Biomedical subjects

Ellen L Brown

Publications and source records attributed to Ellen L Brown.

11 recordsLinked to original sources

PubMed2006

Does every allusion to possible suicide require the same response?

Assess patients with major depression or substance abuse for suicide ideation, as they are at elevated risk for self-harm. Severity of suicide ideation is associated with suicide risk. Its assessment, therefore, should proceed sequentially from passive to active suicide ideation, to a specific detailed plan, including intention to harm oneself, reasons for living, and impulse control. Primary care patients at mild to moderate risk for suicide can be effectively treated in primary care settings; however, patients at high risk should be referred to mental health specialists given their need for intensive treatments and frequent monitoring.

Depressive Disorder↗

PubMed2005

Symptoms of depression in older home-care patients: patient and informant reports.

The purpose of this study was to examine the level of agreement and patterns of disagreement between home-care patient and informant reports of depressive symptoms. The authors interviewed a sample of 355 older home-care patients and their informants using the Structured Diagnostic Interview for DSM-IV (R. L. Spitzer, M. Gibbon, & J. B. Williams, 1995). Informants reported more psychological symptoms than patients, and this type of discrepancy was higher for patients with cognitive impairment and patients who had younger informants. Younger informants also reported more cognitive symptoms, whereas patients were more likely to report suicidal thoughts or ideation if they were not cognitively impaired. The patterns of these discrepancies may reflect age- and cohort-related response bias in the reports of depressive symptoms obtained from older adults.

Adult↗

PubMed2004

Depression in elderly homecare patients: patient versus informant reports.

BACKGROUND: This study compares patient and informant reports of depressive disorders in a community sample of elderly medical homecare patients. The associations between specific patterns of agreement/disagreement and other patient and informant characteristics are examined. METHOD: A random sample of 355 elderly medical homecare patients and their informants were interviewed using the current mood section of the Structured Clinical Interview for DSM-IV (SCID). RESULTS: Thirty-seven patients (10.4 %) reported a depressive disorder (major or subsyndromal) that was also identified by their informant while 27 (7.6 %) patients self-reported depression that the informant did not identify. There were 250 patients (70.4 %) who were not depressed according to both patient and informant report and 41 patients (11.5%) were identified as depressed by informant report alone. Patients identified as depressed by informant report alone were similar to patients who self-reported depression on a number of the sociodemographic and clinical correlates of depression, but had significantly poorer performance on items assessing orientation and short-term recall. These patients also had poorer functioning in a number of domains (social, cognitive, and functional) when compared with patients who were not depressed according to both the patient and informant. Finally, patients with younger informants were more likely to be identified as depressed by their informant. CONCLUSIONS: Obtaining informant reports of depression may be a useful method for detecting clinically significant cases of late-life depression that would otherwise be missed when relying only on patient report.

Activities of Daily Living↗

PubMed2004

Does depression predict falls among home health patients? Using a clinical-research partnership to improve the quality of geriatric care.

This study found that patients with depressed mood or anhedonia identified on the OASIS were nearly three times more likely to fall. The authors describe the ways these findings are being used in a fall prevention program. The clinical-research partnership used in the study was found to help agencies develop clinically driven research, analyze clinical and administrative data for quality improvement, and provide a foundation for research consultation/collaboration in applied settings.

Accidental Falls↗

PubMed2004

An agency-university research partnership: focus on late-life depression.

Does anyone working in home care have the time to do one more thing? We would think most clinicians, administrators, educators, and quality improvement coordinators would answer "NO." This article provides a current example of what happened when three Medicare-certified home health agencies answered "YES" to a research partnership dedicated to addressing the unique challenges of enhancing late-life depression treatment and outcomes in the home care setting. The development of an ongoing home care agency-university partnership is described to stimulate other agencies to consider this type of research collaboration.

Aged↗

PubMed2004

Recognition of late-life depression in home care: accuracy of the outcome and assessment information set.

This study evaluated the accuracy of home care nurses' ratings of the Outcome and Assessment Information Set (OASIS) depression items. The accuracy of home care nurses' depression assessments was studied by comparing nurse ratings of OASIS depression items with a research diagnostic assessment based on the Structured Clinical Interview for Axis I Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID). The setting for this study was a nonprofit, Medicare-certified, voluntary home healthcare agency. Sixty-four home care nurses assessed 220 patients aged 65 and older with the OASIS upon admission. Of the 220 patients, using standard SCID criteria, 35 cases of major or minor depression were identified. The home care nurses accurately documented the presence of depression in 13 of 35 cases (sensitivity=37.1%; positive predictive value=0.56). Of the 220 patients, 185 had no SCID-identified major or minor depression. The nurses agreed on the absence of depression in 175 of 185 cases (specificity=94.6%; negative predictive value=88.8%). This study indicates that home care nurses often do not accurately rate OASIS depression items for older adult patients.

Aged↗

PubMed2003

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.

Aged↗

PubMed2002

Assessing behavioral health using OASIS: Part 1: Depression and suicidality.

This article is the first of a two-part series on assessing behavioral health in adult and elderly patients using OASIS. Direct questioning about emotional and behavioral symptoms in addition to observation, reports from family members, and input from other team members are used. This approach improves assessment information and increases nurse confidence and accuracy when making referrals for further psychiatric evaluation and treatment.

Adult↗

PubMed2002

Major depression in elderly home health care patients.

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.

Activities of Daily Living↗

PubMed2002

Assessing behavioral health using OASIS: part 2: cognitive impairment, problematic behaviors, and anxiety.

This article is the second of a two-part series on assessing behavioral health in adult and elderly home care patients using OASIS. Part 1 presented an assessment approach for depressive symptoms and suicidality. This article presents the assessment of cognitive impairment, problematic behaviors, and anxiety using OASIS as a framework and stresses the importance of direct questioning. Case scenarios and guidelines for referral for further evaluation and possible treatment are provided.

Aged↗

PubMedDate not supplied

One-month stability of depression among elderly home-care patients.

OBJECTIVE: Studies in primary care settings have shown that depression is often chronic and associated with negative outcomes among patients with medical illness. The stability of depression among home care recipients has not been investigated. The authors examined the 1-month stability of major depression in a representative sample of elderly adults shortly after their admission to home care. METHODS: A group of 539 subjects over age 65, newly admitted to home care for skilled nursing, were interviewed with the Structured Clinical Interview for DSM-IV (SCID-IV). Depression severity, medical comorbidity, pain, functional status, cognitive status, and recent life events were also assessed. Of 84 subjects who met criteria for major depression (MDD) at baseline, 74 were available for 1-month follow-up interview. RESULTS: At 1-month follow-up, 31 subjects (42%) continued to meet MDD criteria; 20 (27%) achieved partial remission; and 23 (31%) were in full remission. Fewer instrumental activity limitations at baseline, experiencing "a great deal" of pain, and absence of a recent stressful life event were associated with full remission at 1-month follow-up. CONCLUSION: Nearly one-half of newly admitted elderly home care patients who meet criteria for MDD continue to meet full criteria 1 month later. Functional and psychosocial factors affect the short-term course.

Aged↗