While many people maintain positive emotional wellbeing as they age, around half of older Australians living in residential aged care have significant levels of depression. Symptoms such as low mood, lack of interest or pleasure in life and difficulty sleeping are common.

Rates of depression in aged care appear to be increasing, and without adequate treatment, symptoms can be enduring and significantly impair older adults’ quality of life.

But only a minority of aged care residents with depression receive services specific to the condition. Less than 3% of Australian aged care residents access Medicare-subsidised mental health services, such as consultations with a psychologist or psychiatrist, each year.

Instead, residents are typically prescribed a medication by their GP to manage their mental health, which they often take for several months or years. A recent study found six in ten Australian aged care residents take antidepressants.

While antidepressant medications may help many people, we lack robust evidence on whether they work for aged care residents with depression. Researchers have described “serious limitations of the current standard of care” in reference to the widespread use of antidepressants to treat frail older people with depression.

Given this, we wanted to find out whether psychological therapies can help manage depression in this group. These treatments address factors contributing to people’s distress and provide them with skills to manage their symptoms and improve their day-to-day lives. But to date researchers, care providers and policy makers haven’t had clear information about their effectiveness for treating depression among older people in residential aged care.

The good news is the evidence we published today suggests psychological therapies may be an effective approach for people living in aged care.

We reviewed the evidence

Our research team searched for randomised controlled trials published over the past 40 years that were designed to test the effectiveness of psychological therapies for depression among aged care residents 65 and over. We identified 19 trials from seven countries, including Australia, involving a total of 873 aged care residents with significant symptoms of depression.

The studies tested several different kinds of psychological therapies, which we classified as cognitive behavioural therapy (CBT), behaviour therapy or reminiscence therapy.

CBT involves teaching practical skills to help people re-frame negative thoughts and beliefs, while behaviour therapy aims to modify behaviour patterns by encouraging people with depression to engage in pleasurable and rewarding activities. Reminiscence therapy supports older people to reflect on positive or shared memories, and helps them find meaning in their life history.

The therapies were delivered by a range of professionals, including psychologists, social workers, occupational therapists and trainee therapists.

In these studies, psychological therapies were compared to a control group where the older people did not receive psychological therapy. In most studies, this was “usual care” – the care typically provided to aged care residents, which may include access to antidepressants, scheduled activities and help with day-to-day tasks.

In some studies psychological therapy was compared to a situation where the older people received extra social contact, such as visits from a volunteer or joining in a discussion group.

What we found

Our results showed psychological therapies may be effective in reducing symptoms of depression for older people in residential aged care, compared with usual care, with effects lasting up to six months. While we didn’t see the same effect beyond six months, only two of the studies in our review followed people for this length of time, so the data was limited.

Our findings suggest these therapies may also improve quality of life and psychological wellbeing.

Psychological therapies mostly included between two and ten sessions, so the interventions were relatively brief. This is positive in terms of the potential feasibility of delivering psychological therapies at scale. The three different therapy types all appeared to be effective, compared to usual care.

However, we found psychological therapy may not be more effective than extra social contact in reducing symptoms of depression. Older people commonly feel bored, lonely and socially isolated in aged care. The activities on offer are often inadequate to meet their needs for stimulation and interest. So identifying ways to increase meaningful engagement day-to-day could improve the mental health and wellbeing of older people in aged care.

Some limitations

Many of the studies we found were of relatively poor quality, because of small sample sizes and potential risk of bias, for example. So we need more high-quality research to increase our confidence in the findings.

Many of the studies we reviewed were also old, and important gaps remain. For example, we are yet to understand the effectiveness of psychological therapies for people from diverse cultural or linguistic backgrounds.

Separately, we need better research to evaluate the effectiveness of antidepressants among aged care residents.

What needs to happen now?

Depression should not be considered a “normal” experience at this (or any other) stage of life, and those experiencing symptoms should have equal access to a range of effective treatments. The royal commission into aged care highlighted that Australians living in aged care don’t receive enough mental health support and called for this issue to be addressed.

While there have been some efforts to provide psychological services in residential aged care, the unmet need remains very high, and much more must be done.

The focus now needs to shift to how to implement psychological therapies in aged care, by increasing the competencies of the aged care workforce, training the next generation of psychologists to work in this setting, and funding these programs in a cost-effective way.

Tanya Davison, Adjunct professor, Health & Ageing Research Group, Swinburne University of Technology and Sunil Bhar, Professor of Clinical Psychology, Swinburne University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Does it seem like most vegetables you serve your children end up left on the plate, or worse, strewn across the floor? But mention dessert, and your fruit skewers are polished off in an instant.

Or maybe the carrot and cucumber sticks keep coming home in your child’s lunchbox untouched, yet the orange slices are nowhere to be seen.

If you’re facing these struggles with your child, you’re not alone. Many children prefer fruit to vegetables.

So if your child eats lots of fruit but minimal or no vegetables, is that OK? And how can you get them to eat more veggies?

Children have an innate preference for fruit

The Australian Dietary Guidelines’ recommended daily intakes for vegetables and fruit depend on a child’s age.

Consumption among Australian children falls well below recommendations. Around 62.6% of children aged over two meet the recommended daily fruit intake, but only 9% meet the recommended vegetable intake.

This is not surprising given children have a natural preference for fruit. At least in part, this is due to its sweetness and texture, whether crispy, crunchy or juicy. The texture of fruit has been linked to a positive sensory experience among children.

Vegetables, on the other hand, are more of an acquired taste, and certain types, such as cruciferous vegetables, can be perceived by children as bitter.

The reason children often prefer fruit over vegetables could also be related to the parents’ preferences. Some research has even suggested we develop food preferences before birth based on what our mother consumes during pregnancy.

Balance is key

So, a preference for fruit is common. But is it OK if your child eats lots of fruit but little to no vegetables? This is a question we, as dietitians, get asked regularly.

You might be thinking, at least my child is eating fruit. They could be eating no veggies and no fruit. This is true. But while it’s great your child loves fruit, vegetables are just as important as part of a balanced eating pattern.

Vegetables provide us with energy, essential vitamins and minerals, as well as water and fibre, which help keep our bowels regular. They also support a strong immune system.

If your child is only eating fruit, they are missing some essential nutrients. But the same is true if they are eating only veggies.

Fruit likewise provides the body with a variety of essential vitamins and minerals, as well as phytochemicals, which can help reduce inflammation.

Evidence shows healthy consumption of fruit and vegetables protects against chronic diseases including high blood pressure, heart disease and stroke.

Consumed together, fruit and vegetables in a variety of colours provide different nutrients we need, some of which we can’t get from other foods. We should encourage kids to eat a “rainbow” of fruit and vegetables each day to support their growth and development.

What if my child eats too much fruit?

If your child is eating slightly more fruit than what’s recommended each day, it’s not usually a problem.

Fruit contains natural sugar which is good for you. But too much of a good thing, even if it’s natural, can create problems. Fruit also contains virtually no fat and very little to no protein, both essential for a growing child.

When overindulging in fruit starts to displace other food groups such as vegetables, dairy products and meat, that’s when things can get tricky.

6 tips to get your kids to love vegetables

1. Get them involved

Take your child with you when you go shopping. Let them choose new vegetables. See if you can find vegetables even you haven’t tried, so you’re both having a new experience. Then ask them to help you with preparing or cooking the vegetables using a recipe you have chosen together. This will expose your child to veggies in a positive way and encourage them to eat more.

2. Sensory learning

Try to expose your child to vegetables rather than hiding them. Kids are more likely to eat veggies when they see, smell and feel them. This is called sensory learning.

3. Have fun with food

Use colourful vegetables of different sizes and textures. Make them fun by creating scenes or faces on your child’s plate. Add edible flowers or mint for decoration. You can even serve this with a side of veggie-based dip such as hummus or guacamole for some bonus healthy fats.

4. Teach them to grow their own

Teach your child how to grow their own vegetables. Evidence shows kids are more inclined to try the food they have helped and watched grow. You don’t need to have a big backyard to do this. A windowsill with a pot plant is a perfect start.

5. Lead by example

Your child learns from you, and your eating habits will influence theirs. Ensure they see you eating and enjoying veggies, whether in meals or as snacks.

6. Practise persistence

If your child refuses a particular vegetable once, don’t give up. It can take many attempts to encourage children to try a new food.

Yasmine Probst, Associate Professor, School of Medical, Indigenous and Health Sciences, University of Wollongong; Olivia Wills, Accredited Practising Dietitian, PhD candidate, University of Wollongong, and Shoroog Allogmanny, Accredited Practising Dietitian, PhD candidate, University of Wollongong

This article is republished from The Conversation under a Creative Commons license. Read the original article.