TAILIEUCHUNG - Major Depression in Elderly Home Health Care Patients

In addition to the traditional FFS Medicare or Medicare Managed Care (MMC) insurance, many elderly buy supplemental insurance policies to cover prescription drugs or catastrophic expenses. These supplemental policies are known as MediGap plans, because they help fill gaps in the available health insurance coverage. Some Medicare beneficiaries are dual eligibles – covered by both Medicare (health insurance for the aged) and Medicaid (health insurance for the poor with chronic disabilities or endstage renal disease). Dually eligible beneficiaries receive prescription drug coverage as part of their Medicaid insurance. During the period of this study (1998–2000) beneficiaries with FFS Medicare did not have any prescription drug coverage unless they had purchased supplemental insurance. About half. | Article Major Depression in Elderly Home Health Care Patients Martha L. Bruce . . Gail J. McAvay . . Patrick J. Raue . Ellen L. Brown . . . Barnett S. Meyers . Denis J. Keohane . . David R. Jagoda . . . Carol Weber . . Objective Despite the growth of geriatric home health services little is known about the mental health needs of geriatric patients seen in their homes. The authors report the distribution correlates and treatment status of DSM-IV major depression in a random sample of elderly patients receiving home health care for medical or surgical problems. Method Geriatric patients newly admitted to a large traditional visiting nurse agency were sampled on a weekly basis over a period of 2 years. The 539 patients ranged in age from 65 to 102 years 351 65 were women and 81 15 were nonwhite. The Structured Clinical Interview for DSM-IV Axis I Disorders was used to interview patients and informants. The authors reviewed the results of these interviews plus the patients medical charts to generate a best-estimate DSM-IV psychiatric diagnosis. Results The patients had substantial medical burden and disability. According to DSM-IV criteria 73 of the 539 patients were diagnosed with major depression. Most of these patients N 52 71 were experiencing their first episode of depression and the episode had lasted for more than 2 months in most patients N 57 78 . Major depression was significantly associated with medical morbidity instrumental activities of daily living disability reported pain and a past history of depression but not with cognitive function or sociodemographic factors. Only 16 22 of the depressed patients were receiving antidepressant treatment and none was receiving psychotherapy. Five 31 of the 16 patients receiving antidepressants were prescribed subtherapeutic doses and two 18 of the 11 who were prescribed appropriate doses reported not complying with their antidepressant treatment. .

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