Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial

BMJ 1999;319:676-682 ( 11 September )

General Practice

Editorial by Haynes

Robert H Llewellyn-Jones, lecturer, Karen A Baikie, senior research officer, Heather Smithers, research officer, Jasmine Cohen, data manager, John Snowdon, clinical associate professor, Chris C Tennant, professor.

Department of Psychological Medicine, University of Sydney, New South Wales 2006, Australia

Correspondence to: R H Llewellyn- Jones, Healthy Aging Research Unit, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales 2077, Australia rljones{at}mail.usyd.edu.au

Objective: To evaluate the effectiveness of a populationbased, multifaceted shared care intervention for late life depressionin residentialcare.
Design: Randomised controlled trial, with controland intervention groups studied one after the other and blindfollow up after 9.5months.
Setting: Population of residential facility in Sydneyliving in self care units andhostels.
Participants: 220 depressed residents aged $>=$ 65 without severecognitiveimpairment.
Intervention: The shared care intervention included: (a)multidisciplinary consultation and collaboration, (b) trainingof general practitioners and carers in detection and managementof depression, and (c) depression related health education andactivity programmes for residents. The control group receivedroutinecare.
Main outcome measure: Geriatric depressionscale.
Results: Intention to treat analysis was used. Therewas significantly more movement to "less depressed" levels ofdepression at follow up in the intervention than control group(Mantel-Haenszel stratification test, P=0.0125). Multiple linearregression analysis found a significant intervention effect aftercontrolling for possible confounders, with the intervention groupshowing an average improvement of 1.87 points on the geriatricdepression scale compared with the control group (95% confidenceinterval 0.76 to 2.97, P=0.0011).
Conclusions: The outcome of depression among elderly peoplein residential care can be improved by multidisciplinary collaboration,by enhancing the clinical skills of general practitioners andcare staff, and by providing depression related health educationand activity programmes forresidents.

Key messages

Large numbers of depressed elderly people live in residential care but few receive appropriate management
A population based, multifaceted shared care intervention for late life depression was more effective than routine care in improving depression outcome
The outcome of late life depression can be improved by enhancing the clinical skills of general practitioners and care staff and by providing depression related health education and activity programmes for residents
The intervention needs further refining and evaluation to improve its effectiveness and to determine how best to implement it in other residential care settings

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Rapid Responses:

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bmj.com, 30 Sep 1999 [Full text]
Two faint cheers: David Ames
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