Research projects

Caring for the depressed elderly in the emergency department: Establishing linkages between sub-acute, primary and community care

Principal Researchers

Dr Lynette Jouberta,b, Dr Andrew Denta, Professor David Amesb, Dr Peter Huntera, Ms Rebecca Powera, Ms Shelley Coxa, Professor Stephen Klimidisb, Dr David Isaaca, Ms Jinsu Leeb

Institution

a St Vincent’s Health Melbourne

b The University of Melbourne

Funding

$60,000

Award Type

beyondblue Victorian Centre of Excellence

Project completion year

2007

Project brief

The project investigated depression in elderly people who present at emergency departments (ED) with complex physical health and social problems.  Specifically, it aimed to develop a method to identify and manage depression in elderly patients who present to the ED at St Vincent’s  Health.  It also explored the feasibility of a management protocol that included informing patients’ GPs of their patients’ depressive symptoms, and linking these patients and their carers with primary and community care resources, and into existing programs at St Vincent’s Health.

The study examined whether such a program would improve health outcomes and reduce ED presentations for the elderly.

ED patients aged 65 years and over were screened for depression, using the short-form Geriatric Depression Scale (GDS).  Those who screened positive were included in the study, and referred to usual hospital care (control) or the outreach community care program.

Semi-structured interviews conducted six weeks and three months after recruitment assessed the participants’ depressive mood, social supports, social functioning and quality of life.

Key findings

Of the 771 ED patients who met the age criteria, 65 were ineligible because they were non-English speaking, had psychiatric histories, had cognitive or other impairments or did not have GPs.  Among 706 patients who received initial screening, 66 showed some evidence of depressive symptoms.  Of the 66, 15 (22 per cent) screened positive on the GDS, and eight of these 15 agreed to participate in the study.

Among the elderly who screened positive for depression, improving leisure activities, social activity and community support were considered important in improving quality of life.

Participants indicated that health professionals should be educated about “ageist” attitudes and the assumption that depression is a “natural” consequence of ageing.

Implications for policy, practice and further research

Informing GPs about their patients’ depression, and having health or allied health professionals help patients access social supports and services, could reduce depression in elderly people.

A four-question screening assessment could be included in the general assessment tools of health professionals working in the integrated-care programs that have been included in emergency departments across Victoria.  The telephone follow-up to support the patient in accessing community resources is an important element in the outreach program.

It is suggested that an integrated process of care – screening, information, medical and allied health/nursing response and supported links to the GPs with community-service follow-up – be tested in a controlled trial as an intervention that may reduce depression in the elderly.

The project highlighted the difficulty of recruiting and introducing services to elderly people with depression who present in emergency departments.

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