Elderly Home Care Patients Research Articles

Características y factores relacionados con sobrecarga en una muestra de cuidadores principales de pacientes ancianos con demencia

ObjectiveTo describe the characteristics and determining factors of carer stress in a group of elderly home care patients with dementia evaluated in a Geriatric Assessment Unit. Material and methodsAn observational descriptive cross-sectional study was conducted using an assessment of baseline characteristics of patients and carers. Estimation of caregiver burden was registered by validated scales: Goldberg Anxiety Scale (GAS), Goldberg Depression Scales (GDS), and Zarit Burden Scale (ZS). ResultsA total of 130 patients were included. No item related to dementia patients was associated with caregiver burden. A poor perception of health and quality of life by the caregivers were associated with anxiety risk, depression and burden. Attendance rates for primary care and lack of paid work outside the home were associated with both, depression (GDS>2) and anxiety (GAS>4). Carer age and a lower education were related to depression. Anti-inflammatory, anxiolytics and antidepressants consumption was associated with anxiety, and anti-inflammatory consumption with caregiver burden (ZS >47). ConclusionsThe profile of carers in our sample is comparable to that described in other national studies, but care time is longer. The target population is difficult to identify and in need of help. Although there is not a formal demand for help, we should be encouraged to develop new healthcare methods.

Patient Activation and Disparate Health Care Outcomes in a Racially Diverse Sample of Chronically Ill Older Adults

The Patient Activation Measure (PAM) assesses people's ability to self-manage their health. Variations in PAM score have been linked with health behaviors, outcomes, and potential disparities. This study assessed the relative impacts of activation, socio-demographic and clinical factors on health care outcomes in a racially diverse sample of chronically ill, elderly homecare patients. Using survey and administrative data from 249 predominantly non-White patients, logistic regression was conducted to examine the effects of activation level and patient characteristics on the likelihood of subsequent hospitalization and emergency department (ED) use. Activation was not a significant predictor of hospitalization or ED use in adjusted models. Non-Whites were more likely than Whites to have a hospitalization or ED visit. Obesity was a strong predictor of both outcomes. Further research should examine potential sources of disadvantage among chronically ill homecare patients to design effective interventions to reduce health disparities in this population.

Datapoints: Psychotropic Drug Use Among Elderly Patients in Home Care in the United States

Back to table of contents Previous article Next article ColumnsFull AccessDatapoints: Psychotropic Drug Use Among Elderly Patients in Home Care in the United StatesVishal Bali, M.S., Satabdi Chatterjee, M.S., and Rajender R. Aparasu, Ph.D.Vishal BaliSearch for more papers by this author, M.S., Satabdi ChatterjeeSearch for more papers by this author, M.S., and Rajender R. AparasuSearch for more papers by this author, Ph.D.Published Online:1 Jan 2012https://doi.org/10.1176/appi.ps.2012000p6AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail An estimated 1.5 million persons in the United States receive home-based care involving a range of therapeutic and medical services (1). Most patients who receive home-based health care are elderly, with various levels of functional impairment. Although psychotropic medications are extensively used in the elderly population, limited data exist on the psychotropic needs of elderly home health patients.Psychotropic medication use was examined among elderly home health care patients age 65 and older by using the 2007 National Home and Hospice Care Survey (NHHCS), a national survey of U.S. home health and hospice agencies (2). Patient data for the NHHCS were obtained from interviews with designated agency staff members, who provided information from medical and medication administration records. Descriptive statistics, including 95% confidence intervals (CIs), were used to examine prevalence patterns of psychotropic drug use.More than a half million of the elderly home health care patients received at least one psychotropic agent—.54 million patients (CI=.50–.58) or 53.52% of the elderly patients (CI=50.60–56.44). As shown in Figure 1, antidepressants were the most frequently prescribed psychotropic agents (33.51%, CI=30.71–36.31), followed by sedatives-hypnotics-anxiolytics (30.65%, CI=27.96–33.34), mood stabilizers (9.87%, CI=8.15–11.59), and antipsychotics (7.55%, CI=6.08–9.03). Selective serotonin reuptake inhibitors (SSRIs) were the most frequently prescribed antidepressants (21.83%, CI=19.39–24.28), and benzodiazepines constituted a majority of the sedatives-hypnotics-anxiolytics prescribed (21.30%, CI=18.93–23.68).This study found that the overall prevalence of psychotropic use among elderly home health care patients was 54%, nearly 10 percentage points less than psychotropic use in nursing homes (63%) (3). The high prevalence of psychotropic use among home health care patients was mainly driven by the use of SSRIs and benzodiazepines. Given the inappropriate use of psychotropic agents among elderly patients and the poor health status of those receiving home health care, there is a need to monitor use of psychotropic drugs in this vulnerable population.The authors are affiliated with the Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, TX 77030 (e-mail: [email protected]edu). Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column.Acknowledgments and disclosuresThe authors report no competing interests.References1 Caffrey C , Sengupta M , Moss A , et al.: Home Health Care and Discharged Hospice Care Patients: United States, 2000 and 2007. National Health Statistics Reports, 38. Hyattsville, Md, National Center for Health Statistics, 2011 Google Scholar2 2007 National Home and Hospice Care Survey and National Home Health Aide Survey. Atlanta, Ga, Centers for Disease Control and Prevention, 2007. Available at www.cdc.gov/nchs/data/nhhcsd/NHHCS_NHHAS_web_documentation.pdf Google Scholar3 Bhattacharjee S , Karkare SU , Kamble P , et al.: Psychotropic drug utilization among elderly nursing home residents in the United States. Psychiatric Services 61:655, 2010 Link, Google ScholarFigures and TablesFigure 1 Psychotropic medication use among elderly home health care patients in 2007 FiguresReferencesCited byDetailsCited ByEuropean Geriatric Medicine, Vol. 8, No. 1 Volume 63Issue 1 January 2012Pages 6-6 Metrics Acknowledgments and disclosuresThe authors report no competing interests.PDF download History Published online 1 January 2012 Published in print 1 January 2012

Qualidade de vida de idosos atendidos em programa de assistência domiciliária

OBJETIVO: Avaliar a qualidade de vida de idosos em assistência domiciliária. MÉTODO: estudo transversal analítico. Foram avaliados idosos de um programa de assistência domiciliária quanto aos dados sociodemográficos, clínicos, funcionais e de qualidade devida pelo instrumento WHOQOL-Bref. Foram excluídos idosos com déficit cognitivo e/ou déficit auditivo grave. Utilizou-se o teste de Mann Whitney, Kruskal-Wallis e correlação de Spearman para verificar a associação do WHOQOL-Bref com as variáveis (α=0,05). RESULTADO: a amostra foi constituída por 23 idosos, com média etária de 84,22±7,89 anos, maioria feminina (69,6%). O número de comorbidades encontrado foi de 7,13±2,32. O tempo médio de dependência funcional foi de 3,48±2,5 anos. As variáveis que se aproximaram dos domínios do WHOQOL-Bref foram: sintomas depressivos (p<0,001), número de comorbidades (p=0,037) e capacidade funcional (p=0,019) com o domínio físico; idade (p=0,015), capacidade funcional (p=0,004), número de medicamentos (p=0,037) e sintomas depressivos (p=0,002) com o psicológico; idade (p=0,002), sintomas depressivos (p=0,002), número de comorbidades (p=0,010) com o meio-ambiente; afecções psiquiátricas (p=0,016) e capacidade funcional (p=0,001) com o domínio relações sociais; e queixa de dor (p=0,002), escala visual analógica de dor (p=0,021), número de medicamentos (p=0,002) e sintomas depressivos (p=0,050) com o domínio geral (overall). CONCLUSÃO: os fatores que influenciam negativamente a QV de idosos em AD são: idosos mais jovens, queixa de dor em maior intensidade, polifarmacoterapia, maior número comorbidades, presença de sintomas depressivos e outras afecções psiquiátricas e comprometimento funcional.

Preferences for depression treatment among elderly home health care patients.

The authors hypothesized that the depression treatment preferences of elderly home care patients would vary by their experience of depression and that preferences for active treatment would be associated with current depression and with antidepressant treatment. The authors conducted cross-sectional secondary analyses of data from the TRIAD study (Training in the Assessment of Depression) of 256 randomly selected elderly patients newly admitted to home care. The study assessed preference for active treatments (medication or psychotherapy) and nonactive or complementary approaches (such as religious activities or doing nothing). Nondepressed patients were asked to choose as if they had serious depression. Two separate indicators of depression experience were used: a current diagnosis of major or minor depression and current or previous antidepressant treatment. Of the 256 patients, 16% (N=41) met criteria for major or minor depression. Forty-seven percent of the sample (N=121) preferred an active treatment as their first choice, and others preferred nonactive or complementary approaches. Logistic regression indicated that current antidepressant use, previous psychotherapy experience, white or Hispanic race-ethnicity (versus black), greater impairment in instrumental activities of daily living, and less personal stigma about depression were independently associated with preference for an active treatment. Elderly home care patients had a variety of treatment preferences, ranging from active treatments, to religious or spiritual activities, to no treatment. Several factors were associated with a preference for active treatment, including treatment experience, physical impairment, race-ethnicity, and attitudes and beliefs. An understanding of patient preferences may help engage older depressed home care patients in treatment.

Preferences for Depression Treatment Among Elderly Home Health Care Patients

Major depressive disorder and milder forms of depression are disproportionately high among home healthcare patients, approaching 14% and 11% respectively (1). While effective pharmacological (2) and psychological treatments (3, 4) exist for depression in older adults, depression remains under-treated in the homecare setting (1, 5, 6) for a variety of reasons including patient reluctance to initiate and adhere to recommended treatments. Examination of patient preferences for depression treatment may shed light on this reluctance, and may identify subgroups of patients more likely to prefer such treatment. The majority of research on treatment preferences has been conducted in primary care settings (7–16), with little known about the preferred mental health treatment approaches of elderly homecare patients. A pilot study found that prayer was the most preferred approach identified by elderly long-term care patients (17). Personal experience with depression, however, increased patient preference for medication or psychotherapy (17). Using cross sectional data from the TRIAD (“Training in the Assessment of Depression”) study of elderly patients newly admitted to homecare (18, 19), we examined the treatment preferences of this understudied population at high risk for experiencing depression. Previous work suggests that depression experience, namely diagnoses of major or minor depression or use of antidepressant medication (7, 12, 14, 17), would be associated with preferences for an active treatment such as antidepressant medication or psychotherapy. We also explored the association of other sociodemographic and clinical variables with preferences for an active treatment.

Depression and Increased Short-Term Hospitalization Risk Among Geriatric Patients Receiving Home Health Care Services

Depression and Increased Short-Term Hospitalization Risk Among Geriatric Patients Receiving Home Health Care Services

The Difference in Outcomes for the Use of Telemonitoring on Elderly Home Care Patients With a Primary or Secondary Diagnosis of Heart Failure

The Difference in Outcomes for the Use of Telemonitoring on Elderly Home Care Patients With a Primary or Secondary Diagnosis of Heart Failure

Use of Antipsychotics in Older Home Care Patients in Finland

To investigate the use of antipsychotic medications, and factors associated with such use, in elderly patients in home care in Finland. A retrospective study was designed using cross-sectional data gathered between 1 July and 31 December 2004 in Finland. Data were extracted from the Resident Assessment Instrument (RAI) database, based on Minimum Data Set for Home Care (MDS-HC) assessments. Patients aged >or=65 years from five home care units in different parts of Finland (urban and rural) were included, yielding a total of 1106 patient assessments. The prevalence of antipsychotic use was 11% among home care patients. Factors independently associated with use of antipsychotics in the logistic regression model were: any psychiatric diagnosis (odds ratio [OR] 6.62, 95% CI 4.19, 10.45), delusions (OR 4.19, 95% CI 2.22, 7.90), parkinsonism (OR 3.08, 95% CI 1.07, 8.87), not at ease interacting with others (OR 1.88, 95% CI 1.06, 3.36) and moderate-to-severe cognitive impairment (OR 1.47, 95% CI 1.06, 2.04). By contrast, patients aged >or=85 years (OR 0.59, 95% CI 0.43, 0.81) were significantly less likely to be taking antipsychotics. Use of atypical antipsychotic medication was associated in the logistic regression model with delusions (OR 4.05, 95% CI 2.01, 8.17), parkinsonism (OR 3.66, 95% CI 1.10, 12.19), any psychiatric diagnosis (OR 3.06, 95% CI 1.66, 5.63), moderate-to-severe cognitive impairment (OR 2.0, 95% CI 1.32, 3.03) and age >or=85 years (OR 0.66, 95% CI 0.44, 0.99). However, use of conventional antipsychotics was associated only with any psychiatric diagnosis (OR 8.88, 95% CI 5.05, 15.61) and age >or=85 years (OR 0.65, 95% CI 0.44, 0.98). The prevalence of antipsychotic medication use in elderly home care patients was higher than that previously reported among elderly people living in the community in Finland and Sweden (3-9%). Several predictive factors such as psychiatric diagnosis, delusions and cognitive impairment were associated with use of antipsychotics whereas there was a negative association between age >or=85 years and use of antipsychotics.

Suicidal ideation among elderly homecare patients

To identify the prevalence, correlates, and one-year naturalistic course of suicidal ideation in a representative sample of elderly adults newly admitted to visiting nurse homecare. Five hundred and thirty-nine participants (aged > or =65), newly initiating homecare for skilled nursing services, were interviewed with the Structured Clinical Interview for DSM-IV (SCID-IV) and measures of depression severity, medical comorbidity, functional status, and social support. Participants were classified as having no suicidal ideation in the past month, passive ideation, active ideation, or active ideation with poor impulse control or suicide plan. Fifty-seven participants (10.6%) reported passive and six (1.2%) reported active suicidal ideation. Higher depression severity, greater medical comorbidity, and lower subjective social support were independently associated with the presence of any level of suicidal ideation. At one year, suicidal ideation persisted for 36.7% of those with ideation at baseline, and the incidence of suicide ideation was 5.4% The high prevalence, persistence, and incidence of suicidal ideation in medically ill home healthcare patients underscore the relevance of this population for suicide prevention efforts. The clinical and psychosocial factors associated with suicidal ideation in this underserved, high-risk population are potentially modifiable, and thus useful targets for suicide prevention interventions.

In a prospective observational study, influenza vaccination prevented hospitalization among older home care patients

Objective The aim of the study is (1) to describe the prevalence of vaccination against influenza in older home care patients and (2) to investigate the protective effect of influenza vaccination for hospitalization events. Study Design and Setting This is an observational study conducted in four large cohorts of elderly patients in home care during the 1998–1999, 1999–2000, 2000–2001, and 2001–2002 influenza seasons. We analyzed data from the Italian Silver Network Home Care project. A total of 2,201 patients were enrolled in the present study. The main outcome measures were prevalence of vaccination against influenza and the rate of hospitalization according to vaccination status and influenza season. Results The rate of influenza vaccination was around 48% of the studied sample. During the follow-up including the peak of influenza and the total influenza season, 412 subjects (40%) were hospitalized among vaccinated compared to 610 subjects (59%) among not vaccinated ( P < 0.001). After adjusting for age, gender, location of home care program, and all the variables significantly different between vaccinated and not-vaccinated subjects, vaccinated subjects were less likely to be hospitalized compared to not-vaccinated subjects (OR, 0.73; 95% CI 0.60–0.90). Conclusions Vaccination against influenza has an important prognostic implication for frail geriatric patients living in the community.

Potentially Inappropriate Medication Use Among Elderly Home Care Patients in Europe

Criteria for potentially inappropriate medication use among elderly patients have been used in the past decade in large US epidemiological surveys to identify populations at risk and specifically target risk-management strategies. In contrast, in Europe little information is available about potentially inappropriate medication use and is based on small studies with uncertain generalizability. To estimate the prevalence and associated factors of potentially inappropriate medication use among elderly home care patients in European countries. Retrospective cross-sectional study of 2707 elderly patients receiving home care (mean [SD] age, 82.2 [ 7.2] years) representatively enrolled in metropolitan areas of the Czech Republic, Denmark, Finland, Iceland, Italy, the Netherlands, Norway, and the United Kingdom. Patients were prospectively assessed between September 2001 and January 2002 using the Minimum Data Set in Home Care instrument. Prevalence of potentially inappropriate medication use was documented using all expert panels criteria for community-living elderly persons (Beers and McLeod). Patient-related characteristics independently associated with inappropriate medication use were identified with a multiple logistic regression model. Combining all 3 sets of criteria, we found that 19.8% of patients in the total sample used at least 1 inappropriate medication; using older 1997 criteria it was 9.8% to 10.9%. Substantial differences were documented between Eastern Europe (41.1% in the Czech Republic) and Western Europe (mean 15.8%, ranging from 5.8% in Denmark to 26.5% in Italy). Potentially inappropriate medication use was associated with patient's poor economic situation (adjusted relative risk [RR], 1.96; 95% confidence interval [CI], 1.58-2.36), polypharmacy (RR, 1.91; 95% CI, 1.62- 2.22), anxiolytic drug use (RR, 1.82; 95% CI, 1.51-2.15), and depression (RR, 1.29; 95% CI, 1.06-1.55). Negatively associated factors were age 85 years and older (RR, 0.78; 95% CI, 0.65-0.92) and living alone (RR, 0.76; 95% CI, 0.64-0.89). The odds of potentially inappropriate medication use significantly increased with the number of associated factors (P<.001). Substantial differences in potentially inappropriate medication use exist between European countries and might be a consequence of different regulatory measures, clinical practices, or inequalities in socioeconomic background. Since financial resources and selected patient-related characteristics are associated with such prescribing, specific educational strategies and regulations should reflect these factors to improve prescribing quality in elderly individuals in Europe.

Late-life depression among black and white elderly homecare patients.

The authors compared the prevalence of major depressive disorder (MDD) and the prescription rates of antidepressant medication, by race, among frail, older homecare patients. A random sample of 56 black and 458 white newly admitted homecare patients age 65 and over was assessed for MDD with structured interviews and medical records, and antidepressant prescription rates were tallied. The prevalence of MDD did not differ significantly across racial groups. Only 16.7% of black patients and 32.0% of white patients were prescribed antidepressant medication. Prevalence of MDD was similar among black and white elderly homecare patients. In both groups, depression is undertreated and contributes to the burden of this frail, older patient group.

Late-Life Depression Among Black and White Elderly Homecare Patients

Objective The authors compared the prevalence of major depressive disorder (MDD) and the prescription rates of antidepressant medication, by race, among frail, older homecare patients. Methods A random sample of 56 black and 458 white newly admitted homecare patients age 65 and over was assessed for MDD with structured interviews and medical records, and antidepressant prescription rates were tallied. Results The prevalence of MDD did not differ significantly across racial groups. Only 16.7% of black patients and 32.0% of white patients were prescribed antidepressant medication. Conclusions Prevalence of MDD was similar among black and white elderly homecare patients. In both groups, depression is undertreated and contributes to the burden of this frail, older patient group. The authors compared the prevalence of major depressive disorder (MDD) and the prescription rates of antidepressant medication, by race, among frail, older homecare patients. A random sample of 56 black and 458 white newly admitted homecare patients age 65 and over was assessed for MDD with structured interviews and medical records, and antidepressant prescription rates were tallied. The prevalence of MDD did not differ significantly across racial groups. Only 16.7% of black patients and 32.0% of white patients were prescribed antidepressant medication. Prevalence of MDD was similar among black and white elderly homecare patients. In both groups, depression is undertreated and contributes to the burden of this frail, older patient group.

Characteristics of the Mini-Nutritional Assessment in elderly home-care patients.

To assess the risk of malnutrition among elderly people living at home and receiving regular home-care services using the Mini-Nutritional Assessment (MNA) and to study the characteristics of the instrument in this patient group. A cross-sectional study using the MNA score to assess the nutritional status of elderly home-care patients. Municipal home-care services in rural Finland. A total of 178 (65%) out of 272 eligible patients aged 75-94 y agreed to participate. MAJOR OUTCOME METHODS: MNA questionnaire, anthropometrics, structured questionnaire, menu record. According to MNA, 3% were malnourished (MNA < 17 points), 48% at risk for malnutrition (17-23.5 points) and 49% well nourished (>23.5 points). The mean MNA score was 23.4. Weight loss, psychological stress, nutritional status, decline in food intake, self-perceived health status and mid-arm circumference (MAC) showed the strongest significant correlations (P=0.0001) to total MNA score. MNA questions with the strongest significant intercorrelations (P=0.0001) were body mass index with MAC and calf circumference; and the decline of food intake and self-perceived nutritional status. The number of eating problems correlated significantly to the MNA score (P=0.0011). Those with chewing and swallowing problems (n=64, 36%) had a significantly lower MNA score than others (P=0.0001). Dry mouth together with chewing and swallowing problems (n=40, 22%) reduced the MNA score even further (P=0.0001). The results suggest that MNA is a useful tool in the identification of elderly home-care patients at risk for malnutrition.

One-Month Stability of Depression Among Elderly Home-Care Patients

Objective Studies in primary care settings have shown that depression is often chronic and associated with negative outcomes among patients with medical illness. The stability of depression among home care recipients has not been investigated. The authors examined the 1-month stability of major depression in a representative sample of elderly adults shortly after their admission to home care. Methods A group of 539 subjects over age 65, newly admitted to home care for skilled nursing, were interviewed with the Structured Clinical Interview for DSM-IV (SCID-IV). Depression severity, medical comorbidity, pain, functional status, cognitive status, and recent life events were also assessed. Of 84 subjects who met criteria for major depression (MDD) at baseline, 74 were available for 1-month follow-up interview. Results At 1-month follow-up, 31 subjects (42%) continued to meet MDD criteria; 20 (27%) achieved partial remission; and 23 (31%) were in full remission. Fewer instrumental activity limitations at baseline, experiencing “a great deal” of pain, and absence of a recent stressful life event were associated with full remission at 1-month follow-up. Conclusion Nearly one-half of newly admitted elderly home care patients who meet criteria for MDD continue to meet full criteria 1 month later. Functional and psychosocial factors affect the short-term course. Studies in primary care settings have shown that depression is often chronic and associated with negative outcomes among patients with medical illness. The stability of depression among home care recipients has not been investigated. The authors examined the 1-month stability of major depression in a representative sample of elderly adults shortly after their admission to home care. A group of 539 subjects over age 65, newly admitted to home care for skilled nursing, were interviewed with the Structured Clinical Interview for DSM-IV (SCID-IV). Depression severity, medical comorbidity, pain, functional status, cognitive status, and recent life events were also assessed. Of 84 subjects who met criteria for major depression (MDD) at baseline, 74 were available for 1-month follow-up interview. At 1-month follow-up, 31 subjects (42%) continued to meet MDD criteria; 20 (27%) achieved partial remission; and 23 (31%) were in full remission. Fewer instrumental activity limitations at baseline, experiencing “a great deal” of pain, and absence of a recent stressful life event were associated with full remission at 1-month follow-up. Nearly one-half of newly admitted elderly home care patients who meet criteria for MDD continue to meet full criteria 1 month later. Functional and psychosocial factors affect the short-term course.

One-Month Stability of Depression Among Elderly Home-Care Patients

Studies in primary care settings have shown that depression is often chronic and associated with negative outcomes among patients with medical illness. The stability of depression among home care recipients has not been investigated. The authors examined the 1-month stability of major depression in a representative sample of elderly adults shortly after their admission to home care. A group of 539 subjects over age 65, newly admitted to home care for skilled nursing, were interviewed with the Structured Clinical Interview for DSM-IV (SCID-IV). Depression severity, medical comorbidity, pain, functional status, cognitive status, and recent life events were also assessed. Of 84 subjects who met criteria for major depression (MDD) at baseline, 74 were available for 1-month follow-up interview. At 1-month follow-up, 31 subjects (42%) continued to meet MDD criteria; 20 (27%) achieved partial remission; and 23 (31%) were in full remission. Fewer instrumental activity limitations at baseline, experiencing "a great deal" of pain, and absence of a recent stressful life event were associated with full remission at 1-month follow-up. Nearly one-half of newly admitted elderly home care patients who meet criteria for MDD continue to meet full criteria 1 month later. Functional and psychosocial factors affect the short-term course.

Assessing Behavioral Health Using OASIS

This article is the second of a two-part series on assessing behavioral health in adult and elderly home care patients using OASIS. Part 1 presented an assessment approach for depressive symptoms and suicidality. This article presents the assessment of cognitive impairment, problematic behaviors, and anxiety using OASIS as a framework and stresses the importance of direct questioning. Case scenarios and guidelines for referral for further evaluation and possible treatment are provided.

Therapeutic Recreation Treats Depression in the Elderly

ABSTRACT Therapeutic recreation can be an effective method to treat depression in elderly home care patients. Home care is the fastest growing component in the Medicare budget. The co-occurrence of physically limiting conditions and depression in the elderly is well documented. Untreated depression carries an enormous risk and cost. Therapeutic recreation is an ideal psychosocial treatment for use in the home care setting because of its effectiveness and versatility. Certified therapeutic recreation specialists use various interventions such as poetry, music, and exercise as part of a treatment team. In addition to effectively managing depression, therapeutic recreation can be beneficial in reducing the effects of many concurrent physical conditions.

Utilization of Home Health Care Services by Elderly Patients with Heart Failure

Heart failure is one of the most common reasons for admission to home health care among older adults Patients with heart failure present complex challenges for home health care agency staff, given the chronic yet variable nature of the disease and the importance of behavioral factors in long-term management of heart failure. The purpose of this study was to examine the patterns of health service utilization and outcomes of home care among elderly home care patients with heart failure. The sample included 104 patients with a primary or secondary diagnosis of heart failure admitted to a large Medicare-certified home care agency. Finding from the study revealed that subjects received an average of 11 skilled nursing visits over a 37-day period. Twelve percent of the subjects were rehospitalized before their home care treatment plans were completed. Although the percentage of patients rehospitalized in this study was relatively low, additional research is needed that will investigate the relationship between home care nurses' interventions and the patient outcomes associated with these interventions.