Abstract
Background:
Many older people living in care homes (long term residential care or nursing
homes) are depressed. Exercise is a promising non-drug intervention for
preventing and treating depression in this population.
Objective:
To evaluate the impact of a ‘whole-home’ intervention,
consisting of training for residential and nursing home staff backed up with
a twice-weekly, physiotherapist-led exercise class on depressive symptoms in
care home residents.
Design:
A cluster randomised controlled trial with a cost-effectiveness analysis to
compare (1) the prevalence of depression in intervention homes with that in
control homes in all residents contributing data 12 months after homes were
randomised (cross-sectional analysis); (2) the number of depressive symptoms
at 6 months between intervention and control homes in residents who were
depressed at pre-randomisation baseline assessment (depressed cohort
comparison); and (3) the number of depressive symptoms at 12 months between
intervention and control homes in all residents who were present at
pre-randomisation baseline assessment (cohort comparison).
Setting:
Seventy-eight care homes in Coventry and Warwickshire and north-east
London.
Participants:
Care home residents aged ≥ 65 years.
Interventions:
Control intervention: Depression awareness training
programme for care home staff. Active intervention: A
‘whole-home’ exercise intervention, consisting of training
for care home staff backed up with a twice-weekly, physiotherapist-led
exercise group.
Main outcome measures:
Geriatric Depression Scale-15, proxy European Quality of Life-5 Dimensions
(EQ-5D), cost-effectiveness from an National Health Service perspective,
peripheral fractures and death.
Results:
We recruited a total of 1054 participants. Cross-sectional
analysis: We obtained 595 Geriatric Depression Scale-15 scores
and 724 proxy EQ-5D scores. For the cohort analyses we obtained 765 baseline
Geriatric Depression Scale-15 scores and 776 proxy EQ-5D scores. Of the 781
who we assessed prior to randomisation, 765 provided a Geriatric Depression
Scale-15 score. Of these 374 (49%) were depressed and constitute our
depressed cohort. Resource-use and quality-adjusted life-year data, based on
proxy EQ-5D, were available for 798 residents recruited prior to
randomisation. We delivered 3191 group exercise sessions with 31,705 person
attendances and an average group size of 10 (5.3 study participants and 4.6
non-study participants). On average, our participants attended around half
of the possible sessions. No serious adverse events occurred during the
group exercise sessions. In the cross-sectional analysis the odds for being
depressed were 0.76 [95% confidence interval (CI) 0.53 to 1.09] lower in the
intervention group at 12 months. The point estimates for benefit for both
the cohort analysis (0.13, 95% CI −0.33 to 0.60) and depressed
cohort (0.22, 95% CI −0.52 to 0.95) favoured the control
intervention. There was no evidence of differences in fracture rates or
mortality (odds ratio 1.07, 95% CI 0.79 to 1.48) between the two groups.
There was no evidence of differences in the other outcomes between the two
groups. Economic analysis: The additional National Health
Service cost of the OPERA intervention was £374 per participant (95%
CI −£655 to £1404); the mean difference in
quality-adjusted life-year was −0.0014 (95% CI −0.0728 to
0.0699). The active intervention was thus dominated by the control
intervention, which was more effective and less costly.
Conclusion:
The results do not support the use of a whole-home physical activity and
moderate-intensity exercise programme to reduce depression in care home
residents.
Trial registration:
Current Controlled Trials ISRCTN43769277.
Funding:
This project was funded by the National Institute for Health Research Health
Technology Assessment programme and will be published in full in
Health Technology Assessment; Vol. 17, No. 18. See the
Health Technology Assessment programme website for further project
information.
