Agency Tests Protocol for Depression Screening and Referral for Adult Day Center Clients
From 2001 to 2002, staff at North Country Aging Services in Edina, Minn., collaborated with four adult day centers to develop and test a screening and referral protocol for depression among elderly clients.
- Project staff developed the protocol for depression screening, referral and ongoing monitoring of elderly adult day center clients.
- Of 82 clients screened, 25 tested positive for depression.
- After referral of the 25 positively diagnosed clients to their personal physicians for additional screening:
- Eight again tested as depressed and seven of these started on antidepressants.
- An additional eight of the clients changed from positive assessments for depression to negative.
The Robert Wood Johnson Foundation (RWJF) funded this project through a grant of $30,564.
Depression is one of the most common psychiatric disorders in older people, but it often goes unrecognized. When left untreated, depression in this population can lead to serious dysfunction and increased risk of premature death.
Adult day centers offer social, recreational and health activities and services in a group setting that help mentally and physically impaired adults maintain their level of functioning in order to remain in the community. Clients attend on a scheduled basis and use a variety of services, including health monitoring and medication assistance.
Four adult day centers participated in the project; although serving a population at high risk for depression, none had previously had a depression screening or referral protocol.
The grantee organization developed site-specific protocols in collaboration with the project's four adult day centers at seven sites, all in Minnesota. The centers and their sites were:
- Ebenezer Adult Day Health Services in Burnsville and Rosemount.
- Martin Luther Manor Adult Day Health Services in Richfield and Bloomington.
- Sojourn Adult Day Health Services in Spring Park.
- Wilder Adult Day Health Services in St. Paul.
For training purposes, the staff developed a 45-page manual, Screening for Depression at Adult Day Service Centers. The manual includes information on depression in older adults and antidepressant drugs as well as a depression screening tool for adults in English and Spanish. The manual also includes suggested screening protocols for adult day centers and provides a sample care plan, support group ideas and resource information.
During the project period, there were 447 clients enrolled in participating centers; 207 (46 percent) were already on antidepressants and thus were ineligible to be part of the project. Of those who were eligible, 62 percent declined involvement. Ultimately, 82 clients took part in the depression screening; the average age was 78.8 years, and women outnumbered men by more than three to one.
The participants completed an initial five-question assessment and those who scored two or more positive answers responded to a second assessment with 10 additional questions. Patients considered positive for referral for a depression evaluation by their physician scored above five on the second screening.
Project staff sent letters to all physicians (68) of participants in the project. The letter included the screening tool, a list of antidepressants and a request to screen their patients for depression at their annual medical review. State law for adult day center clients requires such annual medical reviews.
Of the 82 clients screened, 25 (30 percent) tested positive for depression at some time during the project. After referral to their personal physicians for additional screening, eight again tested as depressed and seven of these started on antidepressants. An additional eight of the clients changed from positive assessments for depression to negative. Nine other clients withdrew from the project or elected not to see their doctor for a follow-up screening.
The project director made a presentation on the project at the Age Odyssey Conference sponsored by the Minnesota Board on Aging and the Minnesota Department of Human Services Aging Initiative in August 2002, and at the Joint Conference of the National Council on the Aging and the American Society on Aging in Chicago in March 2003. Project staff distributed 73 copies of the training manual, Screening for Depression at Adult Day Service Centers, to adult day centers in Minnesota.
- Physicians, staff members and clients of the adult day centers need to be educated about depression. The project director speculates that one reason so many clients were unwilling to participate in the project was that they felt a stigma attached to depression; center staff felt that having clients diagnosed as depressed would reflect negatively on them. The centers should offer education about depression, including support groups for clients and their families. (Project Director)
- Reflecting on the high prevalence of depression among clients at adult day centers in this project (46 percent already on antidepressants and an additional 30 percent testing positive for depression), the project director suggests that the ideal depression screening would be within a client's first month of entering a center with an annual screening thereafter. (Project Director)
- The project staff found communicating with physicians and clinics so difficult that elderly clients and their family members would not be likely to pursue appointments and treatment. Even the staff, who knew how to negotiate the health care system, had to change protocol to get a response, from sending letters to doctors concerning their patients to making personal phone calls for patient appointments and again to determine doctors' diagnoses. (Project Director)
AFTER THE GRANT
According to the project director, one or two of the centers participating in the project plan to continue the protocol for depression screening and referral.
GRANT DETAILS & CONTACT INFORMATION
Developing a Protocol for Depression Screening and Referral at Adult Day Centers
North Country Aging Services (Edina, MN)
Dates: February 2001 to December 2002
Sally A. Dunn
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Dunn SA. Screening for Depression at Adult Day Service Centers. Edina, Minn.: North Country Aging Services, 2001.
Report prepared by: Susan Baird Kanaan
Reviewed by: Janet Spencer King
Reviewed by: Marian Bass
Program Officer: Constance Pechura