Friday, 14 January 2005 - 12:00 PM

This presentation is part of: Poster Session I

The Effects of Quality of Post-Acute Care on Six Weeks and Six Months Depression Outcomes of Older Adults

Purpose: Depressed elders are disproportionately hospitalized, and after increasingly shorter hospital stays, they are discharged with high needs of post-acute care for recovery. A growing number of studies document that comorbidity is associated with depression in later life; thus, elders with depression are understood to need multiple types of services. However, mental health services research does not pay full attention to those multiple service needs of depressed elders, and tends to examine whether receipt of psychiatric care is associated with better depression outcomes. This study addresses whether quality of post-acute care for those multiple service needs contributes to depression outcomes at six weeks and at six months, guided by a biopsyosocial perspective.

Method: We studied 167 elders hospitalized for depression on a geropsychiatric unit of a large urban hospital and discharged to home settings. They are interviewed at discharge, at six weeks, and at six months. Four domains of needs for care (psychiatric, medical, functional, and psychosocial needs) are assessed through medical records, standardized instruments, and patient interviews at hospital discharge. Quality of post-acute care for each of those domains is assessed both at six weeks, and at six months; it is assessed by whether needs in each domain are met through corresponding services that were determined by extant clinical guidelines, published consensus statements, other literature, and professional judgment of need for services. Depression outcomes are measured by the Geriatric and Depression Scale (GDS).

Results: Multiple regression analyses reveal that high quality of care for functional assistance and psychosocial needs was significantly associated with better depression outcomes at six moths. Interestingly, quality of care for psychiatric and medical needs was not significantly associated with depression outcomes at six months. Also, quality of care for psychiatric, medical, functional, and psychosocial needs was not associated with depression outcomes at six weeks.

Implications: Our findings demonstrate that quality of care for functional assistance and psychosocial needs is important in improving depression outcomes. Thus, social workers need to make efforts to meet multiple domains of needs for depressed elders through providing psychiatric, medical, functional, and psychosocial services. Moreover, our findings show that quality of care was associated with depression outcomes at six months, but not at six weeks. This implies that it may need a longer period of time for quality of post-acute care to affect depression outcomes of older adults.

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