Intended for healthcare professionals

General Practice

Multifaceted shared care intervention for late life depression in residential care: randomised controlled trialCommentary: Beyond the boundary for a randomised controlled trial?

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7211.676 (Published 11 September 1999) Cite this as: BMJ 1999;319:676

Abstract

Objective: To evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care.

Design: Randomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months.

Setting: Population of residential facility in Sydney living in self care units and hostels.

Participants: 220 depressed residents aged ≥65 without severe cognitive impairment.

Intervention: The shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c)depression related health education and activity programmes for residents. The control group received routine care.

Main outcome measure: Geriatric depression scale.

Results: Intention to treat analysis was used. There was significantly more movement to “less depressed” levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P=0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P=0.0011).

Conclusions: The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents.

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

Footnotes

    • Accepted 4 August 1999

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

    1. Robert H Llewellyn-Jones, lecturer (rljones{at}mail.usyd.edu.au),
    2. Karen A Baikie, senior research officer,
    3. Heather Smithers, research officer,
    4. Jasmine Cohen, data manager,
    5. John Snowdon, clinical associate professor,
    6. Chris C Tennant, professor
    1. Department of Psychological Medicine, University of Sydney, New South Wales 2006, Australia
    2. Imperial Cancer Research Fund and NHS Centre for Statistics in Medicine, Institute of Health Sciences, Headington, Oxford OX3 7LF
    1. Correspondence to: R H Llewellyn- Jones, Healthy Aging Research Unit, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales 2077, Australia
    • Accepted 4 August 1999

    Abstract

    Objective: To evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care.

    Design: Randomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months.

    Setting: Population of residential facility in Sydney living in self care units and hostels.

    Participants: 220 depressed residents aged ≥65 without severe cognitive impairment.

    Intervention: The shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c)depression related health education and activity programmes for residents. The control group received routine care.

    Main outcome measure: Geriatric depression scale.

    Results: Intention to treat analysis was used. There was significantly more movement to “less depressed” levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P=0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P=0.0011).

    Conclusions: The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents.

    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

    Footnotes

    • Funding The project was initially conducted while the first author was a research fellow of the New South Wales Institute of Psychiatry. The study received grant aided support from the Commonwealth Department of Health and Family Services, General Practice Evaluation Program and its Aged Care Program Support Program, the University of Sydney McGeorge bequest, the New South Wales Health Department Health Outcomes Program, and a Roche Products clinical research grant. An educational grant from Roche Products was used to devise and produce the materials for the “Insights” general practitioner education workshop on late life depression. This workshop was the third in a series of six general practitioner workshops on depression developed by the “Insights” Depression Education Advisory Committee chaired by associate professor John Tiller. However, only “Insights workshop 3: depression in the elderly” was part of the intervention. The content of this workshop was devised by a project group (chaired by RHL-J) of the advisory committee in association with both Oxford Clinical Communications Sydney and the whole committee.

    • Competing interests RHL-J and JS received small honoraria from Roche Products for attending “Insights” advisory committee meetings. RHL-J was also reimbursed by Roche Products for attending a symposium KAB's work on the study was part funded by a Roche Products clinical research grant. Neither the “Insights” general practitioner education meetings nor the multifaceted intervention as a whole promoted the use of any specific brand of pharmaceutical product.

    • Accepted 4 August 1999

    Commentary: Beyond the boundary for a randomised controlled trial?

    1. Jonathan J Deeks, medical statistician (J.Deeks{at}icrf.icnet.uk),
    2. Edmund Juszczak, medical statistician
    1. Department of Psychological Medicine, University of Sydney, New South Wales 2006, Australia
    2. Imperial Cancer Research Fund and NHS Centre for Statistics in Medicine, Institute of Health Sciences, Headington, Oxford OX3 7LF
    1. Correspondence to: J J Deeks

      Footnotes

      • Competing interests None declared.

        View Full Text