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Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing
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Depression Screening in Medically Ill Homecare Elderly.

Zvi D Gellis1

  • 1Associate Professor, Hartford Geriatric Social Work Faculty Scholar, Center for Mental Health and Aging, School of Social Policy & Practice, University of Pennsylvania.

Best Practices in Mental Health
|July 12, 2011
PubMed
Summary

Depression screening in home health care shows fair agreement between homecare and research raters. Improved training is needed to better detect depression in medically ill older adults receiving home care.

Area of Science:

  • Geriatric Medicine
  • Psychiatry
  • Home Health Care Research

Background:

  • Lack of mental health services in home health care settings.
  • Need for improved geriatric depression screening in routine care.
  • Challenges in detecting depression among medically ill, homebound older patients.

Purpose of the Study:

  • To evaluate a depression screening model (HOME) for medically ill, homebound older patients in acute home health care.
  • To assess the concordance between homecare worker and research interview ratings of depression.
  • To identify patient characteristics influencing homecare worker depression estimates.

Main Methods:

  • Prospective cohort study of 289 elderly patients (≥65 years) from a home health care agency.
  • Data collection on depression, cognitive function, medical comorbidity, functional status, and social isolation.

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  • Use of the structured clinical interview for DSM (SCID) depression module for research interviews.
  • Main Results:

    • Overall prevalence of major depression was 5.7% by both homecare and research raters.
    • Prevalence of subthreshold depressive disorder was 16.4% according to research raters.
    • Observed agreement was 73% and kappa agreement was 0.42 (fair to moderate).

    Conclusions:

    • Depression remains underdetected in medically ill, homebound elderly patients.
    • Enhanced training in depression screening methods for homecare workers is crucial.
    • Patient follow-up interviews and appropriate referrals can improve care for depressed elderly homecare patients.