‘Thriving, not just surviving’: characterising depression amongst cognitively-intact elderly in Residential Aged Care facilities and exploring the effectiveness of two psychosocial therapies to improve outcomes
2017-02-14T02:20:58Z (GMT) by
Successful ageing theories suggest the potential for wellbeing to improve with age. Indeed, rates of depression have been shown to be lower amongst elderly residing in the community compared to younger adults. Unfortunately, the same cannot be said for elderly living in Residential Aged Care facilities (RACFs). Prevalence data indicates rates of depression between 16-50% in Australian RACFs. Moreover, rates of subthreshold depressive symptoms have been reported to be between 10-70%. Of concern, this pervasive and debilitating mental illness has been shown to not only diminish individuals’ quality of life, but also increase their risk of mortality. Although the high level of comorbidity between dementia and depression goes some way towards explaining the increased prevalence of depression in this cohort, research has shown that rates of depression amongst cognitively-intact elderly residing in RACFs are also substantially higher than community-based elderly. A range of biopsychosocial factors have been suggested to account for the increased prevalence of depression in this population; however, the real challenge is to determine how RACFs can create the conditions to reduce mental illness and maximise wellbeing. To date, the focus has been on managing medical illness in the elderly, with early theories of successful ageing emphasising physical illness as the key factor in depleting elderly sense of wellbeing. More recently, psychosocial factors such as self-efficacy, personal mastery and social engagement have been shown to be central to maintaining a sense of wellbeing and reducing the risk of mental illness, particularly depression. Music Therapy and Animal-Assisted Activities are two psychosocial treatments increasing in popularity in many RACFs in Australia. These interventions are typically implemented as aspects of a suite of diversional therapies offered to enrich the residential care environment. Proponents suggest that the interventions not only reduce depression and promote general mental health and wellbeing, but also reduce anxious/agitated behaviours and maintain physical and cognitive abilities. To date, although some favourable findings have been reported for both interventions, research has generally lacked methodological rigour. Moreover, little is known about the effectiveness of the interventions in cognitively-intact elderly samples. The high prevalence of depression in RACFs, and the well-established negative association between depression and wellbeing, makes it ideally suited as a target for intervention amongst this population. To this end, the aim of this thesis was to first characterise the clinical presentation of subthreshold and clinical depression in cognitively-intact elderly using a range of self-report and objective indices; and second, to explore the effectiveness of Music Therapy and Animal-Assisted Activities to reduce depressive symptoms. Participants were recruited from 15 RACFs in Melbourne, Victoria, Australia. Using a Randomised Controlled Trial (RCT) design, each facility was randomly allocated an intervention: Treatment as Usual, Animal-Assisted Activities or Music Therapy. Participants in facilities allocated to an intervention participated in twice-weekly, hour long group therapeutic interventions for four weeks, facilitated by registered therapists’ in the respective interventions. The total sample comprised 96 (84 years ± 6.91 years) cognitively-intact elderly (SMMSE = 26.6 ± 2.62) with varying levels of depression as assessed by GDS-15 scores (score range = 0-13) and clinical interview. Following screening, pre- and post-intervention data for affective (GDS-15, BHS, HADS), quality of life (AQoL) and cognitive functioning (neuropsychological and electrophysiological measures) was collected. Significant differences in the clinical presentation of depression between non-depressed, subthreshold and clinically depressed elderly were observed. Trends consistently revealed higher levels of impairment across affective, quality of life and neuropsychological indices amongst participants in the subthreshold group relative to those with no depressive symptomatology. Participants with clinical depression were shown to have significantly poorer perceptions of quality of life and affective and cognitive functioning relative to participants with no depression and subthreshold depression. Neither of the psychosocial interventions significantly improved affective outcomes relative to Treatment as Usual; however, trends suggested improvements in executive functioning for both Music Therapy and Animal-Assisted Activities relative to Treatment As Usual amongst clinically depressed participants. The findings have implications for the diagnosis and management of depression in Residential Aged Care settings.