Innovative Program for the Depressed Elderly

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An innovative program at St. Joseph’s Centre for Ambulatory Health Services fights the most common psychiatric complaint in the elderly – depression.

As many as 12 per cent of the aged in the general community and up to 36 per cent of the frail elderly experience anxiety, isolation, loss and depression.

Research indicates that physical activity plays an important role in the management of these mild-to-moderate mental health diseases, and there is data suggesting a link between a lack of social relations and social activity and incidence of depression.

“Many elderly people have memory impairment and depressive symptoms,” says Judy Harris, nurse case manager with Positive Actions and Attitudes (PAA). “It’s not necessarily a symptom of growing older, but certainly the older population experiences a lot of losses and changes and with this program we try to deal with that as well.”

As part of the Health for Older Adults Program, specifically the Geriatric Psychiatry Program at the CAHS, PAA was designed to provide a creative intervention for the depressed elderly in our community. It was designed after older individuals with significant mental illness were found to be ineligible for regular exercise programs. It offers a unique combination of therapies designed to maintain or improve the older adult’s current level of physical function and to maintain or increase their health-related quality of life.

Over the sixteen weeks of the program, supervised physical training with a kinesiologist, leisure education with a therapeutic recreationist, and life management skills administered by a psycho-geriatric nurse are provided. During the program participants are provided with ongoing psychiatric support.

An intake group is divided into three smaller groups that stick together over the life of the program. They meet once a week on Friday afternoons, taking turns with all three disciplines.

“Activities are designed to meet the specific needs of individuals. Physical activities are based on a physical assessment and built on the individual needs,” says kinesiologist Heather Madden. “But generally they are meant to maintain and /or improve cardiovascular endurance, muscular strength, balance and flexibility. There are also sessions focusing on areas such as coping with stress and relaxation techniques. And leisure education is provided to assist older adults to reintegrate into the community.”

PAA provides each client with a supportive and a caring atmosphere. “Jodie Alderson, therapeutic recreationist with the program, starts from the beginning building upon each week’s session in terms of getting people to the program,” says Madden. “And looking at other leisure services in the community, investigating why they’re not participating and how can we eliminate any barriers and make it easier for them. We provide additional support and encouragement to attend the program.”

The program aims at reassuring clients that their needs will be understood and that they will be matched with other services in the community. “Our clients develop a lot of trust in the staff and program over the sixteen weeks,” says Madden. “But we didn’t want to foster a program where no one ever wanted to leave. So a really big component of the program is making sure that our clients are re-socialized and reintegrated back into the community. And we follow up our program with a four month check-up to see how our clients are doing.”

It is estimated that there may be as many as 400 new cases of depressed elderly per year in the HOAP clinical population. And PAA would like to expand to fill the need. “We’re out here in the east-end but we’d like to look at servicing other parts of the community,” says Madden. “The results here have been phenomenal, statistically and clinically significant. We’ve had multiple successes with people being happy with the program. This is a totally unique program that we intend to copyright. Positive Actions and Attitudes provides real and tangible results.”

Adults over the age of 60 who are diagnosed with a primary mood disorder, such as depression and/or anxiety are eligible for Positive Actions and Attitudes. A referral may be initiated by any health professional, or a client may self-refer, however, the family physician must provide medical clearance as part of the admission criteria. There is no fee associated with the program.

Program staff includes Heather Madden, Judy Harris, and Jodie Alderson, along with Program Coordinator Janet Hillen, Manager of Ambulatory Services/Urgent Care Liz O’Sullivan, research scientist David Lewis, and co-medical directors Dr. Karen Sapperson (psychiatry) and Dr. Irene Turpie (medicine).

For more information about Positive Actions and Attitudes contact Heather Madden at (905) 573-4844 ext. 8755 or Janet Hillen at (905) 522-1155 ext. 8775.