Lyne K J, Moxon S, Sinclair I, Young P, Kirk C, Ellison S
Psychology Services, Selby and York Primary Care Trust, York, UK.
Aging Ment Health. 2006 Jul;10(4):394-403. doi: 10.1080/13607860600638347.
Approximately 40% of older people in residential care have significant symptoms of depression. A training and care-planning approach to reducing depression was implemented for 114 depressed residents living in 14 residential care homes in North Yorkshire, UK. Care staff were offered brief mental health training by community mental health teams for older people. They were then assigned to work individually with residents in implementing the care-planning intervention, which was aimed at alleviating depression and any health, social or emotional factors that might contribute to the resident's depression. Clinically significant improvements in depression scores were associated with implementation of the care-planning intervention as evidenced by changes in scores on the Geriatric Mental State Schedule-Depression Scale. There was evidence of an interaction between the power of the intervention and degree of dementia. These improvements were not accounted for by any changes in psychotropic medication. The training was highly valued by care staff and heads of homes, and they considered that the care-planning intervention represented an improvement in quality of care for all residents, irrespective of levels of dementia. Staff also reported improvements in morale and increased confidence in the caring role as a result of their participation. The limitations of this study are discussed. On the basis of a growing body of evidence, it is argued that there is an urgent need for a suitably powered randomised controlled trial and economic evaluation, to test the cost-effectiveness of personalised care planning interventions aimed at reducing depression in older people in residential care.
在养老院接受护理的老年人中，约40%有明显的抑郁症状。针对英国北约克郡14家养老院的114名抑郁居民，实施了一种旨在减轻抑郁的培训和护理计划方法。社区老年心理健康团队为护理人员提供了简短的心理健康培训。然后，他们被分配与居民单独合作实施护理计划干预措施，该措施旨在缓解抑郁以及可能导致居民抑郁的任何健康、社会或情感因素。根据老年精神状态检查表 - 抑郁量表的得分变化证明，抑郁得分的临床显著改善与护理计划干预措施的实施有关。有证据表明干预力度与痴呆程度之间存在相互作用。这些改善并非由精神药物的任何变化所导致。护理人员和养老院负责人高度重视该培训，他们认为护理计划干预措施代表了所有居民护理质量的提高，无论痴呆程度如何。工作人员还报告说，由于参与其中，士气得到改善，在护理工作中的信心增强。本文讨论了该研究的局限性。基于越来越多的证据，有人认为迫切需要进行一项有足够样本量的随机对照试验和经济评估，以测试旨在减轻养老院老年人抑郁的个性化护理计划干预措施的成本效益。
