Development of an Evidence-Based Guideline for Screening and Managing Depression in Older Adults

Sunday, 27 July 2014

Mann-Chian Wu, MSN
Institute of Medical Science, Tzu Chi Univeristy, Taiwan., Hualien, Taiwan
Huei-Chuan Sung, PhD, MSN, RN
Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan
Shin-Yann Tsai, MSN, RN
Institute of Medical Sciences, Tzu-Chi University, Hualien, Taiwan
Graeme D. Smith, RN, BA, FEANS, PhD
School of Nursing, Edinburgh Napier University, Edinburgh, United Kingdom

Purpose: This study aimed to develop an evidence-based guideline for screening and managing depression in older adults.

Background: Depression and dementia are common mental problems among aging population. Depression in older adults is often ignored and inadequately diagnosed and managed. Literature indicates that older patients with depression may also have cognitive impairment which has similar symptoms with dementia. Therefore, this makes the assessment of depression more difficult among older adults. There is a lack of guideline which can assist clinicians make better assessment and care plan for older adults with depression in Taiwan. Therefore, a clear guideline for nursing professionals to screen and manage older adults with depression is warranted.

Methods: A systematic review method was used and searched published guidelines and systematic reviews from 2000-2012. Relevant guidelines and reviews were appraised by three certified reviewers using appraisal tools and further analyzed. With the results from the systematic reviews and suggestions from expert focus group, we developed the guideline protocol for screening and managing depression suitable for older adults in Taiwan. This guideline protocol was evaluated by 12 psychiatric experts, and further revision was made according to the experts’ recommendations. In addition, the guideline protocol was assessed by 357 clinical health care professionals in psychiatric wards and long-term care facilities using a questionnaire survey method for its feasibility and possible obstacles in implementing the guideline in the clinical settings in Taiwan.

Results: The final version of guideline has 62 recommendations, including identifying high-risk factors for older adults with depression, assessing cognitive function for older adults, assessing depression level of older adults, screening results and referral requirements, and care interventions.

Conclusions: An evidence-based guideline for screening and managing depression of older adults was developed through a systematic review method. This guideline provides nursing professionals a clear guidance and tool to accurately assess depression in order to provide suitable care and interventions in managing depression problems of older adults.