Home care for depression in dementia

Recognition & treatment of depression in elderly What is the power of nurses and nursing assistants? Karel G. Brühl, MD

Depression in elderly & the role of nurses and nursing assistants ... ,[object Object],[object Object]

Depression in elderly & the role of nurses and nursing assistants ... ,[object Object],[object Object],[object Object],[object Object]

Role of nurses in Psycho geriatric care from a dutch perspective ,[object Object],[object Object],[object Object],[object Object],[object Object],I.

Dementia patients: most live at Home, 1 of 6 in Nursing Home I. Dutch perspective

IN NURSING HOMES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],I. Dutch perspective

IN Nursing Homes Netherlands ,[object Object],[object Object],[object Object],I. Dutch perspective

Dementia care at Home Netherlands ,[object Object],[object Object],[object Object],[object Object],[object Object],I.

Dementia care at home: Casemanagement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],I. Dutch perspective

[object Object],[object Object],In the Netherlands yet some areas offer casemanagement at home The Netherlands

Casemanager = specialized nurse ,[object Object],[object Object],[object Object],[object Object],I. Dutch perspective

Patient contacts 2007 I. Geriant Foundation

Casemanagers had over 15.000 contacts in 2007 I.

400.000 nurses in NL 8 Nurses: 1 doctor I.

Nurses’ power ,[object Object],[object Object],[object Object],[object Object],I.

How well do nurses recognize depression? ,[object Object],[object Object],[object Object],[object Object],II.

Prevalence depression elderly living in the community: 15 % II. Beekman et al, Br J Psychiat. 1999

prevalence in elderly depending on long term care: 30% II . recognition Alexopoulos, Lancet 2005

What is depression in Elderly? ,[object Object],[object Object],[object Object],[object Object],II . recognition

About 50% of depressions, in elderly who seek help, are recognized II . recognition Hoogendijk, VUmc 2006

Symptoms of depressive episode: Not simple II . recognition

Depressive episode DSM-IV ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],II . recognition

DSM-IV gateway symptoms: 1. Depressed mood 2. Loss of interest or pleasure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Other symptoms:

Depressive episode in elderly ,[object Object],[object Object],[object Object],[object Object],II . recognition

In dementia: even harder to recognize ,[object Object],[object Object],[object Object],II . recognition

Irritability also symptom of depression in dementia? not in DSM-IV depressive episode II . recognition

Depression in Alzheimer's disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],II . recognition

Back to what is the power of nurses and nursing assistants ,[object Object],[object Object],[object Object],II . recognition

2007 pub med: over 400 studies on elderly depression and nurses II . recognition

Review : Recognition of depression by nurses ,[object Object],[object Object],II . recognition

4 high quality studies ,[object Object],[object Object],[object Object],II. review

Study in nursing homes Baltimore USA Rovner, 1991 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],II. review

Study in Nursing Homes New York Teresi, 2001 ,[object Object],[object Object],[object Object],[object Object],II. review

= about 50% of depressions in elderly who seek help are recognized II. review

USA study, New York in Home health care, Brown, 2002 ,[object Object],[object Object],II. review

Study in Nursing Home Amsterdam, Falck, 1999 ,[object Object],[object Object],[object Object],[object Object],[object Object],II. review

4 High Quality studies: How well do Nurses and NAs recognize depression? II. review 65% Rovner 78% Falck 44% Teresi 45% Brown recognition study

So: recognition of depression by nurses and nursing assistants ,[object Object],[object Object],[object Object],[object Object],II. review

Treatment of depression ,[object Object],[object Object],[object Object],III. ‘ the good part’ Making elderly Feel better

Small talk improves quality of life nursing home residents NIVEL, Beek et al, 2008 III. Treatment

International reviews*: effect of psychosocial interventions for depression in dementia * Verkaik et al, 2005; Livingstone et al, 2005, Verhey 2006 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],III. Treatment

Antidepressive medication ,[object Object],[object Object],[object Object],[object Object],[object Object],III. Treatment

Exercise helps against depression enough studies show evidence for that  “ Appropriate Exercise” III. treatment

Help with exercise works too III. Treatment

Other help? ,[object Object],III. Treatment

Duo bike: a combination of interventions

Another combined intervention? Admission to nursing home ,[object Object],[object Object],III. treatment

Staff training positive effect on depression evidence found in studies all over the world ,[object Object],[object Object],[object Object],[object Object],[object Object],III. treatment

‘Things to do’ ,[object Object],[object Object],[object Object],[object Object],[object Object],IV.

Things to do (2) ,[object Object],[object Object],[object Object],[object Object],IV.

Things to do (3) ,[object Object],[object Object],IV.

Things to do (4) ,[object Object]

Finally ,[object Object],[object Object]

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Home care for depression in dementia

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