THE IMPACT OF HOME ASSESSMENT ON DEPRESSION IN THE ELDERLY - A CLINICAL-TRIAL

Many consider home assessment important to the evaluation and management of elderly patients with mental disorders but no controlled studies of the impact of this activity have been reported. Thus, we conducted a clinical trial to determine if home assessment was more effective than clinic assessment in eliciting useful clinical information and in reducing depression, anxiety, functional disability and social isolation among elderly depressed patients referred to an outpatient clinic. Thirty-two patients aged 65 or alder who scored 16 or more on the depression subscale of the Symptom Checklist (SCL-90) and 4 or less on the Short Portable Mental Status Questionnaire (SPMSQ) and who consented to participate were enrolled in the trial: 15 were randomly allocated to the home assessment group and 17 to the clinic assessment group. Patients in the home assessment group were evaluated at home by a psychiatrist. Cases were assessed on enrolment and 4, 8 and 12 weeks later using five measures: SPMSQ, SCL-42, Older Americans Research and Service Center Instrument (OARS, Activities of Daily Living and Social Resources Scales) and Evaluation of Change Scales (ECS). There were no significant differences between home and clinic assessment groups in useful clinical information elicited. There were significant improvements over time on the SPMSQ, SCL-42, Social Resources and ECS but there were no significant differences in improvement of any outcome measures between the groups. Thus, we failed to prove that home assessment improved the assessment or the outcome of the depressed, cognitively intact, functionally independent, moderately socially isolated elderly patients included in this study.