Agents of change in aged care

Improving Health and Wellbeing

A series of Deakin studies into depression and aged care illustrates how the application of research can make a real difference in people’s lives.

Rates of depression among residents of aged care hostels and homes are higher than those in the general community.

However, the condition is often under-diagnosed and under-treated in aged care residents, contributing to further health complications and poorer quality of life.

Nearly a decade ago, a team of researchers from Deakin University’s Faculty of Health and industry partners, including Uniting Aged Care, Benetas, and beyondblue, began investigating the reasons behind these poor rates of diagnosis and treatment.

The team’s work eventually led to the development of a staff protocol for identifying and treating depression in aged care residents, which has been implemented in aged care facilities around Australia and attracted international interest.

Professor David Mellor, Associate Dean (International) of Deakin’s Faculty of Health and one of the researchers involved, explained that the team originally sought to fill a gap in the existing research, but “each step along the way led to the necessity for another step and a further study.”

The initial study found that more than one third of aged care residents had minor or major depression, but that this was recognised by GPs in less than half the cases.

“That was alarming because depression is treatable, and if it’s left untreated can contribute to poor quality of life and other health problems,” Prof Mellor said.

Prof Mellor said that a number of factors played a role in the under-diagnosis of depression amongst the residents, including co-existing medical conditions, lack of time for GPs to conduct mental health assessments and reluctance on the part of residents to discuss their mental health.

“That led us to think about the role that carers and nurses in aged care play in identifying depression,” he said.

“They have more contact and a more intimate relationship with the residents.

“We thought if we improved their ability to identify depression, they could work with GPs as informants on the mental state of residents.”
Prof David Mellor
Professor David Mellor Associate Dean (International) Faculty of Health

However, a second study focusing on the role of carers found that less than half had undergone depression related training and 40 per cent thought depression was a normal part of ageing.

Carers were often too busy meeting the physical needs of residents to find time to sit down with individuals and gather information on their mental health.

“There was also no established communication process where staff talked to each other, or doctors, about the mental health of residents,” Prof Mellor said.

“There was a lack of monitoring of depression symptoms using standardised checklists, and even where checklists existed, carers were reluctant, or didn’t feel confident enough, to use them.

“Many also found it intimidating to talk to a doctor about any concerns they had about a resident’s mental health.”

The researchers then turned their attention to developing a training program to help carers gain skills and confidence in assessing depression while reducing their perceptions of barriers to communicating with GPs.

“After undergoing the training program, carers’ knowledge about depression and the difference between depression, anxiety and dementia had increased,” Prof Mellor said.

“There was a corresponding decrease in their perception of barriers to using screening tools and communicating with GPs.”

As the pilot trial pointed to the training program being effective, the team and its industry partners undertook a randomised control trail using ARC Linkage funding to study 250 carers in aged care facilities and 50 in community care.

“In this study, we found improved attitudes among carers towards depressed people and increased knowledge and efficacy,” Prof Mellor said.

The rate of referrals of depressed residents to GPs had also increased.

“These changes were maintained after three months, suggesting that programs that train carers as agents of change can improve quality of life for residents,” Prof Mellor said.

The trial program has since been developed into manualised interventions, able to be delivered in different facilities.

It was also adapted for the Australian Centre for Eye Research to train Vision Australia staff working with people with impaired vision, and for palliative care workers.

 

This article was published by Deakin Research on 11 January 2017.