Purpose: •Evaluate potential correlation between high depression levels and uncontrolled diabetes. •Establish medical and social needs which may be attributing to high levels of depression. •Develop prospective policy initiatives for assisting this population.
Methods: Participants in the 2008 program were required to be active recipients of Meals on Wheels services and diagnosed diabetics. In the Fall of 2007 surveys were mailed to each of the potential participants based partially on their participation in the project the previous year and identification of unmet needs by caseworkers. The project was conducted from February 2008 until August 2008. The University of North Texas Health Science Center assigned a geriatric medical social worker to conduct testing and assist with referrals in the program. Also the university provided a student from the public health program and medical school to collect clinical data during the home visits.
Results: •110 identified diabetes were evaluated for depression through home assessments. 26 clients self reported depression and an additional 10 clients were identified for high depression scoring during the evaluation. •33.3% of participants were found to have positive depression scores. This is above the 13% expected depression for community dwelling older adults. These results are between older acute care patients (24%) and nursing home dwelling older adults (43%) (7). •110 Client were provided with potential social and health services options via mail and followed up a few months later through home visit on results. •Mini Mental State Examination (MMSE) results show 20.7% (23 out of 110participants) exhibit mild to severe impairments •95% of clients are content with their living conditions.
Conclusions: This project demonstrated the positive correlation between high depression needs and high A1C level in the community based elderly population. Through this project Meals on Wheels of Tarrant County has begun to evaluate expanding their services to include Geriatric Health Care Management. Currently Tarrant County MOW assigns a caseworker to each of their clients; these services may need to be expanded to include more extensive health and social programs. As a result of this study, starting in 2010 first year TCOM student will be paired with elderly individuals for healthcare home management.