Mark Yaffe

Toward a model of quality of life for family caregivers of stroke survivors.

The important role of family caregivers in maintaining their disabled and elderly members in the community is becoming increasingly recognized. Caregiver research, for the most part, has explored burden and emotional distress as outcomes of the caregiving experience. Although there is a growing consensus among health-care researchers concerning the importance of quality of life (QoL) as an outcome, there is little research examining QoL of family caregivers. The purpose of this paper, therefore, was to construct a conceptual framework from which to study the QoL of family caregivers of stroke survivors. Findings from a review of studies addressing the QoL of these caregivers guided the development of the model. The components of the model include the caregiving situation, characteristics of the caregiver, and environmental factors, and their proposed relationships with QoL. This model provides a framework for investigating how the caregiving experience impacts on the caregivers QoL.

Pathway to psychiatric care of the elderly with depression

Goldberg and Huxley describe a pathway to psychiatric care which has five levels and four filters. To explore the application of this pathway to the elderly with depression we searched the relevant literature to estimate median annual rates of moderate‐severe depression at each level of the pathway. Among 27 elderly per thousand each year who had depression, 22 consulted a family physician who detected the disorder in 5.3. Of these, 2.8 were referred to psychiatric services and 1.3 were ultimately admitted to psychiatric units. Thus, only 10% of the elderly with moderate‐severe depression were assessed or treated by a psychiatrist. If confirmed, these findings have implications for geriatric psychiatry services and research.

The Medi-drama as an Instrument to Teach Doctor-Patient Relationships

This paper reviews an experience of the Curriculum Development Group of the College of Family Physicians of Canada in describing the doctor-patient relationship and its value in the clinical process. It proposes the use of a medi-drama or multi-scene script encompassing a broad range of bio-psycho-social-ethical issues as a practical tool to teach the doctor-patient relationship. Principles for conducting a medi-drama are presented, as are the advantages of this experiential teaching modality. An example of a specific script developed along the theme of Adult Children of Ageing Parents is described, and an evaluation of its usefulness in teaching the doctor-patient relationship is presented from feedback from seven different family medicine residency or faculty development groups. Finally, examples of the breadth of topics that can be generated from a single medi-drama are presented.

Development of a comprehensive hospital-based elder abuse intervention: an initial systematic scoping review.

Introduction Elder abuse, a universal human rights problem, is associated with many negative consequences. In most jurisdictions, however, there are no comprehensive hospital-based interventions for elder abuse that address the totality of needs of abused older adults: psychological, physical, legal, and social. As the first step towards the development of such an intervention, we undertook a systematic scoping review. Objectives Our primary objective was to systematically extract and synthesize actionable and applicable recommendations for components of a multidisciplinary intersectoral hospital-based elder abuse intervention. A secondary objective was to summarize the characteristics of the responses reviewed, including methods of development and validation. Methods The grey and scholarly literatures were systematically searched, with two independent reviewers conducting the title, abstract and full text screening. Documents were considered eligible for inclusion if they: 1) addressed a response (e.g., an intervention) to elder abuse, 2) contained recommendations for responding to abused older adults with potential relevance to a multidisciplinary and intersectoral hospital-based elder abuse intervention; and 3) were available in English. Analysis The extracted recommendations for care were collated, coded, categorized into themes, and further reviewed for relevancy to a comprehensive hospital-based response. Characteristics of the responses were summarized using descriptive statistics. Results 649 recommendations were extracted from 68 distinct elder abuse responses, 149 of which were deemed relevant and were categorized into 5 themes: Initial contact; Capacity and consent; Interview with older adult, caregiver, collateral contacts, and/or suspected abuser; Assessment: physical/forensic, mental, psychosocial, and environmental/functional; and care plan. Only 6 responses had been evaluated, suggesting a significant gap between development and implementation of recommendations. Discussion To address the lack of evidence to support the recommendations extracted in this review, in a future study, a group of experts will formally evaluate each recommendation for its inclusion in a comprehensive hospital-based response.

A mixed methods exploration of family members’/friends’ roles in a self-care intervention for depressive symptoms

Objectives The aims of this exploratory study were to examine the: (1) family and friend (F/F) support patients reported receiving and F/F reported providing to patients while participating in a self-care intervention (SCI) for depressive symptoms and (2) associations between different types of F/F support and patients’ use of the self-care tools in the SCI. Methods Fifty-seven patients aged 40u2009+u2009participating in an uncontrolled feasibility study of an SCI, completed structured telephone interviews about the support they received from F/F while participating in the SCI. Eighteen F/F completed questionnaires on the support they provided to patients during the SCI. Seven F/F participated in a post-study qualitative interview on their involvement in the SCI. Results About 35% of patients reported receiving F/F support with the SCI. Patients’ use of the behavioral tools was positively associated with patients’ report of F/F support, and with F/F’s report of instrumental support provided. F/F reported uncertainty about the type of support they should offer to patients in the SCI. Discussion F/F involvement in SCIs for depressive symptoms may be helpful to patients and may foster adherence to these interventions. More research is warranted on the nature of such involvement from the perspective of patients and F/F.

Family members’ or friends’ involvement in self-care for patients with depressive symptoms and co-morbid chronic conditions

Objectives To describe the support that patients reported receiving from family or friends (F/F) while participating in a self-care intervention for depressive symptoms; examine associations between patient-reported F/F support and use of self-care materials; and describe F/F perceptions of involvement in a subsample of F/F. Methods One hundred eighty-nine of 223 (85%) patients aged 40+ with chronic physical conditions and co-morbid depressive symptoms participating in a randomized self-care intervention trial, completed structured telephone surveys at three months about the F/F support received. Ten F/F participated in post study qualitative interviews on the support provided. Results 30%, 44%, and 91% of patients reported overall F/F support with self-care, F/F involvement with the self-care intervention and emotional support, respectively. 61% felt positively and 10% felt negatively or conflicted with F/F support. F/F involvement in the self-care intervention was the only variable associated with patient use of self-care materials when examined alongside all F/F support variables (Proportional Odds Ratiou2009=u20091.21; 95% C.I.u2009=u20091.01, 1.45). F/F perceived less involvement in the self-care intervention than patients. Discussion Patients engaged in a self-care intervention for depressive symptoms use more self-care materials when they perceive F/F involvement in the intervention. Patients and F/F may perceive involvement differently and benefit from discussions about potential F/F roles.

DEPRESSION IN OLDER ADULTS: THE CASE OF AN 82-YEAR-OLD WOMAN WITH DIZZINESS

1. Rowe JW, Kahn RL. Human aging. Usual and successful. Science 1987;237: 143–149. 2. Phelan EA, Anderson LA, LaCroix AZ et al. Older adults’ views of ‘successful aging’Fhow do they compare with researchers’ definitions? J Am Geriatr Soc 2004;52:211–216. 3. Matsubayashi K, Okumiya K, Wada T et al. Cognitive and functional status of the Japanese oldest old. J Am Geriatr Soc 1997;45:385–386. 4. Matsubayashi K, Okumiya K, Wada T et al. Secular improvement in self-care independence of old people living in community in Kahoku, Japan. Lancet 1996;347:60–60.

Determining Possible Professionals and Respective Roles and Responsibilities for a Model Comprehensive Elder Abuse Intervention: A Delphi Consensus Survey

Objective We have undertaken a multi-phase, multi-method program of research to develop, implement, and evaluate a comprehensive hospital-based nurse examiner elder abuse intervention that addresses the complex functional, social, forensic, and medical needs of older women and men. In this study, we determined the importance of possible participating professionals and respective roles and responsibilities within the intervention. Methods Using a modified Delphi methodology, recommended professionals and their associated roles and responsibilities were generated from a systematic scoping review of relevant scholarly and grey literatures. These items were reviewed, new items added for review, and rated/re-rated for their importance to the intervention on a 5-point Likert scale by an expert panel during a one day in-person meeting. Items that did not achieve consensus were subsequently re-rated in an online survey. Analysis Those items that achieved a mean Likert rating of 4+ (rated important to very important), and an interquartile range<1 in the first or second round, and/or for which 80% of ratings were 4+ in the second round were retained for the model elder abuse intervention. Results Twenty-two of 31 recommended professionals and 192 of 229 recommended roles and responsibilities rated were retained for our model elder abuse intervention. Retained professionals were: public guardian and trustee (mean rating = 4.88), geriatrician (4.87), police officer (4.87), GEM (geriatric emergency management) nurse (4.80), GEM social worker (4.78), community health worker (4.76), social worker/counsellor (4.74), family physician in community (4.71), paramedic (4.65), financial worker (4.59), lawyer (4.59), pharmacist (4.59), emergency physician (4.57), geriatric psychiatrist (4.33), occupational therapist (4.29), family physician in hospital (4.28), Crown prosecutor (4.24), neuropsychologist (4.24), bioethicist (4.18), caregiver advocate (4.18), victim support worker (4.18), and respite care worker (4.12). Conclusion A large and diverse group of multidisciplinary, intersectoral collaborators was deemed necessary to address the complex needs of abused older adults, each having important roles and responsibilities to fulfill within a model comprehensive elder abuse intervention.

Recovery from depression in older depressed patients in primary care : Relation with depression severity and social support

Abstract This study examines the differences between older patients with major depression who significantly improved or remitted and those who did not, in terms of baseline depression severity, social network, and social support. Participants (n = 66), aged 60 or over, were evaluated at a 2-month follow-up on depression symptomatology, diagnosis, and social network and support. Patients were less likely to improve if, at the onset of the study, depressive symptoms, in particular somatic ones, were more severe and if they viewed their social support as inadequate. This research underlines the importance of depression severity, and emotional and instrumental social support, for depression outcome with depressed older adults.

Baseline Psychological Treatment Reduces the Effect of Coaching in a Randomised Trial of a Depression Self-Care Intervention

Objective: To explore the effects of baseline psychological and antidepressant medication treatment in a trial of lay telephone coaching in a low-intensity, supported depression self-care intervention. Method: A single blind, individually randomised, pragmatic trial was conducted among primary care adults with chronic physical conditions and comorbid depressive symptoms. Eligible subjects were randomised to receive a depression self-care toolkit with (intervention group) or without (control group) telephone coaching provided by trained lay coaches. For this brief communication, a secondary analysis of the trial data focused on the effects of baseline psychological and antidepressant treatments on mental health outcomes (Patient Health Questionnaire 9 [PHQ-9], SF-12 Mental Component Summary [MCS], Generalized Anxiety Disorder 7 [GAD-7]) and satisfaction with the intervention. Results: In total, 223 patients were randomised, and 165 (74.0%) completed both 3- and 6-month follow-ups. There were 2 significant interactions of baseline treatment and study group for 6-month mental health outcomes. A significant benefit of coaching on 6-month PHQ-9 was seen only among participants who were not receiving baseline psychological treatment. A smaller interaction was found for baseline antidepressant medications and 6-month mental health. There was a significant main effect for baseline psychological treatment and lower 6-month satisfaction. Conclusions: Depressed patients receiving baseline psychological treatment may not benefit from lay coaching offered as part of a low-intensity depression self-care intervention.