title: Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention.
abstract: BACKGROUND
  Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services.
  
  
  METHODS
  This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation.
  
  
  CONCLUSIONS
  Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01407926.
authors.affiliation: School of Nursing, McMaster University, Hamilton, Ontario, Canada. mreid@mcmaster.ca
authors.forename: Maureen F
authors.initials: MF
authors.lastname: Markle-Reid
authors.forename: Carrie
authors.initials: C
authors.lastname: McAiney
authors.forename: Dorothy
authors.initials: D
authors.lastname: Forbes
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Maggie
authors.initials: M
authors.lastname: Gibson
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hoch
authors.forename: Gina
authors.initials: G
authors.lastname: Browne
authors.forename: Thomas
authors.initials: T
authors.lastname: Peirce
authors.forename: Barbara
authors.initials: B
authors.lastname: Busing
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000523:psychology / Q000628:therapy*; D005500:Follow-Up Studies; D006293:Health Promotion / Q000379:methods*; D006699:Home Care Services; D006801:Humans; D007400:Interprofessional Relations; D008603:Mental Health; D009739:Nursing Services; D011446:Prospective Studies; D012107:Research Design