Abstract
Depression in later life is an underrepresented yet important research area. The aim of the study was to explore depressed older persons’ need for and expectations of improved health services one year after implementation of the Chronic Care Model (CCM). A qualitative evaluative design was used. Data were collected through individual interviews with older persons living in Norway. The qualitative content analysis revealed two themes: The need to be safeguarded and Expectation of being considered valuable and capable. Evaluation of the improvement in care with focus on the CCM components showed that the most important components for improving the depressed older person’s daily life were: delivery system re-design, self-management support, productive interaction and a well-informed active patient. The findings highlight the need for a health services designed for persons suffering from chronic ill-health, where the CCM could serve as a framework for policy change and support the redesign of the existing healthcare system. We conclude that older persons with depression need attention, especially those who have been suffering for many years. The identified components may have implications for health professionals in the promotion of mental healthcare.
Highlights
Mental health conditions, such as depression, have been largely overlooked as a target for development work [1]
The need for improved health services in relation to the Chronic Care Model (CCM) showed that the component Delivery system redesign was linked to The need to be safeguarded, The need for a coordinator and Assess to specialist psychiatric care
The findings demonstrate that the depressed older persons need to be safeguarded, as they did not succeed in obtaining appropriate healthcare
Summary
Mental health conditions, such as depression, have been largely overlooked as a target for development work [1]. People suffering from depression are vulnerable and require support and treatment [1]. This is true of older adults, as they are less likely than their younger counterparts to be identified and treated [3]. Depression is frequently dismissed as a natural reaction to a person’s life situation [4]. The overlap of somatic symptoms of depression, such as fatigue and loss of appetite, with symptoms of physical illness and the side effects of medication can often lead to diagnostic uncertainty, while the core symptom of sadness is frequently absent or reduced in depressed elderly people [4]. The most common risk factors for depression are; female gender, somatic illness, cognitive reduction, stroke, lack or loss of close social contacts, earlier depressive episodes, being a widow, needing help in daily life, stressful life situations, poor financial status and depression inducing drugs [7]
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