A feasibility study for NOn-Traditional providers to support the management of Elderly People with Anxiety and Depression: The NOTEPAD study Protocol

Heather Burroughs,Karina Lovell,Waquas Waheed,Tom Kingstone,Janine Proctor,Simon Gilbody,Bernadette Bartlam,Carolyn Chew-Graham,Della Bailey,Peter Bower,Stephanie Butler-Whalley,Mo Ray,Peter Bullock,Reuben Ogollah,Tom Shepherd

doi:10.1186/s13063-018-2550-6

Abstract

BackgroundAnxiety and depression are common among older people, with up to 20% reporting such symptoms, and the prevalence increases with co-morbid chronic physical health problems. Access to treatment for anxiety and depression in this population is poor due to a combination of factors at the level of patient, practitioner and healthcare system.There is evidence to suggest that older people with anxiety and/or depression may benefit both from one-to-one interventions and group social or educational activities, which reduce loneliness, are participatory and offer some activity. Non-traditional providers (support workers) working within third-sector (voluntary) organisations are a valuable source of expertise within the community but are under-utilised by primary care practitioners. Such a resource could increase access to care, and be less stigmatising and more acceptable for older people.MethodsThe study is in three phases and this paper describes the protocol for phase III, which will evaluate the feasibility of recruiting general practices and patients into the study, and determine whether support workers can deliver the intervention to older people with sufficient fidelity and whether this approach is acceptable to patients, general practitioners and the third-sector providers.Phase III of the NOTEPAD study is a randomised controlled trial (RCT) that is individually randomised. It recruited participants from approximately six general practices in the UK. In total, 100 participants aged 65 years and over who score 10 or more on PHQ9 or GAD7 for anxiety or depression will be recruited and randomised to the intervention or usual general practice care. A mixed methods approach will be used and follow-up will be conducted 12 weeks post-randomisation.DiscussionThis study will inform the design and methods of a future full-scale RCT.Trial registrationISRCTN, ID: ISRCTN16318986. Registered 10 November 2016. The ISRCTN registration is in line with the World Health Organization Trial Registration Data Set. The present paper represents the original version of the protocol. Any changes to the protocol will be communicated to ISRCTN.

Highlights

Anxiety and depression are prevalent among older people, with up to 20% reporting symptoms of depression [1, 2]
The target population means that this study is of strategic importance to the National Health Service (NHS) and social care, and given the existing evidence and changes in demography, has the potential to have a significant impact on many people across the UK
This study will inform a definitive multi-centre randomised controlled trial (RCT), which has the potential to contribute to an innovative reorganisation of existing resources across health and social care, including the third or voluntary sector, and more effectively target resources to early intervention, to prevent the deterioration of mental health symptoms in older people

Summary

Introduction

Anxiety and depression are common among older people, with up to 20% reporting such symptoms, and the prevalence increases with co-morbid chronic physical health problems. Demographic changes mean that even if prevalence rates were to remain stable, the growing numbers of older people will translate into large increases in the demand for treatment for these disorders in this population [3]. This will place an increasing burden on health and social care. Treatment of depression has the potential to improve outcomes for diabetes [7] and to improve mortality from all causes in older adults [8]

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