Behavioral Activation in Nursing Homes to Treat Depression (BAN-Dep): Results From a Clustered, Randomized, Single-Blinded, Controlled Clinical Trial.

OBJECTIVES: To determine if behavioral activation (BA) delivered by trained staff decreases prevalence of clinically significant symptoms of depression among older adults living in residential aged care facilities (RACFs). METHODS: Clustered, randomized, single-blinded, controlled trial of BA for adults aged over 60 years living permanently in a RACF with symptoms of depression (Patient Health Questionnaire, PHQ-9 ≥ 5). BA was delivered over 8-12 weeks using a structured workbook. The proportion of residents with PHQ-9 ≥ 10 at weeks 12, 26, and 52, as well as anxiety symptoms (GAD-7), physical (PCS), and mental (MCS) quality of life, loneliness, and loss to follow-up were main outcomes of interest RESULTS: We recruited 54 RACFs (26 intervention) and 188 of their residents (89 intervention). Participants were aged 61-100 years and 132 (70.2%) were women. PHQ-9 ≥ 10 interacted with BA at week 12 (OR = 0.34, 95%CI = 0.11-1.07), but differences between the groups were not statistically significant at any time-point. GAD-7 ≥ 10 interacted with BA at week 26 (OR = 0.12, 95%CI = 0.02-0.58), but not at any other time-point. Overall, the intervention had no effect on the scores of the PHQ-9, GAD-7, PCS, MCS, and loneliness scale. Loss to follow-up was similar between groups. Adherence to all stages of the intervention was poor (36.2%). CONCLUSIONS: Disruption by the COVID-19 pandemic and staffing issues in RACFs undermined recruitment and adherence. In such a context, a BA program delivered by RACF staff was not associated with better mental health outcomes for residents over 52 weeks.

COVID-19 and mental health: Impact on symptom burden in older people living with mental illness in residential aged care.

OBJECTIVES: COVID-19-related restrictions for residential aged care (RAC) have been significant. However, the mental health impacts for residents already living with mental illness remain poorly understood. In this study, we examined change in mental health symptom burden for this group and potential associations with clinical and contextual factors. METHODS: We retrospectively reviewed medical records of patients of a specialist aged mental health clinical service for RAC. Change in symptoms (measured by the Neuropsychiatric Inventory, Nursing Home version [NPI-NH]) between pre-pandemic and two pandemic timepoints were analysed using Wilcoxon signed-rank tests. Potential associations with baseline diagnosis or severity of 'lockdown' restrictions in RAC were assessed using linear regression. RESULTS: Data from 91 patient files were included. The median NPI-NH score slightly increased during wave one (baseline median NPI-NH score = 17.0 [interquartile range, IQR: 10.0-27.0]; wave one median = 19.0, IQR: 8.0-30.0) and fell during wave two (Median: 15.5, IQR: 7.0-28.0), but changes were not statistically significant (all p-values >0.05). Adjusting for age and gender, an association between neurocognitive disorder diagnosis and NPI-NH score during wave one was statistically but not clinically significant (p = 0.046). No other significant associations were identified. CONCLUSIONS: Accounting for pre-pandemic symptoms, we found no clinically relevant evidence of worsening mental health during COVID-19 for a group of older people living with mental illness in RAC. This adds to evidence of relatively stable mental health in older people during the pandemic. Research and policy should consider underpinning mechanisms and emphasise patient- and carer-centred interventions.