Professor Daniel O’Connor, Dr Kate McSweeny, Ms Aimee Jeffreys
Aged Mental Health Research Unit, Monash University
beyondblue Victorian Centre of Excellence
Project completion year
Findings of an earlier investigation indicated that many recipients of aged residential care experience severe depression. Despite the pressing need for treatment, mainstream aged care facilities appear to be ill-equipped to provide this service. This project sought to determine whether multidisciplinary specialist mental health consultation is more effective than care as usual in treating depression in aged care residents with dementia.
The study included 39 residents selected from 16 aged care facilities. The facilities were allocated to an intervention of either multidisciplinary specialist consultation surrounding best practice management of depression in dementia or to a care as usual condition. Consultations involved individually tailored medical and psychosocial recommendations provided to care staff and general practitioners. In order to assess intervention efficacy, all residents participated in a comprehensive pre-intervention diagnostic assessment which included the administration of the Cornell Scale for Depression in Dementia (CSDD), among other measures. This assessment was repeated about 15 weeks post-intervention.
The project found that multidisciplinary specialist mental health consultation was significantly more effective in treating the clinical depressions of aged care residents with dementia than care as usual. The adjusted mean post-intervention CSDD score was 8.90 for the intervention group and 13.98 for the control group. Clinical diagnosis of major depression was also considered at the post-intervention assessment. Of those receiving specialist consultation, 21 per cent met criteria for the diagnosis. By contrast, 48 per cent of those receiving care as usual were diagnosed with major depression at follow-up. However, this difference was not significant.
The Rating Anxiety in Dementia (RAID) scale and the BEHAVE-AD, an assessment of behavioural and psychological symptoms of dementia, were included as a supplement to information concerning depressive status. After adjusting for pre-intervention scores, there were no significant differences in the post-intervention RAID scores for the intervention and control groups. However, there were significant differences in post-intervention BEHAVE-AD scores between the two groups. The adjusted mean post-intervention BEHAVE-AD scores of 2.81 for the intervention group and 6.20 for the control group indicate that specialist multidisciplinary consultation reduced global estimates of behavioural and psychological symptoms more than care as usual.
Six attitude surveys were returned from staff from four of the seven intervention homes. Four “agreed” or “strongly agreed” that participation in the study improved their understanding of the assessment and management of depression. Five felt that the recommendations made by the research team were easy to implement. Overall, respondents felt that the consultation provided was useful both to the resident (five) and facility staff (four), and most (five) wanted to have continued access to specialist consultation. All of the respondents felt that it would be beneficial for facility staff to participate in training on the assessment and management of depression in aged residential care.
At the outcome assessment, 71 per cent of the intervention group had a change in their antidepressant treatment strategy, compared to only 20 per cent of the control group. This difference was statistically significant but further analysis indicated that, while change in antidepressant strategy on its own was a salient predictor of post-intervention CSDD, in combination with intervention group status, its effect was no longer significant. The effect of intervention group status subsumed that of change in antidepressant strategy.
Implications for policy, practice and further research
At a practical level, the results of this study emphasise the need for more comprehensive training in assessment and management of depression for residential care staff and the GPs who work in these settings. Training programs should delineate best practice guidelines, available resources and when and how to contact specialist services. The results suggest that the psychosocial and medical management of depressed residents can almost certainly be improved. One possible way to achieve this is to assign a suitably qualified staff member the portfolio of mental health clinical specialist. This would facilitate the mobilisation of available resources for residents in need and may act to improve the profile of mental health issues at the facility level. This will be a necessary step in ensuring that care provided by aged residential facilities is holistic and is responsive to the mental health care needs of residents.