scholarly journals Traditional & narrative practices of treatment for depression and depressive symptoms in older adults

2022 ◽  
Vol 9 (1) ◽  
pp. 14-15
Author(s):  
Courtni Jeffers
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Organizational Climate ◽  
Organizational Context ◽  
Treatment Guidelines ◽  
Positive Impact ◽  
Treatment Plan ◽  
Patient Treatment ◽  
Treatment Plans ◽  
Self Discovery

An analysis and evaluation of the literature regarding traditional treatment methods for depression among older adults compared the effectiveness of the results to the benefits of a treatment plan that integrates the narrative practices of storytelling and reflexive writing. Priority was given to peer-reviewed journal articles from 2008 forward, though some earlier information was used for clarification and foundation building. The formation and implementation of individual patient treatment plans for depression and depressive symptoms are impacted by many variables such as: Confusion surrounding provider treatment guidelines, social organizational context, organizational climate and the differing definitions of depression that exist among providers and patients. Patients often struggle to self-identify or put words to depressive symptoms and the process of reflexive writing is transformative and increases narrative competency, which strengthens a patient’s ability to give an account of oneself, aiding in self-discovery and personal symptom awareness. An imbalance of power exists in the clinical encounter and the practices and principles of the discipline of Narrative Medicine can have a positive impact on strengthening the therapeutic alliance and treatment outcomes. Older adults with depression and depressive symptoms have a lower quality of life and often feel less productive in their communities. Traditional pharmacologically based depression treatment plans are one-dimensional and often fail to address personal patient context and preference. Older adults living with diagnosed depression and depressive symptoms can be better served with treatment plans that include narrative techniques that increase alliance, affiliation, self-awareness and self-discovery.  

scholarly journals Perceptions of Treatment Burden Among Elders With Diabetes and Comorbid Alzheimer’s Disease and Related Dementias

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 276-276
Author(s):  
Victoria Vaughan Dickson ◽  
Halia Melnyk ◽  
Rosie Ferris ◽  
Joshua Chodosh ◽  
Caroline Blaum
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Qualitative Study ◽  
Financial Burden ◽  
Controlled Trial ◽  
Healthcare Providers ◽  
Patient Treatment ◽  
Treatment Burden ◽  
Treatment Plans

Abstract Background: An estimated 25% of older adults with diabetes (DM) may have co-occurring Alzheimer’s Disease and Related Dementias (ADRD), complicated by multiple treatment plans and providers. Assessing treatment burden has been limited to patients’ perspectives; little is known about caregiver perceptions of treatment burden despite their important role in personal care and treatment adherence. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for older adults with DM-ADRD. Methods: This qualitative study was conducted in the formative phase of “Enhanced Quality in Primary care for Elders with DM-ADRD (EQUIPED-ADRD) a pragmatic randomized controlled trial in a large, diverse healthcare system. A diverse sample of caregivers (n=15) of patients enrolled in the RCT participated in interviews about their caregiver role and perceptions of treatment burden of DM-ADRD clinical management. Qualitative data were analyzed using content analysis and themes about treatment burden were compared to domains on the Treatment Burden Questionnaire (TBQ). Results: Caregivers reported high levels of burden related to treatment plans for patients with DM-ADRD. Themes related to complexity and burden of medication management, monitoring (e.g., blood pressure, glucose monitoring), dietary and physical activity regimens, navigating healthcare providers and financial burden were reported. Caregivers also described high levels of emotional burden that was associated with patient’s cognitive decline and family functioning stress. Conclusions: Interventions to reduce treatment burden for patients and caregiver should include activating social/nursing services, respite care and care coordination that may support caregivers especially as patient treatment increases in complexity over time.

Impact of a geriatric oncology (GO) clinic on cancer treatment plans and supportive care for older adults with genitourinary (GU) cancer.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 238-238
Author(s):  
Shabbir M.H. Alibhai ◽  
Allison Loucks ◽  
Rana Jin ◽  
Martine Puts ◽  
Sarah Watt ◽  
...  
Keyword(s):  
Older Adults ◽  
Supportive Care ◽  
Treatment Plan ◽  
Tertiary Care ◽  
Geriatric Oncology ◽  
Operative Management ◽  
Best Supportive Care ◽  
Care Hospital ◽  
Treatment Plans ◽  
The Impact

238 Background: Older adults with cancer are complex due to multiple comorbidities, polypharmacy, and functional/cognitive impairments, leading to over-treatment and undertreatment. Studies examining the impact of geriatric assessment (GA) in older adults with various cancers found a median of 39% of treatment plans were revised after the GA ( Ann Oncol 2014; 25:307). Although these findings support the need for a GO clinic, whether such a clinic leads to changes in treatment in patients with GU malignancies is not clear. We examined the impact on the treatment plan of a GO assessment in GU patients, along with other enhancements to patient care for consecutive patients referred to the GO clinic in a tertiary care hospital. Methods: All referred older adults (age 65+) with a GU malignancy seen in the GO clinic at the Princess Margaret Cancer Centre, Toronto, Canada between July 2015 and June 2017 were included. Patients were seen by a geriatric oncologist and GO nurse and treatment recommendations were provided to the referring oncologist. Pre- and post-GO clinic treatment plans and enhancements to supportive care were recorded prospectively. Analyses were descriptive. Results: 98 patients (mean age 80) were seen in the GO clinic, of whom 35 were seen pre-treatment (25 prostate, 5 kidney, 5 bladder). 31 of 35 were referred for input on the treatment plan. The initial treatment plan included surgery (n = 6), radiation (n = 14), systemic therapy (n = 8), and hormonal therapy (n = 11). The final treatment plan was intensified in 1 patient, reduced in 6 patients, changed to best supportive care in 8 patients, and unchanged in 15 patients. Overall, GO resulted in a treatment modification in 52% of patients. Enhancements to care included comorbidity management (87%), educational support (94%), disease-related symptoms (39%), and peri-operative management (19%). Conclusions: The GO clinic results in modifications to the proposed treatment plan in over half of referred patients (predominantly a reduction in treatment intensity), and enhancements to care in the vast majority of patients. GO clinics have the potential to avoid overtreatment and improve care for older adults with GU malignancies.

scholarly journals An analysis on medical expenses of multidisciplinary cancer care under health insurance

2021 ◽  
Vol 64 (10) ◽  
pp. 711-716
Author(s):  
Myungjin Jung ◽  
Byungyul Jun
Keyword(s):  
Health Insurance ◽  
Cancer Patients ◽  
Cancer Care ◽  
Treatment Plan ◽  
Multidisciplinary Care ◽  
Therapeutic Modality ◽  
Patient Treatment ◽  
Medical Expenses ◽  
Hospitalization Costs ◽  
Treatment Plans

Background: Cancer has been the leading cause of death in Korea for more than 40 years. As the aging population in the country increases, this trend is expected to continue. Cancer care is also being subdivided into specialties according to the development of medical technology. This division of care has made it difficult for a single physician to set up a complete cancer treatment plan. As a result, the call for multidisciplinary care has risen. Multidisciplinary cancer care allows physicians to share opinions and choose optimal patient treatment plans across multiple specialties. In August 2014, the Ministry of Health and Welfare designated a set number of approved multidisciplinary treatments and has included them under its health insurance coverage. As a result, multidisciplinary care is rapidly increasing.Current Concepts: An analysis on cancer care was conducted from 2014 to 2018, which examined the average medical expenses, hospitalization costs, and surgery costs per person according to therapeutic modality. Findings showed that multidisciplinary care decreased the overall cost of medical care in cancer patients compared to segmented care provided by single specialty physicians.Discussion and Conclusion: This study predicted that multidisciplinary care would be effective in reducing medical expenses. Cancer patients do not need to be treated by individual subspecialty physicians when personalized care treatment plans through a multidisciplinary approach is possible. The results of this study show that the Korean government should expand health insurance premium support and coverage for multidisciplinary cancer care.

scholarly journals Grandparenting and Health in Later Life: Intensity and Age, Gender, and Urbanicity Variations

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 26-26
Author(s):  
Yue Zeng ◽  
Yu-Chih Chen
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Physical Health ◽  
Role Theory ◽  
Propensity Score Analysis ◽  
Positive Impact ◽  
Later Life ◽  
Social Model ◽  
Mobility Limitations ◽  
Self Rated Health

Abstract Grandparents play increasingly indispensable roles in providing family care. Although prior cross-sectional studies have shown a positive link between grandparenting and health, we know little about the optimal engagement level of grandparenting, its longitudinal implications, and variations on health outcomes. Guided by the role theory and social model of health promotion, we used propensity score analysis and multilevel analysis with three biennial waves of China Health and Retirement Longitudinal Study (2011-2015) to examine the longitudinal impacts of grandparenting intensity (no, low-, moderate-, and high-intensity) on health (mobility limitations, depressive symptoms, cognition, and self-rated health) among 4,925 older adults aged 45 and older, and how these impacts vary by age (45-59/60+), gender (male/female), and urbanicity (urban/rural). Controlling for the baseline sociodemographics (e.g., education and income), health limitations (e.g., ADLs and IADLs), and health behaviors (e.g., drinking and smoking), our results showed that, compared to no grandparenting, grandparenting provided at a moderate level was associated with fewer mobility limitations, lower depressive symptoms, and better cognition. Furthermore, grandparenting had a positive impact on physical, mental and cognitive health for 60+ older adults but not for the young-old. Both older males and females showed better physical health if they provided care at a low level, but older females showed better self-rated health. Older adults in the rural area showed better physical health; for the urban area older adults, better cognition. Findings suggest that policies aimed at supporting grandparents should consider the optimal threshold and variations by age, gender, and urbanicity.

Poor Acceptance of the Past is Related to Depressive Symptoms in Older Adults

GeroPsych ◽  
2020 ◽  
Vol 33 (4) ◽  
pp. 246-251
Author(s):  
Gozde Cetinkol ◽  
Gulbahar Bastug ◽  
E. Tugba Ozel Kizil
Keyword(s):  
Older Adults ◽  
Regression Analysis ◽  
Depressive Symptoms ◽  
Death Anxiety ◽  
Geriatric Depression ◽  
Ego Integrity ◽  
The Past ◽  
Depressed Group ◽  
Total Death ◽  
The Relationship

Abstract. Depression in older adults can be explained by Erikson’s theory on the conflict of ego integrity versus hopelessness. The study investigated the relationship between past acceptance, hopelessness, death anxiety, and depressive symptoms in 100 older (≥50 years) adults. The total Beck Hopelessness (BHS), Geriatric Depression (GDS), and Accepting the Past (ACPAST) subscale scores of the depressed group were higher, while the total Death Anxiety (DAS) and Reminiscing the Past (REM) subscale scores of both groups were similar. A regression analysis revealed that the BHS, DAS, and ACPAST predicted the GDS. Past acceptance seems to be important for ego integrity in older adults.

Analysis of Self-Concept in Older Adults in Different Contexts

2004 ◽  
Vol 20 (4) ◽  
pp. 262-274 ◽  
Author(s):  
Manuel de Gracia Blanco ◽  
Josep Garre Olmo ◽  
María Marcó Arbonès ◽  
Pilar Monreal Bosch
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Depressive Symptoms ◽  
External Validity ◽  
Aging Process ◽  
Well Being ◽  
Self Esteem ◽  
Self Concept ◽  
Self Perceptions ◽  
Discriminatory Capacity

Summary: Self-concept is a construct consisting of a group of specific self-perceptions that are hierarchically organized. Age-associated changes of self-concept are related to the individual's perception of the changes occurring throughout the aging process. The authors examined external validity and internal consistency of an instrument that has been developed to assess self-concept in older adults and examined self-concept's characteristics in two different contexts. Results confirm the multidimensionality of the scale and show a satisfactory external validity, indicating good discriminatory capacity. Findings support the hypothesis that older people who live in a nursing home have a poor self-esteem, self-concept, and psychological well-being and have a greater presence of depressive symptoms than people who live in their own home.

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