Prevalence and recognition of depressive symptoms among homebound older adults with urinary incontinence

Within a group of homebound elders with urinary incontinence, the objective s of this study were to (1) examine the prevalence of depressive symptoms, (2) examine the extent to which depression had previously been recognized b y health care providers, (3) describe the type and intensity of antidepress ant treatment prescribed for subjects, and (4) identify the demographic and functional characteristics associated with depressive symptomatology. A de scriptive correlational design was used. The 15-item Geriatric Depression S cale (GDS-15) was administered to 345 homebound adults age 60 years and ove r referred to a study examining the effectiveness of behavioral therapy for urinary incontinence. Individuals were referred to the study by home care nurses from two large Medicare-approved home health agencies in a large met ropolitan county in Pennsylvania. Data were collected during in-home assess ments and by chart review. Measures included the GDS-15, structured medical history, in-home review of medications, Older Americans Research and Servi ce Center Physical and Instrumental Activities of Daily Living scales, Mini -Mental State Examination (MMSE), Clock Drawing Test, Performance-Based Toi leting Assessment, and bladder diaries. One half of the participants (n = 1 73; 50.1%) had significant depressive symptomatology, with 35.7% having sco res suggesting mild depression and 14.5% severe depression. Only 26.4% and 34.7% of those with mild and severe depressive symptoms, respectively, had a previous diagnosis of depression and only 21.7% and 34.0%, respectively, had been prescribed an antidepressant. The most commonly prescribed class o f antidepressants was tricyclic antidepressants, being taken by 9.0% (n = 3 1) of the total sample, 14 (11.4%) of those with mild symptoms and 4 (8.0%) of those with severe depressive symptomatology. A little over half (60.0%) of subjects being treated with antidepressants continued to exhibit signif icant depressive symptomatology Greater dependence in physical activities o f daily living, the need for assistance during ambulation, higher MMSE scor es, and higher levels of comorbidity were associated (P <.05) with a GDS-15 score of 5 or higher. Depression symptoms are common in homebound older ad ults with urinary incontinence, but clinical recognition and treatment are limited.