Title of Study Mental Health and Quality of Life Among Care Home Residents: A Comparison Study. Research Team: Dr Assumpta Ryan & Marie O’Neill (School of Nursing and Institute of Nursing and Health Research), Professor Brendan Bunting, Dr Siobhan O’Neill, Dr Sam Murphy and Dr Finola Ferry (School of Psychology).

Background  18,000 care homes across the UK supporting 400,000 older people (Joseph Rowntree Foundation, 2012). In NI 12,000 people reside in care homes (DHSSPS, 2012)  Care home residents with mental health needs –a vulnerable group.  An ageing population but limited knowledge about the mental health of older people  Need for information, treatment and support (National Services Framework, 2001; Bamford Review of Mental Health (2007).

Background  Prevalence estimates vary but in UK depression affects between % of older people in care homes (Mozley et al., 2004;Heath 2006) and is associated with disability and dependence (Boyle,2005;Thesis et al,2007).  Epidemiological studies of mental health have largely ignored the growing number of older people in care homes…? unmet need.  Northern Ireland Study of Health and Stress (NISHS)- NI arm of the. WMH Survey Initiative (2011).  Care home residents excluded from NISHS and all WHO studies……a missed opportunity and the impetus for the present.

Aim The overall aim of this study was to determine mental health and quality of life among care home residents and to compare this information with matched individuals in the community using the NISHS dataset.

Objectives 1.To determine the prevalence and the social and demographic correlates of mental health problems among care home residents; 2.To examine medication prescription for mental health problems in care homes; 3.To determine the quality of life of care home residents; 4.To compare the results of this study with matched individuals in the community using the NISHS data set which contains data on 864 individuals aged 65 years and over.

Methodology  Data collected using structured interviews with 75 care home residents between Jan 2011-Jan 2012  Abridged version of the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI) was the primary research instrument.(Kessler & Ustun, 2004)  The interview generates psychiatric diagnoses according to the definitions and criteria of both the International Classification of Diseases (10 th ED ICD-10) (WHO, 1992) and the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) (American Psychiatric Association, 1994).  SF 12 Health Survey…..results are expressed in terms of two meta-scores: the Physical Component Summary (PCS) and the Mental Component Summary (MCS).  SF-6D A measure of perceived health (health-related quality of life (QoL) which assesses six dimensions of health : physical functioning, role limitations, social functioning, pain, mental health and vitality

Ethics and Recruitment  Ethical approval (University of Ulster Filter Committee and ORECNI).  20 care homes randomly selected from a list of homes (n=62) held by the Regulation and Quality Improvement Authority (RQIA).  Random selection of residents who met the selection criteria within each home

Selection Criteria  Over 65 years of age;  Minimal cognitive impairment as defined by the Mini Mental State Examination (Folstein et al., 1975)  Physically able and willing to consent and participate  Initial interviews- checked for rigor

Data Management & Analysis Statistical algorithms, developed in Harvard for use in all WMH surveys, were applied to the final dataset in order to generate a series of DSM-IV dichotomous diagnostic variables for selected mental health disorders (APA 1994).  Twelve month and lifetime prevalence rates of DSM-IV disorders  Statistical comparisons of SF-12  SF-6D: Comparison of care home and general population sample

Results: Demographic Information PopulationNMean Age Std. Deviation Std. Error Mean MaleFemaleTotal NISHS Care Homes Total

Reasons for Admission to Care Home: Mean length of Stay 3.9 years Deterioration in physical health and well-being(n=42: 56%) Isolation, “no-one to take care of me”(n=21: 28%) Transferred from residential/Sheltered accommodation (n=5: 7%) Estranged from family/abused by family member (n=4: 5%) Transferred directly from hospital(n=3: 4%).

Lifetime Prevalence of DSM-IV Disorders DSM –IV DISORDERS NISHS Study 22.2% Care Home Sample 12% Major Depressive Disorder 8.1%2.6% Lifetime Panic Disorder 2.8%2.6% PTSD 6.0%1.3% Lifetime Specific Phobia 5.6%2.6%

Statistical Comparisons of SF-12 Populationmcs_totpcs_tot NISHS Mean N852 Std. Deviation Care Home Sample Mean N75 Std. Deviation Total Mean N927 Std. Deviation

SF-6D: Comparison of Care Home and General Population sample Average Mean Scores NISHS Sample over 65 N=852 Care Home N=75 Physical Functioning * Role Limitations Social Functioning1.73*1.28 Bodily pain Scores2.18*1.73 Mental Health1.84*1.51 Vitality Quality of Life * Significant difference

Medication Profile of NISHS sample and Care Home sample Category NISHS sample (aged over 65) % Care home sample % Sleeping pills or other sedatives Antidepressants Anti-psychotics Tranquilizers3.070 Amphetamines0.160

Points to Consider  Limitations of study-Generalisation of findings  Methodological variances in prevalence of DSM-IV disorders  Somatic symptoms V’s perception of depression  Medication management- 37% prescribed antidepressants  Social and contextual issues

Points to Consider  QoL- Empowerment Care (Kranz, 2011;Tu et al 2006)  Resilience and the elderly population?  Challenges view that healthcare needs of older care home residents are being neglected?  Quality of life in care environments and social networks  ‘Home is where the heart is’?

Future Plans:  Examination of the efficacy of the Composite International Diagnostic Interview in the older population  Further analysis of medication utilisation for physical and mental health disorders  To report and publish findings in scientific journal  Proposal for PhD study will be undertaken to explore the attitudes/perceptions of residents in care home environments to determine their quality of life and it’s impact on mental health.