Skype:  A Solution for Elderly Depression?

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Depression in people age 65 + is a major public health concern. Nearly 6 million elderly Americans suffer from depressive symptoms, yet only 10% receive the care they need (NIMH). Treating depression in this age group is difficult, because identifying it is complex, and as a demographic, the elderly endure more medical illnesses and disabilities, and typically take more medications. These co-existing factors may make it impossible to recognize depressive disorders. Regrettably, depression and its symptoms significantly influence these patients’ risks and recovery.

The presence of depression in elderly individuals elevates the risk factors for many medical problems. The risk of suicide significantly increases for white males, age 80 to 84, which is twice the rate of the general population. Elderly people with depression are twice as likely to develop heart disease, and with it, the threat of heart attack and death increase. Depression also diminishes overall recovery. Its existence in elderly patients increases their chances of death from other illnesses.

Risk factors for Major Depressive Disorder:

• Medication use
• Damage to body from other illnesses (stroke, cancer, amputation, etc.)
• Fear of death
• Social isolation
• Former suicide attempt(s)
• Severe or chronic pain
• Personal or familial history of depression
• Recent loss of a loved one
• Substance abuse
• Dementia
• Chronic high blood pressure (lack of blood flow to brain)

Beyond the difficulty of recognition and increased risk factors, many complications exist in the treatment of elderly patients with depression. While evidence promotes the advantages of exercise for people with depression, unfit and frail patients may not be able to benefit from this as a treatment. Medications such as antidepressants, have shown promise; however, these medications typically take longer to affect elderly patients, particularly because their sensitivities limit their dosing. Additionally, the probability of complications from other medications is higher in this population. Because some drugs, like amitriptyline and imipramin help with insomnia (another symptom and risk factor for depression in the elderly), they may cause sedation or an abrupt drop in blood pressure. Falls may lead to fractures, and combined with depression, a person may never recuperate.

Skype for Seniors Stuck At Home?

For homebound seniors, in-home care and telemedicine have demonstrated promising results. Telemedicine is the transferring of information and services from healthcare providers to a patient at a different location. Tools include two-way radios, e-mail, smart phones, and other wireless devices. A recent report published in JAMA Internal Medicine highlights the benefits of Medicare home health care’s integration of depression treatment during routine care.

The Weill Cornell Medical College (Department of Psychiatry) implemented the Depression Care for Patients at Home (Depression CAREPATH) trial during patients’ regular in-home visits. The researchers assigned 178 specially trained nurses from 6 home health agencies. The nurses served 306 Medicare Home Health patients with depression, and whom were reassessed at 3-, 6-, and 12-month intervals. Although the overall population did not exhibit a reduction in depressive symptoms, 208 participants, with severe depression scores, demonstrated improvements.

The authors of the study highlight that "Medicare recommends depression screening and intervention, but the clinical needs of home health care patients, the scarcity of mental health specialists and the structure and practice of home health care pose challenges to this goal.” These challenges can be met through more training and in-home programs that provide more comprehensive depression treatment. 

More Research Is Needed

Few studies and programs exist that address depression in homebound, elderly populations. Rhode Island Hospital and other organizations have recently created a pilot study that focuses on “telemedicine-based depression care protocol in home health care.” The findings are still in their infancy, but results already indicate patient and caregiver approval. The majority of patients reported to be satisfied to very satisfied and stated they would use the program again. The telemedical equipment was easy to use and few technological glitches occurred. Additionally, the telehealth nurses felt that the overall care of their patients improved and that it was easy to use the Depression TeleCare Protocol.

At follow up, 19 patients with an initial depression severity score in the 'Markedly Severe' range, received depression severity scores in the “Mild” range. The researchers see the results of this pilot study as significant in the future implementation of home healthcare for the elderly who suffer from depression. With improvements to these services, this population may be able to achieve a better quality of life, and the potential benefits for treating other illnesses may be recognized. 

- Melissa Lavery, M.S.

References

Depression in the Elderly: Symptoms, Causes, Treatments. (2014, May 11). Retrieved January 28, 2015, from http://www.webmd.com/depression/guide/depression-elderly

Lifespan. (2010, October 3). Can telemedicine improve geriatric depression?. ScienceDaily. Retrieved January 28, 2015 from www.sciencedaily.com/releases/2010/10/101003205933.htm

The JAMA Network Journals. (2014, November 10). Home health nurses integrated depression care management but limited benefit. ScienceDaily. Retrieved January 28, 2015 from www.sciencedaily.com/releases/2014/11/141110210917.htm

University of Warwick. (2013, May 2). Exercise proves to be ineffective against care home depression. ScienceDaily. Retrieved January 28, 2015 from www.sciencedaily.com/releases/2013/05/130502081747.htm

What is Telemedicine? (n.d.). Retrieved January 28, 2015, from http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.VMi8yy4s7IU