Telemedicine for Geriatric Depression

With previous studies showing high rates of depression among older homebound patients—few, if any, of whom receive adequate treatment—Rhode Island Hospital researchers, working with colleagues at other institutions (Cornell Homecare Research Project at Weill Cornell Medical College, University of Vermont Telemedicine Program, three home health agencies in NY, VT, and FL), developed a telemedicine-based depression care program for home-based care. Early findingsfrom a pilot study to look a the program, called the Depression TeleCare Protocol, were presented yesterday at the 29th Annual Meeting and Exposition of the National Association for Home Care and Hospice.

“Using telemedicine in home care to provide disease management for geriatric depression is timely for several reasons,” explained lead researcher Thomas Sheeran, PhD, ME, clinical psychologist, department of psychiatry. “The home care industry is already using telemedicine to provide chronic disease management for many medical illnesses, such as heart disease. However, guideline-based depression care often is not included in these monitoring programs. Also, research suggests that telemedicine can be successfully used to address mental health needs of the elderly in community settings…Finally, work by the Cornell Homecare Research Partnership and others has shown that community health nurses—who typically are the telehealth disease managers in home care—can identify and successfully provide this service for their elderly home care patients."

Feasibility and patient satisfaction ratings were very high, according to Sheeran, with the majority of participants reporting that they were very satisfied or satisfied with the program, became comfortable quickly with using the teleheatlh equipment, and did soe with few technical issues. Plus, most felt their care had been improved, that confidentiality was maintained, and that they would use the program again. Further, telehealth nurses reported that the protocol was easy to implement with the majority of patients, with few technical problems experienced and both care and depression outcomes improved.

"At the start of the study, 19 of these patients met full diagnostic criteria for major depression, with a mean depression severity score in the 'Markedly Severe' range,” explained Sheeran. “We were very pleased to find that at follow-up, the average depression severity scores were in the 'Mild' range, indicating significant improvement in depression severity through the use of this protocol. While these findings need to be replicated in a more rigorously controlled randomized trial, we believe these results offer great encouragement for reaching this population who can experience a better quality of life from this program."