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Table 1 Depression Risk Management Protocol

From: Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention

Risk Factor

Management Strategy

Best Practice Guideline Recommendation

Presence of Medical Illnesses Associated with Depression, e.g., Parkinson's Disease, Dementia (all types), Cardiovascular Disease, Diabetes, Stroke, TIA + Presence of Multiple Co-morbid Health Conditions + Recent major physical illness

Assessment and management of chronic and acute illness (within last 3 months); continued medical management as per physician; education for disease self-management

[17]

Taking Depressogenic Medications

Taking inappropriate medications as per the Beer's criteria

Regular critical review of all medications, including herbals and OTC for depressogenic medications and potentially inappropriate medications using the Beer's criteria; Initiate Medication Alert to family physician for critical medication review and modification/withdrawal; Medication review by client's own pharmacist; Client education re: safe medication use, reliable means of organizing pills, medication side effects and possible interactions, inform physician/pharmacist of non-prescription medications.

[17]

[57, 58]

Limitations in activities of daily living

Referral to OT/PT or community resources for assistance with ADLs, e.g., personal care, meals on wheels, home maintenance services); Education of caregivers if required

[17]

Cognitive Impairment and/or recent change in mental functioning identified by SMMSE score: < 24/30 [81]

Initiate Dementia Alert to family physician for further assessment or discuss diagnosis and treatment; Ongoing monitoring to anticipate future needs for support; Recommend environmental adaptations; Refer to community supports; Education regarding cognitive limitations, strategies, disease process; Referral to OT/PT and family physician for treatment of perceptual disorders

[17]

[57, 58]

Delirium identified by the Confusion Assessment Method (CAM) [135]

Initiate Delirium Alert to family physician for immediate treatment

Identify potential risk factors for delirium

[17]

[57, 58]

Anxiety identified by Generalized Anxiety Disorder (GAD-7) Screener Score ≥ 5/21 [107, 108]

Provide support and information; Referral to family physician for further assessment and treatment and need for medication

Initiate problem-solving therapy; Refer to community supports

[18]

Living alone

Social isolation or withdrawal

Discussion of increased risk and possible change of living arrangement; Education regarding community resources to enhance social supports, e.g., Seniors club;; Participate in congregate dining; Refer to other community supports

[17]

[57, 58]

Excessive Alcohol Consumption (> 14 standard drinks/wk for men and > 9 standard drinks/wk for women)

Refer to community resources

[17]

Vision/hearing Impairment

Assess client for visual impairment or hearing loss; Suggest use of visual aids (glasses, magnifying glass, CNIB); Referral to audiology; Referral to CNIB

[17]

Low Income Level

Ask client if they have enough money for the things they need; able to afford necessities; Referral to Social Work or other community supports for assistance with financial matters

[17]

Low Education Level

Provide resources for literacy

[17]

Primary caregiver to a significant other with a chronic health condition

Caregiver burden/strain identified by Modified Caregiver Strain Index (CSI) Score [136]

Assess caregiver health (physical and mental), level of caregiver strain, level of social contact and supports, and physical activity;

Refer to community supports; Provide education regarding available community services and supports for caregiving

[17]

Adverse Life Event

Chronic Stress

Ask client about any recent stressful life events (e.g., separation, losses, financial crisis, relocation to LTC); Provide education regarding ways to lessen stress; Refer to community supports

[17]

Recent Bereavement (3 to 6 months)

Refer to community supports, e.g., support groups

[17]

Chronic Pain

Assess current pain levels and treatment; Refer to family physician for review of current treatment; Refer to specialized pain clinic

[17]

Avoidant or Dependent Personality Types

When asking client about previous depression history, also ask about any other psychiatric illness such as personality disorders or anxiety

[17]

Persistent Sleep Difficulties

Assess for change in sleep patterns; Educate client about sleep hygiene techniques, and non-pharmacological approaches to improve sleep; Refer client to physician for further assessment if sleep is identified as a major issue

[17]

Nutritional risk identified by Screen II Score: < 50/64 [137]

Nutrition education; Refer to Registered Dietitian

Assess need for alternative feeding methods and/or supplements; Review medications and potential for food/drug interactions

[17]

  1. ADLs indicates activities of daily living; Screen II, Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II; OT, occupational therapist; PT, physiotherapist; CNIB, Canadian National Institute for the Blind; LTC, long-term care