Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
De Leo et al's study
(2002) confirmed that a
TeleHelpTeleCheck service reduced suicides among elderly service users
in northern Italy. The authors comment that the highest suicide rates in
almost every country (including Hong Kong and China) are among those aged more
than 75 years. The literature suggests that considerable numbers of suicides
among the elderly are due to depression. Conwell
(1996) reported that 60-75% of
those who committed suicide had a diagnosis of depression among patients aged
75 years. This is particularly relevant in elderly people with chronic
physical conditions such as stroke and Parkinson's disease. My colleagues and
I (Tsang et al, 2002)
recently hypothesised, after a comprehensive literature review, that
depression in elderly people with chronic physical illnesses results from
disability and a reduction in psychosocial resources. If depression is left
untreated, suicide may be a consequence.
In view of the high prevalence rates and seriousness of the consequences of the co-occurrence of depression and physical illnesses in later life, various approaches have been developed to counteract the effect of depressed mood. De Leo et al's study reports one such approach, using a telephone helpline and emergency response service. We (Tsang et al, 2002) proposed qigong as a psychosocial intervention to help elderly people with depression and chronic physical illnesses. Qigong has a long history with diverse schools in China. It can be seen as a method to regulate the body, breathing and mind. In China, health and longevity are believed to be determined by strength, balance and cultivation of the three treasures: jing (essence), qi (energy) and shen (spirit). Qigong focuses on these three treasures to represent a holistic view of the human being. Eight-section brocades is one of the many forms of health-promoting Chinese qigong.
A pilot study (Tsang et al, 2002) using a group of eight out-patients (two males and six females) suffering from chronic physical illnesses was conducted in Hong Kong. The mean age of the participants was 68 years (s.d.=10.7). Rating on the Geriatric Depression Scale showed that the participants had a certain degree of depressed mood, even though they did not carry a clinical diagnosis of depression. The participants received 1 h practice of qigong, twice a week, under the supervision of a qualified practitioner. As all participants had satisfactory standing balance, the standing-style eight-section brocades were used as the intervention protocol. The participants were asked to practise it daily (under the supervision of their relatives, who were also trained by the practitioner) for at least 30 min (in addition to the twice-weekly supervised practice in the hospital). The feedback from the participants showed that six of them (75%) felt better in terms of their psychosocial functioning after the 12-week programme. Before 6 weeks of practice, only three (37.5%), however, reported improvement. At an early stage, the feedback centred around physical function such as movement of the limbs and activities of daily living. At a later stage, the feedback then shifted more to psychological aspects. The improvement included feeling more relaxed, more comfortable, better sleep and being more optimistic. All of these reported improvements in psychosocial functioning are indicative of less depressed mood and improved quality of life. This preliminary report showed that qigong is promising as an alternative intervention for elderly people with depression and with chronic physical illness to improve their biopsycho-social health and possibly reduce their suicide rate. More systematic evaluation with larger samples and a longer period of intervention is now underway in Hong Kong.
REFERENCES
Conwell, Y. (1996) Suicide in elderly patients. In Diagnosis and Treatment of Depression in Late Life (eds L. S. Schneider, C. F. Reynolds III, B. D. Lebowitz, et al). Washington, DC: American Psychiatric Press.
De Leo, D., Buono, M. D. & Dwyer, J. (2002)
Suicide among the elderly: the long-term impact of a telephone support and
assessment intervention in northern Italy. British Journal of
Psychiatry, 181, 226
-229.
Tsang, H. W. H., Cheung, L. & Lak, D. (2002) Qigong as a psychosocial intervention for depressed elderly with chronic physical illnesses. International Journal of Geriatric Psychiatry, 17, 1146 -1154.[CrossRef][Medline]
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