Mental Health and Mental Illness: Interventions to Reduce Depression Among Older Adults Home-Based Depression Care Management

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends depression care management at home for older adults with depression on the basis of strong evidence of effectiveness in improving short-term depression outcomes.

The CPSTF has related findings for the following interventions to reduce depression among older adults:

Clinic-based depression care management (recommended)
Community-based exercise interventions (insufficient evidence)

Intervention

Home-based depression care management involves:

Active screening for depression
Measurement-based outcomes
Trained depression care managers
Case management
Patient education, and a
Supervising psychiatrist

An older adult is defined as 60 years of age or older, and depression outcomes include response rates (50% reduction in depression scores), remission (no longer meeting diagnostic criteria), and changes in depression scale scores.

CPSTF Finding and Rationale Statement

Read the CPSTF finding.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 8 studies (search period 1967 – October 2005). The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and experts in research, practice, and policy from the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine.

Summary of Results

For the three studies reporting response and remission rates, there was a 27 43% response rate in depression and a 36% remission rate.

Summary of Economic Evidence

One study of a program with 19-weeks of home visits for Problem Solving Therapy, follow-up phone calls with the psychiatrist, quality control of psychotherapy by trainer, and depression management team sessions reported cost data. The total mean cost per patient for this program was $630. This data does not factor in any cost savings from the intervention, such as reductions in health care utilization.

Applicability

The evidence may be applicable to communities in the United States and elsewhere, including diverse home settings (public housing, residential facilities, home care clients) and participants ranging in age, health status, gender race/ethnicity, education level, and living alone status.