Recognition of Late‐Life Depression in Home Care: Accuracy of the Outcome and Assessment Information Set

Abstract

This study evaluated the accuracy of home care nurses' ratings of the Outcome and Assessment Information Set (OASIS) depression items. The accuracy of home care nurses' depression assessments was studied by comparing nurse ratings of OASIS depression items with a research diagnostic assessment based on the Structured Clinical Interview for Axis I Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). The setting for this study was a nonprofit, Medicare-certified, voluntary home healthcare agency. Sixty-four home care nurses assessed 220 patients aged 65 and older with the OASIS upon admission. Of the 220 patients, using standard SCID criteria, 35 cases of major or minor depression were identified. The home care nurses accurately documented the presence of depression in 13 of 35 cases (sensitivity=37.1%; positive predictive value=0.56). Of the 220 patients, 185 had no SCID-identified major or minor depression. The nurses agreed on the absence of depression in 175 of 185 cases (specificity=94.6%; negative predictive value=88.8%). This study indicates that home care nurses often do not accurately rate OASIS depression items for older adult patients.

Behavioral health needs and problem recognition by older adults receiving home‐based aging services

“…Older adults who do not perceive behavioral health problems may describe their symptoms in physical or other vague terms, which is associated with lower likelihood of recognition by a professional (Kessler et al, 1999). This is concerning, given that professionals frequently do not recognize depression in homebound elders (Brown et al, 2004;Dalby et al, 2008), although those who receive a diagnosis of depression are most likely to receive appropriate treatment, as found in a recent study of aging services in Canada (Dalby et al, 2008).…”

Managing Depression in Home Health Care: A Randomized Clinical Trial

“…Evidence suggests that nurses may lack specific training in depression and may be uncomfortable with assessing depression (Brown, Meyers, Lee, Fyffe, Raue, & Bruce, 2004b;Larson, Chernoff, & Sweet-Holp, 2004;Lloyd Williams & Payne, 2003;McDonald, Passik, Dugna, Rosenfeld, Theobald, & Edgerton, 1999). Thus, there is a need for research on ways to improve the recognition of depression, and the treatment of depression in older adult home care recipients (Brown et al, 2004a;Sherlock, 2005). In an earlier report (Ell et al, 2005), we found that the use of a routine diagnostic screening tool for depression can be implemented with minimal in-house nurse training and improves detection of depression among older adults with significant physical and functional impairment over usual care.…”

“…However, there is evidence that nurse detection of depression may be less than optimal. Recent studies have found that nurses using standard homecare assessment guidelines identified only about half of the patients who were found to be depressed on independent evaluation with a structured diagnostic interview (Brown, Bruce, McAvay, Raue, Lachs, & Nassisi, 2004a;Brown, McAvay, Raue, Moses, & Bruce, 2003). Evidence suggests that nurses may lack specific training in depression and may be uncomfortable with assessing depression (Brown, Meyers, Lee, Fyffe, Raue, & Bruce, 2004b;Larson, Chernoff, & Sweet-Holp, 2004;Lloyd Williams & Payne, 2003;McDonald, Passik, Dugna, Rosenfeld, Theobald, & Edgerton, 1999).…”

Pilot Testing of a Multicomponent Home Care Intervention for Older Adults With Heart Failure

“…29,30 Recent research describes techniques such as problem-solving therapy 31 and cognitive behavioral therapy 32 that have been used successfully with depressed older adults in home care settings. Common to both these methods is the use of pleasant physical, emotional, and social events that patients regularly select as a self-care strategy to alleviate depression and enhance wellness.…”