Frontline healthcare providers’ views of depression and its prevention in older adults

Lu, Li-Ching; Hsieh, Pei‐Ling

doi:10.1111/j.1365-2702.2012.04276.x

Cited by 6 publications

(20 citation statements)

References 25 publications

(40 reference statements)

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“…Our findings lend further support to the critical roles of both intergenerational solidarity and conflicts in older adults’ mental health. Previous observations indicated that the main contributor to depression in older adults was the lack of their children's support, and that lack of support was related to reduced solidarity and increased discordance in the intergenerational relationships, including children not taking care of aged parents, the prevalence of intergenerational conflicts and reduced intergenerational interactions (Lu & Hsieh, ). Consistently with previous studies (Katz, ; Lang & Schütze, ), our study also highlights the importance that consensual‐normative solidarity and affectual closeness have in intergenerational relationships, which have been associated with depression either partially or fully through the older parents’ feelings of loneliness and loneliness‐related insomnia symptoms.…”

Section: Discussionmentioning

confidence: 99%

Intergenerational relationships and depressive symptoms among older adults in urban China: The roles of loneliness and insomnia symptoms

2020

Health Soc Care Community

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The prevalence of depressive symptoms in older Chinese adults has increased recently. Intergenerational relationships play an important role in the mental health conditions of older adults, especially in Chinese culture. Therefore, this study aims to unravel the complex connection between intergenerational relationships and depression, and to explore the potential mediating roles of loneliness and nighttime insomnia symptoms within that connection. A cross-sectional household survey was conducted in China with 2038 participants aged 65 years or above. Variables were measured using the Center for Epidemiologic Studies Short Depression Scale, the Intergenerational Relationship Quality Scale for Aging Chinese Parents (IRQS-AP), three nighttime insomnia symptoms extracted from the Insomnia Severity Index and the De Jong Gierveld Six-Item Loneliness Scale. The IRQS-AP includes four subdimensions: consensual-normative solidarity, structural-associational solidarity, affectual closeness and intergenerational conflicts. Path analyses were performed in Mplus to investigate regression coefficients and mediating effects. Results showed that three general intergenerational relationships (consensual-normative solidarity, affectual closeness and intergenerational conflicts) were significantly correlated with all mental health outcomes, including their symptoms of loneliness, insomnia and depression. A serial mediation model suggested that loneliness mediated the connection between those constructs of intergenerational relationships and depression, with an independent path to insomnia symptoms via loneliness. The proposed mediators fully mediated the effects of affectual closeness on depression. Nighttime insomnia symptoms alone mediated only the relationship between intergenerational conflicts and depression independently from paths involving depression. Removal of sleep item from CES-D did not affect the results of paths. Our findings highlight the importance of intergenerational relationships for mental health, especially for the mediating effects of loneliness and nighttime insomnia symptoms on the relationship between intergenerational relationships and depression. Effective mental health services for older adults can address their feelings of loneliness and sleep problems, especially for those who have a poor relationship with their adult children. K E Y W O R D S depression, intergenerational relationships, loneliness, nighttime insomnia symptoms | 1311 FU and JI

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Section: Discussionmentioning

confidence: 99%

Intergenerational relationships and depressive symptoms among older adults in urban China: The roles of loneliness and insomnia symptoms

2020

Health Soc Care Community

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“…Depression among older adults is underlain by various experiences of loss and maladaptation to distressing life circumstances in late life, including health problems, issues with cognitive functioning and psychosocial isolation (Almeida, ; Hall & Reynolds, ; Lu & Hsieh, ). In this way, depression among older adults, unlike young people, is strongly influenced by the developmental stage of old age and, accordingly, can be considered as a typical reaction due to ageing, or else as the effect of other healthcare problems or medical illnesses, and frequently presents with atypical symptoms (Fiske, Wetherell, & Gatz, ; Vieira, Brown, & Raue, ).…”

Section: Introductionmentioning

confidence: 99%

Depression‐linked beliefs in older adults with depression

Tanaka

2019

Journal of Clinical Nursing

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Aims and objectives To clarify beliefs linked with depression among older adults with depression in Japan. Background As a result of global population ageing, caring for older adults with depression has become an important issue worldwide. In this paper, the concept of “beliefs” pertains to phenomena that lead to distress about disease and can be alleviated through talk therapy. While previous studies focused on illness beliefs in people with mental illness and depression, no studies have yet focused on such beliefs among older adults with depression. Design Qualitative, narrative‐research‐based method. Methods Observation and 1–5 narrative interviews lasting 60–90 min were conducted with each of 19 older adults with depression in a Japanese psychiatric ward. The resulting narratives were thematically analysed to derive relevant themes and subthemes. Reporting of this research adheres to COREQ guidelines. Results Four themes and twelve subthemes were revealed. Depression‐linked beliefs among older adults with depression were (1) “guilt and regret,” (2) “pessimism,” (3) “futility of treatment” and (4) “desire to be needed by loved ones and society.” Conclusion Depression‐linked beliefs among older adults with depression constituted spiritual pain reflecting character tendencies, including experiences of loss and developmental challenges related to ageing as well as subjects' natural diligence and consideration for others. Relevance to clinical practice (1) Helping nurses better understand distress experienced by older adults with depression, who are prone to feel guilt and regret when reflecting on the past and to alleviate distress through dialogue and providing positive affirmation for patients. (2) To understand and assuage distress over experiences of loss in old age. (3) To help older adults with depression form a more relaxed attitude towards life, so that even if they have experienced loss as a result of old age, they can maintain their self‐esteem and existential sense of self‐worth.

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“…Studies reflected both publicly funded and insurance-based systems. Qualitative data were mostly collected via interviews 18,19,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] and/or focus groups 34,39,[43][44][45][46] with two ethnographic studies, 47,48 one conference and nominal group technique, 49 one mixedmethods survey, 50 and one multiple case study. 51 Two-thirds of studies were of good/ very good overall quality (Table 1); most met the checklist criteria and the vast majority were well reported ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Late-life depression was felt to lack suitable therapeutic solutions as it was considered to mainly arise from 'justifiable' causes, many of which related to ageing. The majority of HCPs across all countries primarily attributed late-life depression to difficult social circumstances and, in particular, age-related social issues (for example, loneliness or bereavements) and/or physical health issues, frailty, and functional decline: 18,19,[32][33][34]37,[39][40][41][42][43][44]51 'GPs described depression as part of a spectrum including loneliness, lack of social network, reduction in function, and very much saw depression as "understandable" and "justifiable".' 19 Many GPs and nurses, therefore, felt there was a definite difference between sadness or distress that 'understandably' related to these issues, and clinical depression, but rarely defined where this border lay.…”

Section: Avoidance Of Medicalisation Of Social Circumstancesmentioning

confidence: 99%

Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies

et al. 2019

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BackgroundDepressive symptoms are common in later life and increase both the risk of functional and cognitive decline and the use of healthcare services. Despite older people expressing preferences for talking therapies, they are less likely to be referred than younger adults, particularly when aged ≥80 years.AimTo explore how healthcare professionals (HCPs) manage older people in relation to depression and referrals to psychological therapies.Design and settingSystematic review and thematic synthesis of qualitative studies.MethodMEDLINE, Embase, PsycINFO, CINAHL, and the Social Sciences Citation Index (inception–March 2018) were searched for studies exploring HCPs’ views regarding management of late-life depression across all settings. Studies of older people’s views or depression management across all ages were excluded.ResultsIn total, 27 studies, were included; these predominantly focused on the views of GPs and primary and community care nurses. Many HCPs felt that late-life depression was mainly attributable to social isolation and functional decline, but treatments appropriate for this were limited. Clinicians perceived depression to have associated stigma for older adults, which required time to negotiate. Limited time in consultations and the complexity of needs in later life meant physical health was often prioritised over mental health, particularly in people with frailty. Good management of late-life depression appeared to depend more on the skills and interest of individual GPs and nurses than on any structured approach.ConclusionMental ill health needs to be a more-prominent concern in the care of older adults, with greater provision of psychological services tailored to later life. This may facilitate future identification and management of depression.

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Frontline healthcare providers’ views of depression and its prevention in older adults

Cited by 6 publications

References 25 publications

Intergenerational relationships and depressive symptoms among older adults in urban China: The roles of loneliness and insomnia symptoms

Intergenerational relationships and depressive symptoms among older adults in urban China: The roles of loneliness and insomnia symptoms

Depression‐linked beliefs in older adults with depression

Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies

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