Senior Investigator: Professor Marita McCabe1
Principal Investigators: Associate Professor David Mellor1, Professor Kuruvilla George2, Associate Professor Kate Moore1, Ms Barbara Hamilton3, Ingrid Ozols4, Mr Gery Karantzas1, Ms Sharon Callister5
Research Staff: Dr Tanya Davison1 and Ms Sarah Russo1
1 School of Psychology, Deakin University
2 MBBS, Eastern Health Aged Psychiatry
3 Uniting Aged Care Victoria and Tasmania
4 Consumer and carer representative for Beyond Blue
5 Benetas Aged Care
Beyond Blue Victorian Centre of Excellence
Project completion year
Late-life depression has become a major public health problem, leading to suffering among older people and burdening those who care for them. This serious but treatable medical condition results in substantial health care and social costs to the community.
While the prevalence of depression among older people in the community has been estimated to be approximately 3 per cent, rates of symptoms of major depression in nursing home residents are reported to range from 9 per cent to 26 per cent (McCabe et al., 2006), with up to 40 per cent of residents suffering depressive symptoms that do not meet the criteria for a diagnosis of major depression.
Previous research indicates low recognition rates of depression among elderly residents, with less than half of those older people with MDD being diagnosed and treated (Davison et al., in press).
The purpose of this research project was to pilot a depression-training program specifically designed for staff working in residential and community aged care settings.
This program aimed to increase carers’ knowledge of late-life depression and to increase their self-efficacy and perceived skills in working in aged-care.
Further, the project was designed to increase carers’ skills to detect and monitor depression, including the use of routine standardised procedures to respond to the symptoms of depression.
A further objective of this study was to train professional carers in the use of validated depression screening tools, designed specifically for use with older people, to assist in the early detection and treatment of people with depression in aged care.
It was expected that training professional carers to recognise and respond to signs of depression would help older depressed people receive appropriate treatment and improve their quality of life, as well as easing social and health care costs.
A cross section of 31 professional carers, including six Registered Nurses (RNs) and nine Personal Care Assistants (PCAs) were recruited from residential facilities. In addition, nine care managers and eight direct carers were recruited from community care settings for this project.
The basic four-session packages for PCAs and direct carers provided instruction in the use of standardised procedures for the identification of depression and how to respond appropriately to signs of depression, in particular, referring this information on to senior staff.
Each session lasted 90 minutes. RNs and care managers completed two additional sessions of two hours duration.
These sessions focused on assessment skills and included training in the use of two validated screening tools, as well as skills in collecting a psychiatric history for new care recipients. In addition, these sessions taught participants skills in interfacing with health care providers and in implementing strategies to help older people with depression.
As expected, the present study indicated that carers’ knowledge of depression scores were significantly higher following the training program. This demonstrated the effectiveness of the program for staff in different positions across both residential and community settings.
The significant improvement in scores of knowledge was obtained after only four, 90-minute sessions. In addition, carers’ self-efficacy scores were significantly higher at the completion of the training program, demonstrating that participants were quite confident in detecting depression among older people.
Overall, participants perceived fewer barriers to care following the training program. Before commencing the program, carers reported that lack of training in depression and poor knowledge were barriers to care.
Following the training program, none of the participants reported that lack of training or knowledge were barriers to best-management practices. Preliminary results indicate that the program is feasible as it is easy to implement and leads to significant results after only four sessions (six hours).
Implications for policy and practice
The manualised nature of this program will also facilitate the implementation of the training program in other locations. This cost-effective program is suitable for use within residential and community based aged-care services.
A further controlled trial of the training program is required to determine whether this leads to an improvement in the accuracy of the detection of depression and improved care for older depressed people.
Replication of this study with a larger, broad range of professional carers is needed.
McCabe, M. P., Davison, T. E., Mellor, D., George, K., Moore, K., Ski, C. (2006). Depression among older people with cognitive impairment: Prevalence and detection. International Journal of Geriatric Psychiatry, 21, 633-644.
Davison, T. E., McCabe, M. P., Mellor, D., Ski, C., George, K., & Moore, K. (in press). The prevalence and recognition of depression among aged care residents with and without cognitive impairment. Ageing & Mental Health.