Development and evaluation of a brief psycho-social intervention for delivery by Support Workers from AgeUK North Staffs, to support older people with anxiety and depression: A feasibility study.

Conference:

SAPC ASM 2018 - London

Talk Code:

P1.22

Presenter:

Carolyn Chew-Graham

Co-authors:

Tom Kingstone, Heather Burroughs, Peter Bullock, Simon Gilbody, Karina Lovell, Peter Bower, Mo Ray, Waquas Waheed, Elaine Nicholls, Reuben Ogollah, Bernadette Bartlam.

Author institutions:

Keele University, Age UK (North Staffs), University of York, University of Manchester, University of Lincoln, University of Nottingham,

Problem

Anxiety and depression often co-exist and in older people may be under-diagnosed and under-treated, leading to poor individual health outcomes and quality of life, increased use of health and social care services and raised mortality. Older people may not present to their GP with symptoms because of the stigma they associate with mental health labels, and because treatments offered are often not acceptable.

Approach

A collaborative study with AgeUK North Staffordshire aiming to:• refine a community-based psychosocial intervention for older people with anxiety and/or depression, based on the principles of Behavioural Activation (BA) and for delivery by Support Workers (SWs) in the third sector. • determine whether SWs can be trained to deliver this intervention.• determine if it is feasible to recruit and randomise older people, to pilot procedures, and conduct a process evaluation to provide data to inform a randomised trial.Sequential mixed methods in three phases, informed by Patient and Public Involvement and Engagement. Exploratory research with older people, SWs, and an expert consensus group to refine the intervention, training, SW manuals and patient participant materials. Feasibility study to pilot recruitment procedures and retention, assess fidelity of delivery of the intervention. Process evaluation to assess acceptability.

Findings

Initial qualitative work supported refinement of the psycho-social intervention. comprising one to one contact between older people with anxiety and/or depression, based on the principles of BA with encouragement to attend and participate in a group activity. Recruitment and retention of the SWs was possible; the training, support materials and manual were acceptable; they delivered the intervention as intended. Recruitment of practices from which to recruit patients was feasible, but the recruitment target for older people was not achieved. However, of those who were recruited, retention at four months was 86%. Those older people in the intervention arm of the study found the interaction with SWs acceptable, although sign-posting to groups was not felt to be needed by all. GPs in participating practices recognised the need for additional care for older people with anxiety and depression, but did not feel able to provide this.

Consequences

Third sector support workers, such as those in AgeUK, can be recruited and trained to deliver an intervention based on BA, to older people with anxiety and/or depression. The training and supervision model used was acceptable to SWs. The one-to-one intervention was acceptable to older people, although participation in group activities was not felt useful by all participants. GPs were aware of the support needs of older people, but felt that this was not within their remit. GPs reported that the study did not impact on routine care.

Submitted by:

Carolyn A. Chew-Graham

Funding acknowledgement:

The NOTEPAD study was funded by the National Institute for Health Research Health Services & Delivery Research (HS&DR) Programme ref. 13/54/34. This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.