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Trials. 2019 Jul 11;20(1):424. doi: 10.1186/s13063-019-3534-x.

Depression in the nursing home: a cluster-randomized stepped-wedge study to probe the effectiveness of a novel case management approach to improve treatment (the DAVOS project).

Author information

1
Department of Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. tesky@allgemeinmedizin.uni-frankfurt.de.
2
Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany. tesky@allgemeinmedizin.uni-frankfurt.de.
3
Department of Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
4
Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany.
5
Hessian Institute of Nursing Research (HessIP), Frankfurt University of Applied Sciences (Frankfurt UAS), Nibelungenplatz 3, Frankfurt am Main, 60318, Germany.
6
Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, Frankfurt am Main, 60486, Germany.
7
Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany.
8
Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University of Mainz, Langenbeckstraße 1, Mainz, 55131, Germany.

Abstract

BACKGROUND:

Depression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents have minor or major depression. Although depressive disorders in old age can be improved and even cured with adequate therapy, they often go unnoticed in nursing home residents and remain untreated. This highlights a striking deficit in health care and might result not only in lower quality of life among those concerned but also in poor physical functioning, premature mortality, and increased hospitalization rates.

METHODS:

The aims of the interdisciplinary research project DAVOS are to implement an innovative and stepped structural case management program to improve depression treatment for nursing home residents by a modularized intervention and to assess it in terms of its effectiveness. Intervention modules are in line with recommendations given by the German national treatment guidelines for depression (S3 guidelines). Ten nursing homes in Frankfurt, Germany, will participate in the project, which aims to recruit a study population of 380. The recruitment will continue throughout the trial (open cohort). Persons (>60 years) who live in a nursing home, have no medical diagnosis of dementia, and can provide their informed consent to participate are eligible for inclusion in the study. Residents with a clinical diagnosis of dementia, alcohol or substance-related disorders, or other serious psychiatric illnesses will be excluded. DAVOS is a controlled cluster-randomized study that employs a stepped-wedge design.

DISCUSSION:

Our main hypothesis is that the implementation of the intervention will lead to a decline in the prevalence of depression and a reduction in depression symptoms among the home residents. In addition, we expect the intervention to have a positive impact on secondary outcomes such as level of functioning, quality of life, and social participation. The project's results can make an important contribution toward improving the health care of nursing home residents who have late-life depression.

TRIAL REGISTRATION:

DRKS, DRKS00015686 , Oct. 10, 2018.

KEYWORDS:

Case management; Cluster-randomized intervention study; Late-life depression; Nursing home; Psychotherapeutic treatment; Stepped-wedge design

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