Major Depression in Elderly Home Health Care Patients (original) (raw)
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Depression prevalence and treatment among older home health services users in the United States
Archives of Gerontology and Geriatrics, 2018
The purpose of this study is to provide a nationally representative estimate of the rates of depression and depression treatment, and to explore factors associated with receipt of depression treatment, among older home health services users. Methods: Older home health services users (n = 1666) were selected from 2008 to 2013 Medical Expenditure Panel Survey. Depression was measured by the Patient Health Questionnaire-2. Depression treatment included antidepressants use and receipt of mental health counseling or psychotherapy. Logistic regression was used to examine the association of individual characteristics and receipt of depression treatment. Results: Current depression affected 23% of older home health services users. Less than 40% of those who screened positive for depression reported receiving depression treatment. Among those who received treatment, virtually all (99.8%) reported receiving antidepressants and only 9.5% reported receiving psychotherapy. Among older home health services users with current depression, older age and non-Hispanic black race were associated with lower odds of receiving depression treatment whereas having cognitive impairment was positively associated with receiving depression treatment. Conclusion: Depression affects a substantial proportion of older home health services users and is undertreated. Home health services settings may be important platforms to improve depression care among older adults. Future research is needed to develop optimal strategies for integrating depression assessment and treatment in home health services settings.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2014
Research is scarce on how depression is identified and treated among Medicare home healthcare (HHC) patients age 65+ with disability. The Centers for Medicare & Medicaid Services (CMS) recently incorporated depression screening into the OASIS-C HHC assessment. Our study objectives were to evaluate and characterize depression care management (DCM) in an HHC agency after CMS increased its depression requirements and to determine if there was an association of DCM with disability (activities of daily living [ADLs]) outcomes. The authors conducted a retrospective chart review of 100 new Medicare HHC admissions patients age 65+ (mean age: 81.7) who screened positive for depression and had disability and multimorbidity. Clinical and administrative records were examined and descriptive analyses used. Multivariate regression analyses investigated the association of six DCM components with ADLs improvement. Depression was recognized in care plans of 60% of patients. Documentation of only one...
Decreasing hospitalization rates for older home care patients with symptoms of depression
Journal of the American Geriatrics Society, 1998
To target medically ill older home care patients with symptoms of depression in order to reduce their rate of hospitalization. A case-control study. A private, nonprofit home care organization, the Visiting Nurse Association of St. Louis. Home care patients 65 years of age and older with symptoms of depression who were participants of a Total Quality Management (TQM) intervention (n = 81) were compared with an historical control of home care patients 65 years of age and older with symptoms of depression (n = 69). Utilization of TQM principles to develop a plan including: (a) an educational seminar on depression for home care staff involved in the project; (b) letters to physicians introducing the TQM project; (c) use of the Geriatric Depression Scale (GDS) for screening; (d) recommendation to the primary physician of a home social service (SS) consultation for patients with a GDS of 10 to 14; (e) recommendation to the primary physician of three interventions for patients with a GDS ...
Treating depression in nursing homes: practice guidelines in the real world
The Journal of the American Osteopathic Association, 2003
Depression in nursing home residents is a common phenomenon, though there is a wide range in the severity of this disorder as experienced by elderly adults in the United States. Treating older patients for depression is costly in both human and financial terms. The authors review guidelines and recommendations for the diagnosis of depression and medical treatment of depressed elderly adults from the 1993 Clinical Practice Guidelines for Depression in Primary Care by the US Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality), making note also of similar guidelines provided by the American Medical Directors Association in 1996 and those provided by the American Psychiatric Association in 2000. In November 1999, the authors used a Delphi survey to gather data from prescreened panelists (N = 10) to have the panel review and clarify the importance and feasibility of each "A" rated item in the US Agency for Health Care Policy and Resea...
Journal of Affective Disorders, 2016
Background: Depression is the most common psychiatric disease in older people, often accompanied by co-morbidities and functional limitations. In cross-sectional studies, depression is associated with an increased use of health care resources, including informal care and home care. Longitudinal data are needed to better understand the causal links between depression, functional impairments, and health care utilization. Methods: Data were obtained at baseline and follow-up of the multicenter, prospective cohort study "Late life depression in primary care: needs, health care utilization and costs" (AgeMooDe). A sample of 955 primary care patients aged 75 years and older was interviewed twice. The primary outcomes were the average respective amounts of time spent utilizing home care, professional nursing care, domestic help and informal care. These outcomes were analyzed with Generalized Linear Mixed Models (GLMM). Results: GLMM analysis revealed that the amount of time utilizing home care over the study period was positively associated with depression, higher age, and functional and cognitive impairments, but negatively associated with living alone. In-depth analyses revealed that these associations were particularly obvious for the utilization of informal care. Limitations: The generalizability of our findings may be limited due to use of a dimensional instrument to determine depressive symptoms. Conclusions: Over the study period, the average amount of time receiving home care and especially informal care increased in the group of patients with depression only. People with depressive symptoms experience a growing number of functional limitations over time, increasing their dependency on others. Functional limitations, depression and dependency appear to form a vicious cycle.
Identification of depressive disorder among older people in care homesa feasibility study
… Care Research & …, 2011
Background: Depression is common among older people but more common among those living in care homes. Depression is not easily detected among older adults because of the presentation, and the tendency for older people not to complain of depression, particularly those living in care homes. In general, care home staff have limited training in recognising depression. Depression is undertreated and residents may not receive a therapeutic dose of antidepressant. The true prevalence of depression among care home residents is uncertain. Method: This feasibility study aimed to explore the level of depression among older people in care homes by comparing the outcome of an assessment by care home staff with the outcome of a diagnostic clinical interview, using ICD-10 criteria and the 30-item Geriatric Depression Scale (GDS), conducted by a psychiatrist. Results: In all, 47 older people from four care homes were interviewed by a psychiatrist. Of them, 39.1% (18/46) of residents were prescribed an antidepressant and were no longer depressed; 8.7% (4/46) were prescribed an antidepressant and remained depressed; and 6.5% (3/46) of residents assessed as being depressed, had not been prescribed an antidepressant. That is, 54% (25/46) of residents had been or were currently depressed. Using ICD-10 criteria, the sensitivity of the GDS at a threshold of 10 and 11 was 100%. In total, 89.4% of residents received a correct diagnosis (presence or absence of depression) using the GDS at the 11 threshold. Summary: The prevalence of depression in these homes was 54%. Of the residents with depression, 72% (18/25) were managed with an antidepressant and 28% (7/25) were receiving ineffective or no treatment. The 30-item GDS can provide more useful information than a home care staff assessment for identifying depression. More research should explore the value of training home care staff to administer the 30-item GDS to optimise the management of depression in older people in care homes.
Factors to assess depression in homebound older adults
Mental Health Clinician
Introduction: The number of homebound older adults is expected to increase as the elderly population grows. Many homebound older persons may be at high risk for depression, which has been associated with adverse health outcomes. The objective of this study was to identify selected factors that may predict depression in the homebound older population. Methods: Data from 340 homebound adults, aged 65 and older who were enrolled in Broward Meals on Wheels and who participated in a telephone survey were analyzed. Participants were asked to report demographic information, health status, medication-taking behaviors, mental health, and life satisfaction. Multiple regression analysis was used to identify predictors of depressed mood in this sample of older adults. Results: The majority of the sample (aged 65–95 years; mean, 77 years) were female (76.5%), white (77.1%), and living alone (52.6%). Multivariate modeling indicated that difficulty remembering the number of prescribed medications ...
Managing Depression in Home Health Care: A Randomized Clinical Trial
Home Health Care Services Quarterly, 2007
A prospective randomized trial was conducted to examine the effectiveness, feasibility, and degree of implementation of home health care quality improvement interventions when implemented under usual conditions by usual care providers. 311 older adults were randomized to enhanced usual care (EUC) that included routine depression screening and staff training in depression care management for older adults or to the intervention group (INT) that included antidepressant and/or psychotherapy treatment plus EUC. Implementing a routine screening protocol using the PHQ-9 and depression care management quality improvements is feasible in diverse home health care organizations and results in consistently better (but not statistically significant) depression outcomes in the INT group.