Program Helps Nurses Fight Depression Among Homebound Elderly

A new intervention tool may provide relief to homebound older adults who suffer from moderate to severe depression, show results from a new study recently published in JAMA Internal Medicine.

The intervention program, developed by Weill Cornell Medical College, trains nurses to both identify and manage clinically significant depressive symptoms. 

“The program provides nurses with a framework to deal with depression,” said first author Dr. Martha Bruce, the DeWitt Wallace Senior Scholar and a professor of sociology in psychiatry at Weill Cornell, in a written statement. “It builds on their clinical skills and addresses nurses’ observations that depression interferes with successful management of other medical problems.”

Among older home health care patients, depression is highly prevalent, is often inadequately treated, and contributes to hospitalization and other poor outcomes, the study says of the program’s importance. In fact, more than a quarter of all homebound patients receiving care through Medicare’s home health program suffer from depression—a result consistent with the disability, chronic illnesses and other stresses that characterize the population — yet many don’t receive mental health treatment.

Through the program nurses collaborate with the patient’s physician to manage the patient’s anti-depressant adherence and side effects, provide a game plan designed to improve their symptoms — such as encouraging the patient to socialize and tend to their appearance — and educate their loved ones about their condition. However, nurses are not allowed to prescribe medications.

Bruce and her coauthors conducted a randomized clinical trial at six certified home-health agencies around the country to test the efficacy of the intervention, called Depression CAREPATH. During a regular homecare visit, nurses provided patients over 65 with a questionnaire gauging depression, with those identified as depressive receiving one of the two therapies on a randomized basis. The nurses treated them, and researchers conducted multiple follow-up interviews about their condition, for a year.

Of 502 eligible patients, 306 enrolled in the study. CAREPATH relieved the symptoms of patients who have moderate to severe depression, according to study results.

Patients with more severe depression who were treated with CAREPATH had a more significant improvement in their conditions than those whose nurses had received basic training to identify depression, according to the study, which notes that the outcome was the same whether or not patients were taking antidepressants, and did not require additional nurse visits or more nurse time in the home.

“We designed CAREPATH to reach as many patients as possible,” Bruce said. “We wanted something that would be effective but also flexible enough to fit in with different home-health organizations. To put an intervention on top of an existing service is difficult since many agencies can’t afford the costs of sending an extra person to the home.”

Access the study here.

Written by Cassandra Dowell