Year of Publication

2015

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Peggy El-Mallakh

Clinical Mentor

Dr. Martha Bruce

Committee Member

Dr. Jan Findlay

Abstract

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This review prompted the development and implementation of a depressive disorder protocol implemented in a HH agency. The second manuscript describes the results of a process evaluation, which examined HH clinician fidelity of the protocol. Trained HH clinicians did administer the PHQ-9 according to protocol and seemed more comfortable recording higher depression scores. However, trained clinicians did not refer to a mental health nurse more frequently. Important ways in which the Doctor of Nursing Practice (DNP) prepared clinician can improve care in this area are identified. The report concludes with a policy position statement and recommendations for policy change to improve depression care for older HH patients at various stakeholder levels. Programs that integrate depression care with chronic illness management make good use of HH agency resources and can be operationally and financially feasible.