scholarly journals Perceived Need for Mental Health Care and Associated Factors and Outcomes in Older Adults Consulting in Primary Care

2021 ◽  
pp. 070674372110554
Author(s):  
Catherine Lamoureux-Lamarche ◽  
Djamal Berbiche ◽  
Helen-Maria Vasiliadis
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Unmet Need ◽  
Need For Care ◽  
Societal Costs ◽  
Perceived Need ◽  
Health Related

Objective To assess the individual and health system factors and health-related outcomes associated with perceived need for mental health care in older adults consulting in primary care. Method This longitudinal cohort study was conducted among 771 cognitively intact older adults aged ≥65 years recruited in primary care practices in Quebec between 2011 and 2013 and followed 4 years later. Predisposing, enabling and need factors were based on Andersen’s framework on help-seeking behaviors. Health-related outcomes included course of common mental disorders (CMDs), change in quality of life and societal costs. Perceived need for care (PNC) was categorized as no need, met and unmet need. Multinomial regression analyses were conducted to assess the association between study variables and PNC in the overall and the subsample of participants with a CMD at baseline. Results As compared with individuals reporting no need, those with an unmet need were more likely to have cognitive decline and lower continuity of care; while those with a met need were more likely to report decreased health-related quality of life. As compared with individuals with an unmet need, those reporting a met need were more likely to report ≥ 3 physical diseases and an incident and persistent CMD, and less likely to show cognitive decline. In participants with a CMD, individuals reporting a met as compared with no need were more likely to be categorized as receiving minimally adequate care and a persistent CMD. Need for care was not associated with societal costs related to health service use. Conclusions Overall, physicians should focus on individuals with cognitive impairment and lower continuity of care which was associated with unmet mental health need. Improved follow-up in these populations may improve health care needs and outcomes.

Catastrophic health expenditure and health-related quality of life among older adults in China

2019 ◽  
pp. 1-21
Author(s):  
Yalu Zhang ◽  
Qin Gao
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Health Care ◽  
Catastrophic Health Expenditure ◽  
Health Related Quality ◽  
Physical And Mental Health ◽  
Rural And Urban ◽  
Related Quality ◽  
Health Related

Abstract Older adults have more health-care needs and higher financial burdens but fewer income resources compared to other age groups in China. Meanwhile, substantial inequalities exist between rural and urban older adults in terms of welfare benefits level, access to health care, quality of care and financial resources to pay for health-care services. Using 2011–2013 panel data from the China Health and Retirement Longitudinal Study and a difference-in-differences methodology, this study examined the association between the incidence of catastrophic health expenditure (CHE) and health-related quality of life among older adults in China. To distinguish the dynamic of CHE and generate rigorous estimates, we categorised the older adults into four groups: CHE entry group, non-CHE group, CHE exit group and CHE persistent group. Overall, we found that entry into CHE was associated with poorer physical and mental health for both rural and urban older adults, but this association was more consistent and robust for physical than for mental health. Exiting CHE was found to have a weak and sporadic positive association with physical and mental health across rural and urban areas. The results suggest that financial resources and social services are needed in China to support older adults who experience CHE persistently or periodically to help improve their health outcomes.

scholarly journals The effect of resistance training on health-related quality of life in older adults: Systematic review and meta-analysis

2019 ◽  
Vol 9 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Peter D. Hart ◽  
Diona J. Buck
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Older Adults ◽  
Role Function ◽  
Health Measures ◽  
Physical Role ◽  
Emotional Role ◽  
Related Quality ◽  
Health Related

Background: Resistance training (RT) is recommended as part of our national physical activity guidelines which includes working all major muscle groups on two or more days a week.Older adults can gain many health benefits from RT, such as increased muscle strength,increased muscle mass, and maintenance of bone density. Additionally, certain dimensions of health-related quality of life (HRQOL) have been shown to improve in older adults due to RT intervention. The purpose of this study was to use systematic review and meta-analytic techniques to examine the effect of RT on HRQOL in older adults. Methods: A systematic review of current studies (2008 thru 2017) was conducted using PubMed. Studies were included if they used a randomized controlled design, had RT as an intervention, measured HRQOL using the SF-36/12 assessment, and included adults 50+ years of age. Eight dimension scores (physical functioning, bodily pain, physical role function, general health, mental health, emotional role function, social function, and vitality) and two summary scores (physical component and mental component) were extracted. Ten meta-analyses were performed using standardized mean effect sizes and random effects models. Study quality,moderator and sensitivity analyses were conducted. Results: A total of 16 studies were included in the analyses with a mean Physiotherapy Evidence Database (PEDro) score of 4.9 (SD=1.0). Among the mental health measures, RT had the greatest effect on mental health (Effect size [ES]=0.64, 95% CI: 0.30-0.99, I2=79.7). Among the physical health measures, RT had the largest effect on body pain (ES=0.81, 95% CI: 0.26-1.35, I2=85.9).Initially, RT did not significantly affect measures of emotional role function, social function or physical role function. However, after removing a single study, RT significantly increased all HRQOL measures. Conclusion: The meta-analytic evidence presented in this research clearly supports the promotion of RT in improving HRQOL in older adults.

scholarly journals HEALTH-RELATED QUALITY OF LIFE AND CARDIOVASCULAR DISEASE IN ASIAN AMERICAN AND PACIFIC ISLANDER OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S515-S516
Author(s):  
Lan Doan ◽  
Yumie Takata ◽  
Karen Hooker ◽  
Carolyn Mendez-Luck ◽  
and Veronica L Irvin
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Risk Factors ◽  
Older Adults ◽  
Asian American ◽  
Medicare Advantage ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Abstract Cardiovascular disease (CVD) is the leading cause of death for Asian American (AA), Native Hawaiian, and Pacific Islander (NHPI) older adults, and AAs/NHPIs have not enjoyed decreases in CVD mortality rates, as have non-Hispanic whites (NHWs). Heterogeneity exists in the prevalence of traditional CVD risk factors for AAs/NHPIs. Health-related quality of life (HRQOL) reflect physical and mental burdens beyond clinical burdens, which may help explain discrepant CVD rates and risk factors in AAs/NHPIs. We examined HRQOL among NHW and AA/NHPI Medicare Advantage enrollees with and without a CVD (i.e., coronary artery disease, congestive heart failure, myocardial infarction, and stroke) using the Medicare Health Outcomes Survey. The sample included 655,914 older adults who were 65 years or older, self-reported as AA/NHPI or NHW, and were enrolled in Medicare Advantage plans in 2011-2015. HRQOL was measured using the Veterans RAND 12-item survey and is composed of a physical component score (PCS) and mental component score (MCS), where higher scores reflect better physical and mental health, respectively. Multivariable linear regression was used to explore HRQOL and CVD prevalence. Asian Indian, Filipino, Vietnamese, Other Asian, and NHPI subgroups had lower overall PCS, and all AA/NHPI subgroups had lower overall MCS, compared to NHWs. Among those reporting having any CVD, PCS varied by CVD outcomes and subgroups, whereas MCS was lower for all CVD outcomes and for all but one AA/NHPI subgroups (Japanese), compared to NHWs. Attention to mental health for AA/NHPI older adults could be important for the equitable realization of healthy aging.

scholarly journals A Web-Based eHealth Intervention to Improve the Quality of Life of Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial

10.2196/25175 ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. e25175
Author(s):  
David H Gustafson Sr ◽  
Marie-Louise Mares ◽  
Darcie C Johnston ◽  
Jane E Mahoney ◽  
Randall T Brown ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Chronic Conditions ◽  
Health Care Use ◽  
Multiple Chronic Conditions ◽  
Secondary Outcomes ◽  
Ehealth Intervention

Background Multiple chronic conditions (MCCs) are common among older adults and expensive to manage. Two-thirds of Medicare beneficiaries have multiple conditions (eg, diabetes and osteoarthritis) and account for more than 90% of Medicare spending. Patients with MCCs also experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on laboratory results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving these patients’ lives. Objective This study aims to assess the effects of ElderTree (ET), an eHealth intervention for older adults with MCCs, on quality of life and related measures. Methods In this unblinded study, 346 adults aged 65 years and older with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, and BMI ≥30 kg/m2) were recruited from primary care clinics and randomized in a ratio of 1:1 to one of 2 conditions: usual care (UC) plus laptop computer, internet service, and ET or a control consisting of UC plus laptop and internet but no ET. Patients with ET have access for 12 months and will be followed up for an additional 6 months, for a total of 18 months. The primary outcomes of this study are the differences between the 2 groups with regard to measures of quality of life, psychological well-being, and loneliness. The secondary outcomes are between-group differences in laboratory scores, falls, symptom distress, medication adherence, and crisis and long-term health care use. We will also examine the mediators and moderators of the effects of ET. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; laboratory data are collected from eHealth records; health care use and chronic conditions are collected from health records and patient surveys; and ET use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. Results Recruitment was conducted from January 2018 to December 2019, and 346 participants were recruited. The intervention period will end in June 2021. Conclusions With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ET may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. Trial Registration ClinicalTrials.gov NCT03387735; https://www.clinicaltrials.gov/ct2/show/NCT03387735. International Registered Report Identifier (IRRID) DERR1-10.2196/25175

Home-Based Care and Primary Care Settings for Delivery of Geropsychology Services to Older Persons

2019 ◽  
Author(s):  
Srijana Shrestha
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Primary Care Providers ◽  
Mental Illnesses ◽  
Care Providers ◽  
Primary Care Clinics ◽  
Home Based

Despite high rates of mental illnesses, older adults face multiple barriers in accessing mental health care. Primary care clinics, and home- and community-based senior-serving agencies are settings where older adults routinely receive medical care and social services. Therefore, integration of mental health care with existing service delivery systems can improve access to mental health services and reduce the unmet mental health needs of seniors. Evidence suggests that with innovative components mental health provided in collaboration with primary care providers with or without co-location within primary care clinics can improve depression and anxiety. Home-based models for depression care are also effective, but more research is needed in examining home-based approaches in late-life anxiety treatment. It is noteworthy that integrative models are particularly helpful in expanding the reach in underserved communities: elders from minority and low-income backgrounds and homebound seniors.

Health-related quality of life and co-morbidities among older adults in Bhutan

2018 ◽  
Vol 4 (2) ◽  
pp. 15-24
Author(s):  
Nidup Dorji ◽  
Michael P. Dunne ◽  
Charrlotte Seib ◽  
Sibnath Dep
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Older Adults ◽  
Female Gender ◽  
P Value ◽  
Health Related Quality ◽  
Physical And Mental Health ◽  
Related Quality ◽  
Health Related

Introduction: Health-related quality of life (HRQoL) is a multi-dimensional construct that assesses an individual’s and group’s perceived physical and mental health over time. Measurement of HRQoL is an important medical outcome study and its study among older adults in Bhutan is limited. Methods: This is a cross-sectional study aimed to assess HRQoL and its sociodemographic and health correlates, among older adults in Bhutan. Data for this study was collected from the four major towns of Thimphu, Phuntsholing, Gelephu, and Samdrupjongkhar, Bhutan, from November 2014 - February 2015, using structured questionnaire with face-to-face interview. A total of 337 Bhutanese older adults participated in this study. Statistical analysis was performed using statistical package for social science version 21.0. Results: The overall mean score for the HRQoL among older adults in this study was 0.67 (SD: 0.13) significantly different between the gender (p-value<0.001). A significantly low scores inthe areas of role limitations (p<0.05), pain (p<0.01), mental health (p<0.001), and vitality (p<0.05) of the HRQoL was observed for the female gender. Frequent back pain (67.1%), memory decline (60.5%), depression (46.0%) mobility impairment (45.4%), insomnia (42.1%), and problem affecting breathing (31.8%) were common health problems and were significantly higher among the female gender. Better health conditions was positively related with better HRQoL (p-value<0.001). Conclusions: Low HRQoL was reported higher among female gender and was linked to multiple and cumulative health morbidities. Members of the family, community and healthcare providers could incorporate holistic approach to foster positive health outcomes and HRQoL of the older adults.

scholarly journals Impact of a Mental Health Based Primary Care Program on Quality of Physical Health Care

2017 ◽  
Vol 45 (2) ◽  
pp. 276-285 ◽  
Author(s):  
Joshua Breslau ◽  
Emily Leckman-Westin ◽  
Hao Yu ◽  
Bing Han ◽  
Riti Pritam ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Physical Health ◽  
Care Program ◽  
Primary Care Program ◽  
Physical Health Care

scholarly journals Mental health in primary care: an evaluation using the Item Response Theory

2018 ◽  
Vol 52 ◽  
pp. 17 ◽  
Author(s):  
Hugo André da Rocha ◽  
Alaneir de Fátima dos Santos ◽  
Ilka Afonso Reis ◽  
Marcos Antônio da Cunha Santos ◽  
Mariângela Leal Cherchiglia
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Risk Stratification ◽  
Mental Health Care ◽  
Item Response ◽  
Group Care ◽  
Quality Of Primary Care ◽  
Access And Quality

OBJECTIVE: To determine the items of the Brazilian National Program for Improving Access and Quality of Primary Care that better evaluate the capacity to provide mental health care. METHODS: This is a cross-sectional study carried out using the Graded Response Model of the Item Response Theory using secondary data from the second cycle of the National Program for Improving Access and Quality of Primary Care, which evaluates 30,523 primary care teams in the period from 2013 to 2014 in Brazil. The internal consistency, correlation between items, and correlation between items and the total score were tested using the Cronbach’s alpha, Spearman’s correlation, and point biserial coefficients, respectively. The assumptions of unidimensionality and local independence of the items were tested. Word clouds were used as one way to present the results. RESULTS: The items with the greatest ability to discriminate were scheduling of the agenda according to risk stratification, keeping of records of the most serious cases of users in psychological distress, and provision of group care. The items that required a higher level of mental health care in the parameter of location were the provision of any type of group care and the provision of educational and mental health promotion activities. Total Cronbach’s alpha coefficient was 0.87. The items that obtained the highest correlation with total score were the recording of the most serious cases of users in psychological distress and scheduling of the agenda according to risk stratification. The final scores obtained oscillated between -2.07 (minimum) and 1.95 (maximum). CONCLUSIONS: There are important aspects in the discrimination of the capacity to provide mental health care by primary health care teams: risk stratification for care management, follow-up of the most serious cases, group care, and preventive and health promotion actions.

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