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More insight into the concept of apathy: a multidisciplinary depression management program has different effects on depressive symptoms and apathy in nursing homes

Published online by Cambridge University Press:  02 September 2013

Ruslan Leontjevas ,
Steven Teerenstra ,
Martin Smalbrugge ,
Myrra J.F.J. Vernooij-Dassen ,
Ernst T. Bohlmeijer ,
Debby L. Gerritsen  and
Raymond T.C.M. Koopmans
Ruslan Leontjevas*
Affiliation:
School of Psychology, Open University of the Netherlands, Heerlen, the Netherlands Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Radboud Alzheimer Centre, Nijmegen, the Netherlands
Steven Teerenstra
Affiliation:
Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
Martin Smalbrugge
Affiliation:
Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
Myrra J.F.J. Vernooij-Dassen
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Radboud Alzheimer Centre, Nijmegen, the Netherlands Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Kalorama Foundation, Beek-Ubbergen, the Netherlands
Ernst T. Bohlmeijer
Affiliation:
Department of Mental Health Promotion, University of Twente, Enschede, the Netherlands
Debby L. Gerritsen
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Radboud Alzheimer Centre, Nijmegen, the Netherlands
Raymond T.C.M. Koopmans
Affiliation:
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands Radboud Alzheimer Centre, Nijmegen, the Netherlands
*
Correspondence should be addressed to: Ruslan Leontjevas, School of Psychology, Open University of the Netherlands, P.O. Box 2960, 6401 DL Heerlen, the Netherlands. Phone: +31-45-576-2100. Email: roeslan.leontjevas@ou.nl.
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Abstract

Background:

Apathy is common in nursing home (NH) residents and it overlaps with depression. This study examines the effects of a multidisciplinary depression program on apathy and depressive motivational and mood symptoms.

Methods:

Secondary analyses of a stepped-wedge cluster-randomized controlled trial were conducted with six measurements. Sixteen dementia NH units and 17 somatic units were enrolled. In the intervention condition, a program containing depression assessment procedures and multidisciplinary treatment (activating strategies, psychotherapy, and medication) was introduced. Usual care was provided in the control condition. Outcomes were assessed using the 10-item Apathy Evaluation Scale and the Cornell Scale for Depression in Dementia.

Results:

Intention-to-treat analyses showed that the whole depression management program reduced apathy in dementia units (p < 0.001; Cohen's d, −0.35), and depressive motivational symptoms in somatic units (p = 0.008; Cohen's d, −0.40). Depressive mood symptoms were not affected in both unit types. The effect on apathy in dementia units was mainly attributed to activating strategies (p < 0.001; Cohen's d, −0.73). The effect on motivational symptoms in somatic units was mainly attributed to psychotherapy (p = 0.002; Cohen's d, −0.80). Apathy worsening was associated with pharmacological depression treatment in both unit types (p = 0.009; Cohen's d, 0.35).

Conclusions:

Depression management may affect apathy and depressive symptoms differently, which underpins the position of apathy as a distinct syndrome. NH professionals can effectively use activating strategies in dementia units, and psychotherapy in somatic units. More research is needed on treating depressive mood symptoms, and on effects of antidepressants in NHs.

Keywords

collaborative treatmentintervention studylong-term carepsychosocial interventionsdementia
Type
2013 IPA Junior Research Awards – Third Prize Winner
Information
International Psychogeriatrics , Volume 25 , Issue 12 , December 2013 , pp. 1941 - 1952
Copyright
Copyright © International Psychogeriatric Association 2013 

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