减少老年家庭护理客户的抑郁：一项护士主导的跨专业心理健康促进干预前瞻性研究的设计。
Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention.
机构信息
School of Nursing, McMaster University, Hamilton, Ontario, Canada.
出版信息
BMC Geriatr. 2011 Aug 25;11:50. doi: 10.1186/1471-2318-11-50.
BACKGROUND
Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services.
METHODS/DESIGN: This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation.
DISCUSSION
Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT01407926.
背景
在使用个人支持服务的老年家庭护理客户中，针对抑郁问题的研究非常有限。这些老年人由于认知能力下降、合并慢性疾病、功能受限、缺乏社会支持以及获得医疗服务的机会减少，特别容易抑郁。迄今为止，研究主要集中在初级保健环境中针对老年成年人的协作式、护士主导的抑郁护理计划。目前尚不清楚如何最佳地管理老年家庭护理客户的抑郁问题。本研究的目的是评估一项为期 6 个月的护士主导的、跨专业精神健康促进干预措施的可行性、可接受性和有效性，该干预措施针对使用个人支持服务的有抑郁症状的老年家庭护理客户。
方法/设计：这是一项单组预测试后测试研究，旨在招募 250 名在安大略省加拿大的家庭护理计划中接受个人支持服务、年龄在 70 岁及以上、有抑郁症状且已入住超过 60 天的长期家庭护理客户。由注册护士主导的干预措施是一个多方面的 6 个月计划，包括定期家访、每月病例会议以及使用跨专业方法对抑郁进行基于证据的评估和管理。主要结果是使用流行病学研究中心抑郁量表（CES-D），从基线到 6 个月时抑郁症状严重程度的变化。次要结果包括抑郁和焦虑症状的患病率变化、健康相关生活质量、认知功能以及从基线到 12 个月时抑郁治疗的速度和适当性。将从社会角度评估健康服务使用成本的变化。将收集描述性和定性数据，以检查干预措施的可行性和可接受性，并确定实施的障碍和促进因素。
讨论
数据收集始于 2010 年 5 月，预计于 2012 年 7 月完成。协作式护士主导的策略可能为改善脆弱人群的健康提供一种可行、可接受且有效的方法，方法是改善老年家庭护理客户的抑郁预防、识别和管理。还讨论了在家中护理中设计实用、可转移和可持续的护士主导干预措施所面临的挑战。
试验注册
ClinicalTrials.gov：NCT01407926。
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