Behavioural activation by mental health nurses for late-life depression in primary care: a randomized controlled trial

Background: Depressive symptoms are common in older adults. The effectiveness of pharmacological treatments and the availability of psychological treatments in primary care are limited. A behavioural approach to depression treatment might be beneficial to many older adults but such care is still largely unavailable. Behavioural Activation (BA) protocols are less complicated and more easy to train than other psychological therapies, making them very suitable for delivery by less specialised therapists. The recent introduction of the mental health nurse in primary care centres in the Netherlands has created major opportunities for improving the accessibility of psychological treatments for late-life depression in primary care. BA may thus address the needs of older patients while improving treatment outcome and lowering costs.The primary objective of this study is to compare the effectiveness and cost-effectiveness of BA in comparison with treatment as usual (TAU) for late-life depression in Dutch primary care. A secondary goal is to explore several potential mechanisms of change, as well as predictors and moderators of treatment outcome of BA for late-life depression. Methods/design: Cluster-randomised controlled multicentre trial with two parallel groups: a) behavioural activation, and b) treatment as usual, conducted in primary care centres with a follow-up of 52 weeks. The main inclusion criterion is a PHQ-9 score > 9. Patients are excluded from the trial in case of severe mental illness that requires specialized treatment, high suicide risk, drug and/or alcohol abuse, prior psychotherapy, change in dosage or type of prescribed antidepressants in the previous 12 weeks, or moderate to severe cognitive impairment. The intervention consists of 8 weekly 30-min BA sessions delivered by a trained mental health nurse. Discussion: We expect BA to be an effective and cost-effective treatment for late-life depression compared to TAU. BA delivered by mental health nurses could increase the availability and accessibility of non-pharmacological treatments for late-life depression in primary care. Trial registration: This study is retrospectively registered in the Dutch Clinical Trial Register NTR6013on August 25th 2016. © 2017 The Author(s)

Finding Courage: A Case of an Older Adult with Cognitive Impairment due to a Medical Condition

Corticobasal syndrome (CBS) is a progressive complex neurological disorder which affects motor and cognitive functions. Its clinical features include poor coordination and balance, akinetic rigidity, limb apraxia, myoclonus, cognitive impairment, and speech and language impairment. The onset of symptoms usually begins between the ages of 50–70 with the mean onset at 60. The disease duration has been found to be 6–7 years. Given a lack of validated and agreed diagnostic criteria and biological markers, it is difficult to make a CBS diagnosis. The chapter describes a case of an older adult client with CBS

Create social responses to a changing environment

Communities across the globe, including the United States, face unprecedented environmental challenges influenced by factors such as climate change and an increasing global population. This chapter will focus specifically on natural disasters. While natural disasters have always existed, the current uptick in the frequency of disaster events, growing evidence that disasters negatively affect older adults disproportionally, and larger number of older adults comprising the world’s population than any other age group make it necessary to consider the specific impacts disasters have on the older adult population. Older adults have unique needs during disasters due to vulnerabilities common in late life, as well as social isolation. This chapter details the needs of older adults across the disaster event phases: pre-disaster mitigation and preparedness, during and post-disaster response, and long-term disaster recovery. The chapter concludes with future steps for social work research, policy, and practice