Major depression in elderly home health care patients
Major depression in elderly home health care patients
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DOI：
10.1176/appi.ajp.159.8.1367
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发表时间：
2002-08-01
影响因子：
17.7
通讯作者：
Weber, C
中科院分区：
文献类型：
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作者：
Bruce, ML;McAvay, GJ;Weber, C
目的：尽管老年家庭健康服务日益增多，但人们对居家老年患者的心理健康需求知之甚少。作者报告了随机抽样的因内科或外科问题而接受家庭医疗护理的老年患者中DSM-IV抑郁症的分布、相关性和治疗状况。方法：在两年的时间里，新入院的大型传统探访护理机构的老年患者每周抽样一次。539名患者的年龄从65岁到102岁不等；351名(65%)为女性，81名(15%)为非白人。DSM-IV轴I障碍的结构化临床访谈被用来采访患者和信息者。作者回顾了这些访谈的结果和患者的病历，以产生最好的估计DSM-IV精神诊断。结果：患者有沉重的医疗负担和残疾。根据DSM-IV标准，539例患者中73例(13.5%)被诊断为重度抑郁症。大多数患者(N=52，71%)是首次抑郁发作，大多数患者(N=57，78%)的抑郁发作持续时间超过2个月。重度抑郁症与内科发病率、日常生活功能障碍、报告的疼痛和既往抑郁史显著相关，但与认知功能或社会人口因素无关。只有16名(22%)的抑郁症患者接受了抗抑郁药物治疗，没有一人接受心理治疗。在接受抗抑郁药物治疗的16名患者中，5名(31%)被开出低于治疗剂量的处方，而在11名被开适当剂量处方的患者中，有2名(18%)报告没有遵守抗抑郁药物的治疗。结论：接受家庭护理的老年重度抑郁症患者是接受初级护理的患者的两倍。接受家庭护理的患者中的大多数抑郁症都没有得到治疗。这些患者的医疗和功能状况不佳，家庭保健的组织结构复杂，这对确定治疗老年家庭护理患者的安全和有效策略构成了挑战。
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 (13.5%) 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.Conclusions: Geriatric major depression is twice as common in patients receiving home care as in those receiving primary care. Most depressions in patients receiving home care are untreated. The poor medical and functional status of these patients and the complex organizational structure of home health care pose a challenge for determining safe and effective strategies for treating depressed elderly home care patients.