scholarly journals Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

2021 ◽  
Vol 30 ◽  
Author(s):  
Shiyu Lu ◽  
Tianyin Liu ◽  
Gloria H. Y. Wong ◽  
Dara K. Y. Leung ◽  
Lesley C. Y. Sze ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Symptom Severity ◽  
Social Care ◽  
Late Life ◽  
Community Dwelling ◽  
Service Utilisation ◽  
Late Life Depression ◽  
Social Care Service ◽  
Health And Social Care

Abstract Aims Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. Methods We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. Results The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). Conclusions The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

scholarly journals Cognitive Functioning and Late-Life Depression

2014 ◽  
Vol 20 (5) ◽  
pp. 461-467 ◽  
Author(s):  
Aaron M. Koenig ◽  
Rishi K. Bhalla ◽  
Meryl A. Butters
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Cognitive Functioning ◽  
Neuropsychological Assessment ◽  
Cognitive Deficits ◽  
Late Life ◽  
Cognitive Outcomes ◽  
Review Of The Literature ◽  
Late Life Depression ◽  
The Relationship

AbstractThis brief report provides an introduction to the topic of cognitive functioning in late-life depression (LLD). In addition to providing a review of the literature, we present a framework for understanding the heterogeneity of cognitive outcomes in this highly prevalent disorder. In addition, we discuss the relationship between LLD and dementia, and highlight the importance of regularly assessing cognitive functioning in older adults who present with depressive symptoms. If cognitive deficits are discovered during a neuropsychological assessment, we recommend referral to a geriatric psychiatrist or cognitive neurologist, for evaluation and treatment of the patient’s symptoms. (JINS, 2014, 20, 1–7)

The association of loneliness with health and social care utilisation in older adults in the general population: A systematic review

2021 ◽  
Author(s):  
Kimberley J Smith ◽  
Christina Victor
Keyword(s):  
Older Adults ◽  
General Population ◽  
Social Care ◽  
Care Home ◽  
Service Utilisation ◽  
Study Quality ◽  
Cross Sectional ◽  
Consistent Finding ◽  
Care Utilisation ◽  
Health And Social Care

Abstract Background and Objectives Loneliness is proposed to be linked with increased service use. This review examined the association of loneliness and health and social care utilisation (HSCU) in older adults from the general population. Research Design and Methods Four databases were screened for studies that examined the association of loneliness (predictor) with HSCU (outcome) in older adults (defined as majority of sample 60 or older). Study quality was assessed with the NIH scale for observational cohorts and cross-sectional studies. Results We identified 32 studies, of which 9 prospective studies were evaluated as being good or good-fair quality. Two good-fair quality studies found loneliness at baseline was associated with subsequent admission to a residential care home. There was emerging evidence that loneliness was associated with emergency department use (n=1), and CVD-specific hospitalisation (n=1). Once adjusted for confounders the highest quality studies found no association of baseline loneliness with physician utilisation, outpatient service utilisation, skilled nursing facility use, and planned or unplanned hospital admissions. The remaining, studies were cross-sectional, or of fair to poor quality, and inadequate to reliably determine whether loneliness was associated with a subsequent change in HSCU. Discussion and implications There was heterogeneity in study design, measurement, and study quality. This generated an inconsistent evidence base where we cannot determine clear inferences about the relationship between loneliness and HSCU. Only one consistent finding was observed between two good-fair quality studies regarding care home admission. To determine clinical implications and make reliable inferences additional good quality longitudinal research is needed.

Culturally adapted and lay-delivered cognitive behaviour therapy for older adults with depressive symptoms in rural China: a pilot trial

2020 ◽  
pp. 1-5
Author(s):  
Jiaqi Yuan ◽  
Yi Yin ◽  
Xinfeng Tang ◽  
Tan Tang ◽  
Qinshu Lian ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Health Workers ◽  
Pilot Trial ◽  
Depression Scale ◽  
Late Life ◽  
Late Life Depression ◽  
Mixed Effect ◽  
Culturally Adapted ◽  
Cognitive Behaviour

Abstract Background: Late-life depression issues in developing countries are challenging because of understaffing in mental health. Cognitive behavioural therapy (CBT) is effective for treating depression. Aim: This pilot trial examined the adherence and effectiveness of an eight-session adapted CBT delivered by trained lay health workers for older adults with depressive symptoms living in rural areas of China, compared with the usual care. Method: Fifty with screen-positive depression were randomly assigned to the CBT arm or the care as usual (CAU) arm. The primary outcomes were the session completion of older adults and changes in depressive symptoms, assessed using the Geriatric Depression Scale (GDS). Results: The majority (19/24) of participants in the CBT arm completed all sessions. Mixed-effect linear regression showed that the CBT reduced more GDS scores over time compared with CAU. Conclusion: Lay-delivered culturally adapted CBT is potentially effective for screen-positive late-life depression.

scholarly journals BROODING MODERATES THE RELATIONSHIP BETWEEN CEREBROVASCULAR BURDEN AND VASCULAR DEPRESSION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S877-S878
Author(s):  
Manuel Herrera Legon ◽  
Daniel Paulson
Keyword(s):  
Older Adults ◽  
Depressive Symptomatology ◽  
Depression Scale ◽  
Late Life ◽  
Community Dwelling ◽  
Self Report ◽  
Future Research ◽  
Late Life Depression ◽  
Vascular Depression ◽  
The Relationship

Abstract Objective: The vascular depression hypothesis posits that cerebrovascular burden confers risk for late-life depression. Though neuroanatomical correlates of vascular depression (prefrontal white matter hyperintensities) are well established, little is known about cognitive correlates; the identification of which may suggest therapeutic targets. Aims of this study are to examine the hypothesis that the relationship between cerebrovascular burden and depressive symptoms is moderated by brooding, a type of rumination. Method: A sample of 52 community-dwelling, stroke-free, individuals over the age of 70, without history of severe mental illness or dementia completed the Ruminative Responses Scale, and provided self-report (cardiac disease, hypertension, diabetes, high cholesterol) CVB data. The Geriatric Depression Scale was used to assess depressive symptomatology. Results: Results of a bootstrapped model were that self-reported measures of CVB predicted depressive symptomatology. This relationship was significantly moderated by brooding. Among older adults, those who self-reported high CVB and medium to elevated levels of rumination experienced disproportionately more depressive symptomatology. Conclusions: These findings suggest that brooding rumination may be one correlate of the vascular depression syndrome. Future research should examine neuroanatomical correlates of rumination among older adults, and further explore brooding as a therapeutic target for those with late-life depression.

scholarly journals Advancing the screening of fibromyalgia in late-life depression: practical implications for psychiatric settings

2015 ◽  
Vol 27 (9) ◽  
pp. 1513-1521 ◽  
Author(s):  
John R. Jochum ◽  
Amy E. Begley ◽  
Mary Amanda Dew ◽  
Debra K. Weiner ◽  
Jordan F. Karp
Keyword(s):  
Older Adults ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Late Life ◽  
Community Dwelling ◽  
Screening Tests ◽  
Health Clinic ◽  
Low Back ◽  
Late Life Depression

ABSTRACTBackground:Fibromyalgia (FM) is common in older adults suffering from mood disorders. However, clinical diagnosis of FM is challenging, particularly in psychiatric settings. We examined the prevalence of FM and the sensitivity of three simple screeners for FM.Methods:Using cross-sectional data, we evaluated three tests against the American College of Rheumatology (ACR) 1990 Criteria for the Classification of FM: a “Do you often feel like you hurt all over?” question, a pain map score, and the Pope and Hudson (PH) interview for FM. Participants were 185 community-dwelling adults ≥ 60 years old with comorbid depression and chronic low back pain evaluated at a late-life mental health clinic.Results:Fifty three of 185 participants (29%) met the ACR 1990 FM criteria. Compared to those without FM, the FM group had more “yes” answers to the “hurt all over?” question and higher pain map scores. To reach a sensitivity of at least 0.90, the cut-off score for the pain map was 8. The sensitivity of the pain map, “hurt all over?” question, and PH criteria were 0.92 [95%CI 0.82–0.98], 0.91 [95%CI 0.79–0.97], and 0.94 [95%CI 0.843–0.99] respectively.Conclusions:Nearly one in three older adults suffering from depression and chronic low back pain met ACR 1990 FM criteria. Three short screening tests showed high sensitivity when compared to the ACR 1990 FM criteria. Implementation of one of the simple screeners for FM in geriatric psychiatry settings may guide the need for further diagnostic evaluation.

Literature on health and social care

2019 ◽  
pp. 103-122
Author(s):  
Sandra Torres
Keyword(s):  
Ethnic Minorities ◽  
Social Care ◽  
Care Service ◽  
Care Staff ◽  
Service Utilisation ◽  
Social Care Service ◽  
Care Services ◽  
The North ◽  
Behavioural Patterns ◽  
Health And Social Care

This chapter focuses on the literature on ethnicity/ race and ageing/ old age that brings attention to issues related to health and social care. Just as it was the case in the previous chapter, this chapter exposes the main trends observed as far as what characterises the literature in focus. Besides being research on the North American context and focusing on very few ethnic minorities, this chapter discusses the fact that this literature takes for granted that ethnicity and race matter for older people’s health and social care service utilisation but does not, in fact, answers why this is the case. In addition, this chapter problematizes the fact that by focusing almost exclusively on older ethnic minorities’ experiences, the literature fails to bring attention to the views of those whose practices are important to the issues being discussed (i.e. health and social care staff). Noted is also that few of the studies reviewed take into account the attitudinal and/or behavioural patterns that are implicitly conveyed to pose a challenge to older ethnic minorities’ access and usage of health and social care services. Thus, by bringing attention to the areas that have received attention (i.e. access and usage/ attitudes, preferences and experiences/ the suitability of different programs, interventions and services and self-care practices), this chapter identifies the array of areas that remain unexplored.

scholarly journals “Being all alone makes me sad”: loneliness in older adults with depressive symptoms

2014 ◽  
Vol 26 (9) ◽  
pp. 1541-1551 ◽  
Author(s):  
Ilse M. J. van Beljouw ◽  
Eric van Exel ◽  
Jenny de Jong Gierveld ◽  
Hannie C. Comijs ◽  
Marjolijn Heerings ◽  
...  
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Emotional Distress ◽  
Older Persons ◽  
Logical Consequence ◽  
Community Dwelling ◽  
Care Utilization ◽  
Health Consequences ◽  
Late Life Depression

ABSTRACTBackground:The consequences of co-occurring persistent loneliness and late life depression are yet unknown. The aim of this study was to get a deeper insight into the mental health consequences of loneliness in older persons with depressive symptoms and their perspectives of emotional distress by using a mixed-methods study design.Methods:Two hundred and forty nine community-dwelling older persons with depressive symptoms according to the Patient Health Questionnaire-9 (≥6) were included. A validated cut-off score on the Loneliness Scale was used to distinguish lonely elders from elders who were not lonely. Quantitative and qualitative data were used to examine differences in mental health and perspectives on emotional distress between lonely and not lonely older persons with depressive symptoms.Results:Loneliness was highly prevalent among older persons with depressive symptoms (87.8%). Lonely people suffered from worse mental ill-health (e.g., more severe depressive symptoms, more often a depressive disorder and a lower quality of life) compared to not lonely individuals. Depressive symptoms were regarded as a logical consequence of loneliness. Lonely people perceived little command over their situation: causes of loneliness were attributed externally to perceived deficits in their social networks and they mainly expressed the need to be listened to.Conclusion:Our findings underline the importance of paying considerable attention to (severe) loneliness in older adults with depressive symptoms given its high prevalence and serious mental health consequences. Future studies should look into whether addressing loneliness when discussing depressive symptoms in clinical practice may provide an opportunity to better adjust to older persons’ depression perceptions and might therefore improve care utilization.

Late life depression: a comparison of risk factors and symptoms according to age of onset in community dwelling older adults

2009 ◽  
Vol 25 (10) ◽  
pp. 981-987 ◽  
Author(s):  
Damien Gallagher ◽  
Aine Ni Mhaolain ◽  
Elaine Greene ◽  
Cathal Walsh ◽  
Aisling Denihan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Age Of Onset ◽  
Late Life ◽  
Community Dwelling ◽  
Late Life Depression ◽  
Community Dwelling Older Adults

scholarly journals Frailty and Home Confinement during the COVID-19 Pandemic: Results of a Pre-Post Intervention, Single Arm, Prospective and Longitudinal Pilot Study

2021 ◽  
pp. 1-2
Author(s):  
C.P. Launay ◽  
L. Cooper-Brown ◽  
V. Ivensky ◽  
O. Beauchet
Keyword(s):  
Older Adults ◽  
Social Isolation ◽  
Social Care ◽  
Assessment Tool ◽  
Community Dwelling ◽  
Phone Call ◽  
Care Providers ◽  
Care Plans ◽  
Health And Social Care ◽  
Community Dwelling Older Adults

The COVID-19 pandemic had severe consequences for older adults. First, COVID-19 was associated with more severe medical complications and an increased mortality rate in older compared to younger adults (1). Second, home confinement, an intervention that reduces the spread of COVID-19, was associated with adverse consequences for the older community-dwelling population (2). It broke down social networks and the continuum of primary care, resulting in medication or food delivery issues, psychological fallout and increasing frailty risks (3). Frailty assessment provides insight into the degree of older community dwellers’ health status vulnerability, social isolation and adverse health event risks, and it should be assessed before interventions are proposed (3). We designed a short assessment tool known as “Evaluation SOcio-GERiatrique” (ESOGER) for Montreal’s homebound community-dwelling older adults (3). In a phone call, ESOGER briefly assessed frailty and social isolation and provided recommendations, facilitating contact with health or social care providers who initiate appropriate health and social care plans (3). This study aims to examine the longitudinal effects of ESOGER on frailty and social isolation in Montreal’s homebound community-dwelling older adults.

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