| Samenvatting (Engels) | Depressive and anxiety disorders are a very common, serious and underdetected problem in homes for the elderly. As the number of elderly persons aged 75 years or older increased, the group of very old persons in homes for the elderly has been increasing rapidly.In addition, the levels of psychological and physical frailty are increasing. Elderly persons in residential homes are at high risk for developing major depressive and anxiety disorders, and deserve attention with regard to prevention.
The aim of this thesis therefore was to evaluate the (cost)effectiveness of a stepped care programme on the prevention of depression and anxiety in residential homes for the elderly.
Chapter 1. General introduction
Chapter 1 starts with a case vignette in order to illustrate some of the complexities of becoming old while living in a residential home. Depression and anxiety disorders are often considered to be consequences of physical vulnerability, rather than problems that deserve attention in their own right. Therefore, the focus of treatment and care for elderly people living in a residential home is mainly restricted to physical disability and disease. From there on depression and anxiety disorders in older people are described, followed by the mechanisms and the importance of preventive activities. Following, Chapter1 describes the stepped care prevention programme that we used in our study. This programme is a model to organise the expertise in efficient way, and may be particularly relevant for an environment of limited resources. The Chapter ends with a description of the objectives and the outline of this thesis.
Chapter 2. Study design
Chapter 2 presents the protocol of the pragmatic randomised clinical trial. This protocol describes a randomised trial on the feasibility and (cost) effectiveness of a stepped care programme for the prevention of depressive and anxiety disorders in homes for the elderly. The main outcome measure is the incidence of depressive
and anxiety disorder in one year with a two-year follow up. Secondary outcomes are symptoms of depression and anxiety, quality of life, direct health care costs and satisfaction with treatment. The number of studies examining the effects of preventive interventions on the incidence of mental disorders in the elderly population is
very small. However, indicated prevention by means of a stepped care programme seems to be an important option for decreasing the burden of illness for residents and their caregivers. This study contributes to the body of knowledge in this field.
Chapter 3. Pilot study for the screening procedure
Chapter 3 describes the problems that we met when screening for depressive and anxiety disorders in elderly persons in residential homes. The proposed prevention protocol has been developed for elderly persons who have a certain level of self-reliance, but who are part of an at-risk group in relation to the development of
a depressive and/or anxiety disorder. A comparable protocol was found to be feasible with fragile elderly persons (75+) in the general population and it, therefore, also seemed to be a suitable method for elderly persons in residential homes. Of all the residents approached, 44% were prepared and/or able to fill in the screen-
ing list, with help if required. This was lower than we had expected on the basis of the previously mentioned research in the general population, in which two thirds completed this list. Of the residents who filled in the questionnaire, 37% appeared to have symptoms of depression and/or anxiety. It can be derived from this that
the prevalence of the symptoms of depression and anxiety in this residential home is certainly as high as expected. However, we were subsequently expecting, on the basis of comparable research in the general population, that 80% of these residents with symptoms were prepared to participate. This was not the case. We
concluded that a personal approach, performed by familiar persons, directed at the more independent inhabitants is most likely to succeed. The need for research on the effectiveness and feasibility of evidence-based methods in residential care remains evident. However, the more vulnerable residents, possibly already being
considered for nursing homes, have other needs.
Chapter 4. Criterion validity of the screening instrument
Chapter 4 concerns the characteristics of our screening instrument, the Center for Epidemiological Studies Depression Scale (CES-D) in a residential home population. The CES-D is an instrument that is commonly used to screen for depression in community-based studies of the elderly, but the characteristics of the CES-D
in a residential home population have not yet been studied. The aim of this study was to investigate the criterion validity and the predictive power of the CES-D for both depressive and anxiety disorders in a vulnerable, very old population living in residential
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| Samenvatting (Nederlands) | Bewoners van verzorgingshuizen vormen een hoog risicogroep voor het ontwikkelen van een depressie en/of een angststoornis. Deze stoornissen hebben een grote impact op het welzijn en functioneren van bewoners, komen veel voor en worden vaak slecht herkend. Er is daarom grote behoefte aan effectieve interventies om deze stoornissen te behandelen en te voorkomen. Preventie is extra belangrijk omdat deze stoornissen grote aantallen mensen treffen, en de verwachting is dat dit in de komende jaren alleen maar zal toenemen.
Dit proefschrift beschrijft een onderzoek naar de haalbaarheid en de effectiviteit van een stapsgewijs preventief programma bij bewoners van verzorgingshuizen die een verhoogd risico hebben op het ontwikkelen van een depressie en/of angststoornis. We hebben tevens bekeken wat de kosten zijn van een dergelijke aanpak.
In tien hoofdstukken worden de verschillende aspecten van dit onderzoek besproken.
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