Depression is a major mental health problem among older people, affecting around 12% of people over the age of 64. Evidence shows that a combination of antidepressant medication and psychological treatments such as cognitive behavioural therapy can be effective in treating elderly people with depression. However, there has been less research into how these treatments should be delivered, and whether it is better to provide them in patients’ homes or in hospitals.
Researchers studied 60 patients with major depression, who were aged over 64 and living in Graz, a town in Austria. Half the participants received home treatment over a 12-month period. Treatment was delivered by a team consisting of one psychiatrist, two psychologists, and one social worker. The team visited each patient once or twice a week, or up to 4 times a week in crisis situations. There was also telephone support available for the patient and their carer.
The other half of the participants acted as a control group. They received conventional out-patient care, with free access to out-patient appointments with psychiatrists. They also had an initial meeting with a psychologist, where they were given information about how to access health and social services in their local area.
All the participants in the study were assessed for symptoms of depression at the start of the study, after 3 months and after 12 months. The researchers found that patients who received home treatment had significantly fewer symptoms of depression and a better quality of life at 3 months and 12 months.
In the home treatment group, one person was admitted to a nursing home during the study period. The admission was temporary and the person was discharged after 27 days. In the control group, eight people were admitted to a nursing home and seven stayed there until the end of the study. The total costs of care per participant were €8,751.44 (about £7,430) for the home treatment group and €21,031.84 (about £17,855) for the control group.
Lead researcher Dr Günter Klug said: “Home treatment was not only associated with lower depression scores and more positive clinical outcomes, but also with substantially lower costs of care. Participants in the home treatment group had fewer admissions to nursing homes and spent fewer days in psychiatric in-patient care. Because of the successful prevention of admissions to psychiatric inpatient care and nursing homes, home treatment was a very effective and cost-effective form of treatment.”
Dr Klug concluded: “The findings from our trial are very positive and encouraging. Although they need to be replicated in other settings and with larger samples, our study supports the case for investing in such services to improve patient outcomes and reduce costs.”
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Klug G, Hermann G, Fuchs-Nieder B, Panzer M, Haider-Stipacek A, Zapotoczky HG and Priebe S (2010) Effectiveness of home treatment for elderly people with depression: randomised controlled trial, British Journal of Psychiatry, 197: 463-467