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Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention

DOI: 10.1186/1471-2318-11-50

Keywords: Depression, Ageing, Chronic Illness, Clinical Effectiveness, Home Care, Nurse-Led Interventions, Mental Health Promotion

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Abstract:

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.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.ClinicalTrials.gov: NCT01407926Depression affects 26% - 44% of older adults using home care services - at least twice that among older persons in general [1-3]. They also suffer from a fourfold increase in more severe forms of depression than the general population [4]. Yet, this population is one of the most undertreated populations for mental health [1,4-6]. In one study only 22% of depresse

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