Outcomes of community-based social service interventions in homebound elders.
OBJECTIVE
To document within-client change in function and quality of life over 6 months, and determine whether social service interventions, comorbidity, depressive symptoms, social support and stress are predictors of within-patient change.


METHODS
Assess homebound elderly referred for social services on depressive symptoms measured by the Geriatric Depression Scale (GDS), comorbidity with the Charlson Index, and stress and support with the Duke instrument. Function was measured by the Functional Autonomy Scale (FAS), measuring Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), mobility, communication and mental function. The SF-36 measured quality of life.


RESULTS
Among 56 new homebound clients with an average age of 82, 33% had depressive symptoms at baseline (>7 on the GDS). At baseline clients were at or below 25th percentile for five of eight domains of the SF-36, and mental and physical summary scores. Further at baseline, 90% had difficulties with mobility and IADLs; 61% had ADL limitations. At 6-month follow-up overall, 26% had depressive symptoms at follow-up. Greater comorbidity was associated with more depressive symptoms at both baseline and follow-up. By 6 months, 18% had deteriorated on the FAS, while 11% improved. More clients had changes in quality of life; regarding the physical component score, 13% had important deterioration, while 63% improved. Similarly, 33% declined on the mental component while 27% improved.


CONCLUSIONS
Among newly homebound elders, those with significant depressive symptoms are more likely to experience deterioration in function and quality of life over 6 months. However, those with more support showed significant improvement in the SF-36 mental component scale at 6 months.
Charlson
Mary E
ME
Center for Complementary and Integrative Medicine, Weill Cornell Medical College, New York, NY, USA. mecharl@med.cornell.edu
Peterson
Janey C
JC
Syat
Beth L
BL
Briggs
William M
WM
Kline
Robin
R
Dodd
Mary
M
Murad
Velda
V
Dionne
William
W
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000523:psychology*; D015577:Geriatric Assessment / Q000379:methods; D006299:Health Services for the Aged / Q000458:organization & administration*; D018577:Homebound Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D009519:New York City; D017063:Outcome Assessment, Health Care / Q000379:methods; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012944:Social Support; D012946:Social Welfare; D012947:Social Work / Q000458:organization & administration*