Prevalence and correlates of depressive symptoms in the elderly of rural communities in southern Taiwan

The purpose of this study was to determine the prevalence and level of depressive symptoms and the influence of demographic characteristics on depressive symptoms in elders residing in rural Taiwan. Also, the association was explored between depressive symptoms and life stressors in the Taiwanese Elderly Stress Inventory (TESI). A cross-sectional design utilizing face-to-face administered instruments was used. A total of 195 older community residents participated in the study. Levels of depressive symptoms wese measured by the Geriatric Depression Scale - Short Form (GDS-SF) while life stressors were assessed with the Taiwanese Elderly Stress Inventory (TESI). Overall, 57% of the subjects had a GDS-SF score of 7 or above (M = 7.58, SD = 3.89), indicating that the majority were depressed. Additionally, gender, educational level, marital status, living arrangements, and socioeconomic status (SES) were significant factors to depressive symptoms. Women were more likely to experience depression than men. Elders who had received no formal education, were separated from their spouse due to death or divorce, lived alone, or had lower SES were at higher risk of more severe depression. Also, significant correlations were found between depressive symptoms and 19 stressors identified in the TESI. These stressors mostly include events related to physical functioning and family issues. The findings of this study will provide community health professionals in Taiwan with a better recognition of depressive symptoms in rural elders and stressors that are associated with depressive symptoms. This information can be used to plan health-related services and interventions for rural elders.     

Self-care management and risk factors for depressive symptoms among Taiwanese institutionalized older persons

BACKGROUND: Depression in the elderly has become a serious healthcare issue worldwide, but studies of self-care strategies and risk factors for depressive symptoms are limited. OBJECTIVES: To determine the self-care strategies and risk factors for depressive symptoms among residents of public elder care homes in Taiwan. METHODS: A cross-sectional design was used. Two of 18 public elder care homes were chosen by random sampling throughout Taiwan. Residents (N = 200) of these two care homes who were 65 years old or above and without severe cognitive deficit participated in this study. RESULTS: Nearly half of the participants (49%) were identified by the Geriatric Depression Scale as depressed. Most participants (93%) used self-care strategies to manage their depressive symptoms. The most frequently used strategy was "take a walk." Self-learning was the main information source for self-care strategies. Logistic regression analysis indicated that cognitive function, perceived health status, and osteoarthritis were significant predictors of depression in this sample. CONCLUSIONS: Because older persons tended to engage in activities and to interact with others to manage their depressive symptoms, healthcare providers in public elder care homes may consider arranging enough activities and people contacts for residents. Due to the limited number of healthcare providers in these homes, the author recommends increasing the knowledge of both providers and residents about depression and self-care management strategies.     

Depressive symptoms among older residents at nursing homes in Taiwan

Aims and objectives. To examine the depressive symptoms of older residents at nursing homes and the relationship between their depressive symptoms and certain selected variables. Background. Depression has become a major healthcare concern among the older people, but nursing home‐based studies on risk factors of depression have still hardly been well performed in Taiwan. Design. A cross‐sectional design was developed and implemented. Methods. A research sample of 138 older residents was recruited from eight nursing homes located in southern Taiwan. During face‐to‐face interviews, the Center for Epidemiological Studies Depression Scale, Social Support Scale, Chronic Condition Checklist and Socio‐demographic Inventory were used for data collection. Results. The results showed that 81·8% of those residents were identified as being depressed. It was further discovered that the length of residency, number of chronic conditions, perceived health status and the amount of social support from their family and relatives could explain 38·8% of the total variances in depressive symptoms. Conclusions. Our study suggests that, in Taiwan, older people who live in nursing homes suffer from more depressive symptoms than those in community dwellings. To maintain and improve the health status for the elderly as much as possible, it is suggested that healthcare providers at nursing homes should develop an effective health promotion program for these older peoples. Relevance to clinical practice. There exists a high rate of depressive symptoms among older residents at nursing homes. It is imperative that a proper identification and its correspondent treatment for this health problem on the older residents are required. In late life, to maintain a higher level of quality of life, it is important to suggest that the health providers should regularly screen older people to increase the likelihood of diagnosis and improved treatment of late‐life depressive symptoms.     

The effects of a Socially Supportive Activities Program (SSAP) on mood in long term care: A pilot study

This study examined the effects of a facilitated 10-week Socially Supportive Activities Program (SSAP) designed to improve mood in a geriatric institutional setting. A sample of 68 Taiwanese elders in long-term care facilities with depressive symptoms were randomly assigned to either an experimental group (N = 35) or a control group (N = 33). Outcomes were measured before the intervention, week 1, and at week 12, one-week post intervention. In the experimental group, pre-post measurement results demonstrated significant reductions in depressive symptoms, measured by Geriatric Depression Scale, and significantly higher levels of self-transcendence, measured by the Self-Transcendence Scale. An additional post-intervention measure of mood was collected with the Apparent Emotional Rating Scale. The AERS also demonstrated a significantly higher score (better mood) in the experimental group than in the control group. This study supports the use of a structured, facilitated, well-designed social activities program like the SSAP, to enhance and improve mood in elders who live in long-term care facilities.     

Psychometric evaluation of the Chinese version of the Cornell Scale for Depression in Dementia

Elders with cognitive impairments frequently experience concomitant unidentified depressive symptoms due to an impaired capacity for verbal communication. Therefore, determination of a valid and reliable instrument with which to detect depression in this population requires confirmation through observation. The Cornell Scale for Depression in Dementia (CSDD) has been employed worldwide. However, no formally established psychometric properties have yet been made available for its Chinese version. For this study, we attempted to translate and test the validity and reliability of the CSDD Chinese version (CSDD-C). After completing translation and expert validity, a convenient sample of 145 older adults with dementia was assessed by their caregivers in several care facilities in Southern Taiwan. The CSDD-C was administered to collect data along with the Geriatric Depression Scale short form (GDS-SF). Results found an expert content validity index (CVI) of .92 and concurrent validity between CSDD-C and GDS-SF of .322 (p < .001). The number of factors extracted through our samples is consistent with the original CSDD; inter-rater agreement over a two-week period on each item was significant (Kappa = .43-89); and the Cronbach's alpha for internal consistency reliability was .84. Results indicate the CSDD-C to be a reliable and valid instrument to help Chinese speaking caregivers determine signs and symptoms of depression in elders with dementia under their care.     

A framework for studying the nutritional health of community-dwelling elders

BACKGROUND: Ensuring nutritional health for elders has been shown to reduce healthcare costs and enhance quality of life. Studies, however, have shown that malnutrition is present in 2% to 51% of community-dwelling elders, depending on the definition used and the population studied. An empirically tested framework for studying nutritional health in community-dwelling elders is not yet available. OBJECTIVE: To test the goodness-of-fit exhibited by the framework of nutritional health among community-dwelling elders based on the Roy Adaptation Model using structural equation modeling (SEM). METHODS: A population-based study investigated 243 elders dwelling in public housing. Demographics, polypharmacy, chronic illness, oral health, depressive symptoms, functional status, and satisfaction with social support were assessed to test their relation with nutritional health according to the propositions of the Roy Adaptation Model and scientific evidence. RESULTS: The SEM analysis indicated that functional status, oral health, depressive symptoms, and satisfaction with social support affect nutritional health directly. Oral health, depressive symptoms, functional status, and satisfaction with support mediated the effects of age, ethnicity, education, and number of medications and chronic illnesses on nutritional health. The model accounted for 35% of the variance in nutritional health and demonstrated a good fit with the data and with the values for Bentler's Comparative Fit Index (0.94) and chi (1.76). CONCLUSIONS: The propositions of the Roy Adaptation Model were supported, and the findings showed that this framework of nutritional health among community-dwelling elders could serve as a theoretical and empirical base for future inquiry.     

Predicting long-term care institution utilization among post-rehabilitation stroke patients in Taiwan: a medical centre-based study

Purpose: Early identification of predictive factors relevant to the utilization of long-term care institution for stroke patients is important and thus investigated in this study on stroke patients receiving rehabilitation therapy. Methods: This prospective follow-up investigation carried out during patients' clinical visits, at homes or long-term care institutions, was conducted at least 6 months after stroke on 151 stroke survivors. Functional ability was evaluated with the functional independence measure (FIM TM ) instrument at discharge of the inpatient rehabilitation programme. Balance status was measured using the seven item balance scale of the Fugl-Meyer sensorimotor assessment (FMSA). Major medical, rehabilitative and sociodemographic factors were also examined during hospitalization period as independent variables. Results: Of all the patients surveyed, 23 (15.2%) had been living in long-term care institutions. Univariate statistical analysis indicated that the significant factors related to longterm care institution utilization included recurrence of attack, bilateral involvement, impaired orientation, and functional and balance status at discharge. Conclusions: Basing on the significant predictors identified, analysis using the logistic regression model correctly classified three quarters of the subjects as long-term care institution residents. The strongest predictors of long-term care institution utilization for stroke patients following rehabilitation therapy were: bilaterally affected, impaired orientation and poor standing ability at discharge.     

Predicting long-term care institution utilization among post-rehabilitation stroke patients in Taiwan: a medical centre-based study.

PURPOSE: Early identification of predictive factors relevant to the utilization of long-term care institution for stroke patients is important and thus investigated in this study on stroke patients receiving rehabilitation therapy. METHODS: This prospective follow-up investigation carried out during patients' clinical visits, at homes or long-term care institutions, was conducted at least 6 months after stroke on 151 stroke survivors. Functional ability was evaluated with the functional independence measure (FIM) instrument at discharge of the inpatient rehabilitation programme. Balance status was measured using the seven item balance scale of the Fugl-Meyer sensorimotor assessment (FMSA). Major medical, rehabilitative and sociodemographic factors were also examined during hospitalization period as independent variables. RESULTS: Of all the patients surveyed, 23 (15.2%) had been living in long-term care institutions. Univariate statistical analysis indicated that the significant factors related to long-term care institution utilization included recurrence of attack, bilateral involvement, impaired orientation, and functional and balance status at discharge. CONCLUSIONS: Basing on the significant predictors identified, analysis using the logistic regression model correctly classified three quarters of the subjects as long-term care institution residents. The strongest predictors of long-term care institution utilization for stroke patients following rehabilitation therapy were: bilaterally affected, impaired orientation and poor standing ability at discharge.     

Effects of perceived self-efficacy and functional status on depression in patients with chronic heart failure

The purpose of this study was to test the relationships between perceived self-efficacy, functional status and depression in a group of chronic heart failure patients. The conceptual model for this study was primarily derived from Bandura's social learning theory. The study is based on an exploratory, correlational design. A sample of 100 chronic heart failure patients who met the inclusion criteria were recruited from four cardiovascular clinics of major hospitals in northern Taiwan. The instruments used in this study included Jenkins' Self-Efficacy Expectation Scales, Seattle Angina Inventory, and Geriatric Depression Scale. Results demonstrate a significant inverse relationship between perceived self-efficacy and depressive symptoms (r = -.61, p < .001), a significant positive relationship between perceived self-efficacy and functional status (r = .55, p < .001), and a significant negative relationship between functional status and depressive symptoms (r = -.33, p < .001). The findings of the path analysis support the hypothesis that after controlling for disease severity, perceived self-efficacy has a direct and negative effect on depressive symptoms. An indirect effect of perceived self-efficacy on depression through functional status in heart failure patients was also revealed in the finding. All paths in the model were significant (p < .05). Results of the study can help to identify heart failure patients who are at risk for low perceived self-efficacy, low functional status, and a depressed mood. Nursing intervention to address these factors can then be developed and tested.     

Long-term care for the elderly in Taiwan

An aging population, the prevalence of chronic disease and functional disabilities, and changes in society have caused a greater demand for long-term care in Taiwan. The development of long-term care has gone through four stages: undeveloped, early beginning, expanding, and establishment. Problems in several areas including lack of care providers and facilities, expenses of care, and difficulty coordinating health and social services are issues that must be explored. Well-planned and managed long-term care services are an important task for the Taiwanese government to address so holistic care of elders can be provided in this new century.     

Dimensions of quality in long-term care facilities in Taiwan

AIM: This article presents the results of a qualitative study designed to explore the perceptions of Taiwanese elders about the quality of their care while in residence at a long-term care facility. BACKGROUND: As the population of elders in Taiwan is increasing rapidly, quality long-term care has become both a necessity and social responsibility. Research related to quality of care has focused on structure, process and outcomes as well as perceptions of quality of care and life satisfaction. Few authors have considered residents' perspectives within a cultural context. METHOD: A convenience sample of 22 residents, aged between 61 and 86 years and living in four Taiwanese care facilities, participated in semi-structured interviews. The data were generated during 2001/2002 and were analysed using content analysis. RESULTS: Six key dimensions of quality care were elicited. The dimensions were: a caring attitude, respect for individual differences, emotional support, social interaction, a supportive environment, and accessible care. These dimensions are discussed within a cultural context supportive of family connectedness and filial piety, values underpinning care expectations of elders. CONCLUSIONS: The findings provide a foundation for increased understanding of the perceived gaps between residents' aspirations about quality care and priorities identified in other studies. Additional studies based on these data are planned in order to generate a culturally relevant, psychometrically sound resident assessment tool to evaluate the quality of care from a resident perspective in long-term care facilities in Taiwan.     

Factors associated with depressive symptoms in low-income, older Korean women with hypertension

The purpose of this study was to identify the factors that are associated with depressive symptoms in community-dwelling, low-income, older Korean women with hypertension. A total of 107 low-income, older (aged 74 ± 6 years) Korean women with hypertension participated in the study. Information about depressive symptoms, functional status, and social support were collected by interviews that used the Geriatric Depression Scale, Katz's Activities of Daily Living, and the Lubben Social Support Network Scale, respectively. A logistic regression analysis was used to determine the factors that affected depressive symptoms. The results indicated that the depressed women had been diagnosed with hypertension for a longer period of time and took a larger number of medications than the women in the non-depressive group. They also had poorer functional status and an "isolated" social support network. The social support network, length of time since diagnosis, number of medications, and functional status were associated independently with depressive symptoms. It was concluded that clinicians should assess for the factors that are associated with depressive symptoms, including a poor social support network, poor daily activity, the number of medications, and the length of time since diagnosis in order to prevent the symptoms of comorbidities worsening in low-income, hypertensive, older women.     

Increased health burden associated with comorbid depression in older diabetic Mexican Americans. Results from the Hispanic Established Population for the Epidemiologic Study of the Elderly survey.

OBJECTIVE: To examine the health burden associated with concomitant depressive symptoms and diabetes in older Mexican Americans. RESEARCH DESIGN AND METHODS: Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly were used to assess the association between high levels of depressive symptoms, measured with the Center for Epidemiologic Studies of Depression scale, and comorbid chronic health conditions, diabetic complications, functional disability, health service use, and medication use among 636 older diabetic Mexican Americans, in comparison with 2,196 older nondiabetic Mexican Americans. RESULTS: Overall, 31.1% of the older diabetic individuals reported high levels of depressive symptoms. The risks of comorbid myocardial infarction, hypertension, arthritis, and angina were significantly higher in the presence of concomitant depressive symptoms, as were the risks of diabetic complications, functional disability, incontinence, vision impairment, poorer perceived health status, and health service use among both diabetic and nondiabetic individuals. Rates were substantially higher among depressed diabetic individuals, however, in comparison to depressed nondiabetic individuals. Importantly, this increased health burden was evident even when controlling for sociodemographic risk factors, including sex, age, level of education, marital status, immigrant status, and living arrangements. CONCLUSIONS: The presence of concomitant depressive symptoms among older diabetic Mexican Americans is associated with a substantially greater health burden than is seen among diabetic individuals without depression or depressed individuals without diabetes. This association of depression with higher rates of chronic conditions, poorer functioning, and increased health service use is particularly significant in that this study was conducted among community-dwelling adults and was not confounded by the potential association of health care-seeking behavior that might occur in a medically ill sample.     

Associations between chewing and swallowing problems and physical and psychosocial health status of long-term care residents in taiwan: a pilot study

Oral health is often overlooked in institutional elder care but may have an impact on general health and ability to communicate. We aimed to determine the factor associated with chewing and swallowing problems among long-term care residents in Taiwan. Staff nurses trained to evaluate oral health assessed 781 residents using relevant sections of the Minimum Data Set 2.1 for nursing homes (Chinese version), including the Cognitive Performance Scale, Index of Social Engagement, and Activities of Daily Living Scale. Individuals with chewing and swallowing problems (n = 345) tended to be women (odds ratio [OR] = 1.51, P = .019) in smaller facilities (OR = 4.18, P < .001) with fewer natural teeth (OR = 0.54, P = .011); more broken, loose, or carious teeth (OR = 1.74, P = .042); and with more frequently inflamed gums (OR = 2.72, P?= .025) than residents without chewing and swallowing problems (n = 436). Residents' chewing and swallowing problems were significantly associated with parenteral/enteral intake, oral health status, nutritional status, concomitant disease and infection, cognitive function, and social engagement.     

Single ability among activities of daily living as a predictor of agitation

Aims. The aims of this study were to investigate whether the interaction effect between restraint and functional ability, and single ability during activities of daily living can predict agitation among residents with dementia. Background. Agitated behaviour is one of the most common symptoms of dementia and might endanger the patients themselves, caregivers and institutions. However, the prevalence of problem behaviours and its associated factors at long‐term care facilities in Taiwan are less understood. Design. A direct observation was used to observe the agitated behaviours of residents with dementia in special care units. Methods. Residents of dementia special care units who were diagnosed with dementia in eight long‐term care facilities were recruited. Measurements included: demographic data, the Barthel Index, the Mini‐Mental State Examination and the Cohen‐Mansfield Agitation Inventory. Results. The number of subjects who were identified with problem behaviours was 163 (43·5%). Significant differences in sex, being restrained, restrained time, age, family visits, functional status and mental status were found between the agitated and non‐agitated groups. However, mental status, family visits, walking ability, being restrained and getting in and off toilet were five independent factors associated with agitated behaviours after controlling for all other factors. Conclusions. It is recommended that strategies be constructed to encourage the family to periodically visit older residents and to develop restraint‐free environments in long‐term care facilities. Relevance to clinical practice. Residents with dementia require significant daily living support and behaviour management as their illness progress.     

Spirituality and depressive symptoms in primary care outpatients

BACKGROUND: Although many studies have examined the relationship between religiosity and depressive symptoms in patient populations, there has been little work to understand and measure the effect of spirituality on depressive symptoms. OBJECTIVE: The purpose of this study was to examine the association of spirituality and symptoms of depression in primary care outpatients. METHODS: A cross-sectional analysis was performed of a dataset using 509 primary care outpatients who participated in an instrument validity study in the Kansas City (US) area. Patients were administered the Zung Depression Scale (ZDS) and the Spirituality Index of Well-Being (SIWB) in the waiting area before or after their appointment. Bivariate and multivariate analyses were performed to determine the relationship between the factors of interest and depressive symptoms. RESULTS: In bivariate analyses, less insurance coverage (P < 0.01) and greater spirituality (P < 0.01) were associated with less reported depressive symptoms. In a model adjusted for covariates, spirituality (P < 0.01) remained independently associated with less symptoms. CONCLUSION: Primary care outpatients who report greater spirituality are more likely to report less depressive symptoms.