The prevalence and recognition of major depression among low-level aged care residents with and without cognitive impairment

AUTHORS:Kerstin Johansson, Karolina Thömkvist, Ingmar Skoog and Sacuiu SF* (*presenter)OBJECTIVE:To determine the effects of electroconvulsive therapy (ECT) in major depression in relation to the development of dementia during long-term follow-up.METHOD:In an observational clinical prospective study of consecutive patients 70 years and older diagnosed with major depression at baseline 2000-2004 (n=1090), who were free of dementia and received antidepressant treatment, with or without ECT, we sought to determine if cognitive decline (mild cognitive impairment and dementia) during 15 -year follow-up was associated with receiving ECT at baseline. The control group was selected among the participants in the Gothenburg H70 Birth Cohort Studies matched by age group and sex 1:1.RESULTS:Among patients with affective syndromes 7% received ECT. During follow-up, 157 patients were diagnosed with dementia, equal proportions among those who received ECT (14.5%) and those who did not receive ECT (14.5%). The relation between ECT and cognitive decline remained non-significant irrespective antidepressive medication or presence of mild cognitive impairment at baseline.CONCLUSION:Preliminary results indicate that ECT was not associated with the development of cognitive decline in the long-term in a hospital-based cohort of 70+ year-olds. The results remain to verify against controls from a representative community sample.

Download Full-text

Dementia in Aboriginal people in Residential Aged Care Facilities in Alice Springs: A Descriptive Study

Brain Impairment ◽

10.1017/brimp.2019.23 ◽

2019 ◽

Vol 20 (2) ◽

pp. 171-179

Author(s):

Bruce Hocking ◽

Michael Lowe ◽

Tricia Nagel ◽

Caroline Phillips ◽

Melissa Lindeman ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Assessment ◽

Aboriginal People ◽

Aged Care ◽

Residential Aged Care ◽

Aboriginal Populations ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities ◽

Clinical File

AbstractBackground:A high prevalence of dementia among Aboriginal and Torres Strait Islanders has been reported but knowledge of underlying causes and associations remains limited.Objective:To identify the prevalence of factors that may be associated with the categories of Major neurocognitive disorders (Major NCDs) in Aboriginal people living in residential aged care facilities in Alice Springs in the Northern Territory (NT).Design and Setting:This descriptive cross-sectional study analysed clinical file and cognitive assessment data of participants who were identified as having cognitive impairment between January and June 2016.Method:Screening for the presence of cognitive impairment using the Kimberley Indigenous Cognitive Assessment (KICA) was undertaken and 58 of 84 Aboriginal people were admitted to the study. Using a clinical file audit, diagnoses of Major NCDs consistent with the DSM-5 classification were made and the prevalence of factors possibly associated with these diagnoses described.Results:Fifty of the 58 participants were diagnosed with a Major NCD. The most frequent diagnoses were Major NCD due to vascular disease (30%), Major NCD due to Alzheimer’s Disease (26%) and Major NCD due to brain injury (20%). Hypertension, Type 2 Diabetes Mellitus and alcohol misuse were commonly reported together with hypothyroidism, hypoglycaemia and vitamin D deficiency.Conclusion(s):This study identified possible associations with Major NCDs in this population as well as a different spread of Major NCD diagnoses to previous studies in Aboriginal populations. There is a need for further research to understand the causes of dementia in Australian Aboriginal people and to use this information to appropriately tailor treatment and prevention programmes.

Download Full-text

Comparison of Cognitive Impairment Associated With Major Depression Following Stroke Versus Traumatic Brain Injury

Psychosomatics ◽

10.1176/appi.psy.43.4.295 ◽

2002 ◽

Vol 43 (4) ◽

pp. 295-301 ◽

Cited By ~ 5

Author(s):

Amane Tateno ◽

Yuichi Murata ◽

Robert G. Robinson

Keyword(s):

Traumatic Brain Injury ◽

Cognitive Impairment ◽

Brain Injury ◽

Major Depression

Download Full-text

Relationship of depression and cognitive impairment to self-injury in borderline personality disorder, major depression, and schizophrenia

Psychiatry Research ◽

10.1016/0165-1781(91)90054-s ◽

1991 ◽

Vol 38 (1) ◽

pp. 77-87 ◽

Cited By ~ 30

Author(s):

J.Wesley Burgess

Keyword(s):

Cognitive Impairment ◽

Borderline Personality Disorder ◽

Major Depression ◽

Personality Disorder ◽

Borderline Personality ◽

Self Injury ◽

Relationship Of

Download Full-text

Intergenerational Programs May Be Especially Engaging for Aged Care Residents With Cognitive Impairment: Findings From the Avondale Intergenerational Design Challenge

American Journal of Alzheimer s Disease & Other Dementias® ◽

10.1177/1533317517703477 ◽

2017 ◽

Vol 32 (4) ◽

pp. 213-221 ◽

Cited By ~ 6

Author(s):

Jess Rose Baker ◽

Lindl Webster ◽

Nigel Lynn ◽

Julie Rogers ◽

Jessica Belcher

Keyword(s):

Cognitive Impairment ◽

Control Period ◽

Aged Care ◽

Total N ◽

Intergenerational Programs ◽

Technology Students ◽

Meaningful Activity ◽

Design Challenge ◽

Lifestyle Activities

Intergenerational programs are an authentic way to engage elders in meaningful activity and report benefits to both elders and youth. The Avondale Intergenerational Design Challenge (AVID) randomly assigned small teams of technology students aged 13 to 15 years (total N = 59) to 1 of 24 aged care residents with a range of cognitive impairment. Students met with the resident 4 times over 15 weeks and ultimately crafted a personalized item for them. Students showed no change in self-reported attitudes to elders, empathy, or self-esteem post-AVID or at 3-month follow-up, compared to a 3-month within-subject control period pre-AVID. Compared to usual lifestyle activities, residents showed significant improvements in self-reported positive affect and negative affect after student visits and were observed to be significantly more engaged during visits, especially residents with greater cognitive impairment. The personal and guided nature of intergenerational programs may be especially effective in engaging elders with cognitive impairment in meaningful activity.

Download Full-text

An Examination of the “Gold Standard” Diagnosis of Major Depression in Aged-Care Settings

American Journal of Geriatric Psychiatry ◽

10.1097/jgp.0b013e318190b901 ◽

2009 ◽

Vol 17 (5) ◽

pp. 359-367 ◽

Cited By ~ 38

Author(s):

Tanya E. Davison ◽

Marita P. McCabe ◽

David Mellor

Keyword(s):

Major Depression ◽

Gold Standard ◽

Aged Care

Download Full-text

Identifying the Association Between Older Adults' Characteristics and Their Health-Related Outcomes in a Transition Care Setting: A Retrospective Audit

Frontiers in Public Health ◽

10.3389/fpubh.2021.688640 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jo-Aine Hang ◽

Jacqueline Francis-Coad ◽

Chiara Naseri ◽

Angela Jacques ◽

Nicholas Waldron ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Care Service ◽

Aged Care ◽

Functional Improvement ◽

Residential Aged Care ◽

Discharge Destination ◽

Transition Care ◽

Retrospective Audit ◽

Health Related

Introduction: Continued evaluation of Transition Care Programs (TCP) is essential to improving older adults' outcomes and can guide which older adults may benefit from undertaking TCP. The aim of this study was to audit a transition care service to identify the association between the characteristics of older adults undertaking a facility-based TCP and (i) discharge destination and (ii) functional improvement.Materials and methods: An audit (n = 169) of older adults aged 60 years and above who completed a facility-based TCP in Australia was conducted. Outcomes audited were performance of activities of daily living (ADL) measured using the Modified Barthel Index (MBI) and discharge destination. Data were analyzed using logistic regression and linear mixed modeling.Results: Older adults [mean age 84.2 (±8.3) years] had a median TCP stay of 38 days. Fifty-four older adults (32.0%) were discharged home, 20 (11.8%) were readmitted to hospital and 93 (55%) were admitted to permanent residential aged care. Having no cognitive impairment [OR = 0.41 (95% CI 0.18-0.93)], being independent with ADL at admission [OR = 0.41 (95% CI 0.16-1.00)] and a pre-planned team goal of home discharge [OR = 24.98 (95% CI 5.47-114.15)] was significantly associated with discharge home. Cases discharged home showed greater improvement in functional ability [MBI 21.3 points (95% CI 17.0-25.6)] compared to cases discharged to other destinations [MBI 9.6 points (95% CI 6.5-12.7)].Conclusion: Auditing a facility-based TCP identified that older adults who were independent in ADL and had good cognitive levels were more likely to be discharged home. Older adults with cognitive impairment also made clinically significant functional improvements.

Download Full-text

Depression, cognitive, and functional outcomes of Problem Adaptation Therapy (PATH) in older adults with major depression and mild cognitive deficits

International Psychogeriatrics ◽

10.1017/s1041610219001716 ◽

2020 ◽

Vol 32 (4) ◽

pp. 485-493

Author(s):

Dora Kanellopoulos ◽

Paul Rosenberg ◽

Lisa D. Ravdin ◽

Dalynah Maldonado ◽

Nimra Jamil ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Treatment Group ◽

Major Depression ◽

Rating Scale ◽

Treatment Options ◽

Supportive Therapy ◽

Psychosocial Interventions ◽

World Health ◽

Time Interaction

ABSTRACTObjectives:Antidepressants have limited efficacy in older adults with depression and cognitive impairment, and psychosocial interventions for this population have been inadequately investigated. Problem Adaptation Therapy (PATH) is a psychosocial intervention for older adults with major depression, cognitive impairment, and disability.Design:This study tests the efficacy of PATH versus Supportive Therapy for Cognitively Impaired Older Adults (ST-CI) in reducing depression (Montgamery Asberg Depression Rating Scale [MADRS]) and disability (World Health Organization Disability Assessments Schedule-II [WHODAS-II]) and improving cognitive outcomes (Mini Mental State Examination [MMSE]) over 24 weeks (12 weeks of treatment and 12-week post-treatment follow-up).Setting:Participants were recruited through collaborating community agencies of Weill Cornell Institute of Geriatric Psychiatry. Both interventions and all research assessments were conducted at home.Participants:Thirty-five older adults (age ≥ 65 years) with major depression and cognitive impairment no dementia (CIND).Interventions:PATH aims to increase emotion regulation by incorporating a problem-solving approach, teaching compensatory strategies, and inviting caregiver participation. Supportive Therapy aims to facilitate the expression of affect, as well as promote empathy.Measurements:Depression was measured using the MADRS, disability using the WHODAS-II, and cognition using the MMSE.Results:PATH participants showed significantly greater reduction in MADRS total score (7.04 points at 24 weeks, treatment group by time interaction: F[1,24.4] = 7.61, p = 0.0108), greater improvement in MMSE total score (2.30 points at 24 weeks, treatment group by time interaction: F[1,39.8] = 13.31, p = 0.0008), and greater improvement in WHODAS-II total score (2.95 points at 24 weeks, treatment group by time interaction: F[1,89] = 4.93, p = 0.0290) than ST-CI participants over the 24-week period.Conclusions:PATH participants had better depression, cognitive, and disability outcomes than ST-CI participants over 6 months. PATH may provide relief to depressed older adults with CIND who currently have limited treatment options.

Download Full-text