离退休老年人抑郁障碍的影响因素：1000名调查分析

背景：老年抑郁障碍是老年人常见的一种心理障碍，可导致机体各种功能的减退，对老年人及其家庭危害很大。 目的：探讨离退休老年抑郁障碍的影响因素，为加强对离退休老年人的精神护理，降低老年人抑郁障碍患病率提供基础依据。 设计：抽样调查。 单位：华北煤炭医学院护理系。 对象：2002-08／12调查唐山市市区居住的离退休老年人1000例。其中男574人。女426人；年龄60-88岁，平均年龄67.04岁；已婚者851人，离婚者10人。丧偶者139人；小学及以下的159人，初中362人，高中280人。大专及以上199人。 方法：使用老年抑郁量表和个人一般情况调查表。采取家庭访问调查的方法完成问卷调查工作。调查前向患者说明了调查目的和方法，填写《知情同意书》，调查采取了无记名调查形式。严格培训调查员并经考核合格，保证了调查结果的一致性。调查前进行了预实验调查，检测有无难懂的词句、选项，避免信息偏倚。调查时一般请老年人自填量表，如老年人填写有困难，由调查人员为老人读题后依据老人的选择代其填写，问卷当场收回。 主要观察指标：（1）不同年龄、性别、文化程度离退休老年人抑郁障碍患病情况。（2）不同婚姻状况抑郁障碍患病率。 结果：发放问卷1000份。回收有效问卷1000份。（1）抑郁患病率未见有随年龄增加而增加的趋势。（2）女性抑郁障碍患病率明显高于男性（27．0％．18．6％，P〈0．05）。（3）小学及以下文化程度，初中，高中，大专及以上文化程度老年人患病率为33．9％，22．1％，20．0％，16．1％。随文化程度升高，抑郁患病率下降（P〈0．05）。（4）退休老年人抑郁障碍患病率明显高于离休老年人（25．4％，13．6％，P〈0．05）。（5）离婚者抑郁程度远高于有配偶者和丧偶者（50．0％，21．2％，26．6％，P〈0．05）。 结论：离退休老年人抑郁障碍患病率较高，要重视对离退休老年人的精神保健及社会支持．特别是对离婚老年人要格外关注。     

社区老年人抑郁的发生率及其影响因素

目的：了解社区老人抑郁发生状况，探讨导致老年抑郁的相关因素，为老年健康提供心理学参考。方法：采用自编的相关社会学调查表和ZUNG抑郁自评量表(SDS)。深入西安市2个社区对60岁以上老人进行调查。结果：通过对西安市两个社区的1018个60岁以上老人的调查，抑郁总发生率为26．7％，其中轻度抑郁为16．50％，中、重度抑郁为9．14％，重度抑郁仅为1．08％。导致社区老人抑郁的因素，除于自身的人格因素外，家庭和社会因素有：经济状况不好(582例)、对居住环境不满意(505例)、子女基本状况不好(443例)、家庭状况不好(232例)、对自己目前的生活不满意(471例)、另外对目前的医疗和社会保障担忧(697例)。结论：社区老人心理健康状况不容乐观，导致社区老年抑郁的因素是多方面的。     

社区老年人抑郁的发生率及其影响因素

目的:了解社区老人抑郁发生状况,探讨导致老年抑郁的相关因素,为老年健康提供心理学参考。方法:采用自编的相关社会学调查表和ZUNG抑郁自评量表(SDS),深入西安市2个社区对60岁以上老人进行调查。结果:通过对西安市两个社区的1018个60岁以上老人的调查,抑郁总发生率为26.7%,其中轻度抑郁为16.50%,中、重度抑郁为9.14%,重度抑郁仅为1.08%。导致社区老人抑郁的因素,除于自身的人格因素外,家庭和社会因素有:经济状况不好(582例)、对居住环境不满意(505例)、子女基本状况不好(443例)、家庭状况不好(232例)、对自己目前的生活不满意(471例)、另外对目前的医疗和社会保障担忧(697例)。结论:社区老人心理健康状况不容乐观,导致社区老年抑郁的因素是多方面的。     

离退休老年人抑郁障碍的影响因素: 1000名调查分析

背景:老年抑郁障碍是老年人常见的一种心理障碍,可导致机体各种功能的减退,对老年人及其家庭危害很大。目的:探讨离退休老年抑郁障碍的影响因素,为加强对离退休老年人的精神护理,降低老年人抑郁障碍患病率提供基础依据。设计:抽样调查。单位:华北煤炭医学院护理系。对象:2002-08/12调查唐山市市区居住的离退休老年人1000例。其中男574人,女426人;年龄60～88岁,平均年龄67.04岁;已婚者851人,离婚者10人,丧偶者139人;小学及以下的159人,初中362人,高中280人,大专及以上199人。方法:使用老年抑郁量表和个人一般情况调查表。采取家庭访问调查的方法完成问卷调查工作。调查前向患者说明了调查目的和方法,填写《知情同意书》,调查采取了无记名调查形式。严格培训调查员并经考核合格,保证了调查结果的一致性。调查前进行了预实验调查,检测有无难懂的词句、选项,避免信息偏倚。调查时一般请老年人自填量表,如老年人填写有困难,由调查人员为老人读题后依据老人的选择代其填写,问卷当场收回。主要观察指标:①不同年龄、性别、文化程度离退休老年人抑郁障碍患病情况。②不同婚姻状况抑郁障碍患病率。结果:发放问卷1000份,回收有效问卷1000份。①抑郁患病率未见有随年龄增加而增加的趋势。②女性抑郁障碍患病率明显高于男性(27.0%,18.6%,P<0.05)。③小学及以下文化程度,初中,高中,大专及以上文化程度老年人患病率为33.9%,22.1%,20.0%,16.1%。随文化程度升高,抑郁患病率下降(P<0.05)。④退休老年人抑郁障碍患病率明显高于离休老年人(25.4%,13.6%,P<0.05)。⑤离婚者抑郁程度远高于有配偶者和丧偶者(50.0%,21.2%,26.6%,P<0.05)。结论:离退休老年人抑郁障碍患病率较高,要重视对离退休老年人的精神保健及社会支持,特别是对离婚老年人要格外关注。     

护理干预对157例住院病人抑郁障碍影响的观察

目的：探讨对住院病人抑郁障碍进行护理干预的有效性和实用性。方法：应用汉密尔顿量表对732例住院病人进行抑郁障碍筛查。其中有157例病人伴有抑郁障碍，随机分为3组予以治疗和护理干预。结果：药物＋护理干预组、单纯口服抗抑郁药物组治疗前后抑郁评分有显著性差异（P〈0．01）．对照组治疗前后差异无显著性（P〉0．05）；并且治疗后药物＋护理干预组优于单纯口服抗抑郁药物组（P〈0．01）。结论：护理干预可有效改善病人的抑郁情绪，其效果优于单纯抗抑郁药物。     

心理干预对抑郁障碍患者康复的影响

目的 探讨心理干预对抑郁障碍患者的影响.方法 把183例抑郁患者随机分为研究组(93例)和对照组 (90例).研究组实施药物治疗加12周系统的心理干预,对照组仅接受常规药物治疗及护理.两组于治疗前后进行简明精神病量表(BPRS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)测评.结果 心理干预后两组在焦虑忧郁、缺乏活力、思维障碍、SDS和SAS等方面有显著性差异 ( P<0.05).结论 心理干预对抑郁障碍患者的康复具有积极的影响.     

综合医院老年人抑郁障碍康复疗效及相关因素研究

目的探讨综合医院神经科老年人抑郁障碍的临床特点及其相关因素。方法对年龄≥60岁,符合CCMD-2-R抑郁诊断标准,116例患者进行了相关因素和治疗前后SDS评分分析。结果SDS平均总粗分为(50.64±8.35)分;治疗后SDS平均评分明显降低。该组患者大多数为继发性抑郁障碍(93.1%),少数系心因性抑郁障碍(6.9%)。结论综合医院老年人抑郁障碍多为继发性,除因躯体疾病所致外,还与心理及社会环境因素有关。     

体育锻炼对老年人平衡能力的影响

目的：研究体育锻炼对老年人平衡能力的影响。方法：通过对188例老年受试进行电脑化动态平衡仪感觉整合能力平衡总分测试;同时还分别进行平衡能力简单测试方法,闭目原地踏步,平衡木上行走,起立－走,闭眼单足站立,强化Romberg检查,前庭步测试,改良Wolfson测试,垂直X书写的测试。结果：动态平衡仪感觉整合能力平衡总分,闭目原地踏步,平衡木上行走,垂直X书写测试,改良Wolfson测试,前庭步测试结果表明常锻炼的老年人平衡能力比不常锻炼组明显好（P＜0．05,P＜0．001）,结论：体育锻炼对延缓老年人的平衡能力退行性变化有积极作用。     

体育锻炼对老年人平衡能力的影响

目的研究体育锻炼对老年人平衡能力的影响。方法通过对188例老年受试者进行电脑化动态平衡仪感觉整合能力平衡总分测试;同时还分别进行平衡能力简单测试方法,闭目原地踏步、平衡木上行走、起立－走、闭眼单足站立、强化Romberg检查、前庭步测试、改良Wolfson测试、垂直X书写的测试。结果动态平衡仪感觉整合能力平衡总分、闭目原地踏步、平衡木上行走、垂直X书写测试、改良Wolfson测试、前庭步测试结果表明常锻炼的老年人平衡能力比不常锻炼组明显好（P<0.05,P<0.001）。结论体育锻炼对延缓老年人的平衡能力退行性变化有积极作用。     

Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention in fall-prone older adults

AIM: This paper reports a study to determine changes in the physical fitness (knee and ankle muscle strength, balance, flexibility, and mobility), fall avoidance efficacy, and fall episodes of institutionalized older adults after participating in a 12-week Sun-style Tai Chi exercise programme. BACKGROUND: Fall prevention has a high priority in health promotion for older people because a fall is associated with serious morbidity in this population. Regular exercise is effective in fall prevention for older adults because of improvements in strength and balance. Tai Chi exercise is considered to offer great potential for health promotion and rehabilitation, particularly in the maintenance of good mental and physical condition in older people. METHODS: A quasi-experimental design with a non-equivalent control group was used. Data were collected from September 2001 to January 2002. A total of 68 fall-prone older adults with a mean age of 77.8 years participated in the study, and 29 people in the Tai Chi group and 30 controls completed the post-test measures. The Tai Chi exercise programme was provided three times a week for 12 weeks in the experimental group. Data were analysed for group differences using t-tests. RESULTS: At post-test, the experimental group showed significantly improved muscle strength in knee and ankle flexors (P < 0.001) and extensors (P < 0.01), and improved flexibility (P < 0.01) and mobility (P < 0.001) compared with the control group. There was no significant group difference in fall episodes, but the relative risk ratio for the Tai Chi exercise group compared with the control group was 0.62. The experimental group reported significantly more confidence in fall avoidance than did the control group. CONCLUSION: The findings reveal that Tai Chi exercise programmes can safely improve physical strength and reduce fall risk for fall-prone older adults in residential care facilities.     

Frontline healthcare providers’ views of depression and its prevention in older adults

Aims and objectives.  To describe healthcare providers’ views on depression and its prevention in older people. Background.  There is an urgent need to develop public health approaches to depression prevention in older adults because of the growing older population and the high rate of depression among community‐dwelling older adults in Taiwan. Prior studies have focused on the prevalence of and risk factors for depression in Taiwanese community‐dwelling older adults. Research from the viewpoints of prevention and healthcare providers is needed to guide these approaches. Design.  A qualitative study involving semi‐structured interviews. Methods.  A purposive sample of 25 healthcare providers was recruited from a city in northern Taiwan. Data were collected through in‐depth individual interviews and analysed using thematic analysis. Results.  Results were embedded within four major themes: lack of children’s support, maladaptation to distressing life circumstances in late life, innate vulnerability in the individuals and being unaware of or reluctant to accept an illness. Conclusions.  Participants’ accounts of depression and its prevention were conceptualised within the family and socio‐cultural contexts older adults lived in. Lack of children’s support was reported as a main contributor to depression in older adults. Society was reported as the main context in which depression prevention intervention should take place. Communal activities were described as important for mental wellness and depression prevention. Relevance to clinical practice.  Study findings show how family, Chinese culture and socio‐economic circumstances influence accounts of depression and its prevention in older adults. Attention to the cultural construction of meanings may help extend our vision beyond a focus on the biomedical discourse and promote innovative ways of tackling depression that match the policy goals with the needs of older adults and community.     

Physical exercise and depression

Abstract

Objectives: The objective was to review studies which used physical exercise as an intervention to treat major depression, focusing on methodology, mechanisms of action, types of physical exercise and treatment outcomes.

Methods: Perform a search of the literature in the databases PsycINFO and PubMed 2000–2010 with ‘major depression’, ‘exercise’, ‘outcome’, ‘physical activity’ and ‘aerobic training’ as search terms. The inclusion criteria were: RCT treating depression with physical exercise with no limitations concerning age, gender or medication status.

Results: Eight studies fulfilled the inclusion criteria and were included. Seven of the eight studies showed significantly improved mood and reduced depression. Physiological and psychological mechanisms may be more relevant to mechanisms of action than social factors. Physical exercise had the same positive effect as sertraline in two studies. Also physical exercise and sertraline given together in one of two studies had a positive effect. Three studies measured an increase in aerobic capacity, two with correlated mood improvements. One showed a correlation between increased muscle strength and reduced feelings of depression.

Conclusion: Physical exercise can be an effective treatment against depression. A mood enhancing effect of exercise was identified in the interventions regardless of the mechanism of action. There is a need for more highly controlled clinical intervention studies treating depression with physical exercise, focusing on increasing the knowledge about mechanisms of action, type of exercise, intensity and frequency of exercise.