Annals of Long Term Care

Training Nursing Staff to Recognize Depression in Home Healthcare
Ellen L. Brown, EdD, RN, Patrick J. Raue, PhD, Bernard A. Roos, MD, Thomas Sheeran, PhD, ME, and Martha L. Bruce, PhD, MPH

OBJECTIVES: To describe the implementation and acceptability of the TRaining In the Assessment of Depression (TRIAD) intervention, which has been tested in a randomized trial. The primary aim of TRIAD is to improve the ability of homecare nurses to detect depression in medically ill, older adult homecare patients.

DESIGN: Description of the important components of TRIAD, its implementation, and evaluation results from nurse surveys.

SETTING: Three certified home healthcare agencies in Westchester County, New York.

PARTICIPANTS: Thirty-six homecare nurses.

INTERVENTION: Participants randomly assigned to TRIAD (n=17) were provided with the opportunity to observe and practice patient interviewing. The approach focused on clinically meaningful identification of the two “gateway” symptoms of depression and is consistent with the newly revised Medicare mandatory Outcome and Assessment Information Set (OASIS-C). Control group participants (n=19) received no training beyond that which agencies may have provided routinely.

MEASUREMENTS: Baseline and 1-year nurse confidence in depression detection, and postintervention acceptability ratings of the TRIAD intervention.

RESULTS: Participants randomized to the TRIAD intervention reported a statistically significant increase in confidence in assessing for depression mood (P<.001), whereas the usual care group's confidence remained unchanged (P=.34) 1 year later.

CONCLUSION: An educational program designed to improve depression detection by giving nurses the skills and confidence to integrate depression assessment into the context of routine care can be successfully implemented with homecare agency support. The authors discuss the intervention in terms of OASIS-C and the “real world” realities of intervention implementation. J Am Geriatr Soc 2010;58(1):122-128.

Potentially Inappropriate Medications and Functional Decline in Elderly Hospitalized Patients
Andrea Corsonello, MD, Claudio Pedone, MD, Fabrizia Lattanzio, MD, Maria Lucchetti, ScD, Sabrina Garasto, ScD, Massimo Di Muzio, ScD, Sergio Giunta, MD, Graziano Onder, MD, Angelo Di Iorio, MD, Stefano Volpato, MD, Francesco Corica, MD, Chiara Mussi, MD, and Raffaele Antonelli Incalzi, MD on behalf of the Pharmacosur Veillance in the Elderly Care Study Group

OBJECTIVES: To verify whether the use of potentially inappropriate medications (PIMs) is associated with loss of independence in elderly in-patients by promoting adverse drug reactions (ADRs).

DESIGN: Prospective observational study.

PARTICIPANTS: Five hundred six patients aged 65 and older admitted to 11 acute care medical wards.

MEASUREMENTS: In-hospital loss of one or more activities of daily living (ADLs) and three or more ADLs. PIMs were identified according to diagnosis-independent Beers criteria and ascertained by study physicians based on daily review of medical and nurse records. The relationship between risk factors and outcomes was assessed using logistic regression.

RESULTS: Overall, 104 patients (20.6%) were taking at least one PIM at the time of admission (baseline users), and 49 (9.7%) were newly prescribed at least one PIM during their hospital stay. The loss of one or more ADLs occurred in 9.6% of baseline users, 16.3% of new users, and 8.5% of nonusers (P=.21) and that of three or more ADLs in 7.7% of baseline users, 12.2% of new users, and 4.8% of nonusers (P=.10). The lack of association was confirmed after correction for potential confounders, including ADRs.