Acupuncture for older adults with depression–a pilot study to assess acceptability and feasibility
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INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2006; 21: 599–600. Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.1544 RESEARCH LETTER Acupuncture for older adults with depression–a pilot study to assess acceptability and feasibility Jodie Williams 1 and Candida Graham 2* 1 South London & Maudsley NHS Trust, Maudsley Hospital, London, UK 2 Wolfson Centre for Age-Related Diseases, London, UK INTRODUCTION The use of complementary and alternative medicine (CAM) by older adults is high and increasing. Com- munity samples in the US show rates of CAM use in older adults of 41% (Astin et al., 2000) and commu- nity samples in Italy show rates of 29.5% (Buono et al., 2001). Acupuncture use ranged in these sam- ples from 14%–34%. Depression and depressive symptoms are among the most frequent reasons for older adults accessing acupuncture therapy. Recent studies in younger adults show some promising results for the effectiveness of acupuncture in the treatment of depression [Allen et al., 1998; Roschke et al., 2000] but no studies have looked at the accept- ability of such trials in older adults or the feasibility of delivery of an acupuncture service within mental health services for older adults. The authors evaluated a pilot service for the delivery of acupuncture to older adults with depression. PILOT SERVICE DELIVERY A member of the nursing team was known to be a qua- lified acupuncturist registered with the British Acu- puncture Council and for 2 days a week it was agreed for her to offer an acupuncture pilot service to clients with depression. A room at a day hospital was made available and an existing treatment couch proved adequate for treatment purposes. The only other cost incurred were acupuncture needles costing £7 per 100 with between 6 and 12 needles used per treatment. A course of treatment consisted of 12 acu- puncture sessions on a weekly basis over 12 weeks. Ethic committee approval for the pilot study was gained. Two consultants for older adults referred cli- ents to the service. All clients referred had moderate depression diagnosed by the consultant clinician in the absence of significant cognitive impairment. Consenting participants completed the semi-struc- tured Hamilton Depression Rating Scale–17 item (HAMD) (Hamilton, 1960), the self-rated Measure Yourself Medical Outcome Profile (MYMOP) (Paterson, 1996) and a client satisfaction scale at mid-treatment, at end of treatment and at one month follow-up. The referring consultants were interviewed and their reasons for client referral recorded. RESULTS Thirteen patients participated in acupuncture therapy over the 6 month pilot (12 female and 1 male, average age 74 years). Of these 13 patients one dropped out before mid-study ratings at week 6 and three dropped out after mid-study ratings. One of the latter patients had fully recovered with a mid-study HAMD score of 0 and should be viewed as a therapy completer. So the total drop-out rate for therapy was three (23%) com- parable with other therapies. Of these three patients one found therapy too painful and the other two felt the therapy was unhelpful. Received 26 September 2005 Copyright # 2006 John Wiley & Sons, Ltd. Accepted 13 December 2005 *Correspondence to: Dr C. Graham, The Wolfson Centre for Age- Related Diseases, The Wolfson Wing, Hodgkin Building, Guy’s Campus, London, SEI IUL, UK. Tel: 020 7848 8071. E-mail: [email protected]
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Transcript of Acupuncture for older adults with depression–a pilot study to assess acceptability and feasibility
INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY
Int J Geriatr Psychiatry 2006; 21: 599–600.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.1544
RESEARCH LETTER
Acupuncture for older adults with depression–a pilotstudy to assess acceptability and feasibility
Jodie Williams1 and Candida Graham2*
1South London & Maudsley NHS Trust, Maudsley Hospital, London, UK2Wolfson Centre for Age-Related Diseases, London, UK
INTRODUCTION
The use of complementary and alternative medicine(CAM) by older adults is high and increasing. Com-munity samples in the US show rates of CAM use inolder adults of 41% (Astin et al., 2000) and commu-nity samples in Italy show rates of 29.5% (Buonoet al., 2001). Acupuncture use ranged in these sam-ples from 14%–34%. Depression and depressivesymptoms are among the most frequent reasons forolder adults accessing acupuncture therapy. Recentstudies in younger adults show some promisingresults for the effectiveness of acupuncture in thetreatment of depression [Allen et al., 1998; Roschkeet al., 2000] but no studies have looked at the accept-ability of such trials in older adults or the feasibility ofdelivery of an acupuncture service within mentalhealth services for older adults. The authors evaluateda pilot service for the delivery of acupuncture to olderadults with depression.
PILOT SERVICE DELIVERY
Amember of the nursing team was known to be a qua-lified acupuncturist registered with the British Acu-puncture Council and for 2 days a week it wasagreed for her to offer an acupuncture pilot serviceto clients with depression. A room at a day hospital
was made available and an existing treatment couchproved adequate for treatment purposes. The onlyother cost incurred were acupuncture needles costing£7 per 100 with between 6 and 12 needles used pertreatment. A course of treatment consisted of 12 acu-puncture sessions on a weekly basis over 12 weeks.
Ethic committee approval for the pilot study wasgained. Two consultants for older adults referred cli-ents to the service. All clients referred had moderatedepression diagnosed by the consultant clinician inthe absence of significant cognitive impairment.
Consenting participants completed the semi-struc-tured Hamilton Depression Rating Scale–17 item(HAMD) (Hamilton, 1960), the self-rated MeasureYourself Medical Outcome Profile (MYMOP)(Paterson, 1996) and a client satisfaction scale atmid-treatment, at end of treatment and at one monthfollow-up. The referring consultants were interviewedand their reasons for client referral recorded.
RESULTS
Thirteen patients participated in acupuncture therapyover the 6 month pilot (12 female and 1 male, averageage 74 years). Of these 13 patients one dropped outbefore mid-study ratings at week 6 and three droppedout after mid-study ratings. One of the latter patientshad fully recovered with a mid-study HAMD score of0 and should be viewed as a therapy completer. So thetotal drop-out rate for therapy was three (23%) com-parable with other therapies. Of these three patientsone found therapy too painful and the other two feltthe therapy was unhelpful.
Received 26 September 2005Copyright # 2006 John Wiley & Sons, Ltd. Accepted 13 December 2005
*Correspondence to: Dr C. Graham, The Wolfson Centre for Age-Related Diseases, The Wolfson Wing, Hodgkin Building, Guy’sCampus, London, SEI IUL, UK. Tel: 020 7848 8071.E-mail: [email protected]
The majority [69%] of patients had chronic symp-toms lasting over one year. Patients’ antidepressantmedication remained unchanged for the course ofthe study.
The reasons for consultant clinicians referringpatients for acupuncture were recorded (see Table 1).HAMD ratings, wellbeing and activity significantlyimproved from baseline to end-treatment and thesegains were sustained through to one month follow-up (HAMD; Kendall’s W test mean ranks; baseline2.89, end-treatment 1.94, follow-up 1.17 p¼ 0.001;MYMOP activity level; Kendall’s W test mean ranks;baseline 2.44, end-treatment 2.22, follow-up 1.33,p¼ 0.021; MYMOP wellbeing; Kendall’s W testmean ranks; baseline 2.67, end-treatment 1.83, fol-low-up 1.50, p¼ 0.013). Patients found the clinicalsetting satisfactory, did not find therapy unacceptablypainful and found therapy relaxing and also felt ithelped improve their mood.
DISCUSSION
Only very limited conclusions can be drawn fromsuch a small pilot study but in view of the lack of data
on the use of acupuncture in older adults with mentalhealth problems it is worth considering the limitedconclusions that are inferred to direct further studies.This pilot has shown that acupuncture can be deliv-ered in a mental health day care setting with minimaldisruption and to the satisfaction of patients. As wellas the need for randomised controlled trials to assessefficacy this study highlights the pragmatic need toassess the likely use of the service by clinicians. Ifclinicians use/refer to the service for chronic, resistantand co-morbid depression, as was the case in thisstudy, there is little point proving efficacy for patientswith uncomplicated depression.
REFERENCES
Allen JJB, Schnyer RN, Hitt SK. 1998. The efficacy of acupunturein the treatment of major depression in women. Psychol Sci 9(5):397–401.
Astin JA, Pelletier KR, Marie A, Haskell WL. 2000. Complemen-tary and alternative medicine use among elderly persons: one-year analysis of a Blue Shield Medicare supplement. J Gerontol55(1): M4–M9.
Buono MD, Urciuoli O, Marietta P, Padoani W, De Leo D. 2001.Alternative medicine in a sample of 655 community-dwellingelderly. J Psychosom Res 50: 147–154.
Hamilton M. 1960. A rating scale for depression. J. Neuol Neuro-surg Psychiatr 25: 14–17.
Paterson C. 1996. Measuring outcomes in primary care: a patientgenerated measure, MYMOP, compared with the SF-36 healthsurvey. Br Med J 312: 1016–1020.
Roschke J, Wolf C, Muller MJ, et al. 2000. The benefit from wholebody acupuncture in major depression. J Affect Disord 57: 73–81.
Table 1. Reasons for referral for acupuncture
Treatment resistant depression n¼ 5 [38.5%]Co-morbid physical illness n¼ 5 [38.5%]Co-morbid high anxiety n¼ 5 [38.5%]Negative cognitions n¼ 2 [15.4%]Complex case n¼ 1 [7.7%]
600 j. williams and c. graham
Copyright # 2006 John Wiley & Sons, Ltd. Int J Geriatr Psychiatry 2006; 21: 599–600.
