Morning Session 5 Powerpoint (eng) · 2017. 10. 3. · Microsoft PowerPoint - Morning Session 5 Powerpoint (eng) Author: johnma Created Date: 10/3/2017 11:37:05 AM

2017/10/3

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香港大學The University of Hong Kong

秀圃老年研究中心Sau Po Centre on Ageing

Session 5Enhance Mental Health of the Elderly:

The Effectiveness of Instrumental Reminiscence Intervention (IRI)

用功能性缅怀治疗提升老年人的精神健康

Vivian Lou

Director, Sau Po Centre on Ageing

HKCFP 40th Anniversary ConferenceFrom Seedling to Forest – Ever Enriching Primary Care2-3 September 2017



The city is ageing…

8.7%10.2%11.2%

12.4%13.2%14.7%

17.0%

21.0%

25.0%27.0%28.0%

1991 1996 2001 2006 2011 2014 2019 2024 2029 2034 2039

Proportion of elders in Hong Kong 1991-2039

(Census and Statistics Department, 2007; 2010; 2012; 2015)



Empty-nested Older adults (living alone or with spouse only) （純老戶）

482 040

629 555747 052

852 796941 312

1 027 20027.4% 27.6%29.8%

32.8%36.2%

0%

5%

10%

15%

20%

25%

30%

35%

40%

0

200 000

400 000

600 000

800 000

1 000 000

1 200 000

1 400 000

1991 1996 2001 2006 2011 2013

⾧者人口獨居或兩老同住佔⾧者人口比率

(Census and Statistics Department, 2002; 2008; 2013)



Living Alone & Its Impacts

Suicidal ideation / Suicide

Depressive

symptoms /

Depression

Loneliness

(Chou & Chi, 2005; Yip et al., 2003)



Loneliness and depression

• Prevalence of depressive symptoms in HK– 10-15%; ≥60 y.o. community dwelling elders; GDS cutoff ≥8 (Chi

et al., 2005)• Risk factors for depressive symptoms

– Poor self-rated health– Functional impairment– Visual limitation– Pain– Lack of social support– Perceived inadequacy of care– Stressful/negative life event– Financial strain– Higher level of self-reported loneliness

(Chi et al., 2005; H.-C. Chiu, Chen, Huang, & Mau, 2005; Chou & Chi, 2000; Chou & Chi, 2005; Chou, Chi, & Chow, 2004; Jongenelis et al., 2004)



Objectives

Examine the profile of living alone older adults in regard with their depressive symptoms

Evaluate the effectiveness of a reminiscence intervention for those with mild to moderate levels of depressive symptoms

Propose a 3-tier intervention model to enhance well-being of community-dwelling older adults

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What to Do? Effectiveness of Reminiscence intervention for

treating depression

(Pinquart et al. 2007)



Functions of Reminiscence

Use of reminiscence Relationship with psychological well-being

Identity (i.e. Integrative)

+ Self-positiveDeath Preparation

Problem Solving (i.e. Instrumental)

Teach/ InformO Pro-social

Conversation

Boredom Reduction

- Self-negativeBitterness Revival

Intimacy Maintenance

(Cappeliez & O'Rourke, 2006)



Types of Reminiscence Intervention

• Integrative– Life review that integrates life events and

crystalise the sense of who we are

• Instrumental– recollections of one’s planning and coping

behaviours

• Transmissive– Teach/inform younger generations about

one’s cultural heritage or personal legacy香港大學The University of Hong Kong


Instrumental Reminiscence Intervention (IRI)

• Developed by Prof. Philippe Cappeliez

• Why IRI?

1. Reminiscence intervention developed with a CBT framework

2. Pragmatic approach– Problem-solving focused

– Coping with reality

Theoretical framework –Appraisal and Coping



IRI-HK – A Cultural Adaptation• Size

– 6-8 participants

• Interventionist– Social worker + observer

• Structure – 6 sessions (+ 2 follow-up

sessions)

• Duration– 90 minutes

Session 1 Session 2 - 6

Introduction

Review of Homework

Introducing the concept of

IRI

Contractingand

preparation

Relaxation exercise

Theme discussion (e.g.Branching points)

Feedback from participants

Discussion of homework

Question and feedback

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Cultural Sensitive Theme Building

節數主題

第一節人生轉捩點

第二節家庭生活

第三節事業或工作

第四節喜愛或討厭的人或事

第五節艱難的經歷

第六節人生的意義及目標



Homework Design for Low Literacy Older Population

• Homework assignment – Verbal and simple

• The use of tactic cards



Procedures

Target• Aged 60 or above• Living alone or with spouse only• Aged 60 or above• Living alone or with spouse only

Invitation• Contacted 1,387 eligible elders by phone• Via a District Elderly Community Centre in Wong Tai Sin• Contacted 1,387 eligible elders by phone• Via a District Elderly Community Centre in Wong Tai Sin

Screening• Interviewed 572 participants individually• Interviewed 572 participants individually

Grouping• Categorized them into 3 groups according to their GDS-15

(Geriatric Depression Scale) score• Categorized them into 3 groups according to their GDS-15

(Geriatric Depression Scale) score

Intervention• Targeted intervention / measures for different groups • Targeted intervention / measures for different groups



Outcome Evaluation

• Pilot (2 groups)

• RCT– Wait-list control

– Single blind (i.e. participants)



Select The Right Place!

慈樂邨

慈正邨

慈愛苑

慈民邨

鳳德邨

龍蟠苑

沙田坳邨

慈安苑

鳳禮苑私樓

富山邨

東頭村

橫頭磡



Select The Right Participants!

• Inclusion criteria1. aged 60 or older; 2. living alone or with a spouse only, in the community3. mild to moderate level of depressive symptoms as indicated by a score of 8-13 on

the GDS-15 Chinese version

• Exclusion criteria1. elevated risk of suicide2. substance abuse3. any psychiatric disorder other than primary depression4. cognitive impairment, as indicated by a score lower than 24 (for individuals with

middle school or higher education), 21 (elementary education) or 18 (no schooling), respectively, on the Mini-Mental State Examination (MMSE) Chinese version

5. physical impairment that would have seriously hindered the individual from joining the group program; or

6. currently participating in any other psychological and/or long-term care intervention7. currently taking antidepressant medication

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Participants CharacteristicsFrequency Percentage (%)

GenderMale 211 36.9%Female 361 63.1%

Age (mean = 78.5 years old)60-69 39 6.8%70-79 294 51.4%80-89 217 37.9%90 or above 22 3.8%

EducationNo schooling 269 47.0%Primary 235 41.1%Secondary or higher 68 11.9%

Marital statusNever married 72 12.6%Married and living with spouse 204 35.7%Widowed, separated or divorced 296 51.7%



Outcome Measures

• Depressive symptoms– The Chinese version of Geriatric Depression

Scale – short form (GDS-15)

– 15 items

• Demographics– Age, sex, marital status and education level



Prevalence of Depressive Symptoms

– GDS-15 as a tool to differentiate the elders into 3 groups

• Approximately 20% when GDS cutoff ≥ 8

Group Frequency Percentage (%)

GDS score

0 - 7 No sign of depressive symptoms 456 79.7%

8 - 13 Mild to moderate levels 103 18.0%

14 - 15 Severe levels 13 2.3%

Prevalence of depressive symptoms among older adults living alone

(Chi et al., 2005)



High-Risk Population

Prevalence of depressive symptoms among community dwelling empty-nested older adults

– 22%, > 10-15% found in a previous study using the same cut-off of GDS-15 (Chi et al., 2005)

– Wong Tai Sin and Sham Shui Po only



Effects on Depressive Symptoms

ANCOVA (after controlling for the effect of the covariates):

– Post-test: F(1,77) = 34.77, p < .001.

– 1st follow-up: F(1,67) = 5.93, p < .05.

– 2nd follow-up: F(1,68) = 3.78, p = .06



Percentage Change

• Mann-Whitney U test• Post-test:

U = 481.0, p < .001.

• 1st follow-up: U = 505.5, p = .12

• 2nd follow-up: U = 568.5, p = .44

Deterioration No change Improvement

Time of assessment

Post-test

Experimental (n=39) 0.0% 33.3% 66.7%

Control (n=42) 2.4% 71.4% 26.2%1st follow-up test

Experimental (n=40) 0.0% 52.5% 47.5%

Control (n=31) 0.0% 71.0% 29.0%2nd follow-up test

Experimental (n=39) 2.6% 50.0% 47.4%

Control (n=33) 0.0% 63.6% 36.4%

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IRI – Evidence-based

1. Effective in reducing depressive symptoms among community-dwelling older adults with moderate level of depressive symptoms

2. Successful factors– Pre-group interview and rapport building

– Individual follow-up for absent participants

– Homework assignments and tactic cards香港大學The University of Hong Kong


The three-tier intervention model

• Severely depressed• Individual treatment

Tier 3GDS 14-15

• Mild to moderately depressed• Instrumental Reminiscence

Intervention (IRI)

Tier 2GDS 8-13

• No signs of depressed symptoms• Preventive services

Tier 1GDS 0-7



1st tier: Preventive services

– E.g. Health talks and mental health campaigns

– Accommodate the needs of about 80% of elders living alone

– Prevention is the best way to improve the mental health of older adults



2nd tier: Instrumental Reminiscence Intervention (IRI)

– Recollection of past coping strategies

– Increase their resilience to cope with stress and adversity in daily lives

– Increase self-esteem and self-efficacy reduce depressive symptoms

(Watt & Cappeliez, 2000)



3rd tier: Individual treatment

– Immediate risk management by a multidisciplinary team consisting of a clinical psychologist, a social worker and a nurse

– Prompt and effective approach to alleviate severe depressive symptoms as well as suicide ideation



Current Service for Living Alone Older Adults

STE (Support team for the

elderly)

Vulnerable elders aged 60 or above Attached to

DECC since 1998

Social Networking

Outreaching Services

Senior Volunteerism

(Social welfare Department, 2007)

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Limitation

1. Attrition rate– Control group (51.5%)

– vs Experimental group (15.2%)

2. Therapeutic effects of individual contacts

3. Assessment for exclusion criteria– Suicide risk

– Use of antidepressant, substance abuse, and other psychiatric disorders



Dissemination

• Press conference

• Report and manual



Conclusion

Population aging calls for constructive and effective social responses

Evidence-based practice (EBP) can guide service planning and development

IRI-HK is a culturally sensitive EBP practice for recommendation

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Q & A

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Documents

Morning Session 5 Powerpoint (eng) · 2017. 10. 3. · Microsoft PowerPoint - Morning Session 5 Powerpoint (eng) Author: johnma Created Date: 10/3/2017 11:37:05 AM