The silent epidemic
Depression often undiagnosed in aged care faciltities, but there is hope, says Professor Marita McCabe.
The Australian population continues to age at an alarming rate and because people are living longer, and having fewer children, the proportion of younger people in Australia continues to fall.
This means that as the ‘baby boomer’ generation heads for retirement there will be proportionally less working Australians to support them. This is expected to put considerable strain on society as a whole, and the aged care sector - private and public - in particular.
Against this backdrop, Alfred Deakin Professor Marita McCabe, Director of the Centre for Mental Health and Wellbeing Research, has found that nearly a quarter of aged care residents suffer from clinical depression. More alarmingly, only half of those who experience depression, have their depression detected, and even fewer of these older people receive treatment.
“We were quite surprised at our findings – so many of the residents were quite depressed … and no one knew about it," Professor McCabe said.
“Unfortunately, other studies have shown that depressed aged care residents, as well as having a poorer quality of life, have a shorter lifespan. And this is after having contributed to society all their working lives. I think they deserve better.”
Part of the problem, according to Professor McCabe, is that aged care staff are not trained to diagnose depression let alone refer residents for investigation and possible treatment.
“The staff are usually quite busy with catering to the day-to-day physical and medical needs of residents, and they often don’t have the time to observe closely the mood of those they care for, but something has to be done," she said.
Professor McCabe and her team from the School of Psychology have looked into the problem at a number of Victorian aged care facilities (in partnership with Benetas and Uniting Aged Care) and what they found was that staff were largely unaware of the problem of depression amongst their residents and that management within the facilities was also unaware of this ‘silent epidemic’.
“This was worsened by the fact that the residents themselves didn’t speak up because they don’t like to talk about their mood problems, they don’t want to cause trouble, they are embarrassed by their depression, and they see it as a normal part of ageing which, let me hasten to add, it is not!” she said.
“A further complication was that some of the residents also had Alzheimer’s disease and for those with an advanced stage of the disease their behaviour had deteriorated and was quite disruptive. As a consequence many were heavily sedated so that they were no longer a danger to themselves or others - but this also masked other psychological problems such as depression.
“In addition, while the drugs quieten the patients somewhat, they don’t work perfectly and carry significant risk and side-effects.
“And because of all this, staff experience high levels of stress which leads to burn-out and a high turnover of workers – which is tough for residents, other staff, and management as well.
Professors McCabe and her team have worked with the aged care agencies to find a solution to both the hidden depression amongst residents and the challenging behaviour.
“We found that by training staff to detect and manage depression among residents, and also by training management to support staff in this task, we were able to significantly reduce the rate of depression, drug use and challenging behaviour," she said.
“We also developed a new diagnostic tool (the BPSD Assessment Measure) that helped enormously in the detection and treatment of psychological problems by staff and referral of the problem to clinicians or specialist nurses when required.
“And the staff saw this as a positive development because it helped them to do their task more effectively. As for management, they could see - along with the relatives of residents - that the residents were being better cared for… it really was a win-win situation.”
Professor McCabe also found that having mental health “champions” on hand helped quite a bit.
“We thought that one way to help motivate staff to look more closely at the state of their residents’ mental health would be to nominate a mental health “champion” amongst them who would take responsibility for the screening of both depression and behavioural problems," she said.
According to Professor McCabe, the use of champions taps into the finding that “clinical leadership” is the most efficient and cost-effective way of overcoming barriers to the introduction of new routines into aged care.
“We showed that mental health champions, people motivated to be vigilant about residents’ psychological state, were able to introduce new practices into the centre and make it part of the staff duties. It provided a hurdle over the organisational barriers," she said.
But more remains to be done. For example, despite introducing these new techniques of detecting depression in aged care residents, Professor McCabe found that they were not being used by staff.
“We found a number of organisational barriers at the coal-face, so to speak. This is despite showing that it would improve things for the residents and make staff members’ jobs easier," she said.
“One problem is the naturally conservative nature of managers and supervisors who don’t particularly like to change work practices without really good evidence that it will improve things... while not affecting the bottom line too much.
So Professor McCabe has set her targets on what she sees as the next organisational hurdle - management.
“We are currently working with management teams to see how we can get them on-board. First we will need to get their perspectives on the problem, and then we’ll see what strategies will encourage management to actually become part of the “clinical leadership” team," she said.
As well as being director of the Centre for Mental Health and Wellbeing Research, and having a busy administrative and supervision load, Professor McCabe is also an internationally recognized expert in the area of body image disturbance and sexual psychological health. She has also been an advisor to governments on a range of issues and has led World Health Organisation committees looking at global sexual health.
“Yep, it all keeps me pretty busy, but then there are so many problems out there!”