Graham J. McDougall

Comparison of depressive symptoms between homebound older adults and ambulatory older adults

Due to the social isolation imposed by chronic illness and functional limitations, homebound older adults are more vulnerable to depression than their mobility-unimpaired peers. In this study, we compared 81 low-income homebound older adults, aged 60 and older, with their 130 ambulatory peers who attended senior centers, with respect to their depressive symptoms, depression risk and protective factors, and self-reported coping strategies. Even controlling for sociodemographics, health problems, and other life stressors, being homebound, as opposed to participating in senior centers, was significantly associated with higher depressive symptoms. However, when the coping resources–social support and engagement in frequent physical exercise, in particular–were added to the regression model, the homebound state was no longer a significant factor, showing that the coping resources buffered the effect of the homebound state on depressive symptoms. In terms of self-reported coping strategies, even among the depressed respondents, only a small proportion sought professional help, and that was largely limited to consulting their regular physician and social workers, who may not have had professional training in mental health interventions.

Dual diagnosis in elders discharged from a psychiatric hospital

Recent evidence indicates persons 60 years and over experience significant alcohol and substance abuse problems. Since a combination of alcoholism and depression is likely to increase the relative rsk of suicide, it is important to examine the prevalence of dual diagnosis in older adults. The purpose of this study is to examine the prevalence and correlates of dual diagnosis in older psychiatric inpatient populations and compare our results with findings from studies of younger hospitalized dually diagnosed patients. A retrospective chart audit was performed on 101 elders who were discharged from three psychiatric hospitals. Clinical variables that were examined included length of hospital stay, psychiatric and medical diagnoses, medications and history of suicidal ideation or intent. The leading psychiatric disorder diagnosis for our sample of hospitalized psychiatric elders was depression. Over one‐third (37.6%) had a substance abuse disorder in addition to a psychiatric disorder, and almost three‐fourths (71%) of this ‘dual diagnosis’ group abused alcohol and 29% abused both alcohol and other substances. In addition, significantly more elders in the ‘dual diagnosis’ group (17.7%) than in the group with only a mental disorder diagnosis (3.3%) made a suicide attempt prior to admission to the hospital. Because affective disorders in conjunction with alcohol abuse are the most frequently found disorders in completed suicides, our findings have important relevance for the advocating of routine use of diagnostic assessment and screening for both substance abuse and mental disorders in this population.

INCREASING METAMEMORY IN OLDER ADULTS

: The purposes of this study were to test the effects of a 2-week, four-session group intervention with older adults, designed to increase memory self-efficacy and memory performance and to evaluate the influence of depression on memory self-efficacy. A total of 145 community-dwelling older adults (M = 71 years) participated in the study. The intervention significantly increased both memory self-efficacy and memory performance in the treatment group (n = 74). In addition, the treatment groups perception of control in memory-demanding situations was strengthened, and their perception of negative changes in memory over time was diminished. The control group (n = 71) experienced a significant decline in memory self-efficacy over time. Memory performance was not significantly related to memory self-efficacy. Those individuals with depression (M = 7.5), as measured by the short Geriatric Depression Scale, had significantly lower memory self-efficacy scores than those without depression; however, there was no difference in memory performance between the depressed and nondepressed subjects. From the posttest to the follow-up period, depressed subjects receiving the intervention showed a significant decrease in memory self-efficacy, while nondepressed subjects showed no change.

The Process and Outcome of Life Review Psychotherapy With Depressed Homebound Older Adults

The purpose of this study was to examine the process and outcomes of life review therapy provided by an advanced practice geropsychiatric nurse to older adults discharged from psychiatric hospitals to home health care. Eighty older adults over 65 years of age with a primary diagnosis of depression were treated at home for life review psychotherapy sessions (M = 13.24, SD = 8.65). Content analysis methods, both latent and manifest, were used to analyze the data and identify themes. Themes were classified as empowerment (connection, coping, efficacy, hope, and trust) or disempowerment (denial, despair, helpless, isolation, loneliness, and loss). Findings showed that, as a result of the life review therapy, there was a significant decrease (p < .0001) in total disempowerment themes (M1 = 13.07; M2 = 9.14).

Predictors of metamemory in older adults.

The purpose of this study was to examine the relationships of depression, health status, self-efficacy, and selected demographic variables to the metamemory of older adults. Community-residing adults (N = 169), 55 years of age and older, were recruited from continuing education programs. No relationships were found between age and seven metamemory factors, Strategy, Task, Capacity, Change, Anxiety, Achievement, and Locus. Those in the age group 65 to 74 years scored significantly higher on the metamemory Strategy factor. Memory efficacy, both level and strength, was significantly correlated (p < .01) with the Capacity, Change, Anxiety, and Locus subscales. Overall, the set of variables accounted for 4% to 21% of the total variance in metamemory factors.

The SeniorWISE study: improving everyday memory in older adults.

We tested whether at-risk older adults receiving memory training showed better memory self-efficacy, metamemory, memory performance, and function in instrumental activities of daily living than participants receiving a health promotion training comparison condition. We followed participants for 26 months. The sample was mostly female (79%) and Caucasian (71%), with 17% Hispanics and 12% African Americans; average age was 75 years, and average education was 13 years. The memory training group made greater gains on global cognition and had fewer memory complaints, but both groups generally maintained their performance on the other cognitive measures and instrumental activities of daily living (IADLs) throughout the 24-month study period. Black and Hispanic participants made greater gains than Whites did on some memory performance measures but not on memory self-efficacy. The unexpected finding that minority elders made the largest gains merits further study. This study contributed to the knowledge base of geropsychiatric nursing by providing evidence for an effective psychosocial intervention that could be delivered by advanced practice nurses.

Memory self-efficacy and strategy use in successful elders.

Studies have demonstrated that in their everyday lives older adults use external memory strategies more often than they use internal memory strategies. However, previous research has failed to account for person and task variables influenced by efficacy expectations. The use of internal and external memory strategies in relation to memory efficacy, anxiety, depression, and health status was examined. Participants were 169 community‐residing adults age 55 or older (mean age = 67.95, SD = 6.35) who had no depression and high perceived health status and were recruited from continuing education programs in Louisiana and Texas. External memory strategies (M. = 3.75) such as lists and notes were used significantly more often than internal memory strategies (M = 3.49) such as elaboration and rehearsal, t(157) = 5.474, p = .0001. Even though the correlations between memory efficacy and the strategy variables were insignificant, there was a significant decrease in memory efficacy with age. The bivariate correlatio...

Symptom management of affective and cognitive disturbance with a group of cancer survivors.

UNLABELLED Cancer survivors 65 years of age and older experience treatment-induced memory impairments. However, clinicians do not intervene for these cognitive problems. This article describes the findings from a pilot study of a memory versus health training intervention and its adaptability for cancer survivors for symptom management. DESIGN AND METHODS A convenience sample of older adults was enrolled in a longitudinal study of a memory and health training intervention and tested on five occasions for 2 years postintervention. The memory training was designed to increase cognitive performance, reduce anxiety, decrease negative attributions, promote health, and increase memory self-efficacy. In this analysis, we included change over time for the first four of the five data collection points. We calculated means and standard deviations on the memory measures for cancer survivors in the intervention (n = 8) and comparison (n = 14) groups. The analysis consisted of a mixed design analysis of variance comparing the two intervention groups across four periods for 12 months. RESULTS The typical cancer survivor in the sample was a 74-year-old Caucasian female; 14% were minorities. Because of the small sample, some of the effects were not statistically significant. Moderate to large effects were revealed in everyday and verbal memory performance scores, memory self-efficacy, strategy use, and memory complaints. There were also moderate effects for group-by-time interactions on the visual memory performance measure, the memory self-efficacy measure, the depression, the trait anxiety measure, and the complaints subscale. The memory intervention group tended to improve more than the health training group, although this was not always consistent. The results suggested that the participants benefited from the memory training intervention. IMPLICATIONS Clinicians are often at a loss on how to intervene with cancer survivors who are experiencing cognitive problems following chemotherapy treatment. Evidenced-based interventions for this aspect of symptom management are almost nonexistent. The Cognitive Behavioral Model of Everyday Memory (CBMEM), derived from Self-Efficacy theory provides an evidence-based intervention for symptom management.

A Systematic Review of Depression in Adults with Heart Failure: Instruments and Incidence

Heart failure (HF) is a life-threatening condition affecting 2.5% of Americans. Depression is reported to be present in 9.5% of the general population, but its incidence is higher in individuals with HF. The aims of this systematic review of older adults with HF were to examine the literature to: (1) identify instruments used to evaluate depression/depressive symptoms; and (2) determine the incidence of depression/depressive symptoms reported. Sixteen articles met inclusion criteria. Six self-reporting screening instruments and two diagnostic-interviews for depression were identified. Depression/depressive symptoms were reported in 14–60% of adults with HF. Use of screening instruments resulted in higher frequencies of depression/depressive symptoms (21–60%) than did diagnostic interviews (14–39%). Screening instruments established prior to the 1987 diagnostic guidelines may not reflect the current definition of depression. Depression screening instruments appear to overestimate the incidence of depression in older adults with heart failure. A complete diagnostic interview for depression should be performed prior to the treatment of older adults with HF.

Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure.

Background:The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. Objective:The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants’ subjective perceptions of the intervention. Methods:This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points—baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention’s effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. Results:The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale). Conclusions:An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.