Transcript UNIVERSITY OF ULSTER

Title of Study
Mental Health and Quality of Life
Among Care Home Residents: A
Comparison Study.
Research Team: Dr Assumpta Ryan & Marie O’Neill
(School of Nursing and Institute of Nursing and Health Research),
Professor Brendan Bunting, Dr Siobhan O’Neill, Dr Sam Murphy
and Dr Finola Ferry (School of Psychology).
Background
 18,000 care homes across the UK supporting 400,000 older
people (Joseph Rowntree Foundation, 2012). In NI 12,000
people reside in care homes (DHSSPS, 2012)
 Care home residents with mental health needs –a
vulnerable group.
 An ageing population but limited knowledge about the
mental health of older people
 Need for information, treatment and support (National
Services Framework, 2001; Bamford Review of Mental
Health (2007).
Background
 Prevalence estimates vary but in UK depression affects between 3040% of older people in care homes (Mozley et al., 2004;Heath 2006)
and is associated with disability and dependence (Boyle,2005;Thesis et
al,2007).
 Epidemiological studies of mental health have largely ignored the
growing number of older people in care homes…? unmet need.
 Northern Ireland Study of Health and Stress (NISHS)- NI arm of the .
WMH Survey Initiative (2011).
 Care home residents excluded from NISHS and all WHO studies……a
missed opportunity and the impetus for the present.
Aim
The overall aim of this study was to determine
mental health and quality of life among care
home residents and to compare this
information with matched individuals in the
community using the NISHS dataset.
Objectives
1. To determine the prevalence and the social and
demographic correlates of mental health problems among
care home residents;
2. To examine medication prescription for mental health
problems in care homes;
3. To determine the quality of life of care home residents;
4. To compare the results of this study with matched
individuals in the community using the NISHS data set
which contains data on 864 individuals aged 65 years
and over.
Methodology
Data collected using structured interviews with 75 care home residents
between Jan 2011-Jan 2012
Abridged version of the World Mental Health-Composite International
Diagnostic Interview (WMH-CIDI) was the primary research
instrument.(Kessler & Ustun, 2004)
The interview generates psychiatric diagnoses according to the definitions and
criteria of both the International Classification of Diseases (10th ED ICD-10)
(WHO, 1992) and the Diagnostic and Statistical Manual of Mental Disorders
Fourth Edition (DSM-IV) (American Psychiatric Association, 1994).
SF 12 Health Survey…..results are expressed in terms of two meta-scores:
the Physical Component Summary (PCS) and the Mental Component
Summary (MCS).
SF-6D A measure of perceived health (health-related quality of life (QoL)
which assesses six dimensions of health : physical functioning, role limitations,
social functioning, pain, mental health and vitality
Ethics and Recruitment
 Ethical approval (University of Ulster Filter
Committee and ORECNI).
 20 care homes randomly selected from a list of
homes (n=62) held by the Regulation and Quality
Improvement Authority (RQIA).
 Random selection of residents who met the
selection criteria within each home
Selection Criteria
 Over 65 years of age;
 Minimal cognitive impairment as defined by the
Mini Mental State Examination (Folstein et al.,
1975)
 Physically able and willing to consent and
participate
 Initial interviews- checked for rigor
Data Management & Analysis
Statistical algorithms, developed in Harvard for use
in all WMH surveys, were applied to the final
dataset in order to generate a series of DSM-IV
dichotomous diagnostic variables for selected
mental health disorders (APA 1994).
 Twelve month and lifetime prevalence rates of
DSM-IV disorders
 Statistical comparisons of SF-12
 SF-6D: Comparison of care home and general
population sample
Results: Demographic Information
Population
NISHS
Care Homes
Total
N
Mean
Age
Std.
Std. Error
Deviation
Mean
Male
Female
Total
852
73.41
6.334
.217
394
458
852
75
81.15
8.287
.957
17
58
75
411
516
927
Reasons for Admission to Care Home:
Mean length of Stay 3.9 years
Deterioration in physical health and well-being
(n=42: 56%)
Isolation, “no-one to take care of me”
(n=21: 28%)
Transferred from residential/Sheltered
accommodation
(n=5: 7%)
Estranged from family/abused by family
member
(n=4: 5%)
Transferred directly from hospital
(n=3: 4%).
Lifetime Prevalence of DSM-IV
Disorders
DSM –IV
DISORDERS
NISHS Study
22.2%
Care Home Sample
12%
Major Depressive
Disorder
8.1%
2.6%
Lifetime
Panic Disorder
2.8%
2.6%
PTSD
6.0%
1.3%
Lifetime Specific Phobia 5.6%
2.6%
Statistical Comparisons of
SF-12
Population
mcs_tot
pcs_tot
54.02
43.83
N
852
852
Std. Deviation
8.62
12.34
Mean
61.6
35.12
75
75
Std. Deviation
6.91
10.47
Mean
54.63
43.13
N
927
927
Std. Deviation
8.74
12.42
Mean
NISHS
Care
Home Sample
Total
N
SF-6D: Comparison of Care Home
and General Population sample
Average Mean Scores
NISHS Sample over 65 Care
N=852
Home N=75
Physical Functioning
1.58
2.49*
Role Limitations
1.64
1.84
Social Functioning
1.73*
1.28
Bodily pain Scores
2.18*
1.73
Mental Health
1.84*
1.51
Vitality
2.74
2.84
Quality of Life
0.78
0.74
* Significant
difference
Medication Profile of NISHS sample
and Care Home sample
Category
NISHS sample (aged
Care home sample %
over 65) %
Sleeping pills or other
8.24
41.33
Antidepressants
5.75
37.33
Anti-psychotics
0.24
8.0
Tranquilizers
3.07
0
Amphetamines
0.16
0
sedatives
Points to Consider
 Limitations of study-Generalisation of findings
 Methodological variances in prevalence of DSM-IV disorders
 Somatic symptoms V’s perception of depression
 Medication management- 37% prescribed antidepressants
 Social and contextual issues
Points to Consider
 QoL- Empowerment Care (Kranz, 2011;Tu et al 2006)
 Resilience and the elderly population?
 Challenges view that healthcare needs of older care home
residents are being neglected?
 Quality of life in care environments and social networks
 ‘Home is where the heart is’?
Future Plans:
 Examination of the efficacy of the Composite International
Diagnostic Interview in the older population
 Further analysis of medication utilisation for physical and
mental health disorders
 To report and publish findings in scientific journal
 Proposal for PhD study will be undertaken to explore the
attitudes/perceptions of residents in care home
environments to determine their quality of life and it’s impact
on mental health .