Psychological therapies for depression in older adults residing in long-term care settings

Background: Depression is common amongst older people residing in long-term care (LTC) facilities. Currently, most residents treated for depression are prescribed antidepressant medications, despite the potential availability of psychological therapies that are suitable for older people and a preference amongst many older people for non-pharmacological treatment approaches. Objectives: To assess the effect of psychological therapies for depression in older people living in LTC settings, in comparison with treatment as usual, waiting list control, and non-specific attentional control; and to compare the effectiveness of different types of psychological therapies in this setting. Search methods: We searched the Cochrane Common Mental Disorders Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, five other databases, five grey literature sources, and two trial registers. We performed reference checking and citation searching, and contacted study authors to identify additional studies. The latest search was 31 October 2021. Selection criteria: We included randomized controlled trials (RCTs) and cluster-RCTs of any type of psychological therapy for the treatment of depression in adults aged 65 years and over residing in a LTC facility. Data collection and analysis: Two review authors independently screened titles/abstracts and full-text manuscripts for inclusion. Two review authors independently performed data extraction and risk of bias assessments using the Cochrane RoB 1 tool. We contacted study authors for additional information where required. Primary outcomes were level of depressive symptomatology and treatment non-acceptability; secondary outcomes included depression remission, quality of life or psychological well-being, and level of anxious symptomatology. We used Review Manager 5 to conduct meta-analyses, using pairwise random-effects models. For continuous data, we calculated standardized mean differences and 95% confidence intervals (CIs), using endpoint data, and for dichotomous data, we used odds ratios and 95% CIs. We used GRADE to assess the certainty of the evidence. Main results: We included 19 RCTs with 873 participants; 16 parallel group RCTs and three cluster-RCTs. Most studies compared psychological therapy (typically including elements of cognitive behavioural therapy, behavioural therapy, reminiscence therapy, or a combination of these) to treatment as usual or to a condition controlling for the effects of attention. We found very low-certainty evidence that psychological therapies were more effective than non-therapy control conditions in reducing symptoms of depression, with a large effect size at end-of-intervention (SM

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

Life cycle assessment of microbial 2,3-butanediol production from brewer’s spent grain modeled on pinch technology

Microbial production of 2,3-butanediol (BDO) has received considerable attention as a promising alternate to fossil-derived BDO. In our previous work, BDO concentration >100 g/L was accumulated using brewer’s spent grain (BSG) via microbial routes which was followed by techno-economic analysis of the bioprocess. In the present work, a life cycle assessment (LCA) was conducted for BDO production from the fermentation of BSG to identify the associated environmental impacts. The LCA was based on an industrial-scale biorefinery processing of 100 metric tons BSG per day modeled using ASPEN plus integrated with pinch technology, a tool for achieving maximum thermal efficiency and heat recovery from the process. For the cradle-to-gate LCA, the functional unit of 1 kg of BDO production was selected. One-hundred-year global warming potential of 7.25 kg CO2/kg BDO was estimated while including biogenic carbon emission. The pretreatment stage followed by the cultivation and fermentation contributed to the maximum adverse impacts. Sensitivity analysis revealed that a reduction in electricity consumption and transportation and an increase in BDO yield could reduce the adverse impacts associated with microbial BDO production

Optimistic Planning for Markov Decision Processes

International audienceThe reinforcement learning community has recently intensified its interest in online planning methods, due to their relative independence on the state space size. However, tight near-optimality guarantees are not yet available for the general case of stochastic Markov decision processes and closed-loop, state-dependent planning policies. We therefore consider an algorithm related to AO* that optimistically explores a tree representation of the space of closed-loop policies, and we analyze the near-optimality of the action it returns after n tree node expansions. While this optimistic planning requires a finite number of actions and possible next states for each transition, its asymptotic performance does not depend directly on these numbers, but only on the subset of nodes that significantly impact near-optimal policies. We characterize this set by introducing a novel measure of problem complexity, called the near-optimality exponent. Specializing the exponent and performance bound for some interesting classes of MDPs illustrates the algorithm works better when there are fewer near-optimal policies and less uniform transition probabilities

Reminiscence therapy - 2019 (Seminar Series on Ageing)

Presented by Professor Sunil Bhar, this seminar explores Reminiscence Therapy, a form of treatment which aims to enhance the wellbeing of older adults through reviewing past experiences, challenges, and successes. Presented on the 28 June 2019

Reminiscence therapy - 2018 (Seminar Series on Ageing)

This talk will explore reminiscence therapy, a form of treatment which aims to enhance the wellbeing of older adults through reviewing past experiences, challenges, and successes. Presented on Friday 12 October 2018

Adapting CBT for Residential Aged Care (Seminar Series on Ageing)

This webinar will focus on the use of cognitive behavioural therapy (CBT) for older adults, including those living with dementia. The format will consist of a panel of clinical psychology trained practitioners, at varying stages of experience working therapeutically with older adults. Their perspectives on working systemically within residential aged care to deliver evidence-based interventions will be shared. Case studies are discussed, with a particular focus on practical applications of CBT and tips for practitioners interested in working in the older adult mental health field

Reminiscence Therapy (Seminar Series on Ageing)

This talk will explore Reminiscence Therapy, a form of treatment which aims to enhance the wellbeing of older adults through reviewing past experiences, challenges, and successes

Reminiscence therapy - 2022 (Seminar Series on Ageing)

This talk will explore Reminiscence Therapy, a form of treatment which aims to enhance the wellbeing of older adults through reviewing past experiences, challenges, and successes