Testing of a Statewide Initiative to Enhance Depression Care in Older Home Care Patients

Abstract

The prevalence of geriatric depression in home care is extremely high with 15% of older patients meeting the diagnostic criteria for major depression. 1 When milder forms of depression are also included, this number doubles to one third of home care patients. 2 Depression in older adults is associated with reduced quality of life, increased risk of suicide and hospitalizations, as well as greater functional impairment. 3-6 Compared with younger adults, older adults are more likely to have milder forms of depression referred to as dysthymia; however, they tend to have longer and more frequent episodes of depression as well as more medical comorbidities potentially influencing course and outcomes. 7 National data indicate that although depression is widespread in late life, it is often under-recognized and undertreated. According to the National Institutes of Mental Health, there are currently about six million Americans 65 and older dealing with depression, whereas less than 10% are being treated. 8 Depression is a major risk factor for hospitalization for home health care patients. 9-11 A study that analyzed 374,123 Medicare beneficiaries receiving home care services found a 20% increase in hospitalization in patients who demonstrated the presence of depressive symptoms on admission to home care, regardless of other factors such as type of diagnosis and level of functional ability. 10 To encourage home care agencies to screen for depression and implement interventions when detected, the Centers for Medicare and Medicaid now requires that home care agencies document depression screening on Item M 1730 on the Outcome and Assessment Information Set (OASIS-C) at start of care and recertification. 12 Home care professionals have identified lack of education as a major barrier to providing evidence-based care. 13 However, a few previous studies have demonstrated that with training and support, home health care professionals can effectively identify, provide education, and refer patients for treatment. 13,14 These findings underscore the need for further education of home care professionals. Depressive symptoms among older home care patients are a public health concern that affects the lives of many families in a variety of ways. Several personal and service barriers exist that result in the under-detection and suboptimal care for this population. Many people experiencing depressive feelings may mistakenly view these changes as normal aging. 15 For others, treatment for depressive symptoms is not sought due to the stigma of mental illness, fear of side effects from antidepressants, which are often the major medical treatments for depression, and fear of loss of independence or being declared incompetent. Service barriers include fragmented mental 642752H HCXXX10.

Perceptions and practice behaviors regarding late-life depression among private duty home care workers: a mixed-methods study

“…To our knowledge, no studies have specifically examined the perceptions of latelife depression by private duty PCAs. Previous studies often involved multiple occupations across the LTSS settings such as nurses, social workers, physical therapists, and direct care workers (Ayalon et al, 2008;Davison et al, 2009;Delaney, Barrere, Grimes, & Apostolidis, 2016;McCabe et al, 2008;McCrae et al, 2005). The limited literature on home care workers did not specify occupation titles and broadly examined perceptions of mental and behavioral health problems (Gleason & Coyle, 2016;Grundberg et al, 2016;Konnert et al, 2018).…”