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Understanding and Improving Quality of Care in the Context of Depressed Elderly Persons Living in Norway  [PDF]
Elisabeth Severinsson, Anne Lise Holm
Open Journal of Nursing (OJN) , 2014, DOI: 10.4236/ojn.2014.412086
Abstract:

Effective leadership plays an important role in safe patient care. The aim of this paper was to understand and improve the implementation outcomes identified by empirical studies based on Proctors et al.’s key concepts, acceptability appropriateness, feasibility and fidelity, and to propose recommendations for further research. Methods: An interdisciplinary approach using mixed methods. Results: A total of twenty papers based on data from this interdisciplinary study have been published. Overall, our published empirical studies revealed that the CCM intervention had positive results due to staff members’ engagement to improve care, their awareness of the need for collaboration and willingness to assume responsibility for patient care. From the perspective of the depressed elderly persons the results of the research project indicated their need for support to increase self-management. In conclusion, an improved understanding of the implementation outcomes will have an impact on best practice for depressed elderly persons and dissemination purposes. Quality management and highly action-oriented involvement are necessary in implementation research. These will also affect the professional development of interdisciplinary teams as well as constitute a basis for further research on understanding and improving the care of depressed elderly individuals.

Implementation Strategies for Improving the Care of Depressed Elderly Persons—Summary of an International Workshop  [PDF]
Elisabeth Severinsson, Anne Lise Holm
Open Journal of Nursing (OJN) , 2014, DOI: 10.4236/ojn.2014.411076
Abstract: The aim of the study was to identify the most important research priorities as well as future strategies for promoting and implementing evidence-based care of depressed elderly persons. An interdisciplinary workshop was organized using a focus group format and the transcript of the discussion was interpreted by means of the qualitative content analysis. The most important research priorities for improving the care of depressed elderly persons, implementation levels, theoretical approaches as well as possible outcomes were analysed on individual consumer, healthcare system, and policy level. A wide range of theories and methods are necessary to identify and explain implementation processes and results. Qualitative and quantitative methodologies in combination with knowledge synthesis were discussed. In addition, the need to summarize the literature in terms of specific issues was emphasized. In conclusion, the implementation strategies for improving the care of depressed elderly persons should be addressed on three levels: individual consumer, healthcare system and policy. Although some aspects of the implementation model may need to be enhanced, the fact that it includes conditions on individual level, i.e. self-management support, is of importance. The expansion and maintenance of evidence-based care generate potential for change in mental healthcare, thus improving outcomes for individual elderly patients. Areas that require further research are organization, cost and leadership. The use of mixed methods could strengthen future studies. Implementation researchers need a broad repertoire in order to plan and perform evidence-based research. To improve practice, implementation strategies should be developed in clinical and community guidelines.
Acute exercise improves cognition in the depressed elderly: the effect of dual-tasks
Vasques, Paulo Eduardo;Moraes, Helena;Silveira, Heitor;Deslandes, Andrea Camaz;Laks, Jerson;
Clinics , 2011, DOI: 10.1590/S1807-59322011000900008
Abstract: objective: the goal of this study was to assess the acute effect of physical exercise on the cognitive function of depressed elderly patients in a dual-task experiment. introduction: physical exercise has a positive effect on the brain and may even act as a treatment for major depressive disorder. however, the effects of acute cardiovascular exercise on cognitive function during and after one session of aerobic training in elderly depressive patients are not known. methods: ten elderly subjects diagnosed with major depressive disorder performed neuropsychological tests during and after a moderate physical exercise session (65-75%hrmax). a digit span test (forward and backward) and a stroop color-word test were used to assess cognitive function. the elderly participants walked on an electric treadmill for 30 minutes and underwent the same cognitive testing before, during, immediately after, and 15 minutes after the exercise session. in the control session, the same cognitive testing was conducted, but without exercise training. results: the results of the digit span test did not change between the control and the exercise sessions. the results of the stroop color-word test improved after physical exercise, indicating a positive effect of exercise on cognition. conclusions: these data suggest that the cognitive functions of depressed elderly persons, especially attention and inhibitory control, are not impaired during and after an acute session of physical exercise. in contrast, the effect of dual-tasks showed beneficial results for these subjects, mainly after exercise. the dual-task may be a safe and useful tool for assessing cognitive function.
Rationale and design: telepsychology service delivery for depressed elderly veterans
Leonard E Egede, Christopher B Frueh, Lisa K Richardson, Ronald Acierno, Patrick D Mauldin, Rebecca G Knapp, Carl Lejuez
Trials , 2009, DOI: 10.1186/1745-6215-10-22
Abstract: We describe an ongoing four-year prospective, randomized clinical trial comparing the effectiveness of an empirically supported treatment for major depressive disorder, Behavioral Activation, delivered either via in-home videoconferencing technology ("Telepsychology") or traditional face-to-face services ("Same-Room"). Our hypothesis is that in-homeTelepsychology service delivery will be equally effective as the traditional mode (Same-Room). Two-hundred twenty-four (224) male and female elderly participants will be administered protocol-driven individual Behavioral Activation therapy for depression over an 8-week period; and subjects will be followed for 12-months to ascertain longer-term effects of the treatment on three outcomes domains: (1) clinical outcomes (symptom severity, social functioning); (2) process variables (patient satisfaction, treatment credibility, attendance, adherence, dropout); and (3) economic outcomes (cost and resource use).Results from the proposed study will provide important insight into whether telepsychology service delivery is as effective as the traditional mode of service delivery, defined in terms of clinical, process, and economic outcomes, for elderly patients with depression residing in rural areas without adequate access to mental health services.National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT00324701).People who live in rural areas experience significant disparities in health status and access to care compared to their urban counterparts [1,2]. Access to appropriate mental health care services represents a significant problem in many rural and remote areas and as the ageing population expands, this problem will intensify over the next several decades without innovative solutions [1-4]. There is growing awareness that specifically tailored treatment and service delivery strategies are frequently needed for different populations of adult consumers of mental health services [3,5]. Access
Association of sociodemographic characteristics, cardiovascular symptoms and psychosocial stressors in elderly depressed patients with coronary artery disease
Miriam Ximenes Pinho,Osvladir Custodio,Marcia Makdisse,Manes Erlichman
Einstein (S?o Paulo) , 2006,
Abstract: Objective: To describe the prevalence of depressive symptoms inelderly patients with coronary artery disease and to compare theclinical and socio-demographic characteristics between depressedand non-depressed patients. The study also investigates the presenceof psychosocial stressors in patients with depressive symptoms.Methods: A prospective cross-sectional study of 80 elderly patientswith coronary artery disease. Main measures used: GeriatricDepression Scale and interview; echocardiography (ejection fraction);the New York Heart Association Functional Class and the CanadianCardiovascular Society Functional Class. The statistical analysis wasperformed by the following: Student t test, chi-square, Fisher exacttest and Mann-Whitney test. Results: The prevalence rate ofdepressive symptoms was 31%. Depressed patients were youngerthan the non-depressed ones (mean age: 75.5 and 79.3 years, p =0.019, respectively). The socio-demographic variables (sex, schoolingand income) and the clinical variables (previous myocardial infarction,cardiac function, severity of heart failure symptoms and angina)showed no difference between the depressed and non-depressedgroups. The psychosocial stressors were predominant (56%), andamong them, “problems related to primary support group” was themost frequently reported (92.8%). Physical stressors were found in46% of participants and among them, the most frequently reportedwere unrelated to the cardiac disease. Conclusion: The prevalencerate of depressive symptoms was high in this group of patients,but the objective evaluation of the cardiac function was notassociated to depressive symptoms. On the other hand, the patientperception of the cause of their depressive symptoms was mostlyrelated to psychosocial stressors, and problems related to primarysupport group was the most-endorsed category. Depressed elderlypatients have a higher cardiac morbidity and mortality. Our findingssuggest that an assessment of the patient’s psychosocial riskfactors should be an essential part of the global evaluation of thehealth status and therapeutic intervention as much as the cardiacfunction itself.
Comparison between the AA/EPA ratio in depressed and non depressed elderly females: omega-3 fatty acid supplementation correlates with improved symptoms but does not change immunological parameters  [cached]
Rizzo Angela,Corsetto Paola,Montorfano Gigliola,Opizzi Annalisa
Nutrition Journal , 2012, DOI: 10.1186/1475-2891-11-82
Abstract: Background Depression is one of the most frequently missed diagnoses in elderly people, with obvious negative effects on quality of life. Various studies have shown that long chain omega-3 polyunsaturated fatty acids (n-3 PUFA) may be useful in its management. Our objective was to evaluate whether a supplement containing n-3 PUFA improves depressive symptoms in depressed elderly patients, and whether the blood fatty acid pattern is correlated with these changes. Methods The severity of depressive symptoms according to the Geriatric Depression Scale (GDS), blood fatty acid composition and erythrocyte phospholipids were analyzed in 46 depressed females aged 66-95y, diagnosed with depression according to DSMIV, within the context of a randomized, double-blind, placebo-controlled trial. 22 depressed females were included in the intervention group (2.5 g/day of n-3 PUFA for 8 weeks), and 24 in the placebo group. We also measured immunological parameters (CD2, CD3, CD4, CD8, CD16, CD19 and cytokines (IL-5, IL-15). Results The mean GDS score and AA/EPA ratio, in whole blood and RBC membrane phospholipids, were significantly lower after 2 months supplementation with n-3 PUFA. A significant correlation between the amelioration of GDS and the AA/EPA ratio with some immunological parameters, such as CD2, CD19, CD4, CD16 and the ratio CD4/CD8, was also found. Nevertheless, omega-3 supplementation did not significantly improve the studied immunological functions. Conclusions n-3 PUFA supplementation ameliorates symptoms in elderly depression. The n-3 PUFA status may be monitored by means of the determination of whole blood AA/EPA ratio.
Adaptability of Kitchen Furniture for Elderly People in Terms of Safety  [cached]
Jasna Hrovatin,Kaja ?irok,Simona Jev?nik,Leon Oblak
Drvna Industrija , 2012,
Abstract: The number of senior citizens is rapidly increasing, which consequently signifi es an increase in the number of people having sight, hearing or memory diffi culties, people with hampered mobility, and people who find it increasingly diffi cult to process information. Elderly persons experience a greater degree of risk whilst performing daily tasks in their kitchens. Moreover, they are more susceptible to infection and illnesses, necessitating greater care to achieve hygienic conditions within their kitchens. The goal of our research was to determine whether people are generally content with the functionality of their kitchens and whether the degree of dissatisfaction increases with the age of the users. The study aims to pinpoint any major problems facing elderly people whilst working in their kitchens and to establish criteria for kitchen furniture design that could be tailored to senior users’ interests, with the focus on safety. This research was carried out via individual surveys at the respondents’ homes. 204 respondents participated in the research. The results show that most users do not realize that, with more appropriate kitchen equipment, they could perform daily tasks faster, safer, and with less effort. Common shortcomings include insuffi cient lighting (32 %), inappropriate sequential composition of work surfaces (56 %), ease of hygiene maintenance (68 %), inappropriately - shaped furniture (72 %), and tasks that become troublesome because of declining memory (75 %). We believe that it is necessary to design kitchen equipment specifically adjusted for the needs of the elderly.
Safety of etanercept in elderly subjects with rheumatoid arthritis
Alfredomaria Lurati, Mariagrazia Marrazza, Katia Angela, et al
Biologics: Targets and Therapy , 2010, DOI: http://dx.doi.org/10.2147/BTT.S5492
Abstract: fety of etanercept in elderly subjects with rheumatoid arthritis Original Research (5307) Total Article Views Authors: Alfredomaria Lurati, Mariagrazia Marrazza, Katia Angela, et al Published Date December 2009 Volume 2010:4 Pages 1 - 4 DOI: http://dx.doi.org/10.2147/BTT.S5492 Alfredomaria Lurati, Mariagrazia Marrazza, Katia Angela, Magda Scarpellini Fornaroli Hospital, Rheumatology Unit, Magenta, Italy Objective: To report side effects seen in a clinical cohort of patients aged >65 years with rheumatoid arthritis (RA) treated with the tumor necrosis factor-α TNF-α blocker etanercept and to compare the side effects rate with patients aged ≤65 years. Methods: All patients with RA that started etanercept and who were referred to our rheumatology unit from November 2005 to March 2009 were included in this study and prospectively followed to collect side effects related to therapy. Results: One hundred three patients were enrolled: 41 (37 females, 4 males) aged >65 years and 62 (40 females, 22 males) aged <65 years. In the patients aged >65 years, the safety profile (defined as rate of side effects) of etanercept was similar to that in patients aged ≤65 years (P > 0.05) and the survival curves between the groups were similar (P > 0.05). Conclusions: In our three-year experience, the anti-TNFα agent etanercept has been well tolerated and safe in elderly patients. The risk of side effects in these patients was no greater than in subjects aged ≤65 years. However, such inhibitors are associated with various and numerous side effects and elderly patients with RA should be carefully monitored to limit the risk of side effects during anti-TNFα therapy as much as possible.
Safety of etanercept in elderly subjects with rheumatoid arthritis  [cached]
Alfredomaria Lurati,Mariagrazia Marrazza,Katia Angela,et al
Biologics: Targets and Therapy , 2009,
Abstract: Alfredomaria Lurati, Mariagrazia Marrazza, Katia Angela, Magda ScarpelliniFornaroli Hospital, Rheumatology Unit, Magenta, ItalyObjective: To report side effects seen in a clinical cohort of patients aged >65 years with rheumatoid arthritis (RA) treated with the tumor necrosis factor-α TNF-α blocker etanercept and to compare the side effects rate with patients aged ≤65 years.Methods: All patients with RA that started etanercept and who were referred to our rheumatology unit from November 2005 to March 2009 were included in this study and prospectively followed to collect side effects related to therapy.Results: One hundred three patients were enrolled: 41 (37 females, 4 males) aged >65 years and 62 (40 females, 22 males) aged <65 years. In the patients aged >65 years, the safety profile (defined as rate of side effects) of etanercept was similar to that in patients aged ≤65 years (P > 0.05) and the survival curves between the groups were similar (P > 0.05).Conclusions: In our three-year experience, the anti-TNFα agent etanercept has been well tolerated and safe in elderly patients. The risk of side effects in these patients was no greater than in subjects aged ≤65 years. However, such inhibitors are associated with various and numerous side effects and elderly patients with RA should be carefully monitored to limit the risk of side effects during anti-TNFα therapy as much as possible.Keywords: anti-TNF therapy, rheumatoid arthritis, elderly
Public health and food safety in the WHO African region
P Mensah, L Mwamakamba, C Mohamed, D Nsue-Milang
African Journal of Food, Agriculture, Nutrition and Development , 2012,
Abstract: Contaminated food continues to cause numerous devastating outbreaks in the African Region. In Africa, a large proportion of ready-to-eat foods are sold by the informal sector, especially as street foods. The hygienic aspects of vending operations and the safety of these foods are problematic for food safety regulators. The global food crisis has worsened an already precarious food situation because when food is in short supply people are more concerned about satisfying hunger than the safety of the food. The aetiological agents include various pathogenic bacteria, parasites and viruses. Chemical contaminants are becoming increasingly important. Human factors including: unhygienic practices and deliberate contamination, environmental factors, such as unsafe water, unsafe waste disposal and exposure of food to insects and dust,undercooked food, and prolonged storage of cooked food without refrigeration are the main predisposing factors. WHO’s position is that food safety must be recognised as a public health function and access to safe food as a basic human right. The work of WHO in food safety is in line with its core functions and various global and regional commitments, especially the document entitled “Food Safety and Health: A Strategy for the WHO African Region (AFR/RC57/4) adopted in 2007. WHO has been supporting countries to strengthen food safety systems and partnerships and advocacy; to develop evidence-based food safety policies; strengthen laboratory capacity for foodborne disease surveillance; enhance participation of countries in the standard-setting activities of the Codex Alimentarius Commission; and strengthen food safety education using the WHO Five Keys to Safer Food . The implementation of the Regional Food Safety Strategy adopts a holistic farm-to-fork approach which addresses the entire food control system. Much has been achieved since the adoption of the document Food Safety and health: A Strategy for the WHO African Region, but commitment to food safety still remains low due to competing priorities. In particular, countries are now shifting away from fragmented food control implementation towards multi-agency and coordinated as well as single agency systems. The Codex Trust Fund has facilitated participation and capacity building for Codex work. Although funding for the Food Safety Programme has increased as compared to the levels in 2002, this remains inadequate. WHO will continue to support countries to strengthen food safety systems in line with its core functions and as enshrined in the regional food safety strategy.
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