How to Help Depressed Older People Living in Residential Care: A Multifaceted Shared-Care Intervention for Late-Life Depression

Abstract

Objective: To describe a population-based, multifaceted shared-care intervention for late-life depression in residential care as a new model of geriatric practice, to outline its development and implementation, and to describe the lessons learned during the implementation process. Setting: A large continuing-care retirement community in Sydney, Australia, providing three levels of care (independent living units, assisted-living complexes, and nursing homes). Participants:) The intervention was implemented for the entire non-nursing home population (residents in independent and assisted living: N = 1,466) of the facility and their health care providers. Of the 1,036 residents who were eligible and agreed to be interviewed, 281 (27.1%) were classified as depressed according to the Geriatric Depression Scale. Intervention Description: The intervention included: (a) multidisciplinary collaboration between primary care physicians, facility health care providers, and the local psychogeriatric service; (b) trainning for primary care physicians and other facility health care providers about detecting and managing depression; and (c) depression-related health education/promotion programs for residents. Conclusions: The intervention was widely accepted by residents and their health care providers, and was sustained and enhanced by the facility after the completion of the study. It is possible to implement and sustain a multifaceted shared-care intervention for late-life depression in a residential care facility where local psychogeriatric services are scarce, staff-to-resident ratios are low, and the needs of depressed to residents are substantial.

The center for epidemiological studies depression scale (CES‐D) is an adequate screening instrument for depressive and anxiety disorders in a very old population living in residential homes

“…Although depression and anxiety are common disorders among elderly people living in residential homes (Cuijpers and van Lammeren, 2001;Eisses et al, 2002;Llewellyn-Jones et al, 2001;Lyne et al, 2006), recognition of these disorders is difficult and complicated (Bagley et al, 2000). Depression and anxiety disorders are often considered to be consequences of physical vulnerability, rather than problems that deserve attention in their own right.…”

Exercise for depression in care home residents: a randomised controlled trial with cost-effectiveness analysis (OPERA)

“…This is indicative of substantial under-recognition and undertreatment of depression in care homes and concurs with findings in previous studies. 24,26 The mean Mini Mental State Examination score of 18.4 indicates that our participants had substantial levels of cognitive impairment and that our findings are applicable to the many care home residents with cognitive impairment. The mean EQ-5D scores of 0.57 (self-report) and 0.45 (proxy) attest to the overall poor quality of life of our participants.…”

“…21 There is good evidence that both functional impairment and loneliness are risk factors for depression in care home residents. 22 In many cases depression is not recognised by the care home staff or by the resident's general practitioner [23][24][25] and, even if recognised, it is often not treated. 26 Using various depression identification methods, only between 15% and 27% of depressed residents were identified by staff in 30 UK care homes.…”

Examining External Validity in Efficacy and Secondary Articles of Home-Based Depression Care Management Interventions for Older Adults

“…For 2 (13,14) of the 4 efficacy studies, secondary articles addressed 1 or more elements of reach, adoption, implementation, and maintenance. Three secondary articles (15,18,19) described aspects of adoption, such as required skills or expertise of the care managers and procedures for training personnel. A secondary paper (19) was the only paper among all of the articles reviewed (efficacy and secondary) to describe the funding required to support intervention personnel.…”

“…Three secondary articles (15,18,19) described aspects of adoption, such as required skills or expertise of the care managers and procedures for training personnel. A secondary paper (19) was the only paper among all of the articles reviewed (efficacy and secondary) to describe the funding required to support intervention personnel. Secondary articles to studies by Rabins and Waterreus provided more details about intervention intensity (15–18) and fidelity to the intervention treatment plan (15–17).…”