picot question depression in the elderly

In the home health setting of patients age range between 60-75 years old with depression symptoms does the PHQ-2 depression screen versus the GDS-15 assist in early identification of symptom severity and monitor symptoms changes for clinical depression by 100% of patients over a period of 6 months?

Question:
P: In the home health setting of patients age range 60-75 with depression symptoms.

I: Does the PHQ-2 depression screen versus the GDS-15 assist in early identification of symptom severity and monitor symptom changes for clinical depression.

C: Using GDS screening tool VS PHQ-2 SCREEN

O: to improve identification of the clinical depression in the elderly by 100%.

T: in the initial office visit and over a 6 month period?

Provide a title that conveys or describes the assignment.

Introduction – Provide an introduction to your topic or project. The introduction gives the reader an accurate, concrete understanding what the project will cover and what can be gained from implementation of this project.

Overview of the Problem – Provide a synopsis of the problem and some indication of why the problem is worth exploring or what contribution the proposed project is apt to make to practice.

References – Cite references using APA 7th ed. Manual.

ANSWER

Picot Question Depression in the Elderly

Introduction

Major depression has been prevailing among the elderly receiving care in home healthcare settings. This has been described by functional deficiency, pain, as well as medical illness. Clinical depression has been persistent among the elderly population and has been linked to poor outcomes such as healthcare costs, injuries due to falls, high morbidity rates, high risk of hospitalization, and increased mortality rates (Gellis, 2010). However, despite the increased need for healthcare in the elderly patients within home healthcare settings, there have been great barriers within the homecare health settings that have contributed to poor identification and management of depression. These include under-treatment and under-detection.

The main aim of this evidence-based practice intervention project is to examine whether PHQ-2 and GDS-15 can assist in early identification of symptom severity and monitor symptom changes for clinical depression. These are depression screening tools that will be used to identify the depression symptom severity as well as monitor symptom change for clinical depression. The intervention project will illustrate through evidence-based research how the identification of clinical depression in the elderly will be improved by 100% from the initial visit to the office over a period of 6 months.

The intervention plan will target the homecare health setting and liaison with the physicians and patients to direct the identification and monitoring of clinical depression symptoms through the screening tools. Considerably, successful application needs an intervention which suits the standard practice of the homecare health setting which means strategic implementation is required to increase the success of the intervention plans. The interest of this project on homecare health settings has been linked to the epidemiological evidence which has indicated high rates of major depression among the elderly due to under-treatment and late detection. Therefore, the outcome of the project is expected to improve the identification of clinical depression among elderly patients within home healthcare settings by 100%.

Overview of the Problem.

Depression has been one of the leading contributors to the overall burden of diseases in the world. Considerably, depression among the elderly has gone more than personal suffering to increased risk of disability, mortality, and social isolation. Depressed elderly people are less likely to display affective symptoms and display cognitive changes, loss of interest, and somatic symptoms (Groh and Dumlao, 2016). Risk factors that have resulted in elderly depression are likely to consist of neurobiological changes cognitive diathesis and stressful events. Due to its devastating consequences, major depression among adults has been a significant public health concern. Depression has existed with a continuation of severity from low to mid to long-term severe symptoms that have a great impact on the quality of life of the individual (Groh and Dumlao, 2016). Considerably, when the symptoms have reached the chronic end, they become severe and require special management. Severe depressive symptoms result in clinical depression.

Over the years, antidepressants and structured psychotherapy have been combined to improve the treatment and monitoring of depression among old adults. However, the healthcare systems have created barriers to the identification of depression among the elderly within home healthcare settings. For instance, the healthcare workers in the home healthcare settings cannot recognize the depression while the primary caregivers have inadequately treated depression leading to relapse (Gellis, 2010). Ideally, improving the assessment of depression is the only first essential step in quality depression management for elderly depressed homecare patients. Effectiveness assessment of depression demands early detection to facilitate the management of the depression. Older adults in homecare health settings experiencing psychiatric disorders have rarely sought care from the mental health specialists since they are attended by the general physician.

The main challenge in identifying major depression among the elderly is that their conditions are rarely identified through normal clinical judgments. This is because they are less likely to present a complex combination of neurological, medical, and psychological symptoms that lead to recognizing and treating depressive symptoms (Groh and Dumlao, 2016). Therefore, it has been noted that there are under-diagnosis and under-treat of depressive symptoms among the elderly. Without management and proper treatment, the severity and frequency of depressive symptoms and episodes may increase over time. While left untreated, major depression may result in high morbidity and mortality rates.

The home workers offer medical services to old adults within home healthcare settings. However, depressive symptoms have been higher in home healthcare settings as compared to primary care settings. Despite the high prevalence in home healthcare settings, it is evident that old adults with depressive symptoms are less likely to receive treatment and management of their depressive disorders since it is less diagnosed. For instance, most home healthcare workers fail to recognize depressive symptoms. This means that the elderly home healthcare patients are at a greater risk of negative outcomes of low rates of depression management.

The key challenge within healthcare settings is the high frequency of major depression among the elderly as well as the recognition of major depression. Therefore, interventions to diagnose, identity, and management of depression are required. Screening for depression among the elderly has been considered as one of the effective mechanisms for adequate follow-up, diagnosis, and treatment (Ell et al., 2007). Since the home healthcare workers offer medical services to the adults at their homes, they will be in a good position to assess and identify the need for depression care and management through the screening for depression.

The evidence-based practice intervention project is aimed at improving the identification of clinical depression among old adults by 100% through the use of PHQ-2 and GDS-15. The depression screening tools are aimed at lowering the barriers of depression identification and management of symptoms within home healthcare settings. Considerably, the opportunity for monitoring symptoms and early identification will reduce the expenses associated with external mental health therapists. Therefore, the Evidence-based practice will determine the validity, reliability, and sensitivity of PHQ-2 and GDS-15 for major depression identification and monitoring of symptoms among the elderly in home healthcare settings.

It is important to intervene in the problem of depression identification among the elderly since their depressive symptoms are less likely identified through normal clinical judgment. Poor identification and management of depressive symptoms has led to high morbidity and mortality among the elderly (Ell et al., 2007). Therefore, there is a need for an intervention plan that will improve the identification and monitoring of depressive symptoms among the elderly.

The purpose of the evidence-based practice is to examine the reliability of PHQ-2 and GDS-15 in the early identification and monitoring of clinical depression symptoms among the elderly in-home healthcare settings. Considerably, health practitioners that are familiar with the utilization of screening tools improve their diagnosis accuracy, offer more consistent patient care, save time, and monitor the complex behavioral and emotional responses of the therapy. Clinical depression is a more severe form of depression that can greatly interfere with an individual’s ability to function and can affect anyone of any socioeconomic status, gender, or age if it fails to be identified early.

References

Ell, K., Unützer, J., Aranda, M., Gibbs, N. E., Lee, P. J., & Xie, B. (2007). Managing depression in home health care: a randomized clinical trial. Home health care services quarterly, 26(3), 81-104.

Gellis, Z. D. (2010). Depression screening in medically ill homecare elderly. Best practices in mental health, 6(1), 1.

Groh, C. J., & Dumlao, M. S. (2016). Depression in Home-Based Care: The Role of the Home Health Nurse. Home Healthcare Now, 34(7), 360-368.