Saturday, 15 January 2005 - 4:00 PM

This presentation is part of: Services for Older Adults

Configuration of Services Used By Depressed Older Adults in the Six-Month Post-Acute Period

Purpose. Related to the cost constraints in the mental health inpatient services, the length of psychiatric inpatient stay has been shortened. With reduced length of hospital stay, patients discharged into the community for post-acute care are still recovering and still at risk in the immediate post-acute period. Thus, post-discharge service use in the community has become more important. Older adults hospitalized for depression leave the acute care setting with comorbid medical, psychiatric, and psychosocial needs and therefore service use spans multiple service sectors. Thus, this paper characterizes and predicts distinct configurations of post acute care for depressed elders and discusses conceptual and methodology challenges of studying service patterns.

Methods. Data from in-hospital and six month post-discharge interviews and medical records were collected from 140 older adults hospitalized for major depression. Information captures service access and levels of use in different sectors of care (psychiatric, medical, psychosocial, and formal/informal home care). The configurations of services used were identified based on the level and access to care, using cluster analysis (nonhierarchical, Euclidian distance method using the SAS PROC FASTCLUS procedure). Then, associative factors selected from the Andersen and Network Episode Model are tested with multinomial logistic regression.

Results. The results show that in the six-month post acute period, use of psychiatric service is high, with 90% accessing a psychiatrist or another MD for mental health concerns. Given high levels of medical comorbidity, over 92% used a health care professional. Psychosocial service use was lower, with 26% using meal service and 26% transportation. Among users, the amounts of service used were highly positively skewed. Cluster analysis identified three distinct service use patterns among older depressed patients: Home care users, moderate users of outpatient mental health services, and heavy users of all professional services (psychiatric, medical, psychosocial, and formal home care). Compared with heavy users of all professional services, moderate users of outpatient MH services were more likely to live in a rural area, be younger, live with others, and own a home. Home care users were more likely to live with others, own a home, be younger, have more functional impairments, and have severer chronic illness than heavy users of all professional services.

Implications. These findings demonstrate that despite a homogeneous sample of older adults in this study (those with severe depression), access, level, and configurations of psychiatric, medical, and psychosocial service use vary. These findings highlight that the availability of both informal and formal services influences service configurations, as much as psychiatric needs within this group of severely depressed older adults. Over the past decade, social work research has widely addressed factors associated with service use for individual sectors; yet for clients with multiple needs, complex service pattern are likely. Therefore, despite the methodological challenges of identifying clusters, it is important for social work researchers to study service use patterns, as opposed to use of a specific service.

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