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Potentially inappropriate management of depressive symptoms among Ontario home care clients
- Authors:
- DALBY Dawn M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(6), June 2008, pp.650-659.
- Publisher:
- Wiley
The authors' objective was to examine the prevalence and correlates of potentially inappropriate pharmacotherapy (including potential under-treatment) for depression in adult home care clients by means of a cross-sectional study of clients receiving services from Community Care Access Centres in Ontario, 3,321 of whom were assessed with the Resident Assessment Instrument for Home Care (RAI-HC). A score of 3 or greater on the Depression Rating Scale, a validated scale embedded within the RAI-HC, indicates the presence of symptoms of depression. Medications listed on the RAI-HC were used to categorise treatment into two groups: potentially appropriate and potentially inappropriate antidepressant drug therapy. Adjusted logistic regression models were used to explore relevant predictors of potentially inappropriate pharmacotherapy. The results showed 414 (12.5%) had symptoms of depression and 17% received an appropriate antidepressant. Over half (64.5%) received potentially inappropriate pharmacotherapy (including potential under-treatment). At age 75 or older, higher levels of caregiver stress and the presence of greater comorbidity were associated with a higher risk of potentially inappropriate pharmacotherapy in multivariate analyses. Documentation of any psychiatric diagnosis on the RAI-HC and receiving more medications were significantly associated with a greater likelihood of appropriate drug treatment. It was concluded that most clients with significant depressive symptoms were not receiving appropriate pharmacotherapy. Having a documented diagnosis of a psychiatric condition on the RAI-HC predicted appropriate pharmacotherapy. By increasing recognition of psychiatric conditions, the use of standardised, comprehensive assessment instruments in home care may represent an opportunity to improve mental health care in these settings.
Late-life depression, social support, instrumental activities of daily living, and utilization of in-home and community-based services in older adults
- Authors:
- LAM Brian Trung, CERVANTES Anna R., LEE Wilfred K.
- Journal article citation:
- Journal of Human Behavior in the Social Environment, 24(4), 2014, pp.499-512.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This study examined the relationship between social support, depression, instrumental activities of daily living (IADLs), and utilisation of in-home and community-based services. The sample included 39 adults age 65 years old and older. The data were collected by distributing a self-administered questionnaire. Depression levels significantly decreased as levels of social support increased. IADLs functioning significantly decreased as depression levels increased. The number of in-home services used significantly increased as IADLs functioning decreased. The number of community-based services used significantly increased as depression levels decreased. The number of in-home and community-based services used significantly increased as levels of support decreased. (Edited publisher abstract)
Being cared for: a discussion document about older people with depression living at home
- Author:
- COUNSEL AND CARE
- Publisher:
- Counsel and Care
- Publication year:
- 1994
- Pagination:
- 43p.
- Place of publication:
- London
Initial report from a research project looking at the quality of life of older people with depression living in the community, and at the services they are receiving and the kind of services they should be getting.
Screening for depression in older adults with cognitive impairment in the homecare setting: a systematic review
- Authors:
- NICULESCU Iulia, ARORA Twinkle, IABONI Andrea
- Journal article citation:
- Aging and Mental Health, 25(9), 2021, pp.1585-1594.
- Publisher:
- Taylor and Francis
Objective: Previous systematic reviews have examined depression screening in older adults with cognitive impairment (CI) in outpatient and inpatient clinics, nursing homes, and residential care. Despite an increasing number of older adults with CI receiving care in their homes, less is known about best depression screening practices in homecare. The objective of this review is to identify evidence-based practices for depression screening for individuals with CI receiving homecare by assessing tool performance and establishing the current evidence for screening practices in this setting. Methods: This review is registered under PROSPERO (ID: CRD42018110243). A systematic search was conducted using MEDLINE, EMBASE, Health and Psychosocial Abstracts, PsycINFO and CINAHL. The following criteria were used: assessment of depression at home in older adults (>55 years) with CI, where performance outcomes of the depression screening tool were reported. Results: Of 5,453 studies, only three met eligibility criteria. These studies evaluated the Patient Health Questionnaire (n = 236), the Geriatric Depression Scale (n = 79) and the Mental Health Index (n = 1,444) in older adults at home with and without CI. Psychometric evaluation demonstrated moderate performance in the subsamples of people with CI. Conclusion: At present, there is insufficient evidence to support best practices in screening for depression in people with CI in homecare. (Edited publisher abstract)
Perceptions and practice behaviors regarding late-life depression among private duty home care workers: a mixed-methods study
- Authors:
- XIANG Xiaoling, et al
- Journal article citation:
- Aging and Mental Health, 24(11), 2020, pp.1904-1911.
- Publisher:
- Taylor and Francis
Background: This study aimed to examine personal care aides (PCAs)’ knowledge, beliefs, and attitudes towards late-life depression and their experience caring for older adults with depression. Method: This study used a mixed-methods convergent parallel design involving an online survey (n = 87) and semi-structured interviews (n = 22). Survey respondents were recruited using convenience sampling and interviewees using purposive sampling from private duty home care agencies in Michigan. Qualitative data analyzed using a technique involving data reduction and open coding. Survey data were analyzed using descriptive statistics. Results: Most PCAs underestimated suicide rate among older adults, overrated self-help ability of the depressed person, underrated difficulty diagnosing depression, and attributed depression to personality flaws. PCAs favored psychotherapy and informal support and generally regarded medication as unhelpful, particularly in mild/moderate depression. Despite these discordances, PCAs’ self-reported practice behaviors included strategies (i.e., communication, behavioral, cognitive, emotional regulation, relational, and external) that were largely consistent with the scientific view, particularly relating to behavioral activation. A prominent theme from PCAs’ narratives was individualized care, reflected in their assessment of depressive symptoms, attitude towards depression treatment, and strategies caring for clients. Conclusions: Several areas of PCAs’ perceptions regarding late-life depression were discordant with the current scientific view, although their practice behaviors were largely consistent with the principles of evidence-based practice for depression. Specialized mental health training, a standard depression care protocol, and higher training standards are essential to mobilize the large number of PCAs to improve the mental health outcomes of hard-to-reach older adults. (Edited publisher abstract)
Impairments in life quality among clients in geriatric home care: associations with depressive and anxiety symptoms
- Authors:
- DIEFENBACH Gretchen J., TOLIN David F., GILLIAM Christina M.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(8), August 2012, pp.828-835.
- Publisher:
- Wiley
This study examined the independent contributions of depressive and anxiety symptoms to quality of life among older adults who were in receipt of a home care program. Participants were 66 community-dwelling older adults (ages 65 years and older), living in the northwestern United States who were experiencing chronic medical illness and concomitant functional disability. They completed self-report measures of depression, anxiety, and health-related quality of life. Additional data on cognitive, health, and functional status were collected for use as covariates. The associations of depressive symptoms with quality of life impairments in home care were substantial and pervasive. Depressive symptoms were significantly associated with quality of life impairments in nearly all domains. After controlling for depressive symptoms, anxiety symptoms accounted for additional and statistically significant variance in impaired life quality in the domains of mental health, role emotional functioning, and bodily pain. The results show that depressive and anxiety symptoms have negative associations with life quality among older adults receiving home care. The authors highlight the importance of developing community-based programs to assess and treat depressive and anxiety symptoms among home care clients.
Behavioral health needs and problem recognition by older adults receiving home-based aging services
- Authors:
- GUM Amber M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(4), April 2009, pp.400-408.
- Publisher:
- Wiley
Older adults' recognition of a behavioural health (ie mental health or substance abuse) need is one of the strongest predictors of their use of behavioural health services. Thus, study aims were to examine behavioural health problems in a sample of older adults receiving home-based aging services, their recognition of behavioural health problems, and covariates of problem recognition. The study design was cross-sectional. Older adults (n = 141) receiving home-based aging services completed interviews that included: Structured Clinical Interview for DSM-IV; Brief Symptom Inventory-18; attitudinal scales of stigma, expectations regarding aging, and thought suppression; behavioural health treatment experience; and questions about recognition of behavioural health problems. Thirty (21.9%) participants received an Axis I diagnosis (depressive, anxiety, or substance); another 17 (12.1%) were diagnosed with an adjustment disorder. Participants were more likely to recognize having a problem if they had an Axis I diagnosis, more distress on the BSI-18, family member or friend with a behavioural health problem, and greater thought suppression. In logistic regression, participants who identified a family member or friend with a behavioural health problem were more likely to identify having a behavioural health problem themselves. Findings suggest that older adults receiving home-based aging services who recognize behavioural health problems are more likely to have a psychiatric diagnosis or be experiencing significant distress, and they are more familiar with behavioural health problems in others. This familiarity may facilitate treatment planning; thus, older adults with behavioural health problems who do not report familiarity of problems in others likely require additional education .
Configuration of services used by depressed older adults
- Authors:
- CHOI S., MORROW-HOWELL N., PROCTOR E.
- Journal article citation:
- Aging and Mental Health, 10(3), May 2006, pp.240-249.
- Publisher:
- Taylor and Francis
As a more comprehensive service use measure, this study identifies service use configurations based on the use of 17 services. Factors associated with service use configurations are examined guided by the Andersen and Network Episode models. Self-report data at admission and at six-month follow-up were collected, along with information from medical charts among 140 older adults hospitalized for major depression. The data document service access and levels of use in three sectors of care (psychiatric, medical, and psychosocial services) and assess need, predisposing, enabling, and social network factors associated with use. Three distinct service use configurations were identified with cluster analysis: (1) home care users; (2) moderate users of outpatient mental health services; and (3) heavy users of all formal services. Rather than psychiatric needs, post-acute service use was related to: (1) concurrent physical conditions; (2) the availability of formal and informal services; and (3) financial stability. No difference in psychiatric outcomes was found by service use configuration. It is important to understand service use patterns as a measure of service use, given the co-occurring medical, psychiatric, and psychosocial conditions of older adults and corresponding needs in multiple sectors of care.
Mental health distress in homebound older adults: importance of the aging network
- Authors:
- FULLEN Matthew C., et al
- Journal article citation:
- Aging and Mental Health, 25(8), 2021, pp.1580-1584.
- Publisher:
- Taylor and Francis
Homebound older adults may be at risk of suicide due to elevated loneliness, social isolation, and depression. The Interpersonal Theory of Suicide posits that thwarted belongingness, perceived burdensomeness, and reduced fear of death are key components of suicide risk. To better understand suicide risk among culturally diverse, homebound older adults, we collected baseline data on the prevalence of psychological distress, thwarted belongingness, perceived burdensomeness, and past/present suicidality. Standardized measures were completed by 493 adults (ages 60-103) during in-home interviews, and results were compared to existing cutoffs to assess current risk. In total, 15.62% scored above the suicide risk cutoff, 23.73% of homebound older adults reported a history of suicidal ideation or behavior, 65 adults in this sample (13.18%) indicated the possibility of attempting suicide in the future, and 2.43% described a future attempt as “likely” or “very likely.” There were no differences in suicide risk, thwarted belongingness, or perceived burdensomeness based on sex and race. However, there was a significant difference in psychological distress (F(3,428) = 2.624, p = .05), with White females (M = 7.90, SD = 5.63; N = 78) scoring higher than Black males (M = 5.43, SD = 5.04; N = 81). Using Aging Network services such as nutrition services (e.g.home-delivered meal programs) to intervene with at-risk older adults represents a strategy to prevent suicide. Implications for suicide intervention, including the potential to deliver services by linking them to nutrition services programs, are discussed. (Edited publisher abstract)
Depression care services and telehealth technology use for homebound elderly in the United States
- Authors:
- KIM Eun hae, et al
- Journal article citation:
- Aging and Mental Health, 23(9), 2019, pp.1164-1173.
- Publisher:
- Taylor and Francis
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. (Edited publisher abstract)