Investigation On The Depression Symptoms Of The Elderly In The Aged Care Institutions And The Preliminary Intervention Study

Our society has entered a stage of rapid development of population aging.Due to the continuous weakening of family care,more and more elderly people will enter institutions for care.Studies have shown(Simning&Simons,2017)that the proportion of elderly people in nursing homes with varying degrees of depression is 15% to 52%.Depression is a common functional mental disorder in the elderly.It is easy to be considered as "normal aging" and ignored,causing delays in treatment,causing suffering to patients,and increasing the burden of family and social care and economic burden.Depressive symptoms are the precursor state of depression.Effective prevention,early recognition and intervention of the occurrence of depression symptoms can help reduce the occurrence and development of depression in the elderly and promote the mental health of the elderly.Problem-Solving Therapy(PST)is a psychological intervention based on a social problem-solving model(D’Zurilla & Nezu,1999).A number of randomized trials abroad have shown that PST can reduce depression symptoms in the elderly(Erdley et al.,2014;Kirkham et al.,2016;Kristen et al.,2016).However,domestic PST is rarely used in the intervention research of depressive symptoms.This study investigates the current status of depressive symptoms of the elderly in elderly care institutions,analyzes the influencing factors of depressive symptoms,and uses PST for preliminary intervention,explores the effectiveness of PST intervention on depression symptoms of elderly in elderly care institutions,and provides reference for improving the mental health of the elderly in accordance with.This article contains two studies.Research 1 Investigation and research on the current situation.The convenience sampling method was adopted to conduct a questionnaire survey on elderly people over 65 years old in five elderly care institutions with similar conditions and scale in Xuhui District,Shanghai.A total of 612 elderly people participated in the survey,of which 507 valid questionnaires(effective rate 82.84 %).The survey tools are the simplified Geriatric Depression Scale(GDS-15),Montreal Cognitive Assessment Scale(Mo CA),Daily Living Ability Scale(ADL)and self-developed general information questionnaire.Use SPSS 17.0software to input data and make statistical analysis.The statistical methods used descriptive analysis,chi-square test,independent sample t test,correlation analysis,logistic regression analysis,etc.,and the test level was α=0.05.Main results:(1)The incidence of depressive symptoms(GDS-15≥8 points)in elderly care institutions in Xuhui District,Shanghai was16.77%.Among the 507 survey subjects,85 people had depressive symptoms(GDS-15≥8points)),GDS-15 has an average score of 4.34+3.25.(2)Single factor analysis shows:education level,satisfaction with institution life,self-evaluation of health status,self-evaluation of family support,self-care ability in daily life,physical pain,sleep problems,cognitive function,hobbies and habits,etc.Factors are all related to the occurrence of depressive symptoms in the elderly in elderly care institutions(p<0.05).The difference in the incidence of depressive symptoms among groups of different gender,age,marital status,and occupation before retirement is not statistically significant in this study(p> 0.05).(3)Multivariate logistic regression analysis showed: education level(OR=0.91,95%CI=0.67-1.01),satisfaction with institutional life(OR=2.73,95% CI =1.80-3.96),self-evaluation of health status(OR=2.32,95%CI=1.57-3.98),self-assessment of family support(OR=0.86,95%CI= 0.81-0.94),self-care ability in daily life(OR=1.79,95%CI=1.09-2.68)Physical pain(OR=0.93,95%CI=0.79-1.96),sleep problems(OR=2.47,95%CI=0.92-3.07)are all influential factors in the occurrence of depressive symptoms in the elderly(p<0.05).Study 2 Preliminary intervention study.Among the elderly with depressive symptoms(GDS-15≥8 points)in this current situation investigation,according to the inclusion and exclusion criteria of this intervention study,a simple random sampling method was used to select 70 elderly people for a complete randomized controlled trial.Randomly divided into two groups,35 people in the intervention group and 35 people in the control group.Both groups received general health education,and the intervention group received additional PST intervention,once a week,60 minutes each time,eight consecutive times.GDS-15 and Mo CA were evaluated before the intervention and after the intervention,for comparison and comparison.Data entry and statistical analysis were performed using SPSS 17.0 software.The statistical methods are descriptive analysis,chi-square test,t-test,etc.,and the test level is α=0.05.Main results:(1)After eight weeks of problem-solving treatment,compared with the baseline,the GDS-15 score of the intervention group was significantly lower than that before the intervention,and the difference was statistically significant(p<0.001);the control group was GDS-15 after eight weeks The score was also lower than the baseline score,but the difference was not statistically significant(p>0.05).The results of the comparison between the groups showed that the depression symptoms of the elderly in the intervention group were significantly alleviated compared with the control group,and the difference was statistically significant(p<0.001).(2)After eight weeks of problem-solving treatment,compared with baseline,the total score of Mo CA in the intervention group increased compared with that before the intervention,and the difference was not statistically significant(p>0.05);the total score of Mo CA in the control group was 8 There was a slight decrease after one week,but the difference was not statistically significant(p>0.05).The comparison between groups showed that there was no significant difference in the total score of Mo CA between the intervention group and the control group(p>0.05).The main conclusions of this research are as follows:(1)The level of depressive symptoms of the elderly in elderly care institutions in Xuhui District,Shanghai is at the middle level of similar research results,and early screening and intervention should be carried out in a timely manner.(2)Elderly people in nursing homes with low education level,low satisfaction with institutional life,poor self-evaluation of health status,poor self-evaluation of family support,poor ability of daily living,physical pain,and sleep problems may be more prone to depression symptom.(3)The elderly in nursing homes have poor daily self-care ability and cognitive function;cognitive function and self-care ability in daily life are related to the occurrence of depressive symptoms;the worse the cognitive function,the worse the self-care ability in daily life,and the more serious the depressive symptoms.(4)PST group intervention is effective in improving the depressive symptoms of the elderly in nursing homes.Problem-solving group therapy intervention is simple,economical,effective,practical,and the elderly has a high degree of participation.It is suitable for application and promotion in elderly care institutions after training general practitioners,health care workers,and nursing staff.