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.

People who are taller are at greater risk of developing cancer. The World Cancer Research Fund reports there is strong evidence taller people have a higher chance of of developing cancer of the:

• pancreas
• large bowel
• uterus (endometrium)
• ovary
• prostate
• kidney
• skin (melanoma) and
• breast (pre- and post-menopausal).

But why? Here’s what we know, don’t know and suspect.

A well established pattern

The UK Million Women Study found that for 15 of the 17 cancers they investigated, the taller you are the more likely you are to have them.

It found that overall, each ten-centimetre increase in height increased the risk of developing a cancer by about 16%. A similar increase has been found in men.

Let’s put that in perspective. If about 45 in every 10,000 women of average height (about 165 centimetres) develop cancer each year, then about 52 in each 10,000 women who are 175 centimetres tall would get cancer. That’s only an extra seven cancers.

So, it’s actually a pretty small increase in risk.

Another study found 22 of 23 cancers occurred more commonly in taller than in shorter people.

Why?

The relationship between height and cancer risk occurs across ethnicities and income levels, as well as in studies that have looked at genes that predict height.

These results suggest there is a biological reason for the link between cancer and height.

While it is not completely clear why, there are a couple of strong theories.

The first is linked to the fact a taller person will have more cells. For example, a tall person probably has a longer large bowel with more cells and thus more entries in the large bowel cancer lottery than a shorter person.

Scientists think cancer develops through an accumulation of damage to genes that can occur in a cell when it divides to create new cells.

The more times a cell divides, the more likely it is that genetic damage will occur and be passed onto the new cells.

The more damage that accumulates, the more likely it is that a cancer will develop.

A person with more cells in their body will have more cell divisions and thus potentially more chance that a cancer will develop in one of them.

Some research supports the idea having more cells is the reason tall people develop cancer more and may explain to some extent why men are more likely to get cancer than women (because they are, on average, taller than women).

However, it’s not clear height is related to the size of all organs (for example, do taller women have bigger breasts or bigger ovaries?).

One study tried to assess this. It found that while organ mass explained the height-cancer relationship in eight of 15 cancers assessed, there were seven others where organ mass did not explain the relationship with height.

It is worth noting this study was quite limited by the amount of data they had on organ mass.

Another theory is that there is a common factor that makes people taller as well as increasing their cancer risk.

One possibility is a hormone called insulin-like growth factor 1 (IGF-1). This hormone helps children grow and then continues to have an important role in driving cell growth and cell division in adults.

This is an important function. Our bodies need to produce new cells when old ones are damaged or get old. Think of all the skin cells that come off when you use a good body scrub. Those cells need to be replaced so our skin doesn’t wear out.

However, we can get too much of a good thing. Some studies have found people who have higher IGF-1 levels than average have a higher risk of developing breast or prostate cancer.

But again, this has not been a consistent finding for all cancer types.

It is likely that both explanations (more cells and more IGF-1) play a role.

But more research is needed to really understand why taller people get cancer and whether this information could be used to prevent or even treat cancers.

I’m tall. What should I do?

If you are more LeBron James than Lionel Messi when it comes to height, what can you do?

Firstly, remember height only increases cancer risk by a very small amount.

Secondly, there are many things all of us can do to reduce our cancer risk, and those things have a much, much greater effect on cancer risk than height.

We can take a look at our lifestyle. Try to:

• eat a healthy diet
• exercise regularly
• maintain a healthy weight
• be careful in the sun
• limit alcohol consumption.

And, most importantly, don’t smoke!

If we all did these things we could vastly reduce the amount of cancer.

You can also take part in cancer screening programs that help pick up cancers of the breast, cervix and bowel early so they can be treated successfully.

Finally, take heart! Research also tells us that being taller might just reduce your chance of having a heart attack or stroke.

Susan Jordan, Associate Professor of Epidemiology, The University of Queensland and Karen Tuesley, Postdoctoral Research Fellow, School of Public Health, The University of Queensland

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