Prevalence and predictors of symptoms of depression over time among older adults receiving palliative home care services

Background/aims: Depression among older adults is difficult to identify and is often under-diagnosed and undertreated. Aim: To examine whether prevalence of depression symptoms improve or worsen over time, as well as the factors that may increase risk or protect against symptoms of depression over time among community dwelling persons receiving palliative care (PC) services. Methods: Analyses was performed using secondary data collected as part of standard practice using the interRAI Palliative Care assessment instrument. The sample included adults aged 60 years or older assessed (N= 29,934) between January and December, 2014. Change in symptoms of depression, measured using the interRAI Depression Rating Scale (DRS) over time was examined, including predictors of the development of depression. Results: At baseline, symptoms of depression were observed in 11.9% of palliative homecare clients and this increased 13.2% at follow-up. Among clients who did not exhibit any symptoms of depression at baseline, 10.5% reported a higher DRS score indicating worsened symptoms from initial to follow-up assessments, with 3.9% experiencing probable depression. Among the PC clients showing some symptoms of depression (DRS score 1-2) at baseline, 40.6% showed an improvement by follow-up, while 10.3% reported a higher DRS score indicating worsened to probable depression. PC clients reporting involvement in social activities experienced lower odds of depression symptoms of depression at follow-up suggesting a protective effect. Social connectedness showed no protective effects against symptoms of depression at follow-up for PC clients. Conclusions: It is important for care providers to assess and follow-up when persons nearing end of life exhibit symptoms of depression. Healthcare providers and policymakers should prioritize an interdisciplinary team response to address both risk and protective factors in practice and integrate a focus on depression into routine clinical care activities.

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