Thomas M. Richardson

Depression and Its Correlates Among Older Adults Accessing Aging Services

OBJECTIVES : To define the prevalence and correlates of depression among older adults receiving assessments by nonmedical community-based care managers at the point of entry to care and thus prior to provision of aging services. Our long-term goal is to inform development of collaborative care models for late life depression that incorporate Aging Services Providers. METHODS : Aging Services Provider Network (ASPN) clients receiving in-home assessments were administered the Structured Clinical Interview for DSM-IV-TR (SCID) module for affective disorders and measures of depression symptom severity, alcohol use, physical health, functional status, social support, stressful life events, and religiosity. Engagement in mental healthcare was documented. RESULTS : Subjects (N = 378) were primarily white (84%) and women (69%) with household incomes under

Screening Depression Aging Services Clients

1,750/month (62%). Half lived alone (48%). Their mean age was 77 years. Thirty-one percent had clinically significant depressive symptoms and 27% met criteria for a current major depressive episode, of which 61% were being treated with medication and 25% by a mental health provider. Nearly half (47%) had experienced one or more episodes of major depression during their lives. Disability, number of medical conditions, number and severity of recent stressful life events, low social support, and low religiosity were independently associated with current major depression. CONCLUSION : Depressive illness was common among this sample of ASPN clients. Because ASPN care managers have expertise in managing many of the problems correlated with depression, they may play a significant role in identifying, preventing, and collaborating in the treatment of depressive illnesses among community-dwelling older adults.

Mental distress and service utilization among help-seeking, community-dwelling older adults

OBJECTIVES To establish the psychometric characteristics of the Patient Heath Questionnaire (PHQ) (PHQ-2, -9, and their sequential administration) in older adults who use community-based, social service care management. DESIGN Comparison of screening tools with criterion standard diagnostic interview. SETTING A community-based aging services agency. PARTICIPANTS Three hundred seventy-eight adults aged 60 years or older undergoing in-home aging services care management assessments. MEASUREMENTS Subjects were administered the PHQ-9 and Structured Clinical Interview for DSM-IV-TR- fourth edition. The authors examined the sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and receiver operating characteristic (ROC) curve for the PHQ-2 and PHQ-9 separately, and for a two-stage screening process that used each in sequence (the PHQ-2/9). RESULTS Using a cut score of 3, the sensitivity of the PHQ-2 was 0.80 and the specificity was 0.78. The area under the ROC curve (AUC) for the PHQ-2 was 0.87. Using a cut score of 10, the sensitivity and specificity of the PHQ-9 were 0.82 and 0.87. The AUC was 0.91. The sensitivity and specificity of the two-stage PHQ-2/9 were 0.81 and 0.89, respectively, and the AUC was 0.91. CONCLUSIONS The greater specificity of the PHQ-9 is an advantage over the PHQ-2 in aging service settings in which false-positive tests have potentially high cost. The PHQ-2/9 performed equally well as the PHQ-9, but would be more efficient for the agency to administer. Combined with an appropriate referral system to healthcare providers, use of the PHQ-2/9 sequence by aging services personnel can efficiently assist in reducing the burden of late-life depression.

Regular Research ArticlesScreening Depression Aging Services Clients

BACKGROUND This study aimed to characterize healthcare and human services utilization among mentally distressed and non-distressed clients receiving in-home care management assessment by aging services provider network (ASPN) agencies in the U.S.A. METHODS A two-hour research interview was administered to 378 English-speaking ASPN clients aged 60+ years in Monroe County, NY. A modified Cornell Services Index measured service utilization for the 90 days prior to the ASPN assessment. Clients with clinically significant anxiety or depressive symptoms were considered distressed. RESULTS ASPN clients utilized a mean of 2.93 healthcare and 1.54 human services. The 42% of subjects who were distressed accessed more healthcare services (e.g. mental health, intensive medical services) and had more outpatient visits and days hospitalized than the non-distressed group. Contrary to expectations, distressed clients did not receive more human services. Among those who were distressed, over half had discussed their mental health with a medical professional in the past year, and half were currently taking a medication for their emotional state. A far smaller proportion had seen a mental health professional. CONCLUSIONS In the U.S.A., aging services providers serve a population with high medical illness burden and medical service utilization. Many clients also suffer from anxiety and depression, which they often have discussed with a medical professional and for which they are receiving medications. Few, however, have seen a mental health specialist preceding intake by the ASPN agency. Optimal care for this vulnerable, service intensive group would integrate primary medical and mental healthcare with delivery of community-based social services for older adults.

Corneal Decompensation in Chandler's Syndrome: A Scanning and Transmission Electron Microscopic Study

OBJECTIVES To establish the psychometric characteristics of the Patient Heath Questionnaire (PHQ) (PHQ-2, -9, and their sequential administration) in older adults who use community-based, social service care management. DESIGN Comparison of screening tools with criterion standard diagnostic interview. SETTING A community-based aging services agency. PARTICIPANTS Three hundred seventy-eight adults aged 60 years or older undergoing in-home aging services care management assessments. MEASUREMENTS Subjects were administered the PHQ-9 and Structured Clinical Interview for DSM-IV-TR- fourth edition. The authors examined the sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and receiver operating characteristic (ROC) curve for the PHQ-2 and PHQ-9 separately, and for a two-stage screening process that used each in sequence (the PHQ-2/9). RESULTS Using a cut score of 3, the sensitivity of the PHQ-2 was 0.80 and the specificity was 0.78. The area under the ROC curve (AUC) for the PHQ-2 was 0.87. Using a cut score of 10, the sensitivity and specificity of the PHQ-9 were 0.82 and 0.87. The AUC was 0.91. The sensitivity and specificity of the two-stage PHQ-2/9 were 0.81 and 0.89, respectively, and the AUC was 0.91. CONCLUSIONS The greater specificity of the PHQ-9 is an advantage over the PHQ-2 in aging service settings in which false-positive tests have potentially high cost. The PHQ-2/9 performed equally well as the PHQ-9, but would be more efficient for the agency to administer. Combined with an appropriate referral system to healthcare providers, use of the PHQ-2/9 sequence by aging services personnel can efficiently assist in reducing the burden of late-life depression.

Suicide And Death Ideation in Older Adults Obtaining Aging Services

A corneal button obtained from a 58-year-old woman with Chandlers syndrome was studied by light and electron microscopy. Clinically, the patient had mild unilateral glaucoma, slight changes in the iris, endothelial dystrophy, and corneal edema that was increasingly sensitive to intraocular pressure. Corneal pathology included loss of large numbers of endothelial cells with consequent exposure of Descemets membrane. Endothelial cells demonstrated irregular shape, partial loss of tight junctions, and increased numbers of cytoplasmic filaments. Some endothelial cells appeared metaplastic or perhaps were replaced by cells from some source other than the cornea. Proliferation of cells was not apparent. A thin layer of acellular tissue, containing long-spacing collagen and 15-nm-wide fibrils, was interposed between normal Descemets membrane and the endothelium. These observations suggest a basis for the corneal edema that distinguishes Chandlers syndrome from other forms of essential iris atrophy.

How do the phq-2, the phq-9 perform in aging services clients with cognitive impairment?

OBJECTIVES To assess the frequency and correlates of death and suicide ideation in older adults accessing aging services. DESIGN Cross-sectional. SETTING Data for this study were collected via in-home interviews. PARTICIPANTS Aging Services Network (ASN) care management clients aged 60 years and older (N = 377) were recruited for this study. MEASUREMENT The PHQ-9 and the Paykel Suicide Scale were used to assess death and suicide ideation. Correlates of death and suicide ideation were also examined. RESULTS Fourteen percent of subjects endorsed current death or suicide ideation, 27.9% of subjects endorsed death ideation in the past year, and 9.3% of subjects endorsed suicide ideation in the last year. Current death and suicide ideation were associated with greater depressive symptoms. As compared with individuals without ideation, individuals with death ideation demonstrated higher levels of depressive symptoms, more medical conditions, and lower social support. Individuals with suicide ideation demonstrated higher depressive and anxiety symptoms and less perceived social support. Finally, as compared with individuals with death ideation, individuals with suicide ideation demonstrated higher depressive and anxiety symptoms and more alcohol misuse. CONCLUSIONS Death and suicide ideation are common among ASN clients. There were both differences and similarities between correlates of death and suicide ideation. ASN providers are uniquely situated to address many of the correlates of suicide ideation identified in this study; in order to effectively manage suicide ideation in an ASN setting, however, links to primary and mental health care providers are necessary.

Anxiety and its correlates among older adults accessing aging services.

To examine the performance of the Patient Health Questionnaire‐2 (PHQ‐2) and the PHQ‐9 in detecting current major depressive episode (MDE) in aging services care management clients who screen positive for cognitive impairment (CI).

Prevalence of Depression and Cognitive Impairment in Older Adult Emergency Medical Services Patients

To assess the characteristics of anxiety in aging services network (ASN) clients.

Passive Suicide Ideation: An Indicator of Risk Among Older Adults Seeking Aging Services?

Abstract Objectives. To characterize the proportion of older adult emergency department (ED) patients with depression or cognitive impairment. To compare the prevalences of depression or cognitive impairment among ED patients arriving via emergency medical services (EMS) and those arriving via other modes. Methods. Community-dwelling older adults (age ≥60 years) presenting to an academic medical center ED were interviewed. Participants provided demographic and clinical information, and were evaluated for depression and cognitive impairment. Subjects arriving via EMS were compared with those arriving via other modes using the chi-square test, t-test, and the Wilcoxon rank sum test, where appropriate. Results. Consent was obtained from 1,342 eligible older adults; 695 (52%%) arrived via EMS. The median age for those arriving via EMS was 74 years (interquartile range 65, 82), 52%% were female, and 81%% were white. Fifteen percent of EMS patients had moderate or greater depression, as compared with 14%% of patients arriving via other modes (p == 0.52). Thirteen percent of the EMS patients had cognitive impairment, as compared with 8%% of those arriving via other modes (p < 0.01). The depressed EMS patients frequently reported a history of depression (47%%) and taking antidepressants (51%%). The cognitively impaired EMS patients infrequently reported a history of dementia (16%%) and taking medications for dementia (14%%). Conclusions. In this cohort of community-dwelling older adult ED patients, depression and cognitive impairment were common. As compared with ED patients arriving by other transport means, patients arriving via EMS had a similar prevalence of depression but an increased prevalence of cognitive impairment. Screening for depression and cognitive impairment by EMS providers may have value, but needs further investigation.