title: Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care.
  
  
  METHODS
  Randomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months.
  
  
  METHODS
  Population of residential facility in Sydney living in self care units and hostels.
  
  
  METHODS
  220 depressed residents aged >/=65 without severe cognitive impairment.
  
  
  METHODS
  The shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c) depression related health education and activity programmes for residents. The control group received routine care.
  
  
  METHODS
  Geriatric depression scale.
  
  
  RESULTS
  Intention to treat analysis was used. There was significantly more movement to "less depressed" levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P=0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P=0.0011).
  
  
  CONCLUSIONS
  The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents.
authors.affiliation: Department of Psychological Medicine, University of Sydney, New South Wales 2006, Australia. rljones@mail.usyd.edu.au
authors.forename: R H
authors.initials: RH
authors.lastname: Llewellyn-Jones
authors.forename: K A
authors.initials: KA
authors.lastname: Baikie
authors.forename: H
authors.initials: H
authors.lastname: Smithers
authors.forename: J
authors.initials: J
authors.lastname: Cohen
authors.forename: J
authors.initials: J
authors.lastname: Snowdon
authors.forename: C C
authors.initials: CC
authors.lastname: Tennant
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D017028:Caregivers; D002983:Clinical Competence; D003866:Depressive Disorder / Q000628:therapy*; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D007326:Institutionalization; D008297:Male; D015999:Multivariate Analysis; D009517:New South Wales; D010348:Patient Care Team / Q000458:organization & administration*; D011569:Psychiatric Status Rating Scales; D012944:Social Support; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents