Half of Australians in aged care have depression. Psychological therapy could help
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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.
Cochrane Australia
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.
Cochrane Australia
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.
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Want the health benefits of strength training but not keen on the gym? Try ‘exercise snacking’
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The science is clear: resistance training is crucial to ageing well. Lifting weights (or doing bodyweight exercises like lunges, squats or push-ups) can help you live independently for longer, make your bones stronger, reduce your risk of diseases such as diabetes, and may even improve your sleep and mental health.
But not everyone loves the gym. Perhaps you feel you’re not a “gym person” and never will be, or you’re too old to start. Being a gym-goer can be expensive and time-consuming, and some people report feeling unwelcome or awkward at the gym.
The good news is you don’t need the gym, or lots of free time, to get the health benefits resistance training can offer.
You can try “exercise snacking” instead.
Pressmaster/Shutterstock What is exercise snacking?
Exercise snacking involves doing multiple shorter bouts (as little as 20 seconds) of exercise throughout the day – often with minimal or no equipment. It’s OK to have several hours of rest between.
You could do simple bodyweight exercises such as:
- chair sit-to-stand (squats)
- lunges
- box step-ups
- calf raises
- push-ups.
Exercise snacking like this can help improve muscle mass, strength and physical function.
It’s OK to hold onto a nearby object for balance, if you need. And doing these exercises regularly will also improve your balance. That, in turn, reduces your risk of falls and fractures.
OK I have done all those, now what?
Great! You can also try using resistance bands or dumbbells to do the previously mentioned five exercises as well as some of the following exercises:
When using resistance bands, make sure you hold them tightly and that they’re securely attached to an immovable object.
Exercise snacking works well when you pair it with an activity you do often throughout the day. Perhaps you could:
- do a few extra squats every time you get up from a bed or chair
- do some lunges during a TV ad break
- chuck in a few half squats while you’re waiting for your kettle to boil
- do a couple of elevated push-ups (where you support your body with your hands on a chair or a bench while doing the push-up) before tucking into lunch
- sneak in a couple of calf raises while you’re brushing your teeth.
Exercise snacking involves doing multiple shorter bouts (as little as 20 seconds) of exercise throughout the day. Cavan-Images/Shutterstock What does the evidence say about exercise snacking?
One study had older adults without a history of resistance training do exercise snacks at home twice per day for four weeks.
Each session involved five simple bodyweight exercises (chair sit-to-stand, seated knee extension, standing knee bends, marching on the spot, and standing calf raises). The participants did each exercise continuously for one minute, with a one-minute break between exercises.
These short and simple exercise sessions, which lasted just nine minutes, were enough to improve a person’s ability to stand up from a chair by 31% after four weeks (compared to a control group who didn’t exercise). Leg power and thigh muscle size improved, too.
Research involving one of us (Jackson Fyfe) has also shown older adults found “exercise snacking” feasible and enjoyable when done at home either once, twice, or three times per day for four weeks.
Exercise snacking may be a more sustainable approach to improve muscle health in those who don’t want to – or can’t – lift heavier weights in a gym.
A little can yield a lot
We know from other research that the more you exercise, the more likely it is you will keep exercising in future.
Very brief resistance training, albeit with heavier weights, may be more enjoyable than traditional approaches where people aim to do many, many sets.
We also know brief-and-frequent exercise sessions can break up periods of sedentary behaviour (which usually means sitting too much). Too much sitting increases your risk of chronic diseases such as diabetes, whereas exercise snacking can help keep your blood sugar levels steady.
Of course, longer-term studies are needed. But the evidence we do have suggests exercise snacking really helps.
Just a few short exercise sessions can do you a world of good. eggeegg/Shutterstock Why does any of this matter?
As you age, you lose strength and mass in the muscles you use to walk, or stand up. Everyday tasks can become a struggle.
All this contributes to disability, hospitalisation, chronic disease, and reliance on community and residential aged care support.
By preserving your muscle mass and strength, you can:
- reduce joint pain
- get on with activities you enjoy
- live independently in your own home
- delay or even eliminate the need for expensive health care or residential aged care.
What if I walk a lot – is that enough?
Walking may maintain some level of lower body muscle mass, but it won’t preserve your upper body muscles.
If you find it difficult to get out of a chair, or can only walk short distances without getting out of breath, resistance training is the best way to regain some of the independence and function you’ve lost.
It’s even more important for women, as muscle mass and strength are typically lower in older women than men. And if you’ve been diagnosed with osteoporosis, which is more common in older women than men, resistance exercise snacking at home can improve your balance, strength, and bone mineral density. All of this reduces the risk of falls and fractures.
You don’t need heavy weights or fancy equipment to benefit from resistance training.
So, will you start exercise snacking today?
Justin Keogh, Associate Dean of Research, Faculty of Health Sciences and Medicine, Bond University and Jackson Fyfe, Senior Lecturer, Strength and Conditioning Sciences, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Hot And Sour Shiitake Soup
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This is a popular, easy, and delicious soup that nonetheless is not found in many western kitchens, despite being enjoyed in restaurants/take-out. Best of all, making it at home means that you know all the ingredients, can account for quality, and also can customize it per your preferences (i.e. how much heat/sourness you like).
You will need
- 3 cups shiitake mushrooms, sliced
- 3 cups bok choy, chopped
- 2 cups cherry tomatoes, quartered
- 1 cup carrot, grated
- 3 spring onions, chopped
- 2 shallots, sliced lengthways
- 2 serrano chilis (or similar), sliced thinly
- 2 tbsp apple cider vinegar
- 1 tbsp lemon juice
- 1 tbsp fresh ginger, sliced into 1″ strips
- 1 tsp black pepper, coarse ground
- ½ bulb garlic, crushed
- 6 cups low-sodium vegetable stock. Ideally you will have made it yourself from vegetable cuttings that you saved in the freezer until you had enough to make stock from, but if that’s not an option, then low-sodium vegetable stock cubes can be purchased and used.
- Garnish: ¼ cup (or 4 tbsp) cilantro, chopped, or if you have the soap gene, then this time we recommend chopped basil as the subsitution
Method
(we suggest you read everything at least once before doing anything)
1) Put the ginger in a big pot with the stock; cover and simmer for about 20 minutes (otherwise the ginger flavor will remain mostly concentrated in the ginger strips).
2) Bring it to a boil and add the bok choy, mushrooms, shallots, chili peppers, and the carrot; simmer for another 5 minutes
3) Add the remaining ingredients except for the garnish, and simmer for another 5 minutes
4) Serve, adding the garnish
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- The (Longevity) Magic of Mushrooms
- Our Top 5 Spices: How Much Is Enough For Benefits?
- An Apple (Cider Vinegar) A Day…
- Enjoy Bitter/Hot/Sour/Pungent Foods For Your Heart & Brain
- Brain Food? The Eyes Have It!
- Some Surprising Truths About Hunger And Satiety
Take care!
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The Snooze-Button Controversy
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To Snooze Or Not To Snooze? (Science Has Answers)
This is Dr. Jennifer Kanaan. She’s a medical doctor with a focus on pulmonary critical care, sleep disorders, and sleep medicine.
What does she want to tell us?
She wants us to be wary of the many news articles that have jumped on a certain recent sleep study, such as:
- Is hitting the snooze button really a bad idea? Study sheds light on the impact of morning alarms on sleep and cognition
- Hitting Snooze May Help You Feel Less Sleepy and More Alert, Research Says
- Is it okay to press the snooze button?
- Hitting Snooze May Help You Feel Less Sleepy and More Alert, Research Says
- Hitting the snooze button on your alarm doesn’t make you more tired
For the curious, here is the paper itself, by Dr. Tina Sundelin et al. It’s actually two studies, by the way, but one paper:
The authors of this study concluded:
❝There were no clear effects of snoozing on the cortisol awakening response, morning sleepiness, mood, or overnight sleep architecture.
A brief snooze period may thus help alleviate sleep inertia, without substantially disturbing sleep, for late chronotypes and those with morning drowsiness.❞
Notably, people tend to snooze because an alarm clock will, if not “smart” about it, wake us up mid sleep-cycle more often than not, and that will produce a short “sleep hangover”. By snoozing, we are basically re-rolling the dice on being woken up between sleep cycles, and thus feeling more refreshed.
What’s Dr. Kanaan’s counterpoint?
Dr. Kanaan says:
❝If you’re coming in and out of sleep for 30 minutes, after the alarm goes off the first time, you’re costing yourself 30 minutes of uninterrupted, quality, restorative sleep. This study doesn’t change that fact.❞
She advises that rather than snoozing, we should prioritize getting good sleep in the first place, and once we do wake up, mid sleep-cycle or not, get sunlight. That way, our brain will start promptly scrubbing melatonin and producing the appropriate wakefulness hormones instead. That means serotonin, and also a spike of cortisol.
Remember: cortisol is only bad when it’s chronically elevated. It’s fine, and even beneficial, to have a short spike of cortisol. We make it for a reason!
If you’d like to hear more from Dr. Kanaan, you might like this interview with her at the University of Connecticut:
Want the best of both worlds?
A great option to avoid getting woken in the middle of a sleep cycle, and also not needing to hit snooze, is a sunrise alarm clock. Specifics of these devices vary, but for example, the kind this writer has starts gently glowing an hour before the set alarm time,and gradually gets brighter and lighter over the course of the hour.
We don’t sell them, but here’s an example sunrise alarm clock on Amazon, for your convenience
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Ultra-Processed People – by Dr. Chris van Tulleken
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It probably won’t come as a great surprise to any of our readers that ultra-processed food is—to make a sweeping generalization—not fabulous for the health. So, what does this book offer beyond that?
Perhaps this book’s greatest strength is in showing not just what ultra-processed foods are, but why they are. In principle, food being highly processed should be neither good nor bad by default. Much like GMOs, if a food is modified to be more nutritious, that should be good, right?
Only, that’s mostly not what happens. What happens instead is that food is modified (be it genetically or by ultra-processing) to be cheaper to produce, and thus maximise the profit margin.
The addition of a compound that increases shelf-life but harms the health, increases sales and is a net positive for the manufacturer, for instance. Dr. van Tulleken offers us many, many, examples and explanations of such cost-cutting strategies at our expense.
In terms of qualifications, the author has an MD from Oxford, and also a PhD, but the latter is in molecular virology; not so relevant here. Yet, we are not expected to take an “argument from authority”, and instead, Dr. van Tulleken takes great pains to go through a lot of studies with us—the good, the bad, and the misleading.
If the book has a downside, then this reviewer would say it’s in the format; it’s less a reference book, and more a 384-page polemic. But, that’s a subjective criticism, and for those who like that sort of thing, that is the sort of thing that they like.
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Aging with Grace – by Dr. David Snowdon
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First, what this book is not: a book about Christianity. Don’t worry, we didn’t suddenly change the theme of 10almonds.
Rather, what this book is: a book about a famous large (n=678) study into the biology of aging, that took a population sample of women who had many factors already controlled-for, e.g. they ate the same food, had the same schedule, did the same activities, etc—for many years on end. In other words, a convent of nuns.
This allowed for a lot more to be learned about other factors that influence aging, such as:
- Heredity / genetics in general
- Speaking more than one language
- Supplementing with vitamins or not
- Key adverse events (e.g. stroke)
- Key chronic conditions (e.g. depression)
The book does also cover (as one might expect) the role that community and faith can play in healthy longevity, but since the subjects were 678 communally-dwelling people of faith (thus: no control group of faithless loners), this aspect is discussed only in anecdote, or in reference to other studies.
The author of this book, by the way, was the lead researcher of the study, and he is a well-recognised expert in the field of Alzheimer’s in particular (and Alzheimer’s does feature quite a bit throughout).
The writing style is largely narrative, and/but with a lot of clinical detail and specific data; this is by no means a wishy-washy book.
Bottom line: if you’d like to know what nuns were doing in the 1980s to disproportionally live into three-figure ages, then this book will answer those questions.
Click here to check out Aging with Grace, and indeed age with grace!
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When can my baby drink cow’s milk? It’s sooner than you think
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Parents are often faced with well-meaning opinions and conflicting advice about what to feed their babies.
The latest guidance from the World Health Organization (WHO) recommends formula-fed babies can switch to cow’s milk from six months. Australian advice says parents should wait until 12 months. No wonder some parents, and the health professionals who advise them, are confused.
So what do parents need to know about the latest advice? And when is cow’s milk an option?
What’s the updated advice?
Last year, the WHO updated its global feeding guideline for children under two years old. This included recommending babies who are partially or totally formula fed can have whole animal milks (for example, full-fat cow’s milk) from six months.
This recommendation was made after a systematic review of research by WHO comparing the growth, health and development of babies fed infant formula from six months of age with those fed pasteurised or boiled animal milks.
The review found no evidence the growth and development of babies who were fed infant formula was any better than that of babies fed whole, fresh animal milks.
The review did find an increase in iron deficiency anaemia in babies fed fresh animal milk. However, WHO noted this could be prevented by giving babies iron-rich solid foods daily from six months.
On the strength of the available evidence, the WHO recommended babies fed infant formula, alone or in addition to breastmilk, can be fed animal milk or infant formula from six months of age.
The WHO said that animal milks fed to infants could include pasteurised full-fat fresh milk, reconstituted evaporated milk, fermented milk or yoghurt. But this should not include flavoured or sweetened milk, condensed milk or skim milk.
If you’re choosing cow’s milk for your baby, make sure it’s whole milk rather than skim milk. Mr Adi/Shutterstock Why is this controversial?
Australian government guidelines recommend “cow’s milk should not be given as the main drink to infants under 12 months”. This seems to conflict with the updated WHO advice. However, WHO’s advice is targeted at governments and health authorities rather than directly at parents.
The Australian dietary guidelines are under review and the latest WHO advice is expected to inform that process.
OK, so how about iron?
Iron is an essential nutrient for everyone but it is particularly important for babies as it is vital for growth and brain development. Babies’ bodies usually store enough iron during the final few weeks of pregnancy to last until they are at least six months of age. However, if babies are born early (prematurely), if their umbilical cords are clamped too quickly or their mothers are anaemic during pregnancy, their iron stores may be reduced.
Cow’s milk is not a good source of iron. Most infant formula is made from cow’s milk and so has iron added. Breastmilk is also low in iron but much more of the iron in breastmilk is taken up by babies’ bodies than iron in cow’s milk.
Babies should not rely on milk (including infant formula) to supply iron after six months. So the latest WHO advice emphasises the importance of giving babies iron-rich solid foods from this age. These foods include:
- meat
- eggs
- vegetables, including beans and green leafy vegetables
- pulses, including lentils
- ground seeds and nuts (such as peanut or other nut butters, but with no added salt or sugar).
You may have heard that giving babies whole cow’s milk can cause allergies. In fact, whole cow’s milk is no more likely to cause allergies than infant formula based on cow’s milk.
If you’re introducing cow’s milk at six months, offer iron-rich foods too, such as meat or lentils. pamuk/Shutterstock What are my options?
The latest WHO recommendation that formula-fed babies can switch to cow’s milk from six months could save you money. Infant formula can cost more than five times more than fresh milk (A$2.25-$8.30 a litre versus $1.50 a litre).
For families who continue to use infant formula, it may be reassuring to know that if infant formula becomes hard to get due to a natural disaster or some other supply chain disruption fresh cow’s milk is fine to use from six months.
It is also important to know what has not changed in the latest feeding advice. WHO still recommends infants have only breastmilk for their first six months and then continue breastfeeding for up to two years or more. It is also still the case that infants under six months who are not breastfed or who need extra milk should be fed infant formula. Toddler formula for children over 12 months is not recommended.
All infant formula available in Australia must meet the same standard for nutritional composition and food safety. So, the cheapest infant formula is just as good as the most expensive.
What’s the take-home message?
The bottom line is your baby can safely switch from infant formula to fresh, full-fat cow’s milk from six months as part of a healthy diet with iron-rich foods. Likewise, cow’s milk can also be used to supplement or replace breastfeeding from six months, again alongside iron-rich foods.
If you have questions about introducing solids your GP, child health nurse or dietitian can help. If you need support with breastfeeding or starting solids you can call the National Breastfeeding Helpline (1800 686 268) or a lactation consultant.
Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney University; Naomi Hull, PhD candidate, food security for infants and young children, University of Sydney, and Nina Jane Chad, Research Fellow, University of Sydney School of Public Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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