Living with Dementia: Positive Solutions

1. beyondblue: the national depression initiative Presentation to Alzheimer’s Australia National Conference Living with Dementia: Positive Solutions Leonie Young Chief Executive Officer www.beyondblue.org.au May 2005 beyondbluethe national depression initiative www.beyondblue.org.au

2. What is beyondblue? • beyondblue is a national, independent, not-for-profit organisation working to address issues associated with depression, anxiety and related substance-use disorders in Australia. • Endorsed by AHMAC, established in 2000 by the Commonwealth and Victorian Governments, beyondblue is now supported by other State and Territory Governments, private companies and community-based organisations. • beyondblue works in partnership with health services, schools, workplaces, universities, media and community organisations, as well as people living with depression, to bring together their expertise around depression – health promotion in action. beyondbluethe national depression initiative www.beyondblue.org.au

3. beyondblue’s 5 priorities 1 Increasing community awareness of depression, anxiety and related substance-use disorders and addressing stigma 2 Working with people living with depression and promoting their needs and lived experiences of depression with policy makers in the healthcare system 3Developing prevention and early intervention programs around depression 4 Improving training and support for GPs and other healthcare professionals around depression 5 Initiating and supporting depression-related research beyondbluethe national depression initiative www.beyondblue.org.au

4. beyondblue’s approach A snapshot of beyondblue programs across the lifespan Research Practice Post Natal Depression Project beyondbabyblues Ybblue campaign and Ybblue Crew National Schools Research Initiative Every Family Initiative National Depression in the Workplace Program Beyond Ageing Project Maturityblues Antenatal & postnatal Youth Schools Parents Workplace Older people beyondbluethe national depression initiative www.beyondblue.org.au

5. “Report highlights growing dementia cases” Source: Mathers, Vos & Stevenson (1999) beyondbluethe national depression initiative www.beyondblue.org.au

6. How common is depression in the Australian community? Depression is common affecting 1 in 5 Australians: 1 million people at any one time Twelve-month prevalence of mental disorders in Australian adults FEMALES MALES % Population % Population estimate estimate Any depressive disorder 4.2 275,300 7.4 503,300 Any anxiety disorder 7.1 470,400 12.0 829,600 Any substance use disorder 11.1 734,300 4.5 307,500 Any mental disorder 17.4 1,151,600 18.0 1,231,500 Source: Andrews G, Hall W, Teesson M, Henderson S. The mental health of Australians. Mental Health Branch, Commonwealth Department of Health and Aged Care, 1999. beyondbluethe national depression initiative www.beyondblue.org.au

7. Who gets depressed? Prevalence of depression by age and sex (community cases) 1 in 6 males 1 in 4 females Source: Andrews G, Hall W, Teesson M, Henderson S. The mental health of Australians. Mental Health Branch, Commonwealth Department of Health and Aged Care, 1999. beyondbluethe national depression initiative www.beyondblue.org.au

8. Depression in the elderly • However… • Major depression rates among older people with comorbid conditions up to 25-36% • Prevalence rates of major depression among older people living in residential care have been reported as high as 26%, with rates of depressive symptoms reported as high as 40% • High suicide rates identified among older men • Ageing population – number of depressed older Australians expected to double by 2021 beyondbluethe national depression initiative www.beyondblue.org.au

9. beyondblue Depression Monitor beyondbluethe national depression initiative www.beyondblue.org.au

10. beyondblue Depression Monitor • Older respondents (aged 65 and over) were less likely to assign highest ratings of disability to depression when compared with younger age groups: • 19.4% perceived depression affects 1 in 5 • 25.9% perceived depression affects 1 in 20 • 25% perceived depression affects 1 in 50 beyondbluethe national depression initiative www.beyondblue.org.au

11. Prevalence of depression among elderly people in residential care (Centre for Health Risk Behaviours & Mental Health, Deakin University 2004) beyondbluethe national depression initiative www.beyondblue.org.au

12. Screening for depression among older people • Currently no routine screening for depression in residential care • ACAT mini-mental instrument not adequate • Research found that depression instruments are valid indicators of major depression, including where moderate dementia is present • Need for research into whether the routine use of depression instruments can result in improved outcomes for residents with depression beyondbluethe national depression initiative www.beyondblue.org.au

13. Satisfaction with health services for depression • General satisfaction with health service providerbut poor engagement around non-physical symptoms: • “He (GP) is a very nice gentleman, but he’s too busy to spend much time with people” • “…more interested in the physical parts of me” • Poor understanding of illness and low awareness of treatment • Poor perception of improvements in mental state following treatment beyondbluethe national depression initiative www.beyondblue.org.au

14. The need for action • Low level of literacy in the general population and among health care professionals and older people • Chronic under-treatment of depression – older people the most vulnerable • Failure to recognise and diagnose depressive symptoms • Major depression often untreated or wrongly treated • Nihilistic belief that depression ‘is to be expected’ in old age beyondbluethe national depression initiative www.beyondblue.org.au

15. Potential interventions • Prevention methods proposed: • Increasing literacy about depression in old age • Improving recognition/diagnosis in primary care • Promotion of physical exercise to alleviate symptoms of mild to moderate depression • Nutritional supplements • Partnerships: Better Outcomes in Mental Health Care -increased training for GPs beyondbluethe national depression initiative www.beyondblue.org.au

16. Beyond Ageing Project • Largest research project into depression and the elderly • Will examine whether vitamin supplements, exercise and improving knowledge of depression can prevent depression in older people beyondbluethe national depression initiative www.beyondblue.org.au

17. Other beyondblue research into depression and the elderly • Caring for depressed older people in the emergency department • Using physical activity to promote wellbeing in older people in the primary care setting • An interdisciplinary approach to recognising and treating depression among older Australians living in residential care • MAP Project: sector module for aged care workers beyondbluethe national depression initiative www.beyondblue.org.au

18. Where to now? • Beyond Ageing project • Maturityblues/blueVoices - Training program on depression for staff in aged care settings - Research with elderly consumers and carers - Increase community awareness and improve literacy • Partnership with Alzheimer’s Australia and Baptist Community Care beyondbluethe national depression initiative www.beyondblue.org.au