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      Characteristics of Cognitive Behavioral Therapy for Older Adults Living in Residential Care: Protocol for a Systematic Review

      1 , , , BA (Hons), MA (Clin Psych), PhD 1 , , BSc (Hons), DPsych (Clin) 2 , , BA (Hons), PhD 3 , , PhD 4 , , BSc (Psych) (Hons), MClinPsych, PhD 5 , , MA (Hons), MPhil (Clin Psych), PhD 6 , , BA (Psych), MA (Psych), PhD (Clin Psych) 7 , , PhD 8 , , BPsych (Hons), MPsych (Clin), PhD 9
      (Reviewer), (Reviewer), (Reviewer)
      JMIR Research Protocols
      JMIR Publications
      cognitive behavioural therapy, older adults, residential care, delivery, characteristics, systematic review

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          The prevalence rates of depressive and anxiety disorders are high in residential aged care settings. Older adults in such settings might be prone to these disorders because of losses associated with transitioning to residential care, uncertainty about the future, as well as a decline in personal autonomy, health, and cognition. Cognitive behavioral therapy (CBT) is efficacious in treating late-life depression and anxiety. However, there remains a dearth of studies examining CBT in residential settings compared with community settings. Typically, older adults living in residential settings have higher care needs than those living in the community. To date, no systematic reviews have been conducted on the content and the delivery characteristics of CBT for older adults living in residential aged care settings.


          The objective of this paper is to describe the systematic review protocol on the characteristics of CBT for depression and/or anxiety for older adults living in residential aged care settings.


          This protocol was developed in compliance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Studies that fulfill the inclusion criteria will be identified by systematically searching relevant electronic databases, reference lists, and citation indexes. In addition, the PRISMA flowchart will be used to record the selection process. A pilot-tested data collection form will be used to extract and record data from the included studies. Two reviewers will be involved in screening the titles and abstracts of retrieved records, screening the full text of potentially relevant reports, and extracting data. Then, the delivery and content characteristics of different CBT programs of the included studies, where available, will be summarized in a table. Furthermore, the Downs and Black checklist will be used to assess the methodological quality of the included studies.


          Systematic searches will commence in May 2018, and data extraction is expected to commence in July 2018. Data analyses and writing will happen in October 2018.


          In this section, the limitations of the systematic review will be outlined. Clinical implications for treating late-life depression and/or anxiety, and implications for residential care facilities will be discussed.

          Trial Registration

          PROSPERO 42017080113; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=80113 (Archived by WebCite at http://www.webcitation.org/70dV4Qf54)

          Registered Report Identifier


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          Most cited references17

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          Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review.

          The population of older adults in long-term care (LTC) is expected to increase considerably in the near future. An understanding of the prevalence of psychiatric disorders in LTC will help in planning mental health services for this population. This study reviews the prevalence of common psychiatric disorders in LTC populations. We searched electronic databases for studies on the prevalence of major psychiatric disorders in LTC using medical subject headings and key words. We only included studies using validated measures for diagnosing psychiatric disorders or psychiatric symptoms. Our review focused on the following psychiatric disorders: dementia, behavioral and psychological symptoms of dementia (BPSD), major depression, depressive symptoms, bipolar disorder, anxiety disorders, schizophrenia, and alcohol use disorders. We also determined the prevalence of psychiatric disorders in the U.S. LTC population using data from the 2004 National Nursing Home Survey (NNHS). A total of 74 studies examining the prevalence of psychiatric disorders and psychological symptoms in LTC populations were identified including 30 studies on the prevalence of dementia, 9 studies on behavioral symptoms in dementia, and 26 studies on depression. Most studies involved few LTC facilities and were conducted in developed countries. Dementia had a median prevalence (58%) in studies while the prevalence of BPSD was 78% among individuals with dementia. The median prevalence of major depressive disorder was 10% while the median prevalence of depressive symptoms was 29% among LTC residents. There were few studies on other psychiatric disorders. Results from the 2004 NNHS were consistent with those in the published literature. Dementia, depression and anxiety disorders are the most common psychiatric disorders among older adults in LTC. Many psychiatric disorders appear to be more prevalent in LTC settings when compared to those observed in community-dwelling older adults. Policy-makers and clinicians should be aware of the common psychiatric disorders in LTC and further research into effective prevention and treatments are required for this growing population.
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            Prevalence and risk indicators of depression in elderly nursing home patients: the AGED study.

            Depression is a common and disabling psychiatric disorder in later life. Particular frail nursing home patients seem to be at increased risk. Nursing home-based studies on risk indicators of depression are scarce. Prevalence and risk indicators of depression were assessed in 333 nursing home patients living on somatic wards of 14 nursing homes in the North West of the Netherlands. Depressive symptoms were measured by means of the Geriatric Depression Scale (GDS). Major and minor depression were diagnosed according to the DSM-IV criteria, sub-clinical depression was defined as a GDS score >10 while not meeting the DSM-V criteria for depression. The prevalence of major depression was assessed to be 8.1% and the prevalence of minor depression was 14.1%, while a further 24% of the patients suffered from sub-clinical depression. For major depression significant risk indicators were found for pain, functional limitations, visual impairment, stroke, loneliness, lack of social support, negative life events and perceived inadequacy of care. For sub-clinical depression the same risk indicators were found, with the exception of lack of social support. Data were collected cross-sectional. The prevalence of depression in the nursing home population is very high. Whichever way defined, the prevalence rates found were three to four times higher than in the community-dwelling elderly. Age, pain, visual impairment, stroke, functional limitations, negative life events, loneliness, lack of social support and perceived inadequacy of care were found to be risk indicators for depression. Consequently, optimal physical treatment and special attention and focus on psychosocial factors must be major goals in developing care programs for this frail population.
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              Moving in: adjustment of people living with dementia going into a nursing home and their families.

              Most people with dementia in Western societies will eventually be placed in a nursing home. This can be stressful to those with dementia and to their families. The adjustment to this new caring environment by both residents and their family caregivers and the factors that influence this are the focus of this review.

                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                July 2018
                04 July 2018
                : 7
                : 7
                : e164
                [01] 1 Department of Psychological Sciences Swinburne University of Technology Melbourne Australia
                [02] 2 School of Health Sciences Swinburne University of Technology Melbourne Australia
                [03] 3 Faculty of Health Sciences Australian Catholic University Melbourne Australia
                [04] 4 School of Psychology and Counselling University of Southern Queensland Toowoomba Australia
                [05] 5 Royal Prince Alfred Hospital Sydney Australia
                [06] 6 Department of Clinical Psychology Norwich Medical School University of East Anglia Norwich United Kingdom
                [07] 7 School of Psychology The University of Queensland Brisbane Australia
                [08] 8 Lincoln Centre for Research on Ageing (Australian Institute for Primary Care and Ageing) La Trobe University Bundoora Australia
                [09] 9 Centre for Emotional Health Department of Psychology Macquarie University Sydney Australia
                Author notes
                Corresponding Author: Phoebe Chan phoebechan@ 123456swin.edu.au
                Author information
                ©Phoebe Chan, Sunil Bhar, Tanya E. Davison, Colleen Doyle, Bob G. Knight, Deborah Koder, Kenneth Laidlaw, Nancy A. Pachana, Yvonne Wells, Viviana M. Wuthrich. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 04.07.2018.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org.as well as this copyright and license information must be included.

                : 21 January 2018
                : 29 March 2018
                : 30 April 2018
                : 8 May 2018

                cognitive behavioural therapy,older adults,residential care,delivery,characteristics,systematic review


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