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Guthrie DM, Williams N, Jaiswal A, Mick P, O’Rourke HM, Pichora-Fuller MK, Wittich W, Sutradhar R. Prevalence of sensory impairments in home care and long-term care using interRAI data from across Canada. BMC Geriatr 2022; 22:944. [PMID: 36482317 PMCID: PMC9733010 DOI: 10.1186/s12877-022-03671-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In the general population, sensory impairments increase markedly with age in adults over 60 years of age. We estimated the prevalence of hearing loss only (HL), vision loss only (VL), and a combined impairment (i.e., dual sensory loss or DSL) in Canadians receiving home care (HC) or long-term care (LTC). METHODS Annual cross-sectional analyses were conducted using data collected with one of two interRAI assessments, one used for the HC setting (n = 2,667,199), and one for LTC (n = 1,538,691). Items in the assessments were used to measure three mutually exclusive outcomes: prevalence of VL only, HL only, or DSL. Trends over time for each outcome were examined using the Cochran-Armitage trend test. A negative binomial model was used to quantify the trends over time for each outcome while adjusting for age, sex and province. RESULTS In HC, there was a significant trend in the rate for all three outcomes (p < 0.001), with a small increase (roughly 1%) each year. In HC, HL was the most prevalent sensory loss, with a rate of roughly 25% to 29%, while in LTC, DSL was the most prevalent impairment, at roughly 25% across multiple years of data. In both settings, roughly 60% of the sample was female. Males in both HC and LTC had a higher prevalence of HL compared to females, but the differences were very small (no more than 2% in any given year). The prevalence of HL differed by province after adjusting for year, age and sex. Compared to Ontario, Yukon Territory had a 26% higher rate of HL in HC (relative rate [RR] = 1.26; 95% confidence interval [CI]:1.11, 1.43), but LTC residents in Newfoundland and Labrador had a significantly lower rate of HL (RR: 0.57; CI: 0.43, 0.76).When combined, approximately 60% of LTC residents, or HC clients, had at least one sensory impairment. CONCLUSIONS Sensory impairments are highly prevalent in both HC and LTC, with small sex-related differences and some variation across Canadian provinces. The interRAI assessments provide clinicians with valuable information to inform care planning and can also be used to estimate the prevalence of these impairments in specific population sub-groups.
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Affiliation(s)
- Dawn M. Guthrie
- grid.268252.90000 0001 1958 9263Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, ON Canada ,grid.268252.90000 0001 1958 9263Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON Canada
| | - Nicole Williams
- grid.268252.90000 0001 1958 9263Department of Kinesiology & Physical Education, Wilfrid Laurier University, Waterloo, ON Canada
| | - Atul Jaiswal
- grid.14848.310000 0001 2292 3357School of Optometry, Université de Montréal, Montréal, Québec Canada
| | - Paul Mick
- grid.25152.310000 0001 2154 235XDepartment of Surgery, University of Saskatchewan, Saskatoon, SK Canada
| | - Hannah M. O’Rourke
- grid.17089.370000 0001 2190 316XFaculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB Canada
| | | | - Walter Wittich
- grid.14848.310000 0001 2292 3357School of Optometry, Université de Montréal, Montréal, Québec Canada
| | - Rinku Sutradhar
- grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Canada
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Rusli KDB, Tan AJQ, Ong SF, Speed S, Lau Y, Liaw SY. Home-based nursing care competencies: A scoping review. J Clin Nurs 2021; 32:1723-1737. [PMID: 34897853 DOI: 10.1111/jocn.16169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/03/2021] [Accepted: 11/30/2021] [Indexed: 01/26/2023]
Abstract
AIMS AND OBJECTIVES To identify and consolidate the available evidence about nursing-related competencies for home-based care. BACKGROUND Over recent years, the demand for home-based nursing care has increased because of the need to meet the increasing need for chronic disease care to be delivered in patients' homes. However, knowledge is lacking about the expected competencies for home-based care nurses. DESIGN A scoping review was conducted in accordance with Arksey and O'Malley's six-step scoping review framework and the PRISMA-ScR guidelines. The review identified literature using five electronic databases (CINAHL, PubMed, Embase, Cochrane and Scopus) and a hand search for grey literature in relevant home-based care journals and online searches. Key search terms and inclusion and exclusion criteria were used as strategies to identify relevant articles. RESULTS Sixty-four articles were eligible for inclusion. Mapping and narrative synthesis of 116 elements related to home-based nursing care competencies identified the following 10 competencies: (1) care assessments; (2) performance of nursing procedures; (3) management of health conditions; (4) critical thinking and problem-solving skills; (5) interpersonal relationships and communication; (6) interdisciplinary collaboration; (7) leadership and resource management; (8) professional development; (9) technological literacy; (10) quality and safety. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE This review provides insight into current knowledge about home-based nursing care competencies. These competencies could be used to evaluate nurses' competence level for home-based care or for development of appropriate professional education. The review also outlines the scope of nursing practice in home-based care, which provides support for some form of standardisation of home-based nursing care expectations across various stakeholders.
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Affiliation(s)
- Khairul Dzakirin Bin Rusli
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Apphia Jia Qi Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shu Fen Ong
- APN & Speciality Nurse Department, Khoo Teck Puat Hospital, Yishun Health, Singapore, Singapore
| | - Shaun Speed
- Faculty of Health and Social Care, University of Chester, Wirral, UK
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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A Newly Identified Impairment in Both Vision and Hearing Increases the Risk of Deterioration in Both Communication and Cognitive Performance. Can J Aging 2021; 41:363-376. [DOI: 10.1017/s0714980821000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Vision and hearing impairments are highly prevalent in adults 65 years of age and older. There is a need to understand their association with multiple health-related outcomes. We analyzed data from the Resident Assessment Instrument for Home Care (RAI-HC). Home care clients were followed for up to 5 years and categorized into seven unique cohorts based on whether or not they developed new vision and/or hearing impairments. An absolute standardized difference (stdiff) of at least 0.2 was considered statistically meaningful. Most clients (at least 60%) were female and 34.9 per cent developed a new sensory impairment. Those with a new concurrent vison and hearing impairment were more likely than those with no sensory impairments to experience a deterioration in receptive communication (stdiff = 0.68) and in cognitive performance (stdiff = 0.49). After multivariate adjustment, they had a twofold increased odds (adjusted odds ratio [OR] = 2.1; 95% confidence interval [CI]:1,87, 2.35) of deterioration in cognitive performance. Changes in sensory functioning are common and have important effects on multiple health-related outcomes.
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Markle-Reid M, McAiney C, Fisher K, Ganann R, Gauthier AP, Heald-Taylor G, McElhaney JE, McMillan F, Petrie P, Ploeg J, Urajnik DJ, Whitmore C. Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial. PLoS One 2021; 16:e0254573. [PMID: 34310640 PMCID: PMC8312945 DOI: 10.1371/journal.pone.0254573] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity (≥ 2 comorbidities) and depressive symptoms. DESIGN AND SETTING Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control). PARTICIPANTS 127 older adults (≥ 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms. INTERVENTION This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months. OUTCOME MEASURES The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling. RESULTS Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group. CONCLUSIONS Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03157999.
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Affiliation(s)
- Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Carrie McAiney
- School of Public Health and Health Systems and Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Kathryn Fisher
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Ganann
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alain P. Gauthier
- School of Human Kinetics, Laurentian University, Sudbury, Ontario, Canada
| | - Gail Heald-Taylor
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Janet E. McElhaney
- Northern Ontario School of Medicine and Health Sciences North Research Institute, Sudbury, Ontario, Canada
| | - Fran McMillan
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - Penelope Petrie
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Diana J. Urajnik
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - Carly Whitmore
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Gerolamo AM, Pogorzelska-Maziarz M, Gentsch A, Traczuk A, Hsiao T, Amadio G, Haddad T, Rising KL. Unmet Behavioral Health and Social Needs of Home Healthcare Patients and Their Caregivers. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/10848223211002849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lack of recognition and treatment of mental health disorders in the home healthcare (HHC) population has been recognized as a national public health problem. However, there is a gap in understanding the behavioral health needs of HHC patients and caregivers from the perspectives of HHC patients, caregivers, and HHC personnel. These perspectives are critical for informing an acceptable and scalable integrated care model. We conducted semi-structured interviews with HHC patients, caregivers, and HHC personnel to assess the unmet behavioral health needs of HHC patients and their caregivers. Participants were recruited from a Medicare-certified HHC agency that is part of a large health system on the east coast. We completed a total of 31 interviews between January and May 2020. Findings suggest that HHC patients have significant unmet behavioral health and social needs and their caregivers are emotionally and physically drained. Reasons that patients may not be receiving adequate behavioral health services include denial, cost, culture, lack of awareness of available resources, lack of transportation, and homebound status. While most patients discussed the emotional toll of their illness, few were connected to services. HHC personnel offered suggestions on how to meet the behavioral health needs of patients, with the primary focus on providing in-home options. Gaps in meeting the needs of the HHC population necessitate integrated care models that can effectively address the behavioral health and social needs of HHC patients and their families. Future research should develop and test patient and caregiver-directed integrated care models in the HHC setting.
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Affiliation(s)
| | | | | | | | | | - Grace Amadio
- Thomas Jefferson University, Philadelphia, PA, USA
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Markle-Reid M, McAiney C, Ganann R, Fisher K, Gafni A, Gauthier AP, Heald-Taylor G, McElhaney J, Ploeg J, Urajnik DJ, Valaitis R, Whitmore C. Study protocol for a hospital-to-home transitional care intervention for older adults with multiple chronic conditions and depressive symptoms: a pragmatic effectiveness-implementation trial. BMC Geriatr 2020; 20:240. [PMID: 32650732 PMCID: PMC7350576 DOI: 10.1186/s12877-020-01638-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Older adults (> 65 years) with multiple chronic conditions (MCC) and depressive symptoms experience frequent transitions between hospital and home. Care transitions for this population are often poorly coordinated and fragmented, resulting in increased readmission rates, adverse medical events, decreased patient satisfaction and safety, and increased caregiver burden. There is a dearth of evidence on best practices in the provision of transitional care for older adults with MCC and depressive symptoms transitioning from hospital-to-home. This paper presents a protocol for a two-armed, multi-site pragmatic effectiveness-implementation trial of Community Assets Supporting Transitions (CAST), an evidence-informed nurse-led six-month intervention that supports older adults with MCC and depressive symptoms transitioning from hospital-to-home. The Collaborative Intervention Planning Framework is being used to engage patients and other key stakeholders in the implementation and evaluation of the intervention and planning for intervention scale-up to other communities. METHODS Participants will be considered eligible if they are > 65 years, planned for discharged from hospital to the community in three Ontario locations, self-report at least two chronic conditions, and screen positive for depressive symptoms. A total of 216 eligible and consenting participants will be randomly assigned to the control (usual care) or intervention (CAST) arm. The intervention consists of tailored care delivery comprising in-home visits, telephone follow-up and system navigation support. The primary measure of effectiveness is mental health functioning of the older adult participant. Secondary outcomes include changes in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health and social service use and cost, from baseline to 6- and 12-months. Caregivers will be assessed for caregiver strain, depressive symptoms, anxiety, health-related quality of life, and health and social service use and costs. Descriptive and qualitative data from older adult and caregiver participants, and the nurse interventionists will be used to examine implementation of the intervention, how the intervention is adapted within each study region, and its potential for sustainability and scalability to other jurisdictions. DISCUSSION A nurse-led transitional care strategy may provide a feasible and effective means for improving health outcomes and patient/caregiver experience and reduce service use and costs in this vulnerable population. TRIAL REGISTRATION # NCT03157999 . Registration Date: April 4, 2017.
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Affiliation(s)
- Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada. .,Murray Alzheimer Research & Education Program (MAREP), School of Public Health and Health Systems, University of Waterloo,University of Waterloo Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Carrie McAiney
- Murray Alzheimer Research & Education Program (MAREP), School of Public Health and Health Systems, University of Waterloo,University of Waterloo Research Institute for Aging, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Rebecca Ganann
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Kathryn Fisher
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Amiram Gafni
- Department of Health Research Methods, Evidence, and Impact; and Centre for Health Economics and Policy Analysis, McMaster University, 1200 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Alain P Gauthier
- School of Human Kinetics, Laurentian University, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada
| | | | - Janet McElhaney
- Medical Sciences Division, Northern Ontario School of Medicine, Health Sciences North Research Institute, 41 Ramsey Lake Road, Sudbury, ON, P3E 5J1, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Diana J Urajnik
- Centre for Rural and Northern Health Research, Laurentian University, 935 Ramsey Lake Rd., Sudbury, ON, P3E 2C6, Canada
| | - Ruta Valaitis
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
| | - Carly Whitmore
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1200 Main Street West, HSC 3N25B, Hamilton, ON, L8S 4K1, Canada
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Helvik AS, Barca ML, Bergh S, Šaltytė-Benth J, Kirkevold Ø, Borza T. The course of depressive symptoms with decline in cognitive function - a longitudinal study of older adults receiving in-home care at baseline. BMC Geriatr 2019; 19:231. [PMID: 31443638 PMCID: PMC6708209 DOI: 10.1186/s12877-019-1226-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
Background Depressive symptoms in old age are common, but the prevalence, persistence, and incidence of depressive symptoms in older adults with and without dementia receiving in-home care is less well studied, and descriptions of the relationship between severity of cognitive decline and depressive symptoms over time is, to our knowledge, lacking. The aim of the present study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older adults receiving in-home care at baseline, and to explore the association between cognitive function and the course of depressive symptoms over time. Methods In all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study with three assessments over 36 months. Depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. Clinical Dementia Rating Scale, diagnosis of dementia and mild cognitive impairment, general medical health, personal and instrumental activities of daily living, neuropsychiatric symptoms and the use of psychotropic medication were evaluated during the three assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated. Results The baseline prevalence and cumulative incidence of single depressive symptoms were higher in those with dementia at baseline than in those without dementia. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive impairment and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. Furthermore, being younger, female, in very poor physical health, with neuropsychiatric symptoms and not becoming a nursing home resident were associated with more depressive symptoms when assessed simultaneously. Conclusion The baseline prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, as well as the relationship we found between the degree of cognitive decline and depressive symptoms over time show that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older adults receiving in-home care.
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Affiliation(s)
- Anne-Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postboks 8905, NO-7491, Trondheim, Norway. .,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,St Olavs University Hospital, Trondheim, Norway.
| | - Maria Lage Barca
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė-Benth
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, University of Oslo, Campus Ahus, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Tom Borza
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
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Ebadzadeh MR, Nouhi E, Farokhzadian J, Mangolian Shahrbabaki P. What is the supporting role of health care providers from the perspective of patients with renal allograft rejection? A qualitative study. Int J Health Plann Manage 2018; 34:338-345. [PMID: 30146737 DOI: 10.1002/hpm.2639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/01/2018] [Indexed: 01/29/2023] Open
Abstract
Coping with the new conditions for patients with renal allograft rejection is a complex phenomenon influenced by a number of factors. It appears that the supportive role of health care providers in many aspects is 1 of the most important factors in patient satisfaction, increased quality of life, and application of proper coping mechanisms. This study explored the perceptions of patients with renal allograft rejection about the supportive role of health care providers. This study was conducted with a qualitative research approach and content analysis. Participants were 19 patients with renal allograft rejection in teaching hospitals in southeastern Iran who were selected by purposive sampling. Data were collected through semistructured interviews and analyzed by qualitative content analysis. During content analysis, 2 categories emerged: empathy and emotional support and educational counseling. These themes reflect the nature of patient perceptions of the supportive role of health care providers. The findings suggest that the supportive role of health care providers plays an important role in the promoting a feeling of comfort, reliability, and security in patients with renal allograft rejection and improves their coping mechanisms. These findings give health care providers greater motivation to provide comprehensive care from knowledge of their supportive role.
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Affiliation(s)
- Mohammad Reza Ebadzadeh
- Department of Urology, Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmat Nouhi
- Nursing Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Jamileh Farokhzadian
- Nursing Research Center, Department of Community Health Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
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Reckrey JM, DeCherrie LV, Dugue M, Rosen A, Soriano TA, Ornstein K. Meeting the Mental Health Needs of the Homebound: A Psychiatric Consult Service Within a Home-Based Primary Care Program. ACTA ACUST UNITED AC 2018; 16:122-8. [PMID: 26414814 DOI: 10.1891/1521-0987.16.3.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The growing population of homebound adults increasingly receives home-based primary care (HBPC) services. These patients are predominantly frail older adults who are homebound because of multiple medical comorbidities, yet they often also have psychiatric diagnoses requiring mental health care. Unfortunately, in-home psychiatric services are rarely available to homebound patients. To address unmet psychiatric need among the homebound patients enrolled in our large academic HBPC program, we piloted a psychiatric in-home consultation service. During our 16-month pilot, 10% of all enrolled HBPC patients were referred for and received psychiatric consultation. Depression and anxiety were among the most common reasons for referral. To better meet patients' medical and psychiatric needs, HBPC programs need to consider strategies to incorporate psychiatric services into their routine care plans.
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Xiang X, Danilovich MK, Tomasino KN, Jordan N. Depression prevalence and treatment among older home health services users in the United States. Arch Gerontol Geriatr 2018; 75:151-157. [DOI: 10.1016/j.archger.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/19/2017] [Accepted: 12/10/2017] [Indexed: 01/20/2023]
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Wang J, Jia H, Shang J, Kearney JA. Critical Association Between Mental Health Disorders and Medical Status: Depression Intervention Use Indicates a Two-Fold Risk for Subsequent Medical Events in Older American Home Health Care Patients. J Gerontol Nurs 2016; 42:42-55. [PMID: 27379455 DOI: 10.3928/00989134-20160701-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/10/2016] [Indexed: 11/20/2022]
Abstract
The current study examined longitudinal associations between mental disorders and all-cause subsequent medical events in a 5% random sample of records in the 2010 national Outcome and Assessment Information Set. Records of older adults (N = 28,475) receiving home health care (HHC) services were examined with respect to mental disorders and medical events, including acute care hospitalization, emergency department admission, and 30-day rehospitalization. Predominant mental disorders were depression and anxiety identified by formal diagnoses, symptom clusters, and/or prescription of related mental health services. Depression intervention use was the strongest risk factor for all three types of medical events. However, 61.6% of patients receiving depression interventions did not screen positive at admission using the Patient Health Questionnaire-2. Moving forward, nurses must closely monitor high-risk older adults throughout the HHC stay using sensitive depression screening tools, as well as receive targeted training in geriatric psychiatry. [Journal of Gerontological Nursing, 42(10), 42-55.].
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12
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Tak ECPM, van Hespen ATH, Verhaak PFM, Eekhof J, Hopman‐Rock M. Development and preliminary validation of an Observation List for detecting mental disorders and social Problems in the elderly in primary and home care (OLP). Int J Geriatr Psychiatry 2016; 31:755-64. [PMID: 26556009 PMCID: PMC6207924 DOI: 10.1002/gps.4388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 10/06/2015] [Accepted: 10/14/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Even though the prevalence of mental disorders and social problems is high among elderly patients, it is difficult to detect these in a primary (home) care setting. Goal was the development and preliminary validation of a short observation list to detect six problem areas: anxiety, depression, cognition, suspicion, loneliness, and somatisation. METHODS A draft list of indicators identified from a short review of the literature and the opinions of 22 experts was evaluated by general practitioners (GPs) and home care organisations for feasibility. It was then used by GPs and home care personnel to observe patients, who also completed validated tests for psychological disorders (General Health Questionnaire 12 item version (GHQ-12)), depression (Geriatric Depression Scale 15-item version (GDS-15)), anxiety and suspicion (Symptom Checklist-90 (SCL-90)), loneliness (University of California, Los Angeles (UCLA)), somatisation (Illness Attitude Scale (IAS)), and cognition (Mini-Mental State Examination (MMSE)). RESULTS GPs and home care personnel observed 180 patients (mean age 78.4 years; 66% female) and evaluated the draft list during a regular visit. Cronbach's α was 0.87 for the draft list and ≥0.80 for the draft problem areas (loneliness and suspicion excepted). Principal component analysis identified six components (cognition, depression + loneliness, somatisation, anxiety + suspicion, depression (other signs), and an ambiguous component). Convergent validity was shown for the indicators list as a whole (using the GHQ-12), and the subscales of depression, anxiety, loneliness, cognition, and somatisation. Using pre-set agreed criteria, the list was reduced to 14 final indicators divided over five problem areas. CONCLUSION The Observation List for mental disorders and social Problems (OLP) proved to be preliminarily valid, reliable, and feasible for use in primary and home care settings. Copyright © John Wliey & Sons, Ltd.
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Affiliation(s)
- Erwin C. P. M. Tak
- TNO (Netherlands organisation for applied scientific research) Department LifestyleLeidenThe Netherlands
| | - Ariëtte T. H. van Hespen
- TNO (Netherlands organisation for applied scientific research) Department LifestyleLeidenThe Netherlands
| | - Peter F. M. Verhaak
- NIVEL (Netherlands Institute for health services research)UtrechtThe Netherlands
| | - Just Eekhof
- Department of Public Health and Primary CareLUMC (Leiden University Medical Center)LeidenThe Netherlands
| | - Marijke Hopman‐Rock
- TNO (Netherlands organisation for applied scientific research) Department LifestyleLeidenThe Netherlands,Department of Public and Occupational Health, EMGO Institute for Health and Care ResearchVU University Medical CenterAmsterdamThe Netherlands
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Quijano LM, Stanley MA, Petersen NJ, Casado BL, Steinberg EH, Cully JA, Wilson NL. Healthy IDEAS. J Appl Gerontol 2016. [DOI: 10.1177/0733464807299354] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study evaluated an evidence-based intervention for depression delivered by case managers in three community-based service agencies to high-risk, diverse older adults. Case managers were trained to provide screening and assessment, education, referral and linkage, and behavioral activation. Outcomes addressed depression, general health status, social and physical activation, and mental health services use at baseline and 6 months. Participants (n = 94) were predominantly women (79%) and Hispanic (44%), with a mean age of 72 years. Mean Geriatric Depression Scale—15 scores differed significantly between baseline and 6 months (9.0 versus 5.5). At 6 months, significantly more participants knew how to get help for depression (68% versus 93%), reported that increasing activity helped them feel better (72% versus 89%), and reported reduced pain (16% versus 45 %). The authors conclude that nonspecialty providers can be trained to successfully implement an evidence-based self-management intervention for depression with frail, high-risk, and diverse older adults.
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Affiliation(s)
- Louise M. Quijano
- Houston Center for Quality of Care & Utilization Studies Michael E. DeBakey Veterans Affairs Medical Center Baylor College of Medicine
| | - Melinda A. Stanley
- Houston Center for Quality of Care & Utilization Studies Michael E. DeBakey Veterans Affairs Medical Center Baylor College of Medicine
| | - Nancy J. Petersen
- Houston Center for Quality of Care & Utilization Studies Michael E. DeBakey Veterans Affairs Medical Center Baylor College of Medicine
| | | | | | - Jeffrey A. Cully
- Houston Center for Quality of Care & Utilization Studies Michael E. DeBakey Veterans Affairs Medical Center Baylor College of Medicine
| | - Nancy L. Wilson
- Houston Center for Quality of Care & Utilization Studies Michael E. DeBakey Veterans Affairs Medical Center Baylor College of Medicine,
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Wang J, Shang J, Kearney JA. Mental health disorders in home care elders: An integrative review. Geriatr Nurs 2016; 37:44-60. [DOI: 10.1016/j.gerinurse.2015.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
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Bao Y, Eggman AA, Richardson JE, Sheeran TF, Bruce ML. Practices of Depression Care in Home Health Care: Home Health Clinician Perspectives. Psychiatr Serv 2015; 66:1365-8. [PMID: 26423098 PMCID: PMC4666762 DOI: 10.1176/appi.ps.201400481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study assessed gaps between published best practices and real-world practices of treating depression in home health care (HHC) and barriers to closing gaps. METHODS The qualitative study used semistructured interviews with nurses and administrators (N=20) from five HHC agencies in five states. Audio-recorded interviews were transcribed and analyzed by a multidisciplinary team using grounded theory method to identify themes. RESULTS Routine HHC nursing overlapped with all functional areas of depression care. However, gaps were noted between best and real-world practices. Gaps were associated with perceived scope of practice by HHC nurses, knowledge gaps and low self-efficacy in depression treatment, stigma attached to depression, poor quality of antidepressant management in primary care, and poor communication between HHC and primary care clinicians. CONCLUSIONS Strategies to close gaps between typical and best practices include enhancing HHC clinicians' knowledge and self-efficacy with depression treatment and improving the quality of antidepressant management and communication with primary care.
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Affiliation(s)
- Yuhua Bao
- Dr. Bao, Ms. Eggman, and Dr. Richardson are with the Department of Healthcare Policy and Research, and Dr. Bao and Dr. Bruce are with the Department of Psychiatry, all at Weill Cornell Medical College, New York City and White Plains, New York (e-mail: ). Dr. Sheeran is with the Department of Psychiatry and Human Behavior, Rhode Island Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Ashley A Eggman
- Dr. Bao, Ms. Eggman, and Dr. Richardson are with the Department of Healthcare Policy and Research, and Dr. Bao and Dr. Bruce are with the Department of Psychiatry, all at Weill Cornell Medical College, New York City and White Plains, New York (e-mail: ). Dr. Sheeran is with the Department of Psychiatry and Human Behavior, Rhode Island Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Joshua E Richardson
- Dr. Bao, Ms. Eggman, and Dr. Richardson are with the Department of Healthcare Policy and Research, and Dr. Bao and Dr. Bruce are with the Department of Psychiatry, all at Weill Cornell Medical College, New York City and White Plains, New York (e-mail: ). Dr. Sheeran is with the Department of Psychiatry and Human Behavior, Rhode Island Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Thomas F Sheeran
- Dr. Bao, Ms. Eggman, and Dr. Richardson are with the Department of Healthcare Policy and Research, and Dr. Bao and Dr. Bruce are with the Department of Psychiatry, all at Weill Cornell Medical College, New York City and White Plains, New York (e-mail: ). Dr. Sheeran is with the Department of Psychiatry and Human Behavior, Rhode Island Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Martha L Bruce
- Dr. Bao, Ms. Eggman, and Dr. Richardson are with the Department of Healthcare Policy and Research, and Dr. Bao and Dr. Bruce are with the Department of Psychiatry, all at Weill Cornell Medical College, New York City and White Plains, New York (e-mail: ). Dr. Sheeran is with the Department of Psychiatry and Human Behavior, Rhode Island Hospital and Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Bao Y, Shao H, Bruce ML, Press MJ. Antidepressant Medication Management Among Older Patients Receiving Home Health Care. Am J Geriatr Psychiatry 2015; 23:999-1006. [PMID: 25158915 PMCID: PMC4291306 DOI: 10.1016/j.jagp.2014.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 07/03/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Antidepressant management for older patients receiving home health care (HHC) may occur through two pathways: nurse-physician collaboration (without patient visits to the physician) and physician management through office visits. This study examines the relative contribution of the two pathways and how they interplay. METHODS Retrospective analysis was conducted using Medicare claims of 7,389 depressed patients aged 65 years or older who received HHC in 2006-2007 and who possessed antidepressants at the start of HHC. A change in antidepressant therapy (versus discontinuation or refill) was the main study outcome and could take the form of a change in dose, switch to a different antidepressant, or augmentation (addition of a new antidepressant). Logistic regressions were estimated to examine how use of home health nursing care, patient visits to physicians, and their interactions predict a change in antidepressant therapy. RESULTS About 30% of patients experienced a change in antidepressants versus 51% who refilled and 18% who discontinued. Receipt of mental health specialty care was associated with a statistically significant, 10- to 20-percentage-point increase in the probability of antidepressant change; receipt of primary care was associated with a small and statistically significant increase in the probability of antidepressant change among patients with no mental health specialty care and above-average utilization of nursing care. Increased home health nursing care in absence of physician visits was not associated with increased antidepressant change. CONCLUSIONS Active antidepressant management resulting in a change in medication occurred on a limited scale among older patients receiving HHC. Addressing knowledge and practice gaps in antidepressant management by primary care providers and home health nurses and improving nurse-physician collaboration will be promising areas for future interventions.
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Affiliation(s)
- Yuhua Bao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY.
| | - Huibo Shao
- Department of Healthcare Policy and Research, Weill Cornell Medical College,Baptist Memorial Health Care Corporation, Department of Quality
| | | | - Matthew J. Press
- Department of Healthcare Policy and Research, Weill Cornell Medical College,Department of Medicine, Weill Cornell Medical College
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Liebel DV, Friedman B, Conwell Y, Powers BA. Evaluation of geriatric home healthcare depression assessment and care management: are OASIS-C depression requirements enough? Am J Geriatr Psychiatry 2015; 23:794-806. [PMID: 25091519 DOI: 10.1016/j.jagp.2014.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 06/19/2014] [Accepted: 06/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS Depression was recognized in care plans of 60% of patients. Documentation of only one nurse care management activity, antidepressant use, indicated the use of evidence-based standards of depression assessment and DCM. Depression measures were not administered at discharge, recertification, or transfer. Forty percent of patients had a formal depression diagnosis by the referring physician in the chart, and 65% were receiving an antidepressant. Having a depression care plan and depression medication were significantly associated with a large ADLs improvement. CONCLUSION Despite the association of depression care plans with patient disability improvement, inadequate compliance to evidence-based DCM was found. Medicare and HHC agencies must ensure compliance to DCM, including follow-up depression assessment for patients with positive screens.
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Affiliation(s)
| | - Bruce Friedman
- Departments of Public Health Sciences and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Yeates Conwell
- Departments of Public Health Sciences and Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Liebel DV, Powers BA, Hauenstein EJ. Home health care nurse interactions with homebound geriatric patients with depression and disability. Res Gerontol Nurs 2015; 8:130-9. [PMID: 26042245 DOI: 10.3928/19404921-20150105-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Building therapeutic nurse-patient relationships is pivotal to the provision of optimum nurse care management for geriatric home health care (HHC) patients. However, little is known about which strategies most effectively treat older adult HHC patients with concomitant depression and disability. This qualitative descriptive study was conducted in two parts to explore the issue further. The first part involved interviews regarding HHC nurse perceptions of geriatric depression and disability care management. The second part, which is the focus of the current analysis, describes HHC nurses' use of care management and therapeutic during home visits. Observation of nurse-patient interactions involved 25 nurses home visits to HHC patients 60 and older who had depression and disability. Drawing on clinical knowledge and interpersonal skills, nurses built relationships and fostered trust. However, despite their disabilities to make these connections, multiple missed opportunities occurred for nurses to engage in more productive interactions. Four training components to support improvement of nurse-patient therapeutic relationships are described and recommended.
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Self-Rated Health, Cognition, and Dual Sensory Impairment Are Important Predictors of Depression Among Home Care Clients in Ontario. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2015. [DOI: 10.1177/1084822315591812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Depression can be a disabling and debilitating condition among older adults (aged 65+). This study examined risk factors for symptoms of depression in a large sample of older home care clients ( n = 218,850) in Ontario, Canada, using existing data collected with the Resident Assessment Instrument for Home Care (RAI-HC). The RAI-HC has been mandated across the province since 2002. The most important predictors of depression were lower self-rated health (odds ratio [OR] = 3.4), cognitive impairment (OR = 2.9), dual sensory impairment (OR = 1.2), and a primary language other than English or French (OR = 1.5). This suggests that not only physical health but also sensory impairments and communication difficulties increase the risk for depression among home care recipients.
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20
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Sex Differences in Home Care Performance: A Population-Based Study. Womens Health Issues 2015; 25:232-8. [DOI: 10.1016/j.whi.2015.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/29/2014] [Accepted: 01/12/2015] [Indexed: 11/18/2022]
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Abstract
Depression is related to disability and affects rehabilitation participation, outcomes, and compliance with treatment. Improving older adult depression detection and referral requires knowledge, skills, supportive organizational policies, and access to mental health experts. This review provides a selected overview of evidence-based approaches for screening of suspected cases of depression in older adults by physical therapists and other non-mental health professionals and discusses procedures to refer suspected cases to primary care providers and/or mental health specialists for evaluation, including resources and a tool to assist in communicating depression-related information to the primary care provider or mental health specialist. We hope that this review will promote the incorporation of evidence-based screening and referral of suspected cases of depression in older adults into routine practice.
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Affiliation(s)
- Edgar Ramos Vieira
- 1College of Nursing and Health Sciences, Florida International University, Miami. 2Weill Cornell Medical College, Cornell University, White Plains, New York
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Markle-Reid M, McAiney C, Forbes D, Thabane L, Gibson M, Browne G, Hoch JS, Peirce T, Busing B. An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms. BMC Geriatr 2014; 14:62. [PMID: 24886344 PMCID: PMC4019952 DOI: 10.1186/1471-2318-14-62] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services. Methods A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation. Results Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period. Conclusions Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms. Trial registration Clinicaltrials.gov identifier: NCT01407926.
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Polyakova M, Sonnabend N, Sander C, Mergl R, Schroeter ML, Schroeder J, Schönknecht P. Prevalence of minor depression in elderly persons with and without mild cognitive impairment: a systematic review. J Affect Disord 2014; 152-154:28-38. [PMID: 24103852 DOI: 10.1016/j.jad.2013.09.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/08/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Minor depression (MinD) and mild cognitive impairment (MCI) are common disorders in late life that often coexist. The aim of the present review is to demonstrate prevalence rates of minor depression in older patients with and without MCI. METHODS Electronic database searches were performed through Medline, ISI Web of Knowledge, Psycinfo, and Cochrane library. Two independent reviewers extracted the original studies based on inclusion criteria: representative study population aged 55 and older, diagnostics of MinD according to DSM. Data on prevalence rates, risk factors, comorbidity and health care usage were analyzed. RESULTS Point prevalence for MinD is higher in medical settings (median 14.4%) than in the community-based settings (median 10.4%) and primary care patients (median 7.7%). Although minor depression is rarely investigated in elderly persons with MCI, nearly 20% of patients with MCI seem to suffer from MinD. No data was found on the prevalence of MCI in patients with MinD. Risk factors associated with MinD include female gender, history of cerebrovascular diseases, generalized anxiety disorder, loneliness, and long-term institutional care. LIMITATIONS Methodological differences of included studies resulted in a broad range of prevalence rates. No data is shown regarding the prevalence of MCI in MinD group due to insufficient evidence. CONCLUSIONS Our review indicates that MinD is frequent in elderly population. MCI among those subjects has not been sufficiently investigated. Future studies based on clinical structured interviews should be performed in longitudinal design in order to differentiate late-life depression from progressive MCI or early manifestation of Alzheimer's disease.
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Affiliation(s)
- M Polyakova
- Department of Psychiatry, University of Leipzig, Leipzig, Germany; LIFE-Leipzig Research Center for Civilization Diseases, University of Leipzig, Germany; Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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O'Connor M, Davitt JK. The Outcome and Assessment Information Set (OASIS): a review of validity and reliability. Home Health Care Serv Q 2013; 31:267-301. [PMID: 23216513 DOI: 10.1080/01621424.2012.703908] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The Outcome and Assessment Information Set (OASIS) is the patient-specific, standardized assessment used in Medicare home health care to plan care, determine reimbursement, and measure quality. Since its inception in 1999, there has been debate over the reliability and validity of the OASIS as a research tool and outcome measure. A systematic literature review of English-language articles identified 12 studies published in the last 10 years examining the validity and reliability of the OASIS. Empirical findings indicate the validity and reliability of the OASIS range from low to moderate but vary depending on the item studied. Limitations in the existing research include: nonrepresentative samples; inconsistencies in methods used, items tested, measurement, and statistical procedures; and the changes to the OASIS itself over time. The inconsistencies suggest that these results are tentative at best; additional research is needed to confirm the value of the OASIS for measuring patient outcomes, research, and quality improvement.
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Affiliation(s)
- Melissa O'Connor
- New Courtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Liebel DV, Powers BA. Home health care nurse perceptions of geriatric depression and disability care management. THE GERONTOLOGIST 2013; 55:448-61. [PMID: 24158784 DOI: 10.1093/geront/gnt125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 09/06/2013] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Psychosocial interventions alone or combined with antidepressant medication can effectively treat mild to moderate geriatric depression. However, most home health care patients with depression and disability do not receive these interventions. Moreover, relatively little is known about home health care nurse views about depression management. Therefore, our research purpose was to provide a deeper understanding about how home health care nurses perceive and experience depression detection and evaluation within the context of caring for geriatric patients with disabilities. DESIGN AND METHODS This qualitative descriptive study involved 2 focus groups and 16 semistructured interviews with nurses providing care to geriatric home health care patients followed by observation during 25 nurse home visits to geriatric patients who had depression and disability. FINDINGS Nurses demonstrated confidence in caring for elderly patients with disabilities. However, they expressed different views about the nature of depression and the integration of depression and disability care in daily practice. Evidence points to a need for advanced training that supports an enhanced role for generalist homecare nurses in providing depression care management for this vulnerable geriatric population. IMPLICATIONS Policy challenges are associated with ways in which home health care is fiscally organized primarily to address patients' physical and acute skilled care needs and not depression.
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Lysack C, Leach C, Russo T, Paulson D, Lichtenberg PA. DVD Training for Depression Identification and Treatment in Older Adults: A Two-Group, Randomized, Wait-List Control Study. Am J Occup Ther 2013; 67:584-93. [DOI: 10.5014/ajot.2013.008060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. To test the effectiveness of an educational intervention aimed at improving mental health knowledge and skills in occupational therapists working with older rehabilitation patients.
METHOD. The DVD-format educational intervention was evaluated using a two-group randomized wait-list control design. Occupational therapists (n = 75) completed a 32-item knowledge questionnaire at three time points. Patient charts were reviewed (n = 960) at 3 months before and 3 and 6 months after DVD training to evaluate clinical practice change.
RESULTS. A two-way analysis of variance showed knowledge scores increased significantly for both groups after DVD training. A significant Group × Time interaction and significant main effects for time and group were found. Chart review data also showed significant increases in desired clinical behaviors in both groups after training. The greatest single item of clinical practice change was use of a standardized depression screen.
CONCLUSION. DVD-based training can significantly improve mental health practice.
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Affiliation(s)
- Cathy Lysack
- Cathy Lysack, PhD, OT(C), is Deputy Director and Professor of Occupational Therapy, Institute of Gerontology, Wayne State University, Room 231, Knapp Building, 87 East Ferry Street, Detroit, MI 48202;
| | - Carrie Leach
- Carrie Leach, MPA, is Manager, Community Based Research and Engagement, Institute of Gerontology, Wayne State University, Detroit
| | - Theresa Russo
- Theresa Russo is Education Program Coordinator, Alzheimer’s Association–Greater Michigan Chapter, Southfield
| | - Daniel Paulson
- Daniel Paulson, MA, is Doctoral Candidate, Department of Psychology, Wayne State University, Detroit, and Clinical Psychology Intern, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Peter A. Lichtenberg
- Peter A. Lichtenberg, PhD, ABPP, is Director, Institute of Gerontology, and Professor of Psychology, Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit
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McCabe MP, Karantzas GC, Mrkic D, Mellor D, Davison TE. A randomized control trial to evaluate the beyondblue depression training program: does it lead to better recognition of depression? Int J Geriatr Psychiatry 2013; 28:221-6. [PMID: 22555988 DOI: 10.1002/gps.3809] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 03/14/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The aim of this study was to determine if a depression training program could assist aged care staff to better recognize depression among older people in residential care. The use of a "paper trail" for a screening tool and a study champion in combination with this training was evaluated to determine if this improved the level of detection of depression. METHOD The study took the form of a randomized control trial. A total of 107 professional carers from residential aged care services in Melbourne, Australia, participated in the study. Thirty-four carers were allocated to the training-only group and completed a six-session depression training program, 35 carers were allocated to the training-plus-screening protocol group, and 38 carers were assigned to a wait-list control group. In total, 216 residents were screened for depression. Carers in all conditions were asked to identify those residents who they perceived to be depressed. Residents were independently assessed with the SCID-I to determine their depression status. RESULTS Trained staff were not found to be better in detecting depression than non-trained staff. Staff in the training-plus-screening condition correctly identified more residents as depressed, but also classified more non-depressed residents as depressed. CONCLUSION The findings demonstrate the need for a greater focus on recognizing depression among carers working in aged care facilities. Protocols should be developed to assist carers to detect, refer, and monitor depression in residents.
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Affiliation(s)
- Marita P McCabe
- School of Psychology, Deakin University, Melbourne, Australia.
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de Man-van Ginkel JM, Gooskens F, Schepers VPM, Schuurmans MJ, Lindeman E, Hafsteinsdóttir TB. Screening for Poststroke Depression Using the Patient Health Questionnaire. Nurs Res 2012; 61:333-41. [DOI: 10.1097/nnr.0b013e31825d9e9e] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Major depression is disproportionately common among elderly adults receiving home healthcare and is characterized by greater medical illness, functional impairment, and pain. Depression is persistent in this population and is associated with numerous poor outcomes such as increased risk of hospitalization, injury-producing falls, and higher health care costs. Despite the need for mental health care in these patients, significant barriers unique to the home healthcare setting contribute to under-detection and under-treatment of depression. Intervention models target the home healthcare nurse as liaison between patients and physicians, and instruct in the identification and management of depression for their patients. Successful implementation requires interventions that 'fit' how home healthcare is organized and practiced, and long distance implementation strategies are required to increase the reach of these interventions.
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Bruce ML, Raue PJ, Sheeran T, Reilly C, Pomerantz JC, Meyers BS, Weinberger MI, Zukowski D. Depression Care for Patients at Home (Depression CAREPATH): home care depression care management protocol, part 2. ACTA ACUST UNITED AC 2012; 29:480-9. [PMID: 21881429 DOI: 10.1097/nhh.0b013e318229d75b] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
High levels of depressive symptoms are common and contribute to poorer clinical outcomes even in geriatric patients who are already taking antidepressant medication. The Depression CARE for PATients at Home (Depression CAREPATH) intervention was designed to meet the needs of medical and surgical patients who suffer from depression. The intervention's clinical protocols are designed to guide clinicians in managing depression as part of routine home care.
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Affiliation(s)
- Martha L Bruce
- Department of Psychiatry, Weill Cornell Medical College, White Plains, New York, USA.
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Raue PJ, Weinberger MI, Sirey JA, Meyers BS, Bruce ML. Preferences for depression treatment among elderly home health care patients. PSYCHIATRIC SERVICES (WASHINGTON, D.C.) 2011. [PMID: 21532080 DOI: 10.1176/appi.ps.62.5.532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors hypothesized that the depression treatment preferences of elderly home care patients would vary by their experience of depression and that preferences for active treatment would be associated with current depression and with antidepressant treatment. METHODS The authors conducted cross-sectional secondary analyses of data from the TRIAD study (Training in the Assessment of Depression) of 256 randomly selected elderly patients newly admitted to home care. The study assessed preference for active treatments (medication or psychotherapy) and nonactive or complementary approaches (such as religious activities or doing nothing). Nondepressed patients were asked to choose as if they had serious depression. Two separate indicators of depression experience were used: a current diagnosis of major or minor depression and current or previous antidepressant treatment. RESULTS Of the 256 patients, 16% (N=41) met criteria for major or minor depression. Forty-seven percent of the sample (N=121) preferred an active treatment as their first choice, and others preferred nonactive or complementary approaches. Logistic regression indicated that current antidepressant use, previous psychotherapy experience, white or Hispanic race-ethnicity (versus black), greater impairment in instrumental activities of daily living, and less personal stigma about depression were independently associated with preference for an active treatment. CONCLUSIONS Elderly home care patients had a variety of treatment preferences, ranging from active treatments, to religious or spiritual activities, to no treatment. Several factors were associated with a preference for active treatment, including treatment experience, physical impairment, race-ethnicity, and attitudes and beliefs. An understanding of patient preferences may help engage older depressed home care patients in treatment.
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Affiliation(s)
- Patrick J Raue
- Department of Psychiatry, Weill Cornell Medical College,White Plains, NY 10605, USA.
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Sheeran T, Rabinowitz T, Lotterman J, Reilly CF, Brown S, Donehower P, Ellsworth E, Amour JL, Bruce ML. Feasibility and impact of telemonitor-based depression care management for geriatric homecare patients. Telemed J E Health 2011; 17:620-6. [PMID: 21780942 PMCID: PMC3208250 DOI: 10.1089/tmj.2011.0011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 03/31/2011] [Accepted: 04/02/2011] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish- and English-speaking elderly homebound recipients of homecare services. MATERIALS AND METHODS Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. RESULTS An ethnically diverse sample of 48 English- and Spanish-only-speaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the "markedly severe" range at baseline and in the "mild" range at follow-up. CONCLUSIONS Results of this pilot support the feasibility of using homecare's existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English- and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed.
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Affiliation(s)
- Thomas Sheeran
- Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island
| | - Terry Rabinowitz
- University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont
| | | | | | - Suzanne Brown
- Visiting Nurse Services in Westchester, White Plains, New York
| | - Patricia Donehower
- Visiting Nurse Association of Chittenden and Grand Isle Counties, Colchester, Vermont
| | | | - Judith L. Amour
- University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont
| | - Martha L. Bruce
- Weill Cornell Medical College, White Plains, New York, New York
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Markle-Reid MF, McAiney C, Forbes D, Thabane L, Gibson M, Hoch JS, Browne G, Peirce T, Busing B. Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention. BMC Geriatr 2011; 11:50. [PMID: 21867539 PMCID: PMC3184267 DOI: 10.1186/1471-2318-11-50] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 08/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. METHODS/DESIGN This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. DISCUSSION Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed. TRIAL REGISTRATION ClinicalTrials.gov: NCT01407926.
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Lysack C, Lichtenberg P, Schneider B. Effect of a DVD intervention on therapists' mental health practices with older adults. Am J Occup Ther 2011; 65:297-305. [PMID: 21675335 DOI: 10.5014/ajot.2011.001354] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE We tested the effectiveness of an educational intervention in DVD format aimed at strengthening the mental health practices of occupational therapists working with older adults. METHOD The DVD intervention was tested in a pretest-posttest design. Occupational therapists (n = 30) completed a brief knowledge and attitude questionnaire; a chart review (n = 383) of therapists' (n = 20) patients at 3 mo before and 3 mo after DVD training was also conducted. RESULTS Questionnaire data showed that the percentage of therapists with correct answers increased 20%-30% for 5 of the 11 knowledge items. Chart review data showed therapists spoke more often with their older patients about mood, depression, and cognitive impairment; screened more often for depression and cognitive impairment; and reported findings more often to the treatment team after training. CONCLUSION Educational interventions can significantly improve therapists' mental health practice with older adults.
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Affiliation(s)
- Cathy Lysack
- Gerontology and Occupational Therapy, Institute of Gerontology, Wayne State University, Room 231, Knapp Building, 87 East Ferry Street, Detroit, MI 48202, USA.
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Bruce ML, Sheeran T, Raue PJ, Reilly CF, Greenberg RL, Pomerantz JC, Meyers BS, Weinberger MI, Johnston CL. Depression care for patients at home (Depression CAREPATH): intervention development and implementation, part 1. HOME HEALTHCARE NURSE 2011; 29:416-26. [PMID: 21716043 PMCID: PMC3520069 DOI: 10.1097/nhh.0b013e31821fe9f7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
High levels of depressive symptoms are common and contribute to poorer clinical outcomes even in geriatric patients who are already taking antidepressant medication. The Depression CARE for PATients at Home (Depression CAREPATH) intervention was designed for managing depression as part of ongoing care for medical and surgical patients. The intervention provides Home Health Agencies the resources needed to implement depression care management as part of routine clinical practice.
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Affiliation(s)
- Martha L Bruce
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA.
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36
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Allen J, Annells M, Clark E, Lang L, Nunn R, Petrie E, Robins A. Mixed methods evaluation research for a mental health screening and referral clinical pathway. Worldviews Evid Based Nurs 2011; 9:172-85. [PMID: 21707913 DOI: 10.1111/j.1741-6787.2011.00226.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE This study is an exemplar of mixed method evaluation research for development of a clinical pathway. AIM To develop and evaluate an evidence-based, feasible mental health screening and referral clinical pathway for Department of Veterans' Affairs-funded community nursing care of war veterans and war widows in the Australian context. METHODS Mixed methods were applied to formulate and clinically evaluate an appropriate pathway. The pathway was applied at urban and rural sites for the nursing care of 97 war veteran and war widow clients. Evaluative data were collected from clients, their informal carers, community nurses, and general practitioners. Chart auditing and pre-post measures were undertaken. Collaboration occurred with an interdisciplinary design team. RESULTS The final modified six-page pathway includes use of validated screening tools (Kessler Psychological Distress Scale [K10]) and Alcohol Use Disorder Identification Test, appropriate referral information, directions for support and health-promoting education, and evidence-based guidelines. IMPLICATIONS FOR PRACTICE The clinical pathway is a useful, tested, evidence-based guide for generalist community nurses to identify and suitably respond to common mental healthcare needs of war veterans and war widows. The pathway provides outcomes acceptable to clients and their carers, nurses and doctors. CONCLUSIONS This study provides an evaluated clinical pathway for generalist community nurses to screen for mental health difficulties, make appropriate referrals as required and to support war veteran and war widow clients. However, the study also shows how research can be used to develop and evaluate practical, evidence-based clinical pathways.
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Affiliation(s)
- Jacqui Allen
- School of Nursing, Deakin University, Burwood, Victoria, Australia.
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Allen J, Annells M, Nunn R, Petrie E, Clark E, Lang L, Robins A. Evaluation of effectiveness and satisfaction outcomes of a mental health screening and referral clinical pathway for community nursing care. J Psychiatr Ment Health Nurs 2011; 18:375-85. [PMID: 21539682 DOI: 10.1111/j.1365-2850.2010.01688.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The study aimed to explore the effectiveness of a mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia on outcomes of client self-reported mental health, quality of life, and client and carer satisfaction. The pathway was developed by literature review and consultation, then trialled and evaluated. Validated screening tools were embedded within the pathway to support generalist nurses' mental health decision making. Pre- and post-measures were applied. Clients on whom the pathway was trialled were invited to complete an evaluation survey questionnaire, as were their informal carers. Most clients and carers who responded to these questionnaires were highly satisfied or satisfied with care provided through application of the pathway. This study adds understanding about one way that community nurses might identify people with mental health difficulties. The trialled pathway, which was modified and refined following the study, is now available on the Internet as an evidence-based resource for community nurses in Australia to guide practice and maximize holistic care for war veterans and war widow(er)s where that care is funded by Department of Veterans' Affairs.
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Affiliation(s)
- J Allen
- School of Nursing, Deakin University, Burwood, Australia.
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38
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Raue PJ, Weinberger MI, Sirey JA, Meyers BS, Bruce ML. Preferences for depression treatment among elderly home health care patients. Psychiatr Serv 2011; 62:532-7. [PMID: 21532080 PMCID: PMC3139998 DOI: 10.1176/ps.62.5.pss6205_0532] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors hypothesized that the depression treatment preferences of elderly home care patients would vary by their experience of depression and that preferences for active treatment would be associated with current depression and with antidepressant treatment. METHODS The authors conducted cross-sectional secondary analyses of data from the TRIAD study (Training in the Assessment of Depression) of 256 randomly selected elderly patients newly admitted to home care. The study assessed preference for active treatments (medication or psychotherapy) and nonactive or complementary approaches (such as religious activities or doing nothing). Nondepressed patients were asked to choose as if they had serious depression. Two separate indicators of depression experience were used: a current diagnosis of major or minor depression and current or previous antidepressant treatment. RESULTS Of the 256 patients, 16% (N=41) met criteria for major or minor depression. Forty-seven percent of the sample (N=121) preferred an active treatment as their first choice, and others preferred nonactive or complementary approaches. Logistic regression indicated that current antidepressant use, previous psychotherapy experience, white or Hispanic race-ethnicity (versus black), greater impairment in instrumental activities of daily living, and less personal stigma about depression were independently associated with preference for an active treatment. CONCLUSIONS Elderly home care patients had a variety of treatment preferences, ranging from active treatments, to religious or spiritual activities, to no treatment. Several factors were associated with a preference for active treatment, including treatment experience, physical impairment, race-ethnicity, and attitudes and beliefs. An understanding of patient preferences may help engage older depressed home care patients in treatment.
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Affiliation(s)
- Patrick J Raue
- Department of Psychiatry, Weill Cornell Medical College,White Plains, NY 10605, USA.
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Affiliation(s)
- Ellen L. Brown
- Associate Professor of Nursing, College of Nursing and Health Sciences, Florida International University, Miami, Florida
| | - Martha L. Bruce
- Professor of Sociology in Psychiatry, Weill Cornell Medical College, White Plains, New York
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40
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Davitt JK, Gellis ZD. Integrating mental health parity for homebound older adults under the medicare home health care benefit. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2011; 54:309-324. [PMID: 21462061 DOI: 10.1080/01634372.2010.540075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
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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Affiliation(s)
- Joan K Davitt
- School of Social Policy & Practice; and New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Ivanova JI, Bienfait-Beuzon C, Birnbaum HG, Connolly C, Emani S, Sheehy M. Physiciansʼ Decisions to Prescribe Antidepressant Therapy in Older Patients with Depression in a US Managed Care Plan. Drugs Aging 2011; 28:51-62. [DOI: 10.2165/11539900-000000000-00000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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de Man-van Ginkel JM, Gooskens F, Schuurmans MJ, Lindeman E, Hafsteinsdottir TB. A systematic review of therapeutic interventions for poststroke depression and the role of nurses. J Clin Nurs 2010; 19:3274-90. [PMID: 21083778 DOI: 10.1111/j.1365-2702.2010.03402.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Janneke M de Man-van Ginkel
- Department of Rehabilitation, Nursing Science and Sports, Rudolf Magnus Institute of Neuroscience, Utrecht, The Netherlands.
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Annells M, Allen J, Nunn R, Lang L, Petrie E, Clark E, Robins A. An evaluation of a mental health screening and referral pathway for community nursing care: nurses' and general practitioners' perspectives. J Clin Nurs 2010; 20:214-26. [PMID: 21040028 DOI: 10.1111/j.1365-2702.2010.03275.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To evaluate a feasible, best practice mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia. BACKGROUND War veterans commonly experience mental health difficulties and do not always receive required treatment, as can also occur for war widow(er)s. Whenever opportunity arises, such as during community nursing care, it is vital to identify mental health problems in a health promotion framework. DESIGN A clinical pathway was developed by literature review and consultation and then trialled and evaluated using mixed methods--quantitative and qualitative. METHODS Community nurses who trialled the pathway completed an evaluation survey and attended focus groups. General practitioners responded to an evaluation survey. RESULTS Most nurses found the pathway clear and easy to understand but not always easy to use. They emphasised the need to establish trust and rapport with clients prior to implementing the pathway. It was sometimes difficult to ensure effective referral to general practitioners for clients who screened positive for a mental health problem. When referral was accomplished, general practitioners reported adequate and useful information was provided. Some general practitioners also commented on the difficulty of achieving effective communication between general practitioners and nurses. CONCLUSIONS Nurses and some general practitioners found the pathway useful for their practice. They offered several suggestions for improvement by simplifying the trialled pathway and accompanying guidelines and strategies to improve communication between nurses and general practitioners. This study adds understanding of how community nurses might productively screen for mental health difficulties. RELEVANCE TO CLINICAL PRACTICE The trialled pathway, which was modified and refined following the study, is an evidence-based resource for community nurses in Australia and similar contexts to guide practise and maximise holistic care for war veterans and war widow(er)s and possibly other client groups.
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Affiliation(s)
- Merilyn Annells
- Division of Nursing and Midwifery, La Trobe University, Bundoora, Vic., Australia.
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Mitchell AJ, Kakkadasam V. Ability of nurses to identify depression in primary care, secondary care and nursing homes--a meta-analysis of routine clinical accuracy. Int J Nurs Stud 2010; 48:359-68. [PMID: 20580001 DOI: 10.1016/j.ijnurstu.2010.05.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 05/15/2010] [Accepted: 05/17/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE To clarify the ability of nurses and nursing assistants working in primary care, secondary care and nursing homes to identify depressed individuals using their clinical skills using meta-analysis of published studies. METHODS Literature search, appraisal and meta-analysis. We located 22 studies reporting on the detection of depression, 4 involving primary care or community nurses; 7 involving hospital nurses and 11 from nursing homes.17 of 22 studies had specificity data. RESULTS Across all 22 studies involving 7061 individuals, and a prevalence of 28.1% (95% CI=22.6-33.9%), practice and community nurses correctly identified 26.3% (95% CI=16.2-37.8%) of people with depression. They also correctly identified 94.8% (95% CI=91.3-97.4%) of the non-depressed. Nurses working in hospital settings correctly identified 43.1% (95% CI=31.9-54.8%) of people with depression and 79.6% (95% CI=71.5-86.7%) of the non-depressed. Those working in nursing homes correctly identified 45.8% (95% CI=38.1-53.6%) of people with depression and 80.0% (95% CI=68.6-88.7%) of the non-depressed. CONCLUSIONS Nurses have considerable difficulty accurately identifying depression but are probably at least as accurate as medical staff.
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Affiliation(s)
- Alex J Mitchell
- Liaison Psychiatry, Leicester General Hospital, Leicester LE5 4PW, United Kingdom.
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45
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Smith M, Johnson KM, Seydel LL, Buckwalter KC. Depression Training for Nurses. Res Gerontol Nurs 2010; 3:162-75. [DOI: 10.3928/19404921-20100527-99] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Accepted: 03/22/2010] [Indexed: 11/20/2022]
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Abstract
OBJECTIVES Depression in older adult home care recipients is frequently undetected and inadequately treated. Failed communication between home healthcare personnel and the patient's physician has been identified as a barrier for depression care. The purpose of this pilot intervention study was to improve nurse competency for communicating depression-related information to the physician. DESIGN A single group pre-post experimental design. SETTING Two Medicare-certified home healthcare agencies serving an urban and suburban area in New York. PARTICIPANTS Twenty-eight home care nurses, all female Registered Nurses. INTERVENTION Two-hour skills training workshop. MEASUREMENTS To evaluate the intervention, pre-post changes in effective nurse communication using Objective Structured Clinical Examinations and nurse survey reports. RESULTS The intervention significantly improved the ability of the home care nurse to perform a case presentation in a complete and standard organized format pre versus postintervention. The intervention also increased nurse-reported certainty to communicate depression-related information to the physician. CONCLUSIONS Our findings provide support for the ability of a brief, depression-focused communication skills training intervention to improve home care nurse competency for effectively communicating depression-related information to the physician.
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Petkus AJ, Gum AM, Small B, Malcarne VL, Stein MB, Wetherell JL. Evaluation of the factor structure and psychometric properties of the Brief Symptom Inventory-18 with homebound older adults. Int J Geriatr Psychiatry 2010; 25:578-87. [PMID: 20013879 PMCID: PMC4070299 DOI: 10.1002/gps.2377] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Homebound older adults are at high risk for depression and anxiety. Systematic screening may increase identification of these difficulties and facilitate service usage. The purpose of this study was to investigate the factor structure, internal consistency, and concurrent validity of the Brief Symptom Inventory-18 (BSI-18) for use as a screening instrument for depression and anxiety with homebound older adults and to examine if the BSI-18 could be shortened further and exhibit comparable psychometric properties. METHODS A sample of 142 older adults receiving in-home aging services completed interviews that included the BSI-18 and the depression and anxiety modules of the structured clinical interview for DSM-IV. RESULTS Confirmatory factor analysis showed that the theorized three-factor, second-order model of the BSI-18 fit the data well (S-B X(2) = 136.17; p = 0.36). The depression and anxiety subscales exhibited high internal consistency (alpha > 0.81), whereas the somatic subscale exhibited lower internal consistency (alpha = 0.69). Receiver operator curve (ROC) analyses suggest that the BSI-18 depression and anxiety subscales were able to predict those with DSM-IV diagnoses (Depression AUC = 0.89 p < 0.001; Anxiety AUC = 0.80, p < 0.001). The ROC results suggested adapting a cut score of T = 50 to achieve optimal sensitivity and specificity. The short three-item depression scale exhibited comparable psychometric properties to the full scale, while the three-item somatic and anxiety scales exhibited lower internal consistency and sensitivity. CONCLUSIONS These findings provide initial evidence that the BSI-18 is valid for use with homebound older adults.
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Affiliation(s)
- Andrew J. Petkus
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - Amber M. Gum
- Department of Aging and Mental Health Disparities, Louis de la Parte Florida Mental Health Institute, University of South Florida, USA
| | - Brent Small
- School of Aging Studies, University of South Florida, USA
| | | | - Murray B. Stein
- Department of Psychiatry, University of California, San Diego, USA,Department of Family and Preventative Medicine, University of California, San Diego, USA
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Damián J, Pastor-Barriuso R, Valderrama-Gama E. Descriptive epidemiology of undetected depression in institutionalized older people. J Am Med Dir Assoc 2010; 11:312-9. [PMID: 20511097 DOI: 10.1016/j.jamda.2010.01.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 01/26/2010] [Accepted: 01/26/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To measure the prevalence and associated factors of undetected depression in institutionalized older people. DESIGN AND SETTING Epidemiologic cross-sectional study in nursing homes and residential facilities. PARTICIPANTS A stratified cluster sample of residents 65 years of age and older living in institutions of Madrid (Spain). MEASUREMENTS Residents were considered to be depressed if they met at least 1 of the following 3 criteria: 10-item Geriatric Depression Scale score of 4 or higher, physician's diagnosis, or antidepressant use. Prevalence of undetected depression was defined as the proportion of depressed residents without documented diagnosis or treatment. RESULTS A total of 255 of 579 residents had depression (weighted prevalence 46.1%, 95% confidence interval [CI] 41.0%-51.3%) and 108 depressed residents were undetected (undetection prevalence 41.5%, 95% CI 33.2%-50.2%). Undetection was lower in younger residents, private versus public facilities (sex-, age-, and size-adjusted prevalence ratio [PR] 0.59, 95% CI 0.37-0.94), and larger facilities (sex-, age-, and ownership-adjusted PR 0.94 per 50-bed increase, 95% CI 0.88-1.00). Undetected depression was higher in residents with poor self-rated health (sex- and age-adjusted PR 1.83, 95% CI 1.24-2.73), whereas the opposite came about for physician-rated health (PR 0.65, 95% CI 0.44-0.95). Undetection decreased 11% (95% CI 4%-17%) per 1-medication increase, and it was lower in patients with Alzheimer disease, anxiety, and arrhythmia. CONCLUSIONS Number of medications and self-rated health were the main determinants of undetected depression. Physician-rated health, facility characteristics (size and ownership), and some diseases could also be considered.
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Affiliation(s)
- Javier Damián
- National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
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Gellis ZD. Assessment of a brief CES-D measure for depression in homebound medically ill older adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2010; 53:289-303. [PMID: 20461617 PMCID: PMC2905854 DOI: 10.1080/01634371003741417] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
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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Affiliation(s)
- Zvi D Gellis
- Center for Mental Health and Aging, School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Brown EL, Raue PJ, Roos BA, Sheeran T, Bruce ML. Training nursing staff to recognize depression in home healthcare. J Am Geriatr Soc 2010; 58:122-8. [PMID: 20002507 PMCID: PMC3684961 DOI: 10.1111/j.1532-5415.2009.02626.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To describe the implementation and acceptability of the TRaining In the Assessment of Depression (TRIAD) intervention, which has been tested in a randomized trial. The primary aim of TRIAD is to improve the ability of homecare nurses to detect depression in medically ill, older adult homecare patients. DESIGN Description of the important components of TRIAD, its implementation, and evaluation results from nurse surveys. SETTING Three certified home healthcare agencies in Westchester County, New York. PARTICIPANTS Thirty-six homecare nurses. INTERVENTION Participants randomly assigned to TRIAD (n=17) were provided with the opportunity to observe and practice patient interviewing. The approach focused on clinically meaningful identification of the two "gateway" symptoms of depression and is consistent with the newly revised Medicare mandatory Outcome and Assessment Information Set (OASIS-C). Control group participants (n=19) received no training beyond that which agencies may have provided routinely. MEASUREMENTS Baseline and 1-year nurse confidence in depression detection, and postintervention acceptability ratings of the TRIAD intervention. RESULTS Participants randomized to the TRIAD intervention reported a statistically significant increase in confidence in assessing for depression mood (P<.001), whereas the usual care group's confidence remained unchanged (P=.34) 1 year later. CONCLUSION An educational program designed to improve depression detection by giving nurses the skills and confidence to integrate depression assessment into the context of routine care can be successfully implemented with homecare agency support. The authors discuss the intervention in terms of OASIS-C and the "real world" realities of intervention implementation.
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Affiliation(s)
- Ellen L Brown
- College of Nursing and Health Sciences, Florida International University, Miami, FL 33199, USA.
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