Depression and Risk for Adverse Falls in Older Home Health Care Patients

Byers, Amy L.; Sheeran, Thomas; Mlodzianowski, Amy E.; Meyers, Barnett S.; Nassisi, Pamella; Bruce, Martha L.

doi:10.3928/19404921-20081001-03

Cited by 74 publications

(60 citation statements)

References 42 publications

(49 reference statements)

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“…Major and minor depression meeting clinical diagnostic criteria affected almost 1 in 4 older home health patients. (1) Depression in this population was associated with an increased risk of falls,(2, 3) hospitalization,(4) and excess service use. (5, 6) Antidepressants are the dominant mode of treatment of depression in this setting and were used by as much as one-third of all older home health patients.…”

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confidence: 88%

Antidepressant Medication Management Among Older Patients Receiving Home Health Care

Bao

Shao

Bruce

et al. 2015

The American Journal of Geriatric Psychiatry

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Objective Antidepressant management for older patients receiving home health care (HHC) may occur through two pathways: nurse-physician collaboration (without patient visits to the physician) and physician management through office visits. This study examines the relative contribution of the two pathways and how they interplay. Methods Retrospective analysis was conducted using Medicare claims of 7,389 depressed patients 65 or older who received HHC in 2006–7 and who possessed antidepressants at the start of HHC. A change in antidepressant therapy (vs. discontinuation or refill) was the main study outcome and could take the form of a change in dose, switch to a different antidepressant, or augmentation (addition of a new antidepressant). Logistic regressions were estimated to examine how use of home health nursing care, patient visits to physicians, and their interactions predict a change in antidepressant therapy. Results About 30% of patients experienced a change in antidepressants versus 51% who refilled and 18% who discontinued. Receipt of mental health specialty care was associated with a statistically significant, 10–20 percentage-point increase in the probability of antidepressant change; receipt of primary care was associated with a small and statistically significant increase in the probability of antidepressant change among patients with no mental health specialty care and above-average utilization of nursing care. Increased home health nursing care in absence of physician visits was not associated with increased antidepressant change. Conclusions Active antidepressant management resulting in a change in medication occurred on a limited scale among older patients receiving HHC. Addressing knowledge and practice gaps in antidepressant management by primary care providers and home health nurses and improving nurse-physician collaboration will be promising areas for future interventions.

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confidence: 88%

Antidepressant Medication Management Among Older Patients Receiving Home Health Care

Bao

Shao

Bruce

et al. 2015

The American Journal of Geriatric Psychiatry

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“…[3][4][5] A number of studies have documented the suffering and adverse consequences of geriatric depression, including poor quality of life, higher mortality from illness or suicide, adverse events such as falls and hospitalization, higher healthcare costs, and poor adherence to medical treatments. [6][7][8][9][10] However, homecare patients often have little access to skilled depression care and most go untreated or inadequately treated, creating a significant public health problem. 11,12 Telehealth technology in homecare may offer an opportunity to increase access to depression treatment by incorporating evidencebased depression care guidelines into an agency's existing telehealth infrastructure and coordinating service via a trained and supported telehealth nurse.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Impact of Telemonitor-Based Depression Care Management for Geriatric Homecare Patients

Sheeran

Rabinowitz

Lotterman

et al. 2011

Telemedicine and e-Health

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Objective: The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish-and English-speaking elderly homebound recipients of homecare services. Materials and Methods: Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. Results: An ethnically diverse sample of 48 English-and Spanish-onlyspeaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the ''markedly severe'' range at baseline and in the ''mild'' range at follow-up. Conclusions: Results of this pilot support the feasibility of using homecare's existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English-and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed.

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“…In particular, major and minor depression meeting clinical diagnostic criteria affected almost 1 in 4 older home health patients(2), but was seriously under-recognized and poorly managed in this setting(2-4). In addition to enormous amount of suffering, depression was associated with an increased risk of falls(5, 6), hospitalization(7), and excess service use(4, 8) in this population.…”

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confidence: 98%

Misalignment Between Medicare Policies and Depression Care in Home Health Care: Home Health Provider Perspectives

Bao

Eggman

Richardson

et al. 2014

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Objective Depression affects one in four older adults receiving home health care. Medicare policies are influential in shaping home health practice. This study aims to identify Medicare policy areas that are aligned or misaligned with depression care quality improvement in home health care. Methods Qualitative study based on semi-structured interviews with nurses and administrators from five home health agencies in five states (n=20). Digitally recorded interviews were transcribed and analyzed using the grounded theory method. A multi-disciplinary team iteratively developed a codebook from interview data to identify themes. Results Several important Medicare policies are largely misaligned with depression care quality improvement in home health care: Medicare eligibility requirements for patients to remain homebound and to demonstrate a need for skilled care restrict nurses’ abilities to follow up with depressed patients for sufficient length of time; the lack of explicit recognition of nursing time and quality of care in the home health Prospective Payment System (PPS) provides misaligned incentives for depression care; incorporation of a two-item depression screening tool in Medicare-mandated comprehensive patient assessment raised clinician awareness of depression; however, inclusion of the tool at Start-of-Care only but not any other follow-up points limits its potential in assisting nurses with depression care management; under-development of clinical decision support for depression care in vendor-developed electronic health records constitutes an important barrier to depression quality improvement in home health care. Conclusions Several influential Medicare policies and regulations for home health practice may be misaligned with evidence-based depression care for home health patients.

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Depression and Risk for Adverse Falls in Older Home Health Care Patients

Cited by 74 publications

References 42 publications

Antidepressant Medication Management Among Older Patients Receiving Home Health Care

Antidepressant Medication Management Among Older Patients Receiving Home Health Care

Feasibility and Impact of Telemonitor-Based Depression Care Management for Geriatric Homecare Patients

Misalignment Between Medicare Policies and Depression Care in Home Health Care: Home Health Provider Perspectives

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