No abstract

Frail elderly in a LTC facility were able to participate and benefit from a strength training program. The program was delivered with low-cost equipment by an exercise physiologist and LTC staff. The advantage of such a program is that it provides recreational and therapeutic benefits.

For a variety of reasons, the most commonly used advance directive documents (eg, the living will) may not be very useful in many situations that older adults encounter. The durable power of attorney for health care is a more versatile document. We advocate focusing less on "signing away" certain interventions and more on clarifying the goals of care in the ambulatory setting.

OBJECTIVE:To determine the effectiveness of screening and treatment for depression among ambulatory indigent patients visiting resident physicians. DESIGN: Two-group randomized trial ( N = 33 intervention, N = 28 usual care) with baseline, 6-month, and 12-month outcome measurements. SETTING: Internal Medicine Residency Clinic. PATIENTS:Clinic patients over 18 years of age who screened positive for depression on the PRIME-MD during a visit to their resident physician. Patients were not receiving treatment nor seeking care for any emotional problems. All patients were either enrolled in Medicaid or had income below the poverty line. T he underdiagnosis of depression and the need for screening in primary care settings can be especially severe among patients with a lower socioeconomic status. INTERVENTION: 1-5The high prevalence of depression in internal medicine (IM) clinics, depressed patients' low quality of life (lower than patients with severe physical health problems), and their extensive utilization of health care services (both inpatient and ambulatory) underscores the need for testing the effectiveness of depression screening and management in this setting. 4,[6][7][8][9][10][11][12][13][14][15][16][17] Many recent trials have shown that intervention for depressed patients in primary care settings is usually successful in diminishing morbidity when that screening is coordinated with thorough follow-up and treatment. 1,2,6,18 -20 This randomized trial examined how the combination of simple screening and treatment for major depressive disorder affected indigent IM clinic patients' relief of depression symptoms. For this trial, indigent refers to ambulatory clinic patients who either qualified for Medicaid or had no private insurance and income below the poverty line. In a recent study, income below the poverty line was found to multiply the risk of major depression by a factor of 3.8. 21This risk ratio was the largest found in this study among two dozen other sociodemographic variables. Previous trials with a focus on screening and treating indigent IM clinic patients have not been published. A trial specifically targeted depressed patients over 60 years of age who had psychosocial stressors, and clear improvements were demonstrated with intervention. 22Received from Community Health