Session: Depression in Vulnerable Older Adults: Rates, Symptom Severity, and Potential for Intervention (Society for Social Work and Research 14th Annual Conference: Social Work Research: A WORLD OF POSSIBILITIES)

Older adults who experience the onset and/or deterioration of disability and social isolation are more vulnerable to depression than their healthy and socially engaged age peers. Despite these older adults' high vulnerability to depression, identification and treatment of their depression are seriously lacking. To inform evidence-based social work practice in aging and mental health, in this symposium we report on four studies focused on assessment of depression in vulnerable older adults and exploration of the aging services potential to implement depression care.

The first paper presents the outcomes of depression assessments, using the Patient Health Questionnaire (PHQ-9), of 762 recipients of home-delivered meals. Of the sample, 17.3% had clinically significant depressive symptoms (PHQ-9 > = 10) and 8.4% had probable major depressive disorder. Multivariate analysis showed that chronic illnesses, cognitive impairment, and low income were significant correlates of symptom severity, while self-reported diagnosis of depression and antidepressant medication use were not. The utility of the PHQ-9 for screening depression in homebound older adults is discussed.

The second paper reports findings from a survey, including the Geriatric Depression Scale, and the MINI diagnostic interview of 166 residents of independent and assisted living apartments from six retirement communities. Of the sample, 27.7% had subthreshold depression, and 4% suffered from major depression. The subthreshold depressive symptoms included low energy, irritability, worries about the future, low positive affect, and feelings of being downhearted and blue. The major risk factors were lower education, income inadequacy, African American race, loss/grief, and social loneliness.

The third paper reports findings from a baseline (n = 381) and 1-year follow-up (n = 204) study of the relationship between driving cessation and depression in older adults. At follow-up, 17% reported having stopped driving since baseline, and 15.4% had clinically significant depressive symptoms (Center for Epidemiologic Studies Depression Scale >= 16). Driving cessation was found to be an independent contributor to increased depressive symptoms. Other risk factors were baseline depression, older age, ADL impairment, perception of self as a poorer driver, and lower perceived social support than at baseline.

The fourth paper presents the findings of a study that explored the potential to implement depression care in aging service agencies. In-depth interviews with 20 program managers and a survey of 142 staff from 17 agencies found that lack of organizational resources/funding as well as limited knowledge and interest among staff were major barriers to implementing depression care. Only 5 agencies conducted systematic depression screening, 4 had established suicide risk protocols, 5 had mental health consultation, and 11 provided case management. The need for multilevel strategies for implementing sustainable practices is discussed.

Late-life depression is a treatable condition. Validated, easy-to-use screening tools and evidence-based interventions are available but not practiced in most aging service settings. This symposium underscores the conference theme by presenting research findings aimed at facilitating the adoption of screening and treatment of depression in vulnerable older adults. The symposium will conclude with a synthesis and discussion of implications for evidence-based social work practice in aging and mental health.