An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms

BMC Geriatrics

Research Article

Lehana Thabane¹  Jeffrey S Hoch²  Carrie McAiney³  Dorothy Forbes⁴  Maureen Markle-Reid⁵  Gina Browne⁵  Maggie Gibson⁶ 

[1] Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada;Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada;St. Joseph’s Healthcare, Hamilton, Ontario, Canada;Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada;School of Nursing, McMaster University, Hamilton, Ontario, Canada;Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;Veterans Care Program, Parkwood Hospital, St. Joseph’s Healthcare, London, Ontario, Canada;

关键词: Nurse-led interventions;    Home care;    Interdisciplinary;    Depression management;    Older adults;    Clinical effectiveness;   

DOI  :  10.1186/1471-2318-14-62

 received in 2013-12-19, accepted in 2014-04-24,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundDepressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services.MethodsA prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation.ResultsOf the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period.ConclusionsOur findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms.Trial registrationClinicaltrials.gov identifier: NCT01407926.

【 授权许可】

CC BY   
© Markle-Reid et al.; licensee BioMed Central Ltd. 2014