Title of Study

Mental Health and Quality of Life Among Care Home Residents: A

Comparison Study.

Research Team: Dr Assumpta Ryan & Marie O’Neill (School of Nursing and Institute of Nursing and Health Research), Professor Brendan Bunting, Dr Siobhan O’Neill, Dr Sam Murphy

and Dr Finola Ferry (School of Psychology).

Background

18,000 care homes across the UK supporting 400,000 older people (Joseph Rowntree Foundation, 2012). In NI 12,000 people reside in care homes (DHSSPS, 2012)

Care home residents with mental health needs –a vulnerable group.

An ageing population but limited knowledge about the mental health of older people

Need for information, treatment and support (National Services Framework, 2001; Bamford Review of Mental Health (2007).

Background

Prevalence estimates vary but in UK depression affects between 30- 40% of older people in care homes (Mozley et al., 2004;Heath 2006) and is associated with disability and dependence (Boyle,2005;Thesis et al,2007).

Epidemiological studies of mental health have largely ignored the growing number of older people in care homes…? unmet need.

Northern Ireland Study of Health and Stress (NISHS)- NI arm of the . WMH Survey Initiative (2011).

Care home residents excluded from NISHS and all WHO studies……a missed opportunity and the impetus for the present.

Aim

The overall aim of this study was to determine mental health and quality of life among care

home residents and to compare this information with matched individuals in the

community using the NISHS dataset.

Objectives1. To determine the prevalence and the social and

demographic correlates of mental health problems among care home residents;

2. To examine medication prescription for mental health problems in care homes;

3. To determine the quality of life of care home residents;

4. To compare the results of this study with matched individuals in the community using the NISHS data set which contains data on 864 individuals aged 65 years and over.

Methodology

Data collected using structured interviews with 75 care home residents between Jan 2011-Jan 2012

Abridged version of the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI) was the primary research instrument.(Kessler & Ustun, 2004)

The interview generates psychiatric diagnoses according to the definitions and criteria of both the International Classification of Diseases (10th ED ICD-10) (WHO, 1992) and the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) (American Psychiatric Association, 1994).

SF 12 Health Survey…..results are expressed in terms of two meta-scores: the Physical Component Summary (PCS) and the Mental Component Summary (MCS).

SF-6D A measure of perceived health (health-related quality of life (QoL) which assesses six dimensions of health : physical functioning, role limitations, social functioning, pain, mental health and vitality

Ethics and Recruitment

Ethical approval (University of Ulster Filter Committee and ORECNI).

20 care homes randomly selected from a list of homes (n=62) held by the Regulation and Quality Improvement Authority (RQIA).

Random selection of residents who met the selection criteria within each home

Selection Criteria

Over 65 years of age; Minimal cognitive impairment as defined by the

Mini Mental State Examination (Folstein et al., 1975)

Physically able and willing to consent and participate

Initial interviews- checked for rigor

Data Management & Analysis

Statistical algorithms, developed in Harvard for use in all WMH surveys, were applied to the final dataset in order to generate a series of DSM-IV dichotomous diagnostic variables for selected mental health disorders (APA 1994).

Twelve month and lifetime prevalence rates of DSM-IV disorders

Statistical comparisons of SF-12 SF-6D: Comparison of care home and general

population sample

Results: Demographic InformationPopulation N Mean

Age Std.

DeviationStd. Error

MeanMale Female Total

NISHS 852 73.41 6.334 .217 394 458 852

Care Homes 75 81.15 8.287 .957 17 58 75

Total 411 516 927

Reasons for Admission to Care Home:Mean length of Stay 3.9 years

Deterioration in physical health and well-being (n=42: 56%)

Isolation, “no-one to take care of me” (n=21: 28%)

Transferred from residential/Sheltered accommodation

(n=5: 7%)

Estranged from family/abused by family member

(n=4: 5%)

Transferred directly from hospital (n=3: 4%).

Lifetime Prevalence of DSM-IV Disorders

DSM –IV DISORDERS

NISHS Study22.2%

Care Home Sample12%

Major Depressive Disorder

8.1% 2.6%

Lifetime Panic Disorder

2.8% 2.6%

PTSD 6.0% 1.3%

Lifetime Specific Phobia 5.6% 2.6%

Statistical Comparisons of SF-12

Population mcs_tot pcs_tot

NISHS

Mean 54.02 43.83

N 852 852

Std. Deviation 8.62 12.34

CareHome Sample

Mean 61.6 35.12

N 75 75

Std. Deviation 6.91 10.47

Total

Mean 54.63 43.13

N 927 927

Std. Deviation 8.74 12.42

SF-6D: Comparison of Care Home and General Population sample

Average Mean Scores NISHS Sample over 65

N=852

Care

Home N=75

Physical Functioning 1.58 2.49*

Role Limitations 1.64 1.84

Social Functioning 1.73* 1.28

Bodily pain Scores 2.18* 1.73

Mental Health 1.84* 1.51

Vitality 2.74 2.84

Quality of Life 0.78 0.74

* Significant difference

Medication Profile of NISHS sample and Care Home sample

Category NISHS sample (aged

over 65) %

Care home sample %

Sleeping pills or other

sedatives

8.24 41.33

Antidepressants 5.75 37.33

Anti-psychotics 0.24 8.0

Tranquilizers 3.07 0

Amphetamines 0.16 0

Points to Consider

Limitations of study-Generalisation of findings

Methodological variances in prevalence of DSM-IV disorders

Somatic symptoms V’s perception of depression

Medication management- 37% prescribed antidepressants

Social and contextual issues

Points to Consider

QoL- Empowerment Care (Kranz, 2011;Tu et al 2006)

Resilience and the elderly population?

Challenges view that healthcare needs of older care home residents are being neglected?

Quality of life in care environments and social networks

‘Home is where the heart is’?

Future Plans:

Examination of the efficacy of the Composite International Diagnostic Interview in the older population

Further analysis of medication utilisation for physical and mental health disorders

To report and publish findings in scientific journal

Proposal for PhD study will be undertaken to explore the attitudes/perceptions of residents in care home environments to determine their quality of life and it’s impact on mental health .