Hege Bøen. Social Support, mental health and effectiveness of a senior centre. programme for elders living at home - PDF

Description
Hege Bøen Social Support, mental health and effectiveness of a senior centre programme for elders living at home Cross-sectional studies and a randomized controlled trial Faculty of Medicine University

Please download to get full document.

View again

of 144
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Information
Category:

Nature & Wildlife

Publish on:

Views: 13 | Pages: 144

Extension: PDF | Download: 0

Share
Transcript
Hege Bøen Social Support, mental health and effectiveness of a senior centre programme for elders living at home Cross-sectional studies and a randomized controlled trial Faculty of Medicine University of Oslo 2011 Social support, mental health and effectiveness of a senior centre programme for elders living at home Cross-sectional studies and a randomized controlled trial Hege Bøen Department of Health Surveillance and Prevention, Division of Mental Health, Norwegian Institute of Public Health Submitted for the degree of PhD at the Institute of Health and Society, Faculty of Medicine, University of Oslo 2011 TABLE OF CONTENTS ACKNOWLEDGEMENTS... 3 LIST OF PAPERS... 5 ABBREVIATIONS... 6 SUMMARY BACKGROUND INTRODUCTION Late-life depression and risk factors Associations between socio-economic status (SES) and somatic and mental health Associations between social support and somatic and mental health Association between somatic health and mental health Users and non-users of senior centres Prevention and promotion in mental health Seniors centre as arenas for social support interventions Rationale of the study AIMS OF THE THESIS MATERIAL AND METHODS Description of the intervention Population and sample of the survey (Papers I and II) Participants and recruitment of the Randomized Controlled Trial Paper III Measures of mental health and social support Other variables Fidelity of the intervention Ethics, logistics and data handling Statistical methods MAIN FINDINGS DISCUSSION Methodological considerations Discussion of main findings Factors affecting the health of elders Characteristics of senior centre users compared with non-users (Paper I) Social support increases psychological well-being (Paper II) Effects of the senior centre participation project (Paper III) A Randomized controlled trial the right design? CONCLUSIONS IMPLICATIONS AND FUTURE DIRECTIONS REFERENCES PAPER I - III APPENDIX I - VII 2 ACKNOWLEDGEMENTS The present study was conducted at the Norwegian Institute of Public Health and The Faculty of Medicine, University of Oslo during the period from The initial idea for the senior centre programme was designed and implemented by The Norwegian Health Association, and financial support was provided by The Norwegian Extra Foundation for Health and Rehabilitation. First, I would like to express my sincere gratitude to Odd Steffen Dalgard, my main supervisor, for untiringly introducing me to the field of research, and for his great enthusiasm, patience and generosity. Odd Steffen died on the 4 th of April this year and I miss him deeply. I would also like to express my gratitude to Jorunn Dreksler, who developed the ideas for the senior centre programme. Unfortunately, Jorunn also did not experience the final results of this research, as she died much too early in January I miss her practical help, her enthusiasm for older people and their lives and all the inspiring discussions we had. I am also deeply indebted to the entire staff of the Department of Health Surveillance and Prevention, Division of Mental Health: in particular, Rune Johansen for patiently teaching me statistics and being a co-author, Grethe Kjær Hasselblad for managing the administrative project work with great precision and humour, and Erik Nord for being a cosupervisor and co-author who contributed with extensive ideas and constructive criticism. My gratitude also goes to Leif Edvard Aarø, who helped me through the last important months of this work. Finally, thanks as well to the directors, Johannes Wiik, Arne Holte and Ellinor Major and to the Head of Office, Kari Voll, for giving me the opportunity to start the work and to finish it. Thanks also to all my colleagues and fellow PhD students at The Division of Mental Health for sharing their extensive knowledge, their great humour and their warming remarks and interest. 3 I also wish thank all of the research assistants for collecting the data, the three senior centres involved and all the informants. A special, warm thank you goes to Ina Takle Renskaug, who implemented the programme so precisely and was the daily project leader. My co-supervisor and co-author Espen Bjertness offered me great help and support, and I express my gratitude for his constructive help with the manuscripts. Last, but certainly not least, I express my profound thanks to my always supportive friends, Anita Strøm in particular, for following my ups and downs during this work. My family has been interested and supportive during the entire project, and I am so grateful to them for all having been around, reminding me of what matters in life. This doctoral dissertation would not have been a reality without the encouragement, love, discussions, patience and financial support of my dearest Asbjørn, thank you! Oslo, October 2011 Hege Bøen 4 LIST OF PAPERS 1. Socio-demographic, psychosocial and health characteristics of Norwegian senior centre users: A cross-sectional study Hege Bøen, Odd Steffen Dalgard, Rune Johansen & Erik Nord Scandinavian Journal of Public Health, 2010; 38: The importance of social support in the associations between psychosocial distress and somatic- and socio-demographic factors among older adults living at home: A cross-sectional study Hege Bøen, Odd Steffen Dalgard & Espen Bjertness Manuscript resubmitted for publication 3. A randomized controlled trial of a senior centre group programme for increasing social support and preventing depression in older adults living at home. Hege Bøen, Odd Steffen Dalgard, Rune Johansen & Erik Nord Trial Registration: DRKS on DRKS Manuscript resubmitted for publication 5 ABBREVIATIONS BDI CES-D CI CWD HSCL- 5,10,25 HUBRO HUNT HUS LOGG NorLAG OR OSS-3 RCT SES SSB WHO Beck Depression Inventory, instrument Center for Epidemiological Studies Depression Scale Confidence interval Coping With Depression Course Hopkins Symptom Checklist, instrument The Oslo Health Study The Nord-Trøndelag Health Study National health and social conditions survey Life Course, Gender and Generations Norwegian longitudinal panel survey Odds ratio Oslo-3 Social Support Scale, instrument Randomized controlled study Socio-economic status Statistics Norway World Health Organization 6 SUMMARY Depression and depressive symptoms are common mood disorders in later life and a challenging public health problem. Depression among elders is often related to physical symptoms resulting from chronic diseases or other impairments, as well as loneliness, isolation and lack of social support. Depression may lead to substantial costs and unfavourable impairments of health, thereby possibly causing a dramatic reduction in the quality of life. In 2006, The Norwegian Health Association designed and initiated the programme, Senior centre a service to elders with failing health. The aims of the programme were to increase social support and quality of life, and to prevent late-life depression in older adults. The most important aim of the present thesis was to evaluate the impact of the senior centre programme on depression and social support. An additional aim was to gain knowledge about the socio-demographic, psychosocial and health characteristics of users of the senior centres in relation to non-users. The third aim was to investigate the associations between psychological distress and social support, and between somatic and socio-demographic factors. The thesis consists of three papers. The sampling frame for the data used in Papers I and II were obtained from the Norwegian Population Register for two municipal districts in Oslo, Ullern and Østensjø. A random sample was drawn that was limited to 4,000 of the total number of residents over 65 years living at home, with 2,000 from each district. Self report questionnaires were sent by post, and the response rate was 64% and n=2387. Psychological distress was assessed using a Hopkins Symptom Checklist (HSCL-10) and social support with an Oslo-3 Social Support Scale. Both Papers I and II were designed as cross-sectional studies. Paper III is based on a study with a randomized controlled design, and the recruitment of participants was from the same data material as described above. In total, 415 persons fulfilled the inclusion criteria and 277 persons dropped out, leaving 138 subjects for randomization in the trial. 7 The senior centre is the only welfare service in Norwegian elder care serving both fit and less functional pensioners. In Paper I, we investigated the socio-demographic, psychosocial and health characteristics of senior centres users in relation to non-users. The percentage of users was 44 among the survey respondents, with women overrepresented as users. High age and specific health problems were associated with increased use, while living alone predicted a greater use among women but less among men. The association with age could not be explained by socio-demographic, psychosocial or health variables. In Paper II, we investigated the associations between psychological distress and social support. Furthermore, we investigated the associations between psychological distress and somatic- and socio-demographic factors. Finally, we examined changes in the association with somatic and socio-demographic factors when adjusting for social support. We reported a statistically significant association between psychological distress and social support for two of the items from the Oslo-3 Social Support Scale: the item Number of close friends (OR 0.61; 95% ) and for Concern and interest from others (OR 0.68; CI ). A strong association between a lack of social support and psychological distress, irrespective of the variables adjusted for, indicated a direct effect. The associations between psychological distress and physical impairments were somewhat reduced when adjusted for social support, which was particularly the case for the association between distress and hearing. We reported that physical impairments were associated with low levels of social support, which in turn were associated with high scores on psychological distress. In this context, social support functioned as a mediator. We also reported that physical impairments were associated with a reduced social support, which in turn were associated with higher levels of psychological distress than those of the selected diagnoses. Lastly, income was found to be an independent determinant of psychological distress. Paper III reports on the effects of a senior centre programme for increasing social support and preventing depression in older adults. A total of 138 persons were randomized into an intervention group (n=77) and a control group (n=61). The number of persons who provided usable responses both at baseline and at 12 months was 92, with 37 in the intervention group and 55 in the control group. The outcome measures were the Beck 8 Depression Inventory (BDI), in addition to scales/items for the measurement of social support, health and life satisfaction. At follow-up, there were no significant differences between the intervention group and the control group with regard to these outcome measures. This may be due in part to a lack of statistical power. On the other hand, the consistent tendency towards increased social support and life satisfaction in the intervention group, and less increase in depression than among the controls, supports the hypothesis that the programme had a preventive effect by delaying a general agedependent increase in depression, and in improving social support and quality of life. A dose-response effect which was shown by a greater improvement in the number of group meetings attended, was present for all outcome variables. Most of the participants said that the intervention meant much to them and led to an increased use of the centre. The effect sizes, however, were small and differences were not statistically significant, so the intervention did not have the effect we hoped for and expected. High age and specific health problems were associated with increased use. Single women used the senior centres more than married women, whereas single men used the senior centres less than married men. A lack of social support and somatic health problems increased psychological distress. Functional impairments in general, and hearing impairments in particular, were associated with low levels of social support, which again was associated with psychological distress. This is a public health problem because the prevalence of functional impairments is high and loneliness is quite common, thus possibly leading to increased psychological distress. There were no significant effects on depression of the group programme, although the programme may have delayed a general agedependent increase in depression, and shown a moderately improved social support and quality of life. It is recommended that senior centres expand their activities with new group programmes that are free of charge, targeting social isolation and loneliness by the use of activities that strengthen social support. For the depressed however, more specialized programmes to cope with depression might be the right type of intervention. 9 SUMMARY IN NORWEGIAN Depresjon og depressive symptomer er sinnsstemninger som utgjør vanlige plager i eldre år og er et utfordrende folkehelseproblem. Depresjon blant eldre er ofte relatert til fysiske symptomer på kroniske plager og sykdommer, ensomhet, isolasjon og mangel på sosial støtte. Depresjon kan forårsake alvorlige helseproblemer, omfattende kostnader, dårlige prognoser og dermed dramatisk nedgang i livskvalitet. I 2006 utviklet Nasjonalforeningen for Folkehelsen et gruppebasert program kalt Rehabilitering i eldresentre. Hensikten med programmet var å øke sosial støtte og livskvalitet og redusere depresjon. Hovedmålet med denne avhandlingen var å evaluere effekten av eldresenter programmet på sosial støtte og depresjon. I tillegg var målet å finne ut hva som karakteriserer brukere av eldresentre sosioøkonomisk, psykososialt og helsemessig i forhold til ikke brukere. Et tredje mål var å undersøke sammenhengene mellom psykiske plager og sosial støtte og somatiske og sosiodemografiske faktorer. Avhandlingen består av tre artikler. Adresselister vi kunne trekke utvalg fra ble levert av Det norske folkeregisteret for bydelene Ullern og Østensjø i Oslo. Et tilfeldig utvalg ble trukket begrenset til 4000 personer av det totale antall hjemmeboende innbyggere over 65 år, 2000 fra hver bydel. Selvrapporterende spørreskjema ble sendt i posten. Responsraten var 64 % og n=2387. Psykiske plager ble vurdert i forhold til Hopkins Symptom Checklist (HSCL-10) og sosial støtte med Oslo-3 Social Support Scale (OSS-3). Artikkel I og II har tverrsnittsdesign. Artikkel III er bygget over en studie med et randomisert kontrollert design og rekrutteringen av deltakere til denne studien kom fra samme datamaterialet om tidligere beskrevet. Til sammen oppfylte 415 personer inklusjonskriteriene, 277 trakk seg så fra studien og 138 personer ble randomisert i forsøket. Eldresentre er det eneste velferdstiltaket i norsk eldreomsorg som betjener både friske og mindre friske pensjonister. I artikkel I undersøkte vi hva som karakteriserte brukere av eldresentre sosiodemografisk, psykososialt og helsemessig i forhold til ikke brukere. Andelen brukere av eldresentre var 44 % og kvinner var overrepresentert blant brukerne. Høy alder og spesifikke helseproblemer var assosiert med økt bruk av sentre. Enslige 10 kvinner brukte sentrene mer enn gifte kvinner og enslige menn brukte dem mindre enn det gifte menn gjorde. Sammenhengen med alder kan ikke forklares gjennom sosiodemografiske, psykososiale eller helse variabler. I artikkel II undersøkte vi assosiasjonen mellom psykiske plager og sosial støtte. Videre undersøkte vi assosiasjoner mellom psykiske plager og somatiske og sosiodemografiske faktorer. Til slutt undersøkte vi endringer i assosiasjonen med somatiske og sosiodemografiske faktorer etter å ha justert for sosial støtte. Vi fant en statistisk signifikant assosiasjon mellom psykiske plager og sosial støtte for to av punktene i Oslo-3 Social Support Scale: antall nære venner (OR 0.61; 95% ) og for omtanke og interesse fra andre (OR 0.68; CI ). En sterk assosiasjon mellom manglende sosial støtte og psykiske plager uavhengig av hvilke variabler det ble justert for indikerte en direkte effekt. Assosiasjonen mellom psykiske plager og fysiske plager ble noe redusert når vi justerte for sosial støtte. Dette gjaldt særlig for sammenhengen mellom psykiske plager og hørsel. Sosial støtte fungerte med andre ord, i denne sammenhengen, som en mediator. Fysiske plager korrelerte med lav sosial støtte, som i sin tur hang sammen med høy skår på psykiske plager, i større grad enn det som gjaldt for de utvalgte diagnosene. Inntekt var en selvstendig medbestemmende faktor på psykiske plager. I artikkel III rapporteres effekten av gruppe programmet på eldresentre på endepunktene sosial støtte og depresjon. Totalt ble 138 personer randomisert i intervensjonsgruppe (n=77) og kontrollgruppe (n=61). Antall personer som gav brukbar informasjon både ved baseline og etter 12 måneder var 92, 37 i intervensjonsgruppen og 55 i kontrollgruppen. Endepunkter ble målt med Beck Depression Inventory (BDI), og med skalaer for sosial støtte, helse og livskvalitet. Etter 12 måneder var det ingen signifikante forskjeller mellom intervensjonsgruppen og kontrollgruppen når det gjaldt mål på utkomme. Dette kan delvis skyldes manglende statistisk styrke. På den annen side var det en konsistent tendens til økt sosial støtte og tilfredshet med livet i intervensjonsgruppen og mindre økning i depresjon enn i kontroll gruppen. Dette tyder på at programmet hadde en forebyggende effekt ved å forsinke en generell alders avhengig økning i depresjon, og ved å forbedre sosial støtte og livskvalitet. En dose-respons effekt viste større bedring for alle utkomme variablene jo flere ganger deltakerne hadde vært til stede. De fleste deltakerne sa at intervensjonen 11 betydde mye for dem og det førte til økt deltagelse på sentre. Imidlertid er effektene svake og forskjellene er ikke statistisk signifikante. Derfor har ikke intervensjonen gitt den effekt vi hadde håpet på og regnet med. Høy alder og spesifikke helseproblemer førte til økt bruk av eldresentre. Det å bo alene økte bruk av eldresenter blant kvinner men reduserte bruk av eldresenter blant menn. Manglende sosial støtte og somatiske helseproblemer økte psykiske plager. Fysiske plager, spesielt hørselsproblemer har sammenheng med liten sosial støtte som igjen henger sammen med psykiske plager. Dette er et folkehelseproblem fordi forekomsten av fysiske plager er høy og ensomhet er ganske vanlig og kan føre til økte psykiske plager. Det var ingen signifikante effekter av gruppe programmet på depresjon, men programmet kan muligens ha forsinket en generell aldersavhengig økning i depresjon, og forbedret sosial støtte og livskvalitet moderat. Det anbefales at eldresentre øker aktiviteten med nye gruppe programmer som er gratis og retter seg mot sosial isolasjon og ensomhet gjennom å stryke sosial støtte. For de deprimerte, vil mer spesialiserte program rettet mot mestring av depresjon muligens være en nyttig intervensjon. 12 1 BACKGROUND The Norwegian Health Association is a non-profit organization that owns and runs 32 senior centres in Norway. In 2006, it designed and initiated the programme, Senior centre - a service to elders with failing health. The aim of the programme was to increase social support and quality of life, and to prevent late-life depression in older adults. The aim of this study was to evaluate the programme. The Norwegian Institute of Public Health, Division of Mental Health performed the research. The target group of the programme was persons 65 years and older in two areas of Oslo, who had functional
Related Search
Similar documents
View more...
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks