Geneva Health Forum Archive

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Prevalence of Depression among the Elderly Population in Rizal Province Using the Geriatric Depression Scale

Author(s): Cheridine Oro- Josef1, Ma. Cristina dela Cruz1, Teofilo Salandanan Jr.1
Affiliation(s): 1Home Health Care, Quezon City, Philippines
1st country of focus: Philippines
Relevant to the conference theme: Vulnerable groups
Summary (max 100 words): The rate of depression (6.6%)  noted in this study was consistent with local studies done by Filipino authors. This prevalence rate among the elderly in the most populated province of the Philippines shows that depression can be present in Filipino healthy communities. However, it is considerable to note that a fourth (26.5%) of the population have scores suggestive of depression. This is a window for early intervention in the community level. Depression has been found to be associated with poorer prognosis, longer recovery times from illness, and increased health care utilization. Screening the elderly population for possible depression is important to decrease health care utilization and increase wellness for this age group. It is necessary for primary care physicians, geriatricians and caregivers to identify symptoms of depression in patients with scores suggestive of depression to avoid the development of outright depression. The Geriatric Depression Scale Short Form 15 has proven itself to be a fast, simple screen to quickly and efficiently identify those elderly who may be depressed.
Background (max 200 words): Depression in the elderly is an important public health concern worldwide. It is a silent disorder that afflicts many in the elderly population. It is the most common psychiatric disorder among the elderly yet unrecognized and under treated because attention is often focused on the physical medical conditions that are apparent during clinic visits. Typical signs and symptoms of depression are usually absent (such as lack of energy, loss of appetite, constipation, no interest in work, poor sleep or loss of weight) and are masked by physical manifestations of co-morbid conditions. In community practice case reports of elderly suffering from depression were regarded as consequences of the aging process. Contrary to this belief depression in the elderly is not physiologic. It is a pathologic condition that is reversible with prompt and appropriate treatment. Failure to recognize and treat depression increases the risk of a prolonged course of depressive illness as well as other conditions like malnutrition, significant metabolic illnesses, and a greater chance of dying.
Objectives (max 100 words): To determine the prevalence of depression and associated socio demographic and clinical conditions among the elderly in Rizal province. SPECIFIC OBJECTIVES: 1. To describe the socio-demographic and clinical conditions of the elderly in Rizal. 2. To detect depression among the elderly population using GDS SF 15. 3. To determine association between depression and socio-demographic and clinical conditions among the elderly
Methodology (max 400 words): A cross-sectional survey of the elderly population (aged 60 yrs old and above) in Rizal province, Philippines was conducted between August to October 2009. Simple random sampling was done to select 3 barangays from 3 municipalities in Rizal. A list of the elderly (60 years and over) was compiled from each of the barangays. All the subjects were contacted for a personal interview. The subjects' socio-demographic, socio- economic and clinical data were gathered during the interview wherein a structured questionnaire was completed. The Geriatric Depression Scale (GDS) SF 15 was used to screen for depression.
Results (max 400 words): The total number of elderly subjects included in this study was 196. There were 122 females and 74 males. Their mean age ± standard deviations was 67 + 6.89  (male 67.7±.6.7; and female 67.7±7) years. Most of the subjects were married, 56% (n=110) while 37.4% (n=73) were widowed. A few were single, (n=8, 4.1%) and separated (n=4, 2.1%). The majority were unemployed (n=173, 88.7%). Their source of financial support mostly came from their children (n=103, 62.8%). They live with either one or two married children (n=78, 40%) or their nuclear family (n=56, 28.7%). Most of the subjects were independent (n=127, 64.8%) and moved around without support (n=167, 86.5%). The top 3 medical conditions were Hypertension (n=75, 37.9%), Arthritis (n=50,25.3%) and other Heart diseases (n=18, 9.1%) . GDS SF scores suggestive of depression were reported in 52 (26.5%) of the subjects, and 13 (6.6%)  were in the almost always indicative of depression score group. Marital status (p= 0.044) and presence of multiple medical condition (p=0.018) correlated strongly with depression. Separated and widowed individuals are more likely to show symptoms of depression (R= 0.159).
Conclusion (max 400 words): Depressive symptoms are common among Filipino elderly in Rizal. Detection and early intervention may be helpful at the community level. A simple instrument such as the Geriatric Depression Scale SF 15 is useful and easily administered.

RAFT: Telemedicine in Africa

The RAFT-Network provides telemedicine in African Francophone countries. The main challenge adressed is the de-isolation of care professionals working in remote areas of developing countries. The core activity of RAFT is the webcasting of interactive courses targeted to physicians and other care professionals. Courses are webcast every week, freely available, followed by hunderds of professionals who can interact directly with the teacher.


Project/Initiative Outline:

First Name
Antoine
Last Name
Geissbuhler
Name of project or intiative RAFT: de-isolation of care professionals in developing countries
1st country of focus Mali
Additional countries of focus Sub-Saharan Africa and Latin America
Relevant to the conference theme Health information and technologies
Summary Continuing education of healthcare professionals and access to specialized advice are keys to improve the quality, efficiency and accessibility of health system. In developing countries, these activities are usually limited to capitals, and delocalized professionals do not have access to such opportunities, or even to didactic material adapted to their needs. This limits the interest of such professionals to remain active in the periphery, where they are most needed to implement effective strategies for prevention and first-line healthcare.

In order to address these needs, the Geneva University Hospitals have developed a telemedicine network in Africa (the RAFT, Réseau en Afrique Francophone pour la Télémédecine), first in Mali, then in Mauritania, Morocco, Cameroon, and, since 2004, in Burkina-Faso, Senegal, Tunisia, Ivory Coast, Madagascar, Niger, Burundi, Congo-Brazzaville, Algeria, Chad, Benin, Guinea and DRC.
The core activity of the RAFT is the webcasting of interactive courses targeted to physicians and other care professionals, the topics being proposed by the partners of the network. Courses are webcast every week, freely available, and followed by hundreds of professionals who can interact directly with the teacher. 70% of these courses are now produced and webcast by experts in Africa. A bandwidth of 30 kbits/second, the speed of an analog modem, is sufficient, and enables the participation from remote hospitals or even cybercafés.
Other activities of the RAFT network include medical tele-expertise, tele-ultrasonography, and collaborative development of educational on-line material.
The network is currently organized and run by more than 40 national coordinators throughout Africa, and by a coordination team based in Geneva. In each of the partner countries, the RAFT activities are supervised by the focal point, a medical authority (usually a university professor) that links the project to the national governmental bodies (ministry of health, ministry of education). A local medical coordinator (a junior physician) and a technical coordinator take care of the day-to-day operations, including communication with the care professionals, identification of training needs, technical training and support of the various sites within the country.
Key partnerships include the Université Numérique Francophone Mondiale (UNFM) and the World Health Organization (WHO). The RAFT is recognized as an official WHO collaborating center for eHealth and Telemedicine.
The current priority is the large-scale deployment of these telemedicine tools along with IT-enabled diagnostic devices such as portable echography, to the regional and district hospitals in Africa. These infrastructures could also be used to facilitate public health activities including the collection and communication of surveillance and healthcare indicators to the ministries. The usefulness of these tools to support isolated care professionals has been demonstrated, as well as the sustainability of the implementation in large hospitals who can integrate the recurring connection costs in their operational budgets. Given the high costs of satellite connections (about 500 USD per month), which are the only options in remote areas, it has been evaluated that sustainability can currently be achieved down to the district-level hospitals who usually serve populations of 50’000 to 200’000, and operate as the first level of reference for dispensaries and rural hospitals.
In parallel, the network is extending to other linguistic areas: educational sessions have been produced in English since October 2008, and are available to hospitals in English-speaking Africa and the Middle East. Since 2011, the project is being implemented in Latin America.
What challenges does your project address and why is it of importance? The main challenge addressed is the de-isolation of care professionals working in remote areas of developing countries. In most countries, remote areas are understaffed, with a suboptimal use of existing resources, while main cities retain most of the skilled professionals and have overcrowded care facilities.
How have you addressed these challenges? Do you see a solution? The RAFT network provides distance education and tele-expertise services to isolated care professionals, by establishing South-South collaborations between reference hospitals and regional/district hospitals.
How do you know whether you have made a difference? We have many anecdotes showing that these tools are effective both for professional and social de-isolation, and help maintain skilled and motivated professionals in remote areas, thus strengthening thelocal health systems.
Have you or the project mobilized others and if so, who, why and how? The RAFT network has many partnerships in order to provide quality contents and mutualize technical and organizational resources. These include WHO (HUG is a WHO collaborating center for eHealth and telemedicine), UNFM (Université Numérique Francophone Mondiale), AUF (Agence Universitaire de la Francophonie), UNESCO (University of Geneva has a UNESCO chair for distance education), Université Senghor...
When your donor funding runs out how will your idea continue to live? In most countries, the network is supported by the MoH or hospitals within two to three years of the initial deployment in that country.

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GHF2012 – Welcome Message

Welcome to the fourth edition of the Geneva Health Forum (GHF), a key event for those wishing to hear the voice and insights of the global health frontlines.

We are introducing many new features to ensure that views from the frontlines are well represented at the Geneva Health Forum. It is with great pleasure that we offer you the new submission format, suited to submit project implementation experiences as well as scientific abstracts. You can generate more interest in your submission by also submitting photos and audio-visuals.

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