Recognition of depression among elderly recipients of home care services.
OBJECTIVE
Depression among older home care patients is prevalent but undertreated. The purpose of this study was to investigate the ability of home health nurses to correctly identify depression among older patients and to describe nurse and patient characteristics associated with more accurate assessment of depression.


METHODS
Forty-two nurses were surveyed about the presence of depressive symptoms among patients who had been evaluated independently for depressive disorders by research staff using the Structured Clinical Interview for Axis I DSM-IV Disorders. A sample of newly admitted home health care patients who were aged 65 years or older was randomly selected for this evaluation on a weekly basis from December 1997 to December 1999.


RESULTS
Of 403 patients who were evaluated, 97 (24 percent) were found to have either major depression (64 patients) or minor depression (33 patients). The nurses correctly identified depression among 44 of the 97 patients who were depressed (sensitivity of 45.4) and 230 of the 306 patients who were not depressed (specificity of 75.2). The kappa coefficient measuring overall agreement between the nurses' assessment and the diagnosis of depression was.19. Nurses who had more geriatric nursing experience were more likely to correctly identify depression.


CONCLUSIONS
Home health nurses have difficulty making accurate assessments of depression among older home care patients. Inaccuracy in assessment of depression by home health nurses is a significant barrier to treatment in this elderly homebound population.
Brown
Ellen L
EL
Department of Psychiatry, Weill Medical College, Cornell University, White Plains, New York 10605, USA. ebrown@med.cornell.edu
McAvay
Gail
G
Raue
Patrick J
PJ
Moses
Suzanne
S
Bruce
Martha L
ML
D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D003152:Community Health Nursing / Q000592:standards*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000451:nursing; D003937:Diagnosis, Differential; D005260:Female; D006699:Home Care Services / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009730:Nursing Assessment / Q000592:standards; D015995:Prevalence; D014481:United States / Q000453:epidemiology