Analysis Of Effects Of Exercise Training On Older Patients With Depression

PICO (T) is a model for developing a well-built clinical research question. A four-element mnemonic is used for creating a foreground clinical questions. The four elements of the model include: Patient / population / problem (disease), intervention / issue, comparison intervention / comparison issue, outcome and time. The PICO model will be used to inquire the following question: In older adults, does the use of exercise compare to the use of medication adherence for treating depression? To assess the following question two research articles will be used: “The effects of antidepressant medication adherence as well as psychosocial and clinical factors on depression outcome among older adults” (AAPD) and “Does physical activity moderate the association between depressive symptoms and disability in older adults” (PADD). Understanding the topic prior and after completing the search will be reviewed, along with why this subject is relevant to nursing, and how these articles were discovered. The population studied in both articles are older adults with depression.

Depression is “a mood disorder that causes a persistent feeling of sadness and loss of interest. It affects how you feel, think and behave and can lead to emotional and physical problems”. AAPD defines older adults as: 60 years and older, whereas PADD defines older adults as: 65 years and older. The two interventions/ comparison issues in context to treatment towards depression that will be assessed include: medication adherence and physical activity. Prior to conducting a preliminary search of the academic literature, my understanding of this issue was that the use of medication is effective in treating depression but physical activity is also associated in reducing symptoms of depression. This understanding was particularly shaped by prior knowledge, a friend’s personal experience and acquired nursing knowledge. Prior/ acquired knowledge includes the understanding of endorphins. When one exercises, the body releases endorphins a chemical that triggers a positive feeling in the body and diminish the perception of pain. Resulting in a reduction of depressive symptoms. My understanding of antidepressant was built through a friend’s experience/ acquired information. Antidepressants work by balancing chemicals in the brain that affect mood and emotion. Resulting in improved mood, sleep, appetite and concentration.

Depression is a topic relevant to nursing as it affects 300 million people worldwide, it affects nearly 7% of the older adult population. AADP is a research article written by Bosworth et al. (2008) and was published online on June 12th 2007 and was further revised in 2008. The purpose of this study was to evaluate a sample of 241 depressed older adults and the effects of antidepressant medication adherence on 12-month depression scores. Upon completion of this study results indicated that poor antidepressant adherence is related to increased depression severity. Authors further suggest that interventions should be focused on improving antidepressant adherence and modifying psychosocial variables.

The second article that will be assessed is PADD, this research article is written by Lee and Park (2008) and was published online July 10th 2007 and was revised in 2008. The purpose of this study was to evaluate 645 depressed adults over the age of 65, and monitor whether physical activity is associated with depressive symptoms/disabilities. Upon completion of this study results indicated that physical activity was a significant modifier in depressive symptoms/disabilities. Depressive symptoms/disabilities tend to diminish for those engaging in physical activity. In conclusion findings suggest that healthcare professionals should be required to promote a moderate amount of physical activity as an intervention to depression/disability.

In a preliminary search of the academic literature, two, peer reviewed published research articles were located and selected using the data base “academic one file”. To complete this search full-text documents and peer reviewed articles was selected. Lastly a date range was set for between 2008-2018. The primary search for both articles used was “depression”. Secondary searches include: “antidepressant medication & elderly”, “medication adherence & geriatrics”, “pharmacological interventions & older adults”, “physical activity & older adults”, and lastly “non- pharmacological interventions & elderly”. AAPD, medication adherence is studied in relation to psychosocial and clinical predictors of depression. Depression was measured at baseline and 12-months post-baseline. A variety of baseline predictors were assessed some of which included: antidepressant adherence, barriers to antidepressant adherence, four domains of social support, basic/ instrumental activities of daily living and clinical factors including history of depression and medical comorbidities. Analyzation of the following allowed for a complete understanding of the topic.

The second article PADD, discusses the weather physical activity regulates the association between depressive symptoms and disability in older adults. A 15-item Geriatric Depression Scale, Physical Functioning scale, and physical performance tests were used to assess the individual’s depressive symptoms and functional disability. The rational for selecting these two articles is that they were the most relevant to the question being asked, the methods of analyzation presented the most significant information. The identified purpose of the article by Bosworth et, 2008 is to review medication adherence to 12-month depression scores in relation to psychosocial and clinical predictors of depression. The identified purpose of the article by Lee and Park (2008) is to examine if moderations made in physical activity are associated with depressive symptoms and disabilities in older adults. Having read the two articles, my original understanding of the topic is supported.

My original understand was that medication intake and physical activity is effective in treating depression. Given that results indicated that poor medication adherence is directly related to greater depression severity. Results indicated that antidepressant medication nonadherence, barriers to taking medication, and psychosocial factors were significantly related to 12- month depression scores. Physical activity as an intervention is related to decreased levels of depression. Given that results of the research article indicated that physical activity in “older adult’s moderates the association between depressive symptoms and disability”.