Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial   Commentary: Beyond the boundary for a randomised controlled trial?

Abstract Objective: To evaluate the effectiveness of a population based, multifaceted shared care intervention for late life depression in residential care. Design: Randomised controlled trial, with control and intervention groups studied one after the other and blind follow up after 9.5 months. Setting: Population of residential facility in Sydney living in self care units and hostels. Participants: 220 depressed residents aged ≥65 without severe cognitive impairment. Intervention: The shared care intervention included: (a) multidisciplinary consultation and collaboration, (b) training of general practitioners and carers in detection and management of depression, and (c)depression related health education and activity programmes for residents. The control group received routine care. Main outcome measure: Geriatric depression scale. Results: Intention to treat analysis was used. There was significantly more movement to “less depressed” levels of depression at follow up in the intervention than control group (Mantel-Haenszel stratification test, P=0.0125). Multiple linear regression analysis found a significant intervention effect after controlling for possible confounders, with the intervention group showing an average improvement of 1.87 points on the geriatric depression scale compared with the control group (95% confidence interval 0.76 to 2.97, P=0.0011). Conclusions: The outcome of depression among elderly people in residential care can be improved by multidisciplinary collaboration, by enhancing the clinical skills of general practitioners and care staff, and by providing depression related health education and activity programmes for residents. Key messages Large numbers of depressed elderly people live in residential care but few receive appropriate management A population based, multifaceted shared care intervention for late life depression was more effective than routine care in improving depression outcome The outcome of late life depression can be improved by enhancing the clinical skills of general practitioners and care staff and by providing depression related health education and activity programmes for residents The intervention needs further refining and evaluation to improve its effectiveness and to determine how best to implement it in other residential care settings