Social support, self-esteem, and depression in the institutionalized elderly

Psychosocial studies of the elderly have been limited primarily to noninstitutionalized elderly living at home in the community. Only a few studies have explored the psychological implications of being institutionalized despite the fact that approximately 5% of the 25.6 million elderly 65 years or older in the United States reside in nursing homes (Rovner & Rabins, 1985). This correlational study was a beginning effort to investigate the relationships among depression, social support, self-esteem, and selected demographic variables in a sample of 26 institutionalized elderly individuals. The Norbeck Social Support Questionnaire (NSSQ) was used for measuring social support. The Geriatric Depression Scale (GDS) and Rosenberg's Self-Esteem Scale were used to measure depression and self-esteem respectively. The applicability of these instruments for studies of the elderly is discussed. Findings indicated that the demographic characteristics of the subjects had no significant effect on their feeling of self-esteem or depression. However, social support significantly correlated with depression and there was some indication that the type of institutional setting and frequency of religious participation also interacts with the level of depression. The article concludes with recommendations for future research.     

Garden walking and art therapy for depression in older adults: a pilot study

The purpose of this pilot study was to compare garden walking (either alone or guided) with art therapy in older adults with depression. Depression was measured using the Geriatric Depression Scale (GDS) and stories of sadness/joy. Prior to the intervention, 47% of participants had depression scores in the severe range and 53% in the mild range. At the end of the intervention, none of the participants had scores in the severe range, 89% had scores in the mild range, and 11% had scores in the normal range. Results of the GDS data using repeated measures analysis of variance indicated significant decreases in depression for all three groups from pretest to posttest. All participants, regardless of group assignment, had a lower percentage of negative-emotion word use and a higher percentage of positive-emotion word use over time. This study provides evidence for nurses wishing to guide older adults in safe, easy, and inexpensive ways to reduce depression.     

Depression among nursing home elders: Testing an intervention strategy

This study focused on the assessment of depression among nursing home elders, and on determining the efficacy of an intervention strategy for depression using a geropsychiatric nurse in conjunction with trained older adult volunteers in the role of mental health paraprofessionals. Nursing home residents (n = 139) were assessed for depression using the Geriatric Depression Scale (GDS); 94 (68%) were found to have depressive symptomatology. Among those receiving the intervention, depressive symptomatology was significantly reduced, but no significant decline was evident in the control group. The ability of the minimum data set (MDS) to detect depression as compared to the GDS was evaluated. Relationships between depression and health status, life satisfaction, and social support were also examined.     

An exploratory study of depression among older African American users of an academic outpatient rehabilitation program

Variation in the presentation of depressive illness among older African Americans may complicate assessment of depression, especially among those with multiple medical comorbidities and functional disabilities. The purpose of this study was to explore the prevalence of depression among older poor African Americans attending an academic outpatient rehabilitation program, using a depression measure with low somatic item content. Correlates of depression in this population also were explored. Health-care records of 150 older African Americans seen over a 2-year period were examined. Depression was assessed on admission using the 30-item Geriatric Depression Scale (GDS). Using a GDS cutoff score for depression of 11 or higher, 30% of the sample (age 75.5 +/- 7.16 years, range 65-95, 75% women) scored positive for depression. Nine percent also reported having suicidal thoughts within the previous week. Consistent with existing literature, depressed patients, as compared to nondepressed patients, were significantly younger, more suicidal, more likely to rate their general health as poor, had higher mean ratings of pain, and more often limited their social activities. Six GDS items were found to have little ability to discriminate between depressed and nondepressed patients: satisfaction with life, getting bored easily, prefer staying at home, find life exciting, getting started on new projects, and full of energy. The authors recommend further testing of the GDS with similar populations of older, poor, medically ill, and functionally disabled older adults.     

丧偶独居老年人抑郁状况及相关因素的调查

目的调查丧偶独居老年人的抑郁状况及影响因素以便采取有效的干预措施。方法采用老年抑郁量表（cos）及自行设计问卷对某社区内的160例丧偶后独居老年人进行问卷调查。结果62．5％的老人存在不同程度的抑郁情绪,其主要原因号隋感障碍、疾病的影响、经济状况、社会支持缺失及缺乏必要的社会活动有关（P〈0.01）。结论丧偶独居老人抑郁发生率高,影响因素复杂,应引起社会和家庭的关注,以改善老人的健康状况,提高生活质量。     

养老院老年人孤独、抑郁状况及其关系的研究

目的：调查养老院老年人的孤独、抑郁状况,并分析两者之间的关系。方法：采用孤独量表、老年人抑郁量表和一般情况问卷,对北京市第一社会福利院的116位老人进行调查。结果：116名老年人的孤独得分为（31.04±8.53）分,104名（89.70%）有孤独感,其中轻度孤独感80名（69.00%）,中度孤独感24名（20.70%）。抑郁得分为（6.10±4.81）分,19名（16.40%）存在抑郁情绪,其中17名（14.70%）为轻度抑郁,2名（1.70%）为中重度抑郁。回归分析显示,孤独、抑郁情绪相互影响。结论：部分养老院老年人存在孤独、抑郁情绪,且两者相互影响。养老院管理者应重视老年人的心理状况,做好心理疏导,减少其负性情绪。     

养老机构老年人社会支持与抑郁状况的调查

目的 了解养老机构老年人的社会支持与抑郁现状,探讨社会支持与抑郁的相关性.方法 采用社会支持评定量表、老年抑郁量表以及一般资料调查表,对天津市某养老院的164名老年人进行问卷调查.结果 养老院老年人抑郁得分为(17.00±7.00)分,社会支持总分为(28.42±7.26)分,三个维度得分分别为:客观支持(6.00±3.00)分、主观支持(16.82±3.70)分、对支持的利用度(8.00±5.00)分.养老机构老人社会支持总分显著低于国内常模的(34.56±3.73)分. 抑郁得分与社会支持总分呈负相关(P<0.05).结论 抑郁是养老机构老年人常见的心理问题,养老机构工作人员应重视老年人的心理健康,提高养老机构老年人的社会支持,降低老年抑郁的发生.     

Is somatization a significant depressive symptom in older Taiwanese Americans?

Adapting to psychosocial and physical changes can trigger nonspecific somatic complaints and depression. Somatization has been noted in all societies and cultures; however, it is more frequently observed in Asian populations. This study used the Geriatric Depression Scale (GDS) to screen 100 Taiwanese American older adults for depressive symptoms and found that seven participants (7%) experienced depressive symptoms (GDS >/= 14). Although the mean number of illnesses reported was significantly higher (t = -16.8, P <.001) in the depressive group, the seven individuals did not focus on physical symptoms during interview. They reported guilt, sadness, anger, resentment, loneliness, helplessness, hopelessness, inability to enjoy activities, and anhedonia. If older adults are given the time to express themselves, they are able to reveal their emotional pain and distress rather than remain preoccupied with somatic complaints. A simple depression screening tool, such as the GDS, can help detect depression.     

Coincidence of arthrosis and depression in elderly patients - therapeutic implications

Background: More then half of elderly adults over 60 years old suffer from arthrosis. Pain and mobility reduction associated with this disease, reduce elderly peoples independence and are the reason of their physical disability. The aim of this study was to estimate coincidence of arthrosis and depression in population of outpatients of Geriatric Clinic and to asses the influence of each disease on functional ability, pain and selfhealth evaluation. Furthermore we tried to evaluate a relationship between age, sex, education, financial position, self-evaluation of health condition with presence of arthrosis. Methods: The study group consisted of 70 elderly adults over 60 years old - Geriatric Department of Medical University in Bialystok outpatients. In all subject the social and demographic data and clinical diagnosis were evaluated using a self-constructed questionnaire. Furthermore the following tests were used: Geriatric Depression Scale (GDS), Mini Mental State Examination (MMSE) and Personal Activities of Daily Living Scale PADL). Results: Depression was observed more frequently in patients with arthrosis associated with pain. Symptoms of depressions were found in 92% group with arthritis. The present work confirmed high statistical significancy between depression and chronical pain of joits (p=0,000). Relationship between difficulties in performing everyday activities, mobility and arthrosis was also found. Conclusions: 1.Taking into consideration data that emotional disorders in studied group of elderly adults are associated with arthrosis, and publications about positive effect of antidepressive treatment on pain susceptibility in rheumatological diseases, we should pay more attention to diagnosis and treatment (in reasonable cases) of depression in elderly patients in compex therapy of arthrosis. 2.The proper recognition of coincident diseases directs treatment and enables comprehensive approach to medical care. It results in better health condition, quality of life and independence of elderly people.     

A collaborative model for the treatment of depression in homebound elders

Depression is a serious mental health problem for older adults. This study examined the effectiveness of an Advanced Practice Psychiatric Nurse (APPN)-Primary Care Physician (PCP) collaborative model to provide care to homebound elders with depressive symptoms. One hundred seventy nine individuals were screened for depression revealing an incidence of 46%. Of these, 83 (46%) were invited to participate in the study based on their depression scores; 41 (49%) agreed to participate in the study. Significant improvement in depression scores occurred for those who received treatment. Treatment included pharmacological and psychosocial interventions. As the population over the age of 65 continues to grow, many more older adults will need mental health treatment, and creative methods to provide services to homebound individuals must be explored.     

A Collaborative Model for the Treatment of Depression in Homebound Elders

Depression is a serious mental health problem for older adults. This study examined the effectiveness of an Advanced Practice Psychiatric Nurse (APPN)-Primary Care Physician (PCP) collaborative model to provide care to homebound elders with depressive symptoms. One hundred seventy nine individuals were screened for depression revealing an incidence of 46%. Of these, 83 (46%) were invited to participate in the study based on their depression scores; 41 (49%) agreed to participate in the study. Significant improvement in depression scores occurred for those who received treatment. Treatment included pharmacological and psychosocial interventions. As the population over the age of 65 continues to grow, many more older adults will need mental health treatment, and creative methods to provide services to homebound individuals must be explored.     

Socioeconomic and health status differences between depressed and nondepressed ED elders

The objective of the study was to describe differences in demographics, medical conditions, and social situation between depressed and nondepressed elderly emergency department (ED) patients. We studied a prospective convenience sample of English-speaking ED patients greater-than-or-equal 65 years, without altered mental status, obvious dementia or delirium, participating in a depression screening study during an ED visit for a nonpsychiatric complaint. Demographics were collected. Research personnel administered the Geriatric Depression Scale (GDS), the Folstein Mini-Mental State Examination and a health questionnaire. A total of 103 subjects were enrolled. GDS identified 33 patients (32%) with DEP. DEP patients were more likely to report the following: lower income, lower education level, more medical conditions, less independence, assisted living, and poorer overall health than ND patients. A third of these elderly ED patients report symptoms consistent with depression. There are significant differences in socioeconomic characteristics, health status, and functional ability. Future depression studies should focus on elders with these characteristics.     

住院老年慢性病患者抑郁与应对方式的相关性研究

目的了解住院老年慢性病患者抑郁情绪的发生与应对方式的相关性。方法采用老年抑郁量表对300名住院老年慢性病患者的抑郁状况及其应对方式进行调查。结果31．00％的调查对象处于不同程度的抑郁状态;住院老年慢性病患者多采用自责、幻想、退避等消极的应对方式,较少使用解决问题、求助等积极的应对方式。抑郁与解决问题及求助因子呈负相关,与自责、幻想、退避因子呈正相关。结论住院老年慢性病患者存在不同程度的抑郁情绪,与其应对方式有一定相关性,护士应根据患者的具体情况给予其相应的心理支持,以减轻或消除患者的抑郁情绪对健康的不利影响。     

Assessing the mental health of rural older adults in public housing facilities: a comparison of screening tools

This pilot study assessed the prevalence of mental health disorders and cognitive impairment among rural older adults living in a public housing facility and compared screening tools in this setting. Interviews were completed with 20 of the 38 residents older than 60 years. Survey instruments included the following: Primary Care Evaluation of Mental Disorders (PRIME-MD), Medical Outcomes 36-item Short-Form Health Survey (SF-36), Montgomery-Asberg Depression Rating Scale (MADRS), Mini-Mental State Exam (MMSE), and Global Assessment Scale (GAS). Depressive disorders were identified in 50% (n = 10) of participants and included major depression (25%), minor depression (20%), and dysthymia (5%). Cognitive impairment was identified in 15% (n = 3) of participants. Comparative analysis of instruments administered showed high correlations among the PRIME-MD, MADRS, GAS, and SF-36. The screening instruments identified for depression and cognitive impairment can be used reliably by nurses in this setting.     

老年抑郁症恢复期患者的应对方式及社会支持的评价

背景:老年抑郁症表现以不典型抑郁多见,且患者很少就诊或在综合医院就诊,给老年抑郁症的早期识别带来很大困难。目的:探讨老年抑郁症恢复期患者的应对方式及社会支持的特点。设计:病例对照对比观察。单位:华北煤炭医学院心理系。对象:收集2004-11/2005-10于北京安定医院老年门诊就诊的抑郁症恢复期患者为抑郁症组。纳入标准:①发病年龄≥60岁;②符合DSM-Ⅳ抑郁发作的诊断标准;③处于疾病恢复期,老年抑郁量表(GDS)≤10;④受试者知情同意。排除标准:①其他因素导致的抑郁障碍如物质滥用导致的抑郁障碍、精神分裂症后抑郁等;②严重或不稳定的躯体疾病患者,如严重心脑血管病、肝肾疾病、癫痫、内分泌疾病等。发放问卷104份,96份问卷有效,入组患者中男37例,女59例;年龄60～87岁,平均(68±6)岁。病程为0.3～11年,平均1.2年。选择同期北京市某普通社区老年人作为对照组。纳入标准:①年龄≥60岁;②无精神障碍;③获得受试者知情同意。排除标准:同抑郁症组。正常老年人于社区居委会在培训员的协助下当日完成自评量表,发放问卷110份,100份问卷有效。入组受试者中男44名,女56名;年龄60～84岁,平均(67±5)岁。两组受试对象在性别、年龄、受教育程度、居住情况及婚姻情况方面的差异无统计学意义。方法:对96名抑郁症组老年抑郁症恢复期患者及100名对照组普通社区老年人使用自制一般情况调查表、老年抑郁量表、社会支持量表和简易应对方式问卷进行评定。主要观察指标:自制一般情况调查表、老年抑郁量表、社会支持量表和简易应对方式问卷的评分。结果:196名受试者均进入结果分析,没有无效问卷。抑郁组患者积极应对方式低于对照组(P<0.05),消极应对方式明显高于对照组(P<0.05)。抑郁组患者社会支持总分、主观支持和对支持的利用度低于对照组(P<0.05),两组受试对象客观支持分差异无显著性。抑郁组患者积极应对与社会支持总分、主观支持和对支持的利用度呈正相关(P<0.01),消极应对与社会支持总分、主观支持和对支持的利用度呈负相关(P<0.01)。结论:社会支持中的主观支持和对支持的利用度以及消极的应对方式与老年抑郁症发病有关。     

Assessment for depression among nursing home elders: evaluation of the MDS mood assessment

The 30-item Geriatric Depression Scale (GDS), the GDS Short Form, and the Mood Assessments from the Minimum Data Set versions 1 and 2 were completed for 50 nursing home elders. The purpose of the study was to evaluate agreement among these measures of depression, with the GDS considered the gold standard. Although the GDS Short Form performed highly consistently with the GDS, the correlations of the MDS mood assessments with the GDS were relatively low. The results are discussed in the context of the characteristics that surround the use of the MDS, and recommendations are made for improving methods of detecting depression among nursing home elders.     

对老年人实施超越老化团体支持的研究

目的探讨超越老化团体支持对老年人超越老化观感、抑郁及生活满意度的影响。方法采用随机数字表法将符合标准的70名老年人分为试验组和对照组,试验组给予超越老化团体支持,对照组则保持原有的生活方式。干预前后分别用超越老化观感量表、老年人抑郁量表及生活满意度量表对两组研究对象进行问卷调查。结果试验组干预后,超越老化观感、生活满意度得分皆优于对照组,差异具有统计学意义(P<0.05)。结论超越老化团体支持对老年人超越老化观感、抑郁以及生活满意度具有积极影响。     

Examining functional and social determinants of depression in community-dwelling older adults: Implications for practice

Coping with declining health, physical illnesses and complex medical regimens, which are all too common among many older adults, requires significant lifestyle changes and causes increasing self-management demands. Depression occurs in community-dwelling older adults as both demands and losses increase, but this problem is drastically underestimated and under-recognized. Depressive symptoms are often attributed to physical illnesses and thus overlooked, resulting in lack of appropriate treatment and diminished quality of life. The purpose of this study is to assess prevalence of depressive symptoms in community-dwelling older adults with high levels of co-morbidity and to identify correlates of depression. In this sample of 533 homebound older adults screened (76.1% female, 71.8% white, mean age 78.5 years) who were screened using the Geriatric Depression Scale (SF), 35.9% scored greater than 5. Decreased satisfaction with family support (p << 0.001) and functional status (p ≤ 0.001) and increased loneliness (p < 0.001) were significant independent predictors of depression status in this sample; thus, these factors should be considered when planning care.     

小丑照护对养老院老年人情绪的影响

目的 建立小丑照护在养老院老年人中的应用方案,并探讨其应用效果。方法 组建小丑照护团队,通过理论研究、预试验和质性研究的方法确定本土化、个性化的个体干预和团体干预方案,灵活运用幽默、即兴表演、歌曲、游戏等技巧和方法,2019年4月—12月对34名养老院老年人实施每周2次,每次1.5~2 h的小丑照护方案。采用老年抑郁量表、UCLA孤独量表中文简化版、正性负性情绪量表和对老年人的半结构式访谈评价干预效果。结果 干预后养老院老年人的负性情绪、孤独感、抑郁评分降低,正性情绪评分提高,差异有统计学意义（P<0.05）。老年人认为小丑照护可一定程度上满足其社交、被尊重和自我实现的需求。结论 小丑照护可改善养老院老年人的抑郁情绪,有利于其维持正性情绪、抑制负性情绪,缓解其孤独感。