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Effectiveness of home treatment for elderly people with depression: randomised controlled trial

  • Günter Klug (a1), Gerhard Hermann (a1), Brigitte Fuchs-Nieder (a2), Manuela Panzer (a2), Andrea Haider-Stipacek (a2), Hans Georg Zapotoczky (a3) and Stefan Priebe (a4)...

Abstract

Background

There is little evidence available about what service models are effective in the treatment of elderly people with depression.

Aims

To test the effectiveness of home treatment for elderly people with depression living independently.

Method

In a randomised controlled trial, 60 out-patients aged over 64 years with major depression were allocated to a home treatment model over a 1-year period or to conventional psychiatric out-patient care. The primary outcome was the level of depressive symptoms after 3 and 12 months. The secondary outcomes were global functioning, subjective quality of life (SQOL), admissions to nursing homes, duration of psychiatric hospital treatments and the cost of care.

Results

Individuals receiving home treatment had significantly fewer symptoms of depression, better global functioning and a higher SQOL at 3 months and at 12 months. Over 1 year they had fewer admissions to nursing homes, spent less time in psychiatric in-patient care and the cost of care was lower.

Conclusions

Home treatment appears an effective and cost-effective service model for elderly people with depression.

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Copyright

Corresponding author

Günter Klug, Psychosocial Center Graz-East, Hasnerplatz 4, A-8010 Graz, Austria. Email: guenter.klug@gfsg.at

Footnotes

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*

Deceased.

Declaration of interest

None.

Footnotes

References

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Effectiveness of home treatment for elderly people with depression: randomised controlled trial

  • Günter Klug (a1), Gerhard Hermann (a1), Brigitte Fuchs-Nieder (a2), Manuela Panzer (a2), Andrea Haider-Stipacek (a2), Hans Georg Zapotoczky (a3) and Stefan Priebe (a4)...
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eLetters

Home Treatment for elderly people with depression

MOHINDER KAPOOR, Specialty Registrar (ST5) Old Age Psychiatry
26 January 2011

The editorial by Klug et al1 has highlighted an important role played by home based treatment team in managing elderly depressed people. This is in accordance with previous study conducted by Burns et al2 which looked at a controlled trial of home-based acute psychiatric services. Themost important finding in this study was the effect on treatment patterns (and hence costs) of adopting the experimental approach. With no increase in outpatient contacts, experimental teams used less inpatient hospital care than the control teams. They admitted fewer patients, for less time, with fewer repeat admissions. The (arithmetic) mean bed usage of the experimental group was half that of the control group. When we look at thefindings of Klug et al study it states that “over a 1 year period they hadfewer admissions to nursing homes, spent less time in psychiatric in-patient care”. They do not mention anything about fewer admissions in psychiatric hospitals and have not provided any data in relation to this. However, under the implications they claim that Geriatric home treatment appears effective in preventing admissions to nursing homes and psychiatric hospitals. I am not sure about this claim and also it would have been helpful if they would have provided more information in relationto repeat admissions. It is quite possible that although participants in the intervention group (19.6) spent fewer days in psychiatric in-patient care as compared to control group (52.2), the number of admissions/ readmissions might have been higher in the intervention group. There is another issue in relation to the mathematical data about the observed meandifference between times spent by participants in psychiatric in-patient care. The difference should be 52.2-19.6 = 32.60. In the paper the value of 17.6 is mentioned. This can be either a printing error or if the value of 17.6 and 52.2 are correct, then it means days spent by participants in the intervention group should read 34.60 and not 19.60.

I am pleased that authors have acknowledged several limitations of their study. They have stated that interviewers were not masked to the allocation of the individuals, which might have influenced observer ratings. In relation to this I would like to state that the potential for observation bias in ascertainment of outcome can exist in an intervention study. Knowledge of a participant’s treatment status might, consciously ornot, influence the identification or reporting of relevant events. The likelihood of such bias is directly related to the subjectivity of the outcomes under study3. In this study subjective quality of life (SQOL) wasassessed. One way to deal with this is to keep the study participants and / or the investigators blinded so far as possible to the identity of the interventions until data collection has been completed3. I am also aware of the fact that while the effectiveness of blindness as a means to minimise bias is well recognised, it is not always possible to achieve. I think it would have not been possible to incorporate blinding of the participants but two trained interviewers, who conducted all assessments, could have been blinded to allocation of the individuals.

Declaration of interest: None

References:

1.Klug G, Hermann G, Fuchs-Nieder B, Panzer M, Haider-Stipacek A, Zapotoczky HG (deceased), Priebe S. Effectiveness of home treatment for elderly people with depression: randomised controlled trial. Br J Psychiatry 2010; 197: 463-467

2. Burns T, Raftery J, et al. A controlled trial of home - based acute psychiatric services. II: Treatment patterns and costs. Br J Psychiatry 1993; 163: 55-61

3. Hennekens CH, Burning JE et al. Epidemiology in Medicine. Little,Brown and Company Boston/Toronto, 1987
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Conflict of interest: None Declared

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