Does Depression Predict Falls Among Home Health Patients? Using a Clinical-Research Partnership to improve the quality of Geriatric Care

Sheeran, Thomas; Brown, Ellen L.; Nassisi, Pamella; Bruce, Martha L.

doi:10.1097/00004045-200406000-00007

Cited by 33 publications

(52 citation statements)

References 4 publications

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“…Future studies need to look at the efficacy of treatment models that incorporate dual-task cognitive demands while practicing functional activities and functional mobility in the home and in the community. These studies used matched control or randomized control groups to explore patient characteristics and other factors that contributed to patient falls (Isberner et al, 1998;Lewis et al, 2004;Sheeran, Brown, Nassisi, & Bruce, 2004). The findings from these studies propose that risk factors for falls among home health patients are a previous fall event, a primary diagnosis of depression or anhedonia, the use of antipsychotic phenothiazine's and tricyclic antidepressants, a secondary diagnosis of neurological or cardiovascular disorders, balance problems, frailty, and an absence of handrails (Isberner et al, 1998;Lewis et al, 2004;Sheeran et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Fear of Falling on Functional Independence Among Older Adults Receiving Home Health Services

Lawson¹,

Gonzalez²

2014

The Open Journal of Occupational Therapy

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Background: Falls are the fifth leading cause of death for adults aged 65 years and older. Several intrinsic and extrinsic fall risk factors have been identified, butthere is less understanding of the impact of a fear of falling on falls. Seventy percent of recent fallers and 40% percent of non-fallers report a fear of falling. Therefore, the purpose of this study was to examine the correlation between a fear of falling and a history of falls, as well as the impact on the functional independence of community-dwelling older adults receiving home health services.

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Section: Discussionmentioning

confidence: 99%

The Impact of Fear of Falling on Functional Independence Among Older Adults Receiving Home Health Services

Lawson¹,

Gonzalez²

2014

The Open Journal of Occupational Therapy

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“…A large proportion of the older adult population experiences depression, which can have serious, negative consequences in terms of morbidity [1], mortality [2-6], and quality of life [7-9]. Depression among older adults is also associated with excess utilization of health care, increased nursing home placement, greater burden to medical care providers, and higher annual health care costs [10-14].…”

Section: Introductionmentioning

confidence: 99%

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Kales

Nease

Sirey

et al. 2013

The American Journal of Geriatric Psychiatry

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Objective Although antidepressants are an effective treatment for later-life depression, older patients often choose not to initiate or to discontinue medication treatment prematurely. While racial differences in depression treatment preferences have been reported, little is known about racial differences in antidepressant medication adherence among older patients. Design Prospective, observational study comparing antidepressant adherence for older African-American and white primary care patients. Participants One hundred and eighty-eight subjects aged 60 and older, diagnosed with clinically significant depression with a new recommendation for antidepressant treatment by their primary care physician. Measurement Study participants were assessed at study entry and at four-month follow-up (encompassing the acute treatment phase). Depression medication adherence was based on a well-validated self-report measure. Results At four-month follow-up, 61.2% of subjects reported that they were adherent to their antidepressant medication. In unadjusted and two of the three adjusted analyses, African-American subjects (n=82) had significantly lower rates of four-month antidepressant adherence than white subjects (n=106). African-American females had the lowest adherence rates (44.4%) followed by African-American males (56.8%), white males (65.3%) and white females (73.7%). In logistic regression models controlling for demographic, illness, and functional status variables, significant differences persisted between African-American women and white women in reported four-month antidepressant adherence (OR 3.58, 95% CI 1.27-10.07, Wald Chi-square =2.42, df=1, p<0.02). Conclusions The results demonstrate racial and gender differences in antidepressant adherence in older adults. Depression treatment interventions for the older adults should take into account the potential impact of race and gender on adherence to prescribed medications.

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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: 89%

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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Does Depression Predict Falls Among Home Health Patients? Using a Clinical-Research Partnership to improve the quality of Geriatric Care

Cited by 33 publications

References 4 publications

The Impact of Fear of Falling on Functional Independence Among Older Adults Receiving Home Health Services

The Impact of Fear of Falling on Functional Independence Among Older Adults Receiving Home Health Services

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Antidepressant Medication Management Among Older Patients Receiving Home Health Care

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