This proposed study of Late Life Depression in Medical Homecare requests 5 years of funding to assess the prevalence, persistence, and outcomes of major depression and subsyndromal depression in elderly patients newly admitted for medical homecare at a large, regional Visiting Nurses Agency (VNA). Medical homecare patients represent a large and growing proportion of elderly adults and are characterized by substantial medical morbidity and functional disability. Although the NIH Consensus Conference on late life depression highlighted the problems of depression in medically ill and disabled populations, no mention is made of homecare patients. Further, a significant gap in the research literature is any information on the prevalence and clinical features of major depression in elderly patients receiving formal homecare or on the contribution of major and subsyndromal depression to clinical, functional, and health care outcomes in this population. This lack of attention suggests that depression will be undetected and untreated, have a negative impact on morbidity, functioning, and survival, interfere with medical treatment processes, and increase the use of health services. This study is a first attempt to open this """"""""black box""""""""; its primary aims are to: 1) Estimate the current prevalence of major depression and subsyndromal in elderly patients newly admitted to medical homecare; 2) Describe the clinical features, including 1-month persistence, of depression in this population, and 3) Estimate the effect of depression on clinical, functional, and health care outcomes over the ensuring 12 months. The secondary aims are to 4) Identify predictors of depression in terms of physical health, social support, and socioeconomic status; 5) Determine the extent to which major depression and subsyndromal depression are identified by homecare nurses, and 6) Estimate the sensitivity and specificity of a depression screen in medical homecare patients. To address these aims, master level nurses will conduct baseline and follow-up interviews using the SCID and other measures with 520 elderly patients newly admitted for homecare at a large, regional VNA over a 24 month period. Additional information will come from informants, homecare nurses, and homecare records.
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