M0590 Depressive Feelings Reported or Observed in Patient (Mark All That Apply.)
[black small square]1-Depressed mood
[white square] 2-Sense of failure or self reproach
[white square] 3-Hopelessness
[white square] 4-Recurrent thoughts of death
[white square] 5-Thoughts of suicide
[white square] 6-None of the above feelings observed or reported
What questions do you ask the patient when completing M0590? Are feelings of sadness, hopelessness, and recurrent thoughts of death common in the older home care patient? Will it really make a difference to our patients if these symptoms are recognized and treated? The answer is YES they are very common and YES it will make a difference!
In 1999 the Surgeon General reported that, "Depression in older adults not only causes distress and suffering but also leads to impairments in physical, mental, and social functioning" (USDHHS, 1999). In our paper appearing in the American Journal of Psychiatry (Bruce et al., 2002) we reported two startling findings about the older adult home care population. In 539 elderly (age >=65) med/surg patients newly admitted for home care services assessed with a formal research interview, we found that:
* 13.7% met criteria for a DSM-IV diagnosis of major depression.
* Only 12% of patients diagnosed with depression received adequate treatment.
Medical illness can bring on or worsen a depressive illness, and the evidence is convincing that untreated depression increases:
* poor medical outcomes,
* poor adherence to medical treatment,
* self-neglect,
* risk of suicide, and
* behavioral disturbance.
Fortunately, depression can almost always be treated with medication, psychosocial interventions, or a combination of the two. The benefits of treating depression clearly outweigh any possible risks. More good news is that item M0590 provides a feasible framework for routine screening of late-life depression.
Despite depression's high prevalence and strong negative impact on home care patients, the PPS case mix adjustment currently does not include symptoms of depression. Clearly this fiscal decision should be reconsidered in light of the morbidity and mortality associated with untreated depression.
With modest clinician training, the validity of these items can be greatly improved and routine OASIS collection can become an effective, efficient method of depression screening. As part of an ongoing National Institute of Mental Health-funded initiative, we are developing and will evaluate an educational intervention to improve recognition of late-life depression.
If you find your patient is reluctant to talk about depressive feelings try this out just to get started:
"Many times, people who need home care services go through a period of time adjusting. Some people experience this by feeling down or upset..."
Our patients and their families will be grateful that we have spent the time to find out about their emotional health and well-being.
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