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Identification and recognition of depression in community care assessments: impact of a national policy in England

Published online by Cambridge University Press:  04 August 2011

Paul Clarkson ,
Michele Abendstern ,
Caroline Sutcliffe ,
Jane Hughes  and
David Challis
Paul Clarkson*
Affiliation:
Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Manchester, UK
Michele Abendstern
Affiliation:
Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Manchester, UK
Caroline Sutcliffe
Affiliation:
Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Manchester, UK
Jane Hughes
Affiliation:
Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Manchester, UK
David Challis
Affiliation:
Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Manchester, UK
*
Correspondence should be addressed to: Dr Paul Clarkson, Personal Social Services Research Unit (PSSRU), Community Based Medicine, University of Manchester, Dover Street Building, Oxford Road, Manchester, M13 9PL, UK. Phone: +44 (0)161-275 5674; Fax: +44 (0)161 275 5790. Email: paul.clarkson@manchester.ac.uk.
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Abstract

Background: Depression continues to be under-recognized in older people. Most policies addressing this issue focus on the primary health care team. However, recognition may be improved by use of assessment tools and collaboration between secondary health and social care, particularly at the assessment stage. This study aimed to evaluate whether the Single Assessment Process (SAP), introduced in England from April 2004, promoting such processes, improved the identification and correct recognition of depression by enhancing the content of statutory community care assessments by social services care managers.

Methods: An observational study compared depression identification and its accuracy (“correct recognition”) in samples of older people before and after SAP introduction. Participants were interviewed using standardized measures including the Geriatric Depression Scale (GDS). Depression elicited from the GDS was compared with that recorded in community care assessments with calculation of inter-rater reliabilities (kappa statistic) pre- and post-SAP. Logistic regression examined the associations between the policy's introduction, potential confounding factors (depression, cognitive impairment, function, behavior and characteristics) and the identification and correct recognition of depression.

Results: Whilst the identification of depression was more likely after SAP, its correct recognition did not improve after the policy, with only slight agreement between GDS and community care assessments. The existence of depression and cognitive impairment made identification, but not correct recognition, more likely.

Conclusions: Correct recognition of depression was not improved in these statutory care assessments following the policy. Recognizing and thus responding to depression in a coordinated and appropriate way in the community requires further action.

Keywords

old age depressionsocial carecommunity-based care
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 2 , February 2012 , pp. 261 - 269
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Arthur, A., Jagger, C., Lindesay, J., Graham, C. and Clarke, M. (1999). Using an annual over-75 health check to screen for depression: validation of the short Geriatric Depression Scale (GDS15) within general practice. International Journal of Geriatric Psychiatry, 14, 431–439.3.0.CO;2-I>CrossRefGoogle ScholarPubMed
Banerjee, S. and Macdonald, A. (1996). Mental disorder in an elderly home care population: associations with health and social service use. British Journal of Psychiatry, 168, 750–756.CrossRefGoogle Scholar
Brown, E. L., Bruce, M. L., McAvay, G. J., Raue, P. J., Lachs, M. S. and Nassisi, P. (2004). Recognition of late-life depression in home care: accuracy of the Outcome and Assessment Information Set. Journal of the American Geriatrics Society, 52, 995–999.CrossRefGoogle ScholarPubMed
Brown, E. L., Raue, P. J., Roos, B. A., Sheeran, T. and Bruce, M. L. (2010). Training nursing staff to recognize depression in home healthcare. Journal of the American Geriatrics Society, 58, 122–128.CrossRefGoogle ScholarPubMed
Bruce, M. L. et al. (2002). Major depression in elderly home health care patients. American Journal of Psychiatry, 159, 1367–1374.Google Scholar
Bruce, M. L. et al. (2007). A randomized trial of depression assessment intervention in home health care. Journal of the American Geriatrics Society, 55, 1793–1800.Google Scholar
Cape, R. D. T. and Gibson, S. J. (1994). The influence of clinical problems, age and social support on outcomes for elderly persons referred to regional aged care assessment teams. Australian and New Zealand Journal of Medicine, 24, 378–385.Google Scholar
Challis, D. et al. (2004). The value of specialist clinical assessment of older people prior to entry to care homes. Age and Ageing, 33, 25–34.CrossRefGoogle ScholarPubMed
Chew-Graham, C., Baldwin, R. and Burns, A. (2004). Treating depression in later life. BMJ, 329, 181–182.CrossRefGoogle ScholarPubMed
Clinical Standards Advisory Group (1998). Community Health Care for Elderly People. London: The Stationery Office.Google Scholar
Department of Health (1990). Community Care in the Next Decade and Beyond: Policy Guidance. London: Department of Health.Google Scholar
Department of Health (2002a). Guidance on the Single Assessment Process for Older People. HSC 2002/001: LAC (2002) 1. London: Department of Health.Google Scholar
Department of Health (2002b). Fair Access to Care Services. Guidance on Eligibility Criteria for Adult Social Care. LAC (2002) 13. London: Department of Health.Google Scholar
Department of Health (2008). Health and Care Services for Older People: Overview Report on Research to Support the National Service Framework for Older People. London: Department of Health.Google Scholar
Donner, A. (1998). Sample size requirements for the comparison of two or more coefficients of inter-observer agreement. Statistics in Medicine, 17, 1157–1168.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
Donner, A., Eliasziw, M. and Klar, N. (1996). Testing the homogeneity of kappa statistics. Biometrics, 52, 176–183.CrossRefGoogle ScholarPubMed
Dunn, G. (1989). Design and Analysis of Reliability Studies: The Statistical Evaluation of Measurement Errors. London: Edward Arnold.Google Scholar
Ell, K. et al. (2007). Managing depression in home health care: a randomized clinical trial. Home Health Care Services Quarterly, 26, 81–104.CrossRefGoogle ScholarPubMed
Ely, M., Brayne, C., Huppert, F. A., O'Conner, D. W. and Pollitt, P. A. (1997). Cognitive impairment: a challenge for community care. A comparison of the domiciliary service receipt of cognitively impaired and equally dependent physically impaired elderly women. Age and Ageing, 26, 301–308.CrossRefGoogle Scholar
Iliffe, S., Tai, S. S., Haines, A., Booroff, A., Goldenberg, E., Morgan, P. and Gallivan, S. (1993). Assessment of elderly people in general practice. 4. Depression, functional ability and contact with services. British Journal of General Practice, 43, 371–374.Google Scholar
Landis, J. R. and Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.CrossRefGoogle ScholarPubMed
Lynch, S., Clarkson, P., Blenkiron, P. and Fraser, J. (2002). Scale-based protocols for the detection and management of depression. Primary Care Psychiatry, 8, 77–84.CrossRefGoogle Scholar
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
Mayo, E. (1949). Hawthorne and the Western Electric Company, The Social Problems of an Industrial Civilization. London: Routledge.Google Scholar
McDougall, F. A. et al. (2007). Prevalence of depression in older people in England and Wales: the MRC CFA Study. Psychological Medicine, 37, 1787–1795.Google Scholar
Molloy, D. W. and Standish, T. I. M. (1997). Mental status and neuropsychological assessment: a guide to the standardized Mini-Mental State Examination. International Psychogeriatrics, 9, 87–94.CrossRefGoogle Scholar
Netten, A., Darton, R., Bebbington, A. and Brown, P. (2001). Residential or nursing home care? The appropriateness of placement decisions. Ageing & Society, 21, 3–23.CrossRefGoogle Scholar
Pattie, A. H. and Gilleard, C. J. (1979). Manual of the Clifton Assessment Procedures for the Elderly (CAPE). Sevenoaks: Hodder and Stoughton Educational.Google Scholar
Philp, I. (1997). Can a medical and social assessment be combined? Journal of the Royal Society of Medicine, 90 (Suppl. 32), 11–13.Google Scholar
Peveler, R. and Kendrick, T. (2001) Treatment delivery and guidelines in primary care. British Medical Bulletin, 57, 193–206.CrossRefGoogle ScholarPubMed
Sheikh, J. and Yesavage, J. (1986). Geriatric Depression Scale; recent evidence and development of a shorter version. In Brink, T. L. (ed.), Clinical Gerontology: A Guide to Assessment and Intervention (pp. 165–173). New York: Howarth Press.Google Scholar
Stewart, K., Challis, D., Carpenter, I. and Dickinson, E. (1999). Assessment approaches for older people receiving social care: content and coverage. International Journal of Geriatric Psychiatry, 14, 147–156.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
Stuck, A. E., Siu, A. L., Wieland, G. D., Adams, J. and Rubenstein, L. (1993). Comprehensive Geriatric Assessment: a meta-analysis of controlled trials. Lancet, 342, 1032–1036.CrossRefGoogle ScholarPubMed
Volkers, A. C., Nuyen, J., Verhaak, P. F. and Schellevis, F. G. (2004). The problem of diagnosing major depression in elderly primary care patients. Journal of Affective Disorders, 82, 259–263.CrossRefGoogle ScholarPubMed
Yesavage, J. A. (1988). Geriatric Depression Scale. Psychopharmacology Bulletin, 24, 709–710.Google ScholarPubMed