care: 76% answered 4–5 out of 5 items correctly compared to 38% of nursing home staff and 40% of care home staff (p < 0.001). Around 60% of care staff in all settings experienced time pressure. Care staff had high self-efficacy regarding end-of-life communication with patients: the overall mean score across all facilities was 5.47 out of 7 (standard deviation 1.25). Determinants of high self-efficacy were working in a mental health facility, age > 36, female, with formal palliative care training, and knowledge of the palliative care definition.ConclusionMental healthcare staff knew more about palliative care and had higher self-efficacy in end-of-life communication compared to nursing and care home staff. Educating care staff about providing palliative care and training them in it might improve end-of-life communication in these facilities.

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Section: Discussionmentioning

confidence: 99%

Are care staff equipped for end-of-life communication? A cross-sectional study in long-term care facilities to identify determinants of self-efficacy

et al. 2019

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“…2, 3 Recent reviews illustrate a variety of aerobic, anaerobic and combined exercise interventions for patients with psychosis including running, walking, team sports, weight lifting, and yoga. 3–5 Indeed, there have been exciting developments in exercise interventions in schizophrenia populations, and findings suggest that exercise may improve symptom, cognitive, cardiovascular, social and role functioning, and neurobiological domains; potentially facilitating greater quality of life and well-being for people with debilitating mental illnesses. 3, 6–11 Given the demonstrated benefits of exercise interventions in those with a formal psychotic disorder, the current study aims to test the feasibility of an aerobic exercise intervention prior to the onset of the illness.…”

Section: Introductionmentioning

confidence: 99%

A Supervised Exercise Intervention for Youth at Risk for Psychosis

Dean

Bryan

Newberry

et al. 2017

J. Clin. Psychiatry

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Objective A rapidly accumulating body of research suggests that exercise can improve symptoms and wellbeing in patients suffering from psychosis. Exercise may also promote neurogenesis in the hippocampus, a structure that plays an important role in the pathophysiology of psychosis. To date, there has not been an intervention focused on exercise prior to the onset of psychosis, a critical time for prevention of more serious illness. Method In this pilot study, 12 young adults at ultrahigh risk (UHR) for psychosis were enrolled in a 12-week open-label exercise intervention. Participants were randomized to exercise 2 or 3 times each week and exercised between 65–85% of maximal oxygen capacity (VO2max) for 30 minutes each session under the supervision of an exercise physiologist. Positive and negative symptoms, social and role function, performance on neurocognitive tests, cardiovascular fitness, and hippocampal structure and functional connectivity were evaluated before and after the trial. Results A total of 9 participants completed the exercise intervention. Participants showed improved positive and negative symptoms and social and role functioning; improvement in multiple areas of cognition; and increased functional connectivity between the left hippocampus and occipital cortex after 12 weeks of exercise. Conclusion The results of this study suggest that exercise interventions are feasible in an UHR sample and may promote improvement in clinical, social, and cognitive domains as well as changes to brain function in regions impacted by the development of psychosis. These findings set the stage for an ongoing phase-II randomized controlled trial. Clinical Trials Registration (https://clinicaltrials.gov/ct2/show/NCT02155699)

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“…Interventions for older adults with chronic illness have found that while antidepressant pharmacotherapy is effective to address depressive symptoms, most older adults prefer psychotherapeutic or psychoeducational interventions over medication. 10–12 While there is a growing psychotherapy evidence base for older adults broadly, 13,14 we identified only two studies focusing on older patients with cancer. In one, a multidisciplinary team offered treatment to older adults with cancer, including physical therapy, cognitive behavioral training, symptom education, spiritual guidance, and a 200-page manual.…”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Cancer and Aging: Reflections for Elders (CARE): A pilot randomized controlled trial of a psychotherapy intervention for older adults with cancer

et al. 2018

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Objective: Cancer and Aging: Reflections for Elders (CARE) is a novel, telephone-delivered intervention designed to alleviate distress in older cancer patients. This pilot randomized controlled trial tested the feasibility and initial efficacy of CARE, drawing from age-appropriate developmental themes and well-established coping theory. Method: Eligible patients were ≥70 years old; ≥6 months post-diagnosis of lung,prostate, breast, lymphoma, or gynecological cancer; on active cancer treatment or within 6 months of ending cancer treatment; and had elevated scores on the Distress Thermometer (≥4) or Hospital Anxiety and Depression Scale (≥6). Participants completed five sessions of psychotherapy over 7 weeks with assessments at study entry, post-intervention, and 2 months post-intervention. Primary outcomes were feasibility and initial efficacy on anxiety and depression; secondary outcomes included demoralization, coping, loneliness, and spiritual well-being. Results: Fifty-nine participants were randomized to either the CARE arm (n = 31) or the enhanced Social Work Control arm (n = 28). The intervention was feasible and tolerable, meeting a priori criteria for rates of eligibility, acceptance, retention, assessment, and treatment fidelity. Upon completion of the intervention, participants in the CARE arm demonstrated lower mean depression scores (d = 0.58 [CI: 0.04–1.12],P = 0.01) and trended towards increased coping-planning (d = 0.30 [CI: −0.83 to 0.24], P = 0.18). Promising trends in anxiety (d = 0.41 [CI: −0.17 to 0.98], P = 0.10) emerged at 2 months post-intervention; effects for coping-planning dissipated. Conclusion: These pilot data suggest the CARE intervention is feasibly delivered, potentially impacts important psychosocial variables, and is accessible for older, frail patients with cancer. Future research will evaluate this intervention on a larger scale.

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Psychosocial Treatment Options for Major Depressive Disorder in Older Adults

Cited by 33 publications

References 76 publications

Are care staff equipped for end-of-life communication? A cross-sectional study in long-term care facilities to identify determinants of self-efficacy

Are care staff equipped for end-of-life communication? A cross-sectional study in long-term care facilities to identify determinants of self-efficacy

A Supervised Exercise Intervention for Youth at Risk for Psychosis

Cancer and Aging: Reflections for Elders (CARE): A pilot randomized controlled trial of a psychotherapy intervention for older adults with cancer

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