MANAGING LATE-LIFE MENTAL ILLNESS IN THE HOME

Abstract

As the population ages in the United States, so does the percentage of the people with disabilities and who are homebound increase. Millions of older adults have a disability (35.2% of those aged 65 years and older), and 3.4 million Medicare beneficiaries received home health agency services in 2017 because they are homebound. Among homebound older adults, approximately 40% have mental illness. Given the difficulty these older adults have in leaving their homes to attend medical appointments, many of them are underserved by mental health services that are traditionally delivered in outpatient offices. There is thereby a growing need to bring mental health services into the homes of these vulnerable community-dwelling older adults. This symposium will present and discuss four state-of-the-art efforts to bring mental health services into the homes of older adults. First, we will discuss findings from a study designed to deliver problem-solving therapy to older adults via in-home visits. Among older adults with need for in-home supportive services, this study found that the presence of executive dysfunction deficits and slow gait speed may increase the risk of incident major depression or generalized anxiety disorder. Second, we will discuss findings from a study that trained lay advisors to deliver behavioral activation via videoconferencing to older adults receiving home-delivered meals. This study found that behavioral activation delivered by trained lay advisors is a clinically effective treatment leading to meaningful reductions in depressive symptoms. Third, we will discuss the development of an intervention designed to integrate depression management into the routine care provided by home health nurses. More specifically, we will discuss the clinical effectiveness of this intervention, its feasibility in real-world practice, and the utility of long-distance training to support implementation. Lastly, we will discuss the rationale for and development of a multicomponent home health agency-based intervention designed to help older adults transition to and remain in their homes following a skilled nursing facility discharge. This study found that mental illness is common among older adults discharged from the SNF to the community and is associated with a decreased length of stay in the community.