Psychiatric Status among the Homebound Elderly: An Epidemiologic Perspective

Abstract

Objective To compare the prevalence of specific psychiatric disorders in the homebound elderly to other elders, controlling for demographic, physical health, and socio‐economic factors. Design Survey. Setting Epidemiologic Catchment Area (ECA) project in New Haven, CT. Participants 2,553 non‐institutionalized elders representing the total elderly population of the greater New Haven area. Intervention None Main Measures Homebound status determined by self‐report; psychiatric status according to DSM III by the Diagnostic Interview Schedule (DIS); cognitive status by Mini‐Mental Status Examination. Results Cognitive impairment (21.8% vs 11.0%, P < 0.001), depression (2.3% vs 0.7%, P < 0.01), dysthymia (3.9% vs 1.7%, P < 0.01), and anxiety disorders (2.2% vs 0.4%, P < 0.001) were each at least twice as prevalent among elders confined to a bed or chair as among non‐homebound elders. Most of this increase was consistent with the poorer physical health status of the homebound; after controlling for health status, only dysthymia (Odds ratio = 2.1, P < 0.01) was significantly more prevalent among elders confined to a bed or chair. Conclusions The higher prevalence of disorders among the homebound support recommendations that psychiatric assessments become routine in primary care examinations of homebound elders and that the availability of preventive and therapeutic psychiatric services to the homebound increase.

Frequency of Going Outdoors as a Good Predictors for Incident Disability of Physical Function as well as Disability Recovery in Community-Dwelling Older Adults in Rural Japan

“…Demographic, physical, medical, and psychological factors previously associated with the frequency of going outdoors, independent of mobility or functional status were included in the current study, specifically age, sex, chronic medical conditions, 2,22,23 impairments of vision and hearing, 3,22 urinary incontinence, 3,24-26 subjective health, 2 depressive mood state 2,23 and cognitive function. 4 We ascertained the presence of chronic conditions (defined as a history of physician-diagnosed heart disease, stroke or diabetes mellitus) from the subject's report.…”

Using an annual over-75 health check to screen for depression: validation of the short geriatric depression scale (GDS15) within general practice

“…A depression screening day planned for a possible 4500 older people resulted in only two people attending (Forbes et al, 1995), while Ilie et al (1994) found that opportunistic screening for depression by general practitioners did not alter their clinical practice. Secondly, screening instruments used only with surgery attenders will miss depression among groups at particular risk, such as the homebound elderly (Bruce and McNamara, 1992). Thirdly, as part of a wider domiciliary health check, physical and social problems can be considered alongside mental health problems more easily than in a general practice consulting room.…”

Testing the chronic care model for depression in homebound older adults.

“…for the PHQ-2 variable and 227,283 for the Medicare Claims variable) subjects, the PHQ-2 determined that 15,473 (7.0% of the sample) were depressed, and the Medicare Claims determined that 27,249 (12.0% of the sample) were depressed. The resulting depression percentages fell within the ranges of depression that have been found with homebound older adults (Bruce & McNamara, 1992;Choi & McDougall, 2007;Choi et al, 2010;Qiu et al, 2010). The demographics of the PHQ-2 and Medicare Claims samples vary a bit depending on the variables used in each analysis.…”

“…Although both of these measures have issues, the resulting depression percentages fall within the ranges of depression that have been found with homebound older adults (Bruce & McNamara, 1992;Choi & McDougall, 2007;Choi et al, 2010;Qiu et al, 2010). A crosstab analysis between the two depression measures used in the present study revealed that of the 219,883 subjects without missing data in either depression variable, 180,715 (82.2%) were determined by both samples to not be depressed and 1,872 (0.01%) were determined by both samples to be depressed.…”

“…Bruce and McNamara (1992) analyzed data from 2,553 older adults living in New Haven, CT. In a poor determination of homebound status that did not take into account physical illnesses or disabilities, the authors found that when comparing older adults who were in a bed or chair for most of the day to older adults who did not meet this criterion for homebound status, 21.8% vs. 11.0% were cognitively impaired, 2.3% vs. 0.7% were depressed, 3.9% vs. 1.7% had dysthymia, and 2.2% vs. 0.4% had an anxiety disorder.…”