Research That Matters (January 17 - 20, 2008)

Purpose: Heart disease is one of the leading causes of hospitalization of older adults and is associated with greater impairment than arthritis, diabetes, or lung disease. Depressive symptoms in elderly cardiac patients range from 11% to 36%. Despite these high rates, evidence suggests that assessment, recognition, and management of depression by home care nurses are often inadequate. Detection of depression in cardiac patients is a major concern to homecare clinicians seeking to integrate brief screening measures into their practice. To address this gap, data is presented from a home care research program to screen and manage depression in homebound older (65+) cardiac patients. Methods: Data were collected from 289 older cardiac patients recruited for a prospective cohort study of late life depression screening in home care. Screening was based on the U.S. Preventive Services Task Force guidelines. The current mood section of the Structured Clinical Interview for DSM-IV was used to compare home care and research interview ratings of past month depressive symptoms. The primary aim was to investigate differences in these ratings and then to analyze whether certain patterns of agreement and disagreement were related with patient characteristics that are known to be associated with depressive symptoms. The study hypothesized whether older cardiac home care patients who were identified as most likely to be depressed (by home care nurses and research interviews) would have less social contact, greater medical comorbidity, and more functional disability when compared with patients who were not identified as depressed. Descriptive statistics were calculated for patient sociodemographic and clinical characteristics. Categorical measures were compared in the two groups (home care and research ratings) using chi-square tests. Mean values for continuous variables were compared by t test. A multivariate logistic regression model was then estimated for our hypothesis. Results: The home care sample mean age was 76.5 years (SD=6.4; range 65-89); 71% were female; most were Caucasian (85.4%); 67% lived alone; and 98% were on Medicare. Prevalence of depressive symptoms ranged from 30% (nurse ratings) to 42% (diagnostic research ratings) in this cardiac patient sample yet less than 3% of those patients were receiving mental health treatment based on medical chart review. Observed agreement was 73% and kappa agreement was 0.42 indicating a fair to moderate agreement. Medical comorbidity, functional disability, and less social contact were associated with the presence of clinically significant depressive symptoms by both home care nurse and research ratings when compared with depression-absent cases. Implications: The data suggest that depression is substantial in frail elderly homecare patients and underscores the importance of depression screening in this non traditional mental health setting. Authors discuss results in terms of the “real-world” applicability of this screening intervention for late-life depression, and present implications for social work practice and research. Integration of a depression screening program into home care agencies using a brief and valid depression measure would assist home care clinicians in timely evaluation of their older patient's mental health status and in overall improvement of their psychosocial care.