The impact of home assessment on depression in the elderly: A clinical trial

Abstract

Many consider home assessment important to the evaluation and management of elderly patients with mental disorders but no controlled studies of the impact of this activity have been reported. Thus, we conducted a clinical trial to determine if home assessment was more effective than clinic assessment in eliciting useful clinical information and in reducing depression, anxiety, functional disability and social isolation among elderly depressed patients referred to an outpatient clinic. Thirty‐two patients aged 65 or older who scored 16 or more on the depression subscale of the Symptom Checklist (SCL‐90) and 4 or less on the Short Portable Mental Status Questionnaire (SPMSQ) and who consented to participate were enrolled in the trial: 15 were randomly allocated to the home assessment group and 17 to the clinic assessment group. Patients in the home assessment group were evaluated at home by a psychiatrist. Cases were assessed on enrolment and 4, 8 and 12 weeks later using five measures: SPMSQ, SCL‐42, Older Americans Research and Service Center Instrument (OARS, Activities of Daily Living and Social Resources Scales) and Evaluation of Change Scales (ECS). There were no significant differences between home and clinic assessment groups in useful clinical information elicited. There were significant improvements over time on the SPMSQ, SCL‐42, Social Resources and ECS but there were no significant differences in improvement of any outcome measures between the groups. Thus, we failed to prove that home assessment improved the assessment or the outcome of the depressed, cognitively intact, functionally independent, moderately socially isolated elderly patients included in this study.

The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review

“…In many of the included trials, subjective and/or objective social isolation was one of several outcomes (with no clearly specified primary outcome), and for some trials, strategies to reduce social isolation were part of an often much broader service improvement approach (e.g. [70,74,76,89]). Just six trials [43,72,73,75,86,87] had a measure of social isolation as the clearly stated primary outcome.…”

“…Of the six trials that compared an active treatment group with a control group [67-69, 71, 73, 76], findings of four trials suggested superior outcomes for their intervention groups over their control groups on objective social isolation measures: a psychoeducation programme for adults with schizophrenia [67], a social network intervention for people diagnosed with schizophrenia spectrum disorders [73], a preventive senior centre group for seniors with mild depression [69], and Social Cognition and Interaction Training (SCIT) for patients with various diagnoses [68]. One trial involving social education for people with schizophrenia and one trial involving home assessment teams for people with mood disorders did not lead to any improvements in objective social isolation [71,76].…”

“…Other relevant outcomes were included in 10 out of 11 trials [67,[69][70][71][72][73][74][75][76][77]. Of these ten trials, positive findings were reported in four trials: improved mental state was reported by Rivera and his team, who evaluated a supported socialisation intervention for adults with schizophrenia, other psychotic disorders or mood disorders [77]; reduced depression and social avoidance were reported by Stravynski and colleagues, who evaluated a mixture of strategies for people with social phobia and/or avoidant personality disorder [72].…”

Domiciliary clinics II: a cost minimisation analysis

“…However, the arguments favouring home or hospital assessment are essentially impressionistic. A single randomised, but small, study has compared the quality of assessment and outcome of elderly depressed referrals seen at home or in hospital and found no significant difference (Cole et al, 1995).…”

Home assessment in old age psychiatry: a practical guide

“…However, not all of the evidence has favoured home assessment. One trial of 32 elderly patients with depression who were cognitively intact failed to demonstrate an improvement in assessment or outcomes when comparing home assessments with clinic assessments (Cole 1995).…”