The purpose of this study was to examine the prevalence of depressive feelings in older adults in the Medicare home health population and determine if reports of depressive feelings increase the length of stay compared to reports of no depressive feelings. Depressive feelings were defined according to the Outcomes Assessment and Information Set (OASIS) assessments used to collect home health data.
The study involved a quantitative analysis of the Center for Medicare and Medicaid Services (CMS) national database for all Medicare home health beneficiaries. The sample was Medicare beneficiaries age 65 years and older in the state of Texas in 2005 who received home health services and were discharged to the community Using a multivariate regression model, this study examined the impact of age, gender, ethnicity, and the presence of depressive feelings on the length of stay.
Sense of failure or self reproach, hopelessness, thoughts of death, and thoughts of suicide were found in less than one percent of the population. Although the study identified the importance of the 468 beneficiaries who reported thoughts of suicide, the decision was made to group all depressive feelings into one variable called at least one depressive feeling. Final number in sample was 118,172 beneficiaries. Depressive mood was the largest reported depressive feeling (n = 25,837; 21.9%). Beneficiaries with at least one depressive feeling were seen in 22.7% (n = 26,808) of the sample. The sample was mostly Caucasian 65.6% (n = 77,562), female 66% (n = 78,733), with a mean age of 78.19 years (SD = 7.756), and a mean length of stay of 56.75 days (SD = 48.699). Females (n = 18,820; 15.9%) reported more depressive feelings than males (n = 7,988; 6.9%). Of the 26,808 beneficiaries who reported depressive feelings, the largest ethnic group was Caucasians (n = 17,935; 66.9%) followed by Hispanics (n = 6,165; 23%) and African Americans (n = 2,708; 10.1%).
Using a multivariate regression analysis, differences between age, ethnicity, and the presence of at least one depressive feeling was significant (F = 3.774; df = 2/118,154; p = .023) when predicting the length of stay. Although Hispanics and African-Americans had longer lengths of stay compared to Caucasians regardless of reported depressive feelings, the slopes comparing groups were significant. There was a significant increase in length of stay, with Caucasians age 70 who reported depressive feelings compared to Hispanics age 70 and 85 or African-Americans age 70 and 85 who reported depressive feelings. In addition, Caucasians age 85 had higher lengths of stay when they reported depressive feelings compared to Hispanics age 85 who reported depressive feelings. Future investigation is needed to determine if Hispanics and African-Americans do not report depressive feelings. Future studies need to examine cultural and social influences or barriers that impact the reporting of depressive feelings. The barriers would expand the adversities in Ellis's (2001) framework. Although thought of suicide was represented by 0.4% (n = 468) beneficiaries in the sample, additional investigation of this specific depressive feeling is needed due to the severity of the consequences.