Outcomes of community-based social service interventions in homebound elders

To document within-client change in function and quality of life over 6 months, and determine whether social service interventions, comorbidity, depressive symptoms, social support and stress are predictors of within-patient change.

Assess homebound elderly referred for social services on depressive symptoms measured by the Geriatric Depression Scale (GDS), comorbidity with the Charlson Index, and stress and support with the Duke instrument. Function was measured by the Functional Autonomy Scale (FAS), measuring Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), mobility, communication and mental function. The SF-36 measured quality of life.

Among 56 new homebound clients with an average age of 82, 33% had depressive symptoms at baseline (>7 on the GDS). At baseline clients were at or below 25th percentile for five of eight domains of the SF-36, and mental and physical summary scores. Further at baseline, 90% had difficulties with mobility and IADLs; 61% had ADL limitations. At 6-month follow-up overall, 26% had depressive symptoms at follow-up. Greater comorbidity was associated with more depressive symptoms at both baseline and follow-up. By 6 months, 18% had deteriorated on the FAS, while 11% improved. More clients had changes in quality of life; regarding the physical component score, 13% had important deterioration, while 63% improved. Similarly, 33% declined on the mental component while 27% improved.

Among newly homebound elders, those with significant depressive symptoms are more likely to experience deterioration in function and quality of life over 6 months. However, those with more support showed significant improvement in the SF-36 mental component scale at 6 months.