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Understanding and addressing depression and anxiety in older adults accessing in-home aged care

Tracks
Harbour View 1
Education and Training
Future Directions
Home Care
Meaningful engagement
Mental Health
Non-pharmacological interventions
Psychology
Technology
Wellness / Well Being
Friday, November 15, 2024
11:00 AM - 12:30 PM

Speaker

Dr Marissa Dickins
Research Fellow
Silverchain

Understanding and addressing depression and anxiety in older adults accessing in-home aged care

Abstract

Introduction and background
Older adults accessing in-home aged care services are at an increased risk of depression and anxiety, due to high levels established risk factors, including medical comorbidity, frailty, and functional decline. With continued growth in the number of older Australians who receive care in the home, and indications that mental health symptoms are rising in this population, new approaches are required to address these highly prevalent conditions. However, there has been limited research on depression and anxiety in the in-home aged care setting.

Aims
This symposium presents findings from a program of research designed to understand and address depression and anxiety in older adults accessing in-home aged care.

Overview of activities
The first paper reports findings of a telephone survey exploring the prevalence of depression and anxiety among in-home aged care recipients. The second reports the findings of interviews understanding the mental health care experiences and preferences of this group. The third details the findings of a pilot providing psychological treatments for depression within in-home aged care. The final paper shares the learnings from implementation of a digital portal to support older people accessing treatment.

Expected learning outcomes
With major reform in the Australian aged care sector underway, including greater emphasis on mental health in quality standards, the audience will learn critical information about the mental health needs of the in-home aged care population. They will gain insights into innovative approaches to managing late-life depression and anxiety, embedded within aged care service delivery and supported by digital technology.

Biography

Dr Marissa Dickins is a Research Fellow in the Research & Innovation team at Silverchain. She has worked for over 8 years conducting research within the aged care sector, and has a particular interest in developing new ways to provide care that improve the lives of those accessing care in the community.
Dr Marissa Dickins
Research Fellow
Silverchain

The Prevalence of Depression and Anxiety within In-Home Aged Care

Abstract

Older Australians increasingly prefer to age-in-place, accessing in-home aged care to support them to remain at home. Due to a range of factors, older persons are at increased risk for conditions such as depression and anxiety. There is, however, little information regarding the prevalence of these conditions within those receiving in-home aged care. To address this gap in knowledge, this Australian-first study aimed to identify the prevalence of depression and anxiety in this cohort.

A cross-sectional telephone survey was conducted with a random sample of aged care clients accessing Commonwealth Home Support Programme or Home Care Package services from a single aged care provider across three states. Depression (Patient Health Questionnaire, 9 item; PHQ-9) and anxiety (Generalized Anxiety Disorder, 7 item; GAD-7) symptoms were estimated in this group, alongside cognitive impairment, loneliness, social isolation, and quality of life.

A total of 237 individuals participated in the survey. Over half of participants (52%) were experiencing depression symptoms (≥5 on the PHQ-9), while one-third (37%) were experiencing symptoms of anxiety (≥5 on the GAD-7). Almost 3 in 10 (29%) participants were experiencing comorbid symptoms of depression and anxiety. Further analysis will be presented which examine secondary measures and their relationship with depression and anxiety.

For older adults accessing in-home aged care, depression and anxiety symptoms are common. It is important that these symptoms are addressed, and in-home aged care represents an opportunity to improve identification, referral, treatment and monitoring for these individuals and therefore improve wellbeing and likelihood of aging in place.

Biography

Dr Marissa Dickins is a Research Fellow in the Future Care team at Silverchain. She has worked for over 8 years conducting research within the aged care sector, and has a particular interest in developing new ways to provide care that improve the lives of those accessing care in the community.
Ms Julie Kelly
Clinical Psychologist, Phd Candidate
Swinburne University Of Technology

Mental health care preferences of in-home aged care recipients and their experiences of accessing mental health services

Abstract

High prevalence rates of depression and anxiety have been found in older Australians receiving aged care services within their own homes. Psychological treatments are effective for this population; however, mental health services are underutilised. Little is known about the mental health care preferences of in-home aged care recipients and the specific types of barriers and facilitators they experience when seeking mental health support.
To understand these lived experiences and perspectives, an exploratory qualitative study was conducted with individuals experiencing depressive and/or anxiety symptoms, who were receiving in-home aged care services from a single national aged care provider. Twenty-nine semi-structured telephone interview transcripts were analysed using thematic analysis. Four themes were identified that highlighted 1) older adults’ varied mental health self-appraisals and approaches to wellbeing, 2) older adults’ wide-ranging experiences and perspectives related to accessing mental health care, 3) older adults value flexibility within available supports and 4) key barriers and facilitators to accessing mental health supports were related to older adults’ attitudes and awareness of available supports, and the supports’ accessibility.
Understanding such mental health experiences and care preferences will enable aged care and mental health care providers to be in a stronger position to support in-home aged care recipients’ engagement with mental health services, enhance access to care and improve the psychological wellbeing of older Australians. Moreover, it will support providers in meeting new requirements of the strengthened aged care quality standards.

Biography

Julie Kelly is a senior clinical psychologist who is recognised for her expertise and experience working with older adults. Julie has significant experience working in residential aged care including the supervision of post graduate psychology students and is currently completing her PhD at Swinburne University of Technology where she is focusing on evidenced-based care for older Australians accessing in-home aged care. This research is being supported and funded by Silverchain, a leading national aged care provider. She has worked for over 15 years as a clinician in community and acute inpatient and outpatient settings. Julie was the senior clinician in a major NHMRC funded research program called PEARL, which addressed the adjustment issues faced by older adults when transitioning into residential care. She has also been part of a broader team supporting intergenerational programs between older adults and high school students.
Prof Tanya Davison
Director, Research Discovery
Silverchain

Embedding psychological treatments for depression into in-home aged care: A pilot study

Abstract

Depression is common among older people who receive aged care at home, but symptoms are often undetected, and this group has poor access to psychological treatments. Fresh approaches are required to facilitate detection and access to psychological treatments for this high-risk group of older Australians.

We designed a new model of care for the Australian in-home aged care setting: Enhancing the Management of home-Based Elders with Depression (EMBED). EMBED includes training in late-life depression for aged care workforce, routine screening, and individually tailored psychological depression treatments for clients, delivered by mental health clinicians via telehealth and an optional digital client platform.

A pilot study of the EMBED psychological treatment program was conducted to determine the acceptability and feasibility of the treatment program, which was implemented within an in-home aged care service in metropolitan and regional Victoria. Older people with mild symptoms of depression received an assessment, a set of lifestyle modification resources and two telehealth sessions with a clinician. Individuals with moderate levels of depression received the same program, plus an additional four telehealth sessions focused on behavioural activation. Several participants opted to engage in treatments via the digital platform.

Semi-structured post-treatment interviews conducted with participants indicated high satisfaction with treatments; however, overall uptake in the program was lower than anticipated. The results are discussed, including recommendations on how to engage this population in psychological therapy, and the potential benefits of embedding brief psychological therapies into the in-home aged care setting.

Biography

Tanya Davison is Director of Research Discovery at Silverchain, a national provider of in-home health and aged care services, and also holds adjunct professorial appointments at several universities. With a background in Clinical Psychology, Tanya has a longstanding interest in the mental health of older people and has dedicated much of her career to improving the care provided within aged care settings. She has received over $10 Million in grant funding to support her research and published over 120 academic papers. She is leading a program of research to develop, implement and evaluate innovative models of care for the community aged care sector, to address the growing rates of depression in older people receiving aged care at home.
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Dr Hilary Davis
Senior Researcher
Swinburne University of Technology

Implementing digital technology via in-person training to address mental ill-health in home-based aged care.

Abstract

There is a growing body of research that explores the role of technology in supporting the wellbeing of older adults in their own homes. However, little examines how technology might be leveraged to support older adults with mental ill-health, such as mild depression or anxiety. While there has been an enormous growth in digital mental health programs, these are typically designed for younger people. Australia faces critical shortages in the aged care and mental health workforce. Digital technologies offer potential to bridge the gap between older adults and clinicians, mediating evidence-based information delivery in their home environment. We report on the e-EMBED pilot research study that deploys and tests an innovative digitally enabled intervention including video conferencing, evidence-based health information delivery, and social support in the homes of older adults. This presentation outlines how we supported or ‘embedded’ tablet technology for service delivery in older adults’ homes. This included designing and delivering training for researchers visiting participants homes, and training older adults to use and manage technology. Key opportunities such as older adults’ willingness and enthusiasm to learn, and the benefits of face-based support are identified. Technological challenges include unfamiliar tablets, mandatory software updates impacting delivery, and limited responsiveness to visual and cognitive impairments. We reflect on the emotional connections forged between researchers and participants, and how these were managed in the research context. Ultimately, we recognise both the emotional labour required to embed technology support in participants homes, and the richness of social connections between researchers and older adults.

Biography

Dr. Hilary Davis is Senior Research Fellow, at Swinburne University of Technology and stream leader for Place-based economies and approaches. A social scientist with an HCI (Human-Computer Interaction) background, she has a specific interest in the role of technologies in solving wicked social problems. Hilary has a significant track-record of research on the social aspects of digital health to improve health experiences and health services, and skills in developing digital health interventions. She has a strong focus on research for social impact, particularly for people from diverse backgrounds. Hilary Davis co-edited a special issue on Digital Participation for Marginalised and Diverse Communities in the Journal of Community Informatics. Hilary has a significant interest in mental ill-health research. She is a member of the e-EMBED team, seeking to enhance the management of ill-health in home-based elders with depression. She has evaluated Community Mental Health Australia's ACDC - Assisting Communities with Direct Connection, door-knocking program, which seeks to support community members access mental health services in 22 communities, nationwide. She co-led the COVID-19 HRAR Evaluation and Program Development, with Connect Health, Star Health, Peninsula Health, Merri Health and Bendigo Community Health Services. She has led mental health evaluations seeking to provide rural preventive mental health services. These include the Rural Outreach Workers (ROW) project funded by a Primary Care Partnership, and HALT (Help and Assistance Local Tradies) funded by Department of Health. She co-led an ARC discovery project ‘Optimising the roles of online communities in rural resilience’. With colleagues, she has used digital story-making for connecting older people with their communities (60+ Online project), and as a mechanism for addressing elder abuse within diverse community groups (The Free from Violence Research Project). Hilary conducts research with diverse stakeholders including older adults, community members, community leaders and CEOs of health service organisations.
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