Objective To evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care. Design Randomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months. Setting Population of residential facility in Sydney living in self care units and hostels. Participants 220 depressed residents aged >65 without severe cognitive impairment. Intervention The shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c) depression related health education and activity programmes for residents. The control group received routine care. Main outcome measure Geriatric depression scale. Results Intention to treat analysis was used. There was significantly more movement to "less depressed" levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P = 0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P = 0.0011). Conclusions The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents.
The causality-focused approach appears to be as effective as the more common predominantly pharmacological approach, and appears to involve lower human and financial costs.
This paper introduces a two year study at Hornsby/Ku‐Ring‐Gai Hospital which aims to shed more light on the nature of behaviour problems in dementia, and on methods of dealing with them. Rather than trialing a standard therapeutic technique across a range of behaviours, the project attempts to reflect what is often a complex clinical situation not amenable to standard answers. A series of interventions is being instituted in a controlled trial on the assumption that each case is idiosyncratic both in aetiology and other variables which affect treatment choice. Data are collected on quantitative and qualitative aspects of each case, including presumed causes of the behaviour. Outcome is assessed two and five months after the intervention using measures of patient behaviour, and of carer distress, coping and perception of the problem.
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