RESUMEN
Objectives: Despite the increasing evidence for the effectiveness of telehealth technology in screening and treating depression in older adults, they have been slowly adopted by Home Health Care (HHC) agencies. Therefore, this study was conducted to determine how HHC agencies perceive and use telehealth technology for depression care among homebound older adult patients. Methods: Five-hundred-and-sixteen staff from the National Association for Homecare & Hospice (NAHC) member home health care agencies completed the online survey. Questions were asked of HHC staff regarding performance expectancy, effort expectancy, social influences, facilitating conditions, telehealth use and intention to use/continue to use telehealth. Results: The majority had a neutral or positive perception towards telehealth. However, participants from agencies that have yet to use telehealth (mean: 3.25, SD: 1.56) reported a less intention to use the technology for depression care versus those from agencies that did (mean: 4.64, SD: 1.37). This may be partially explained by the finding that only 32% perceived themselves as having the knowledge and 25% as having resources to use telehealth. Additionally, facilitating conditions and social influences were significant predictors of intention to use/continue to use telehealth for depression care (p-values < .01). Conclusion: Overall, staff had a neutral or positive perception towards telehealth. Factors such as fewer years of experience in using telehealth and a small annual budget may explain a negative perception towards telehealth. Therefore, further education and resources are needed to support telehealth use. Future studies may consider comparing telehealth programs and identifying supporting policies.
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Actitud del Personal de Salud , Depresión/terapia , Personas Imposibilitadas/psicología , Telemedicina/métodos , Adulto , Femenino , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Despite the increasing evidence for the effectiveness of telehealth technology in screening and treating chronic diseases, and comorbid depression among older adults, they have been slowly adopted by home health care (HHC) agencies. Therefore, this study aimed to identify factors that determine telehealth technology adoption. Twenty directors from the National Association for Homecare & Hospice member agencies completed a 45-min telephone interview. Questions were asked regarding their perceptions of telehealth, the key determinants of telehealth adoption and use, and recommendations they would give on telehealth adoption. The majority of the participants perceived telehealth as effective for managing symptoms and reducing cost. Meanwhile, some participants had a mixed feeling toward telehealth for depression care as they did not recognize their agency as equipped with the necessary resources and trained staff. Moreover, significant determinants of telehealth adoption included the agency-related characteristics, the patient-home environment, reimbursement and cost-related factors, and staff telehealth perception. Findings imply that there is a need for financial support both at the state and the federal levels to encourage telehealth adoption among HHC agencies. Future studies should consider exploring strategies used by successful programs to overcome barriers.
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Agencias de Atención a Domicilio , Personas Imposibilitadas/rehabilitación , Telemedicina , Adulto , Actitud del Personal de Salud , Enfermedad Crónica/terapia , Depresión/terapia , Femenino , Servicios de Atención de Salud a Domicilio , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
An interprofessional education (IPE) simulation-based geriatric palliative care training was developed to educate health professions students in team communication. In health care, interprofessional communication is critical to team collaboration and patient and family caregiver outcomes. Studies suggest that acquiring skills to work on health care teams and communicate with team members should occur during the early stage of professional education. The Interprofessional Education Collaborative (IPEC®) competency-based framework was used to inform the training. An evaluation examined attitudes toward health care teams, self-efficacy in communication skills, interprofessional collaboration, and participant satisfaction with the training experience. One-hundred and eleven participants completed pre- and post-training surveys. Overall, a majority of participants (97.3%) were satisfied with the training and reported more positive attitudes toward health care teams and greater self-efficacy in team communication skills. IPE participants had higher collaboration scores compared to observer learners. Further research is needed to explore long-term effects of IPE in clinical practice.
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Comunicación , Geriatría/educación , Empleos en Salud/economía , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente/organización & administración , Adulto , Actitud del Personal de Salud , Conducta Cooperativa , Femenino , Humanos , Relaciones Interprofesionales , Masculino , Autoeficacia , Entrenamiento Simulado/organización & administración , Adulto JovenRESUMEN
OBJECTIVES: To determine the effectiveness of Problem-Solving Therapy (PST) in older hemodialysis (HD) patients by assessing changes in health-related quality of life and problem-solving skills. METHODS: 33 HD patients in an outpatient hemodialysis center without active medical and psychiatric illness were enrolled. The intervention group (n = 15) received PST from a licensed social worker for 6 weeks, whereas the control group (n = 18) received usual care treatment. RESULTS: In comparison to the control group, patients receiving PST intervention reported improved perceptions of mental health, were more likely to view their problems with a positive orientation and were more likely to use functional problem-solving methods. Furthermore, this group was also more likely to view their overall health, activity limits, social activities and ability to accomplish desired tasks with a more positive mindset. CONCLUSIONS: The results demonstrate that PST may positively impact mental health components of quality of life and problem-solving coping among older HD patients. CLINICAL IMPLICATIONS: PST is an effective, efficient, and easy to implement intervention that can benefit problem-solving abilities and mental health-related quality of life in older HD patients. In turn, this will help patients manage their daily living activities related to their medical condition and reduce daily stressors.
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Adaptación Psicológica , Depresión/terapia , Solución de Problemas , Psicoterapia/métodos , Calidad de Vida , Diálisis Renal/psicología , Anciano , Depresión/etiología , Humanos , Fallo Renal Crónico/psicología , Fallo Renal Crónico/terapia , Proyectos PilotoRESUMEN
Professional social workers are the largest provider of mental health services in the nation, yet they receive little coursework or clinical training in late-life depression unless they are in a gerontology specialization. Simulation training offers academic experiences that evoke conditions of the real world in a practical way. One hundred and four graduate social work students consented and completed the Standardized Patient Simulation course consisting of a human simulator interview, pre- and postdebriefing on late life depression, and self and faculty ratings of outcome measures. Results from pre-post testing of measures and the debriefing evaluation demonstrated that students gained in knowledge and achieved clinical skill competency. Students reported that the patient simulator was convincing, the environment was realistic, and they were satisfied with the training. The educational methodology tests students in challenging situations and offers immediate educational feedback to integrate and improve practice behaviors towards achieving clinical competency.
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Depresión , Geriatría/educación , Entrenamiento Simulado/métodos , Servicio Social/educación , Competencia Clínica , Depresión/diagnóstico , Depresión/psicología , Humanos , Enfermedades de Inicio Tardío/diagnóstico , Enfermedades de Inicio Tardío/psicología , Evaluación de Programas y Proyectos de Salud , EstudiantesRESUMEN
This article presents findings from an annual program survey of residents of a horizontal neighborhood naturally occurring retirement community (NNORC). The study explored the relationship between several factors (age, co-residents, number of chronic illnesses, self-reported health, loneliness, sense of mastery, locus of control, pain, and psychological distress) and their ability to predict general health, level of psychological distress, and the quantity and type of help-seeking behaviors. Although residents generally reported moderate to high levels of chronic disease, pain, loneliness, and concerns about life issues, 25% of them sought no help from any of the listed resources, and 65% sought help from only one of seven resources. The most common source of help for most (70%) was a primary care physician (PCP), and comparatively few respondents sought help from other sources. Older adults, especially those with chronic illness, generally consider their PCP to be the first, and perhaps only, source to consult. However, research indicates that the most effective health promotional programs for older adults are social and educational group activities, rather than individual health-focused interventions. Possible means of redirecting residents toward NNORC services include more vigorous outreach and creating collaborative partnerships between local PCPs serving older populations and the NNORC.
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Servicios de Salud Comunitaria/estadística & datos numéricos , Conducta de Búsqueda de Ayuda , Estrés Psicológico/psicología , Anciano , Anciano de 80 o más Años , Instituciones de Vida Asistida/normas , Instituciones de Vida Asistida/estadística & datos numéricos , Femenino , Humanos , Modelos Lineales , Soledad/psicología , Masculino , Dolor/complicaciones , Dolor/psicología , Psicometría/instrumentación , Psicometría/métodos , Psicometría/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Estrés Psicológico/complicaciones , Encuestas y CuestionariosRESUMEN
This pilot survey study explores current telehealth use among home health care agencies for chronic illness and depression care, and identifies factors associated with agencies' perception and intention to use telehealth. Between June and August 2014, 73 directors and 13 staff nurses (N = 86) from the Pennsylvania Homecare Association member agencies participated in an online survey. Eighty-five percent of telehealth provider agencies reported utilizing telehealth for monitoring health status while only 7.7% reported use for depression care. Telehealth technology was more positively perceived for chronic illness care (90.7%) than for depression care (53%) services. Factors associated with positive perceptions of telehealth were identified, including: (a) intention to use or continuing to use telehealth, (b) the size of the agency, (c) the participant's agency role, and (d) existence of depression services. These pilot findings have been used to inform the theoretical framework and the survey instrument for our U.S. national survey.
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Enfermedad Crónica/terapia , Depresión/terapia , Manejo de la Enfermedad , Telemedicina/estadística & datos numéricos , Adulto , Anciano , Enfermedad Crónica/psicología , Depresión/psicología , Femenino , Agencias de Atención a Domicilio/tendencias , Humanos , Masculino , Persona de Mediana Edad , Enfermeros de Salud Comunitaria , Pennsylvania , Proyectos Piloto , Encuestas y CuestionariosRESUMEN
AIMS: Depression is common among dialysis patients and is associated with adverse outcomes. Problem-solving therapy (PST) is effective for treating depression in older patients with chronic illness, but its effectiveness has never been reported in hemodialysis (HD) patients. We investigated the feasibility and satisfaction of PST and its impact on depression scores among older HD patients. METHODS: Patients at least 60 years of age receiving maintenance HD at a single outpatient dialysis center were eligible for the study. Randomized patients received either 6 weeks of PST from a licensed renal social worker or usual care. This study modeled the staff-patient ratio standard of most dialysis clinics, and therefore only one social worker provided the interventions. Study outcomes included feasibility (successful completion of 6 weekly sessions) and patient satisfaction with PST as well as impact on depression scores (between-group comparison of mean Beck depression inventory (BDI) and Patient health questionnaire-9 (PHQ-9) scores at 6 weeks, and of mean change-from-baseline scores). RESULTS: The recruitment rate was 92% (35/38). All subjects randomized to the intervention arm (n = 17) and who initiated PST (n = 15) completed the study, and all reported overall satisfaction with the intervention. 87% reported that PST helped them to better solve problems and improved their ability to cope with their medical condition. At 6 weeks, there were no significant differences in mean BDI and PHQ scores between the usual care and the intervention group (BDI 11.3 vs. 9.3, p = 0.6; PHQ 5.7 vs. 3.3, p = 0.1). Mean change-from-baseline depression scores were significantly improved in the intervention group relative to the control group (change in BDI 6.3 vs.- 0.6, p = 0.004; change in PHQ 7.2 vs. 0.3, p < 0.001). CONCLUSIONS: The results demonstrate that PST is feasible in the dialysis unit setting, acceptable to patients, and may positively impact depression among maintenance hemodialysis patients.
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Depresión/terapia , Enfermedades Renales/terapia , Solución de Problemas , Psicoterapia/métodos , Diálisis Renal/psicología , Servicio Social , Adaptación Psicológica , Factores de Edad , Anciano , Anciano de 80 o más Años , Atención Ambulatoria , Depresión/diagnóstico , Depresión/etiología , Depresión/psicología , Estudios de Factibilidad , Femenino , Humanos , Enfermedades Renales/diagnóstico , Enfermedades Renales/psicología , Masculino , Satisfacción del Paciente , Philadelphia , Proyectos Piloto , Escalas de Valoración Psiquiátrica , Diálisis Renal/efectos adversos , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: To evaluate an integrated telehealth intervention (Integrated Telehealth Education and Activation of Mood (I-TEAM)) to improve chronic illness (congestive heart failure, chronic obstructive pulmonary disease) and comorbid depression in the home healthcare setting. DESIGN: Randomized controlled trial. SETTING: Hospital-affiliated home healthcare setting. PARTICIPANTS: Medically frail older homebound individuals (N = 102). INTERVENTION: The 3-month intervention consisted of integrated telehealth chronic illness and depression care, with a telehealth nurse conducting daily telemonitoring of symptoms, body weight, and medication use; providing eight weekly sessions of problem-solving treatment for depression; and providing for communication with participants' primary care physicians, who also prescribed antidepressants. Control participants were allocated to usual care with in-home nursing plus psychoeducation (UC+P). MEASUREMENTS: The two groups were compared at baseline and 3 and 6 months after baseline on clinical measures (depression, health, problem-solving) and 12 months after baseline on health utilization (readmission, episodes of care, and emergency department (ED) visits). RESULTS: Depression scores were 50% lower in the I-TEAM group than in the UC+P group at 3 and 6 months. Those who received the I-TEAM intervention significantly improved their problem-solving skills and self-efficacy in managing their medical condition. The I-TEAM group had significantly fewer ED visits (P = .01) but did not have significantly fewer days in the hospital at 12 months after baseline. CONCLUSION: Integrated telehealth care for older adults with chronic illness and comorbid depression can reduce symptoms and postdischarge ED use in home health settings.
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Prestación Integrada de Atención de Salud/métodos , Depresión/terapia , Servicios de Atención de Salud a Domicilio , Personas Imposibilitadas , Telemedicina/métodos , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Depresión/psicología , Femenino , Humanos , Masculino , Calidad de VidaRESUMEN
Heart disease is a major cause of hospitalization and is associated with greater impairment than arthritis, diabetes mellitus, or lung disease. Depression is prevalent and a serious co-morbidity in heart disease with negative consequences including higher levels of chronic physical illness, decreased psychological well-being, and increased health care costs. The objective of the study was to examine with meta-analysis the impact of community-based cardiac rehabilitation (CR) treatment on depression outcomes in older adults. Randomized controlled trials comparing patients (≥64 years old) receiving CR to cardiac controls were considered. Meta-analyses were based on 18 studies that met inclusion criteria, comprising 1,926 treatment participants and 1,901 controls. Effect sizes (ESs) ranged from -0.39 (in favor of control group) to 1.09 (in favor of treatment group). Mean weighted ES was 0.28, and 11 studies showed positive ESs. Meta-analysis suggests that most CR programs delivered in the home can significantly mitigate depression symptoms. Tailored interventions combined with psychosocial interventions are likely to be more effective in decreasing depression in older adults with heart disease than usual care.
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Rehabilitación Cardiaca , Trastorno Depresivo/diagnóstico , Terapia por Ejercicio/métodos , Calidad de Vida , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/psicología , Trastorno Depresivo/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Ensayos Clínicos Controlados Aleatorios como Asunto , Valores de Referencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Resultado del TratamientoRESUMEN
PURPOSE: Telehealth care is emerging as a viable intervention model to treat complex chronic conditions, such as heart failure (HF) and chronic obstructive pulmonary disease (COPD), and to engage older adults in self-care disease management. DESIGN AND METHODS: We report on a randomized controlled trial examining the impact of a multifaceted telehealth intervention on health, mental health, and service utilization outcomes among homebound medically ill older adults diagnosed with HF or COPD. Random effects regression modeling was used, and we hypothesized that older adults in the telehealth intervention (n = 51) would receive significantly better quality of care resulting in improved scores in health-related quality of life, mental health, and satisfaction with care at 3 months follow-up as compared with controls (n = 51) and service utilization outcomes at 12 months follow-up. RESULTS: At follow-up, the telehealth intervention group reported greater increases in general health and social functioning, and improved in depression symptom scores as compared with usual care plus education group. The control group had significantly more visits to the emergency department than the telehealth group. There was an observed trend toward fewer hospital days for telehealth participants, but it did not reach significance at 12 months. IMPLICATIONS: Telehealth may be an efficient and effective method of systematically delivering integrated care in the home health sector. The use of telehealth technology may benefit homebound older adults who have difficulty accessing care due to disability, transportation, or isolation.
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Insuficiencia Cardíaca/enfermería , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Personas Imposibilitadas/psicología , Evaluación de Procesos y Resultados en Atención de Salud , Enfermedad Pulmonar Obstructiva Crónica/enfermería , Telemedicina , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Masculino , Salud Mental , New York , Satisfacción del Paciente , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Calidad de Vida , Análisis de RegresiónRESUMEN
Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.
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Agencias de Atención a Domicilio/normas , Servicios de Atención de Salud a Domicilio/normas , Medicare/normas , Trastornos Mentales , Manejo de Atención al Paciente , Asistencia Social en Psiquiatría/normas , Anciano , Comorbilidad , Prestación Integrada de Atención de Salud/organización & administración , Política de Salud , Personas Imposibilitadas , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Salud Mental , Atención al Paciente/métodos , Atención al Paciente/normas , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/organización & administración , Cooperación del Paciente , Estados UnidosRESUMEN
Anxiety disorders and related symptoms commonly occur in older people with cognitive impairment or dementia, significantly worsening functioning and reducing quality of life. This review of the literature outlines the extent of the problem, and focuses on current best practices in psychosocial interventions anxiety in persons with dementia. Discussion follows on promising nonpharmacological interventions that are recommended for further consideration and future research.
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Trastornos de Ansiedad , Ansiedad/prevención & control , Terapia Conductista , Trastornos del Conocimiento , Demencia , Personas con Discapacidades Mentales/rehabilitación , Terapia Socioambiental , Actividades Cotidianas/psicología , Anciano , Ansiedad/psicología , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/terapia , Ensayos Clínicos como Asunto , Trastornos del Conocimiento/psicología , Trastornos del Conocimiento/terapia , Demencia/psicología , Demencia/terapia , Humanos , Competencia Mental/psicología , Personas con Discapacidades Mentales/psicología , Guías de Práctica Clínica como Asunto , Calidad de VidaRESUMEN
BACKGROUND: Randomized trial evaluated problem-solving therapy in home care (PSTHC) for homebound older adults with cardiovascular disease receiving acute home care services. This study hypothesized that compared with usual care plus education intervention, home-based PST-HC would significantly reduce depression and anxiety scores, lead to improved quality of life, and greater satisfaction with treatment among elderly with cardiovascular disease. METHODS: Thirty-eight participants were recruited from a university-affiliated home healthcare agency for the trial. Six 1-hour PST-HC sessions included depression education, problem-solving skills, pleasurable activity scheduling, homework, and weekly telephone calls over a 6-week period. The control comparison group received usual care plus two sessions of education and a depression brochure. Outcome measures included the Beck Depression Inventory, Hamilton Rating Scale for Depression, Beck Anxiety Inventory, and the short form (SF)-36 health status measure. After the intervention, both groups completed the Patient Satisfaction Questionnaire. RESULTS: Compared with the control group, the PST-HC group showed a significant decrease in depression but not anxiety scores. The PST-HC group generally reported more favorable satisfaction with treatment than the control group. The PST-HC group improved significantly, when compared with the control group in only two of eight SF-36 subscales: mental health and emotional role function. CONCLUSIONS: The brief PST-HC intervention demonstrated that depression improved among home care elderly. However, there was no change in six of eight health status measures or anxiety level. Authors discuss integrating interdisciplinary depression care in the home care setting.
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Enfermedades Cardiovasculares/terapia , Depresión/terapia , Servicios de Atención de Salud a Domicilio , Solución de Problemas , Psicoterapia Breve/métodos , Anciano , Enfermedades Cardiovasculares/complicaciones , Depresión/complicaciones , Femenino , Humanos , Masculino , Satisfacción del PacienteRESUMEN
Late-life depression has attracted considerable attention in the social work literature. This study examined levels of knowledge and self-efficacy (confidence) in evaluation of depression in late life among a random sample of social workers (N = 168) from the National Association of Social Workers. Relationships among knowledge on aging, job-related variables, and predictors of knowledge of geriatric depression were examined. Participants ranked depression as one of the most frequent clinical problems seen in practice, scored at the lower end on knowledge about aging, and experienced great difficulty on the items pertaining to suicide in the older adults.
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Envejecimiento/psicología , Competencia Clínica/estadística & datos numéricos , Trastorno Depresivo/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Servicio Social/educación , Adulto , Anciano , Femenino , Evaluación Geriátrica , Humanos , Masculino , Persona de Mediana Edad , New York , Autoeficacia , Encuestas y CuestionariosRESUMEN
Depressive symptoms are highly prevalent among medically ill homebound elderly and are associated with significant functional decline, lower quality of life, and increased health care utilization. Despite this, depression is generally underdiagnosed and undertreated among medically ill homebound older adults. The objective of this study was to determine the validity of a brief depression measure (CES-D) and examine the nature of depressive symptoms reported by the older sample. Using confirmatory factor and rating scale analysis, the factor structure of responses in a cross-sectional home care sample (n=618) was examined with a further analysis of item responses from identified urban and rural subsamples. Radloff's (1977) four-factor depression model fit the data well. Some symptom items were expressed differently and this offers an opportunity to understand the unique clinical aspects of depression in homebound older adults.
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Escalas de Valoración Psiquiátrica Breve/normas , Depresión , Anciano Frágil , Evaluación Geriátrica/métodos , Personas Imposibilitadas , Actividades Cotidianas/psicología , Anciano , Anciano de 80 o más Años , Investigación sobre la Eficacia Comparativa , Depresión/diagnóstico , Depresión/psicología , Diagnóstico Precoz , Análisis Factorial , Femenino , Servicios de Salud para Ancianos/estadística & datos numéricos , Humanos , Masculino , Calidad de Vida/psicología , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: This systematic review examined the effectiveness of community-based heart-health interventions on depression outcomes among homebound elderly (64 years and older) with heart disease. DESIGN AND METHODS: A comprehensive literature search and meta analysis was performed to evaluate randomized controlled trials examining outpatient or home-based interventions. Methodological quality was assessed by standard criteria developed by the Cochrane Collaborative Initiative. RESULTS: Fifteen studies met our inclusion criteria and all measured depression outcomes. Studies differed in scope and methodological rigor and sample sizes varied widely. Problems in treatment fidelity and masking of group assignment were noted. Great variability was found in depression outcomes due to the differences in methodology and intervention. Five studies reported significant treatment effect on depression; three of those employed home-based interventions and two were outpatient-clinic interventions. Ten studies were included in the meta analysis and the effect sizes (ESs) ranged from -0.39 (in favor of control group) to 0.65 (in favor of treatment group). The mean weighted ES was 0.11 and six studies showed positive ESs. IMPLICATIONS: Mixed evidence for community-based heart disease interventions on depression outcomes was found. Future research should include sub-analysis of ESs of interventions on depression outcomes by different demographic characteristics of the study sample, common depression outcome measures, and different follow-up periods.
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Depresión/prevención & control , Cardiopatías/psicología , Anciano , Anciano de 80 o más Años , Servicios de Salud Comunitaria , Depresión/terapia , Femenino , Personas Imposibilitadas , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: This article provides data on a depression screening model (HOME) in acute home health care designed to detect clinical depression among medically ill homebound older patients. The model was developed to address the lack of mental health services in home health care settings and to specifically improve geriatric depression screening as part of routine care. Authors report on the concordance of homecare and research interview ratings of depression in older homecare patients. DESIGN AND METHODS: Using a prospective cohort design, data were collected from 289 elderly patients, aged 65 and older, from a large home health care agency to examine depression, cognitive functioning, medical comorbidity, functional status, and social isolation. Research interviews used the depression module of the structured clinical interview for DSM (SCID). RESULTS: The overall prevalence of major depression was 5.7 percent according to both homecare and research raters. The prevalence of subthreshold depressive disorder was 16.4 percent as reported by research raters. Observed agreement was 73 percent and kappa agreement was 0.42, indicating a fair to moderate agreement. We identified patient characteristics that may influence the accuracy of homecare worker estimates of depressive symptoms. IMPLICATIONS: Findings suggest that depression continues to be underdetected in medically ill homebound elderly patients. Ongoing training in depression screening methods, patient follow-up interviews, and appropriate referral would improve care of depressed elderly homecare patients.
RESUMEN
OBJECTIVE: The authors present data from a pilot research program initiated to develop, refine, and test the outcomes of Brief Problem-Solving Therapy in Home Care (PST-HC) that targets the needs of older adults identified with severe depressive symptoms in an acute home care setting. METHODS: A pilot randomized clinical trial compared the impact of PST-HC to usual care (UC) in a sample of older medically ill home care patients identified with severe depressive symptoms. Forty patients were randomly assigned to either six weekly sessions of PST-HC in their home or standard home care services. Depression, quality of life, and problem-solving ability were measured at baseline, posttreatment, three-month follow-up, and six-month follow-up by blinded evaluators. RESULTS: All 40 patients provided follow-up data. No differences between the two groups were found on any demographic variables. Outcome data suggested significant improvements in depression scores over time after PST-HC, relative to UC. PST-HC patients reported higher quality of life and problem-solving ability scores relative to UC. CONCLUSION: Results suggest that PST-HC is well tolerated and holds promise for reducing persistent depressive symptoms. The authors discuss limitations in terms of the "real-world" applicability of this psychosocial treatment for late-life depression.