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

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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

Developing e-health applications to promote a patient-centered approach to medically unexplained symptoms

Medically unexplained symptoms (MUS) are physical symptoms that cannot be (fully) explained by organic pathology despite adequate diagnostic testing. MUS are highly prevalent and range from single, self-limiting complaints to constellations of chronic and disabling symptoms. Apart from the suffering and impairments MUS impose on patients, they are very costly for society due to the associated productivity losses and burden on healthcare. Anne van Gils’ PhD research aimed to develop e-health applications, offering solutions to three obstacles in the treatment of MUS. Communication problems between patients and healthcare providers are the first obstacle. Since many healthcare providers find it difficult to manage patients with MUS, an online course (‘e-learning’) was developed to improve their knowledge, skills, and attitude. Healthcare providers found this an effective and satisfying way to learn about MUS. The second obstacle are the limited availability of and stigma surrounding psychological treatment. Even though psychotherapy is one of few evidence-based treatments for MUS, only a small proportion of patients benefits from this type of treatment. Online self-help can form a widely available and acceptable alternative. Self-help reduces physical symptoms and improves quality of life. This led to the development of Grip: an online, guided self-help intervention, offered in general practice. Grip also addresses the third obstacle: the large variation in symptom characteristics and etiological factors of MUS. Personalizing the contents of psychological treatments may thus improve their effectiveness. Grip uses algorithms, based on results of online questionnaires and diaries to personalize treatment

Clinical Presentation, Diagnostic Features, and Mortality in Dementia with Lewy Bodies.

BACKGROUND: Dementia with Lewy bodies (DLB) is the second most common degenerative dementia in older people. However, rates of misdiagnosis are high, and little is known of its natural history and outcomes. Very few previous studies have been able to access routine clinical information for large, unbiased DLB cohorts in order to establish initial presentation, neuropsychological profile, and mortality. OBJECTIVE: To examine in detail, symptom patterns at presentation and their association with outcomes, including mortality, in a large naturalistic DLB cohort from a secondary care sample. METHODS: A retrospective cohort design was used to identify a DLB cohort (n = 251) from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT). Information relating to first consultation, diagnosis, and DLB diagnostic features were extracted. RESULTS: A wide range of presenting complaints and differential initial diagnoses were identified for the cohort. Along with memory loss (27.1%) and hallucinations (25.4%), low mood (25.1%) was noted as a key presenting complaint among the DLB cohort. Rates of REM sleep disorder were considerably lower (8.4%) than would be expected. Deficits in non-amnestic cognitive domains were associated with reduced mortality compared with amnestic-only presentations. CONCLUSION: Individuals later diagnosed with DLB present initially to secondary care with a wide range of symptoms and complaints, some of which are not immediately suggestive of a DLB diagnosis. More examinations of large cohorts such as this are needed to further elucidate the complex presentation and clinical course of DLB, and to confirm whether amnestic-only presentation confers a worse outcome.Alzheimer's Society; CPFT; NIHR Cambridge Biomedical Research Centr