ABSTRACT
OBJECTIVE: To document within-client change in function and quality of life over 6 months, and determine whether social service interventions, comorbidity, depressive symptoms, social support and stress are predictors of within-patient change. METHOD: Assess homebound elderly referred for social services on depressive symptoms measured by the Geriatric Depression Scale (GDS), comorbidity with the Charlson Index, and stress and support with the Duke instrument. Function was measured by the Functional Autonomy Scale (FAS), measuring Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), mobility, communication and mental function. The SF-36 measured quality of life. RESULTS: Among 56 new homebound clients with an average age of 82, 33% had depressive symptoms at baseline (>7 on the GDS). At baseline clients were at or below 25th percentile for five of eight domains of the SF-36, and mental and physical summary scores. Further at baseline, 90% had difficulties with mobility and IADLs; 61% had ADL limitations. At 6-month follow-up overall, 26% had depressive symptoms at follow-up. Greater comorbidity was associated with more depressive symptoms at both baseline and follow-up. By 6 months, 18% had deteriorated on the FAS, while 11% improved. More clients had changes in quality of life; regarding the physical component score, 13% had important deterioration, while 63% improved. Similarly, 33% declined on the mental component while 27% improved. CONCLUSION: Among newly homebound elders, those with significant depressive symptoms are more likely to experience deterioration in function and quality of life over 6 months. However, those with more support showed significant improvement in the SF-36 mental component scale at 6 months.
Subject(s)
Frail Elderly/psychology , Health Services for the Aged/organization & administration , Homebound Persons/psychology , Social Welfare , Social Work/organization & administration , Activities of Daily Living , Aged , Aged, 80 and over , Female , Follow-Up Studies , Geriatric Assessment/methods , Humans , Male , New York City , Outcome Assessment, Health Care/methods , Psychiatric Status Rating Scales , Quality of Life , Social SupportABSTRACT
An occupational therapy program and an agency that addresses the needs of community elderly collaborated to resolve a problem of the homebound people who receive Meals-on-Wheels. Staff of the agency realized that many elders were unable to safely and comfortably reheat their delivered meals. Risk factors of malnutrition, bacterial infection, functional decline and reduced quality of life are the sequelae. To solve this complex problem, an interdisciplinary team formed to clarify the nature of the problem and implement a plan of action. The result is "The Microwave Project," designed to enhance nutrition and function of elderly people who are homebound.
