Health Care Management for the Elderly in Community Through Screening

Depression in late life has been associated with losses in functioning and quality of life, mortality, and increased health care costs. Although late life depression can be successfully treated with antidepressant medication or psychotherapy, few older adults receive adequate trials of such treatment in community in Korea. Barriers, such as loss of loved ones, medical illnesses, and social stigma associated with depression, lack of social and financial support, to effective treatment of depression can be especially problematic for older adult. Screening has been valuable in overcoming barriers to diagnosis. Over 60 year old community dwelling people will be screened for symptoms of four geriatric conditions (depression, dementia, urinary incontinence, and sleep disorder). Those who will be screened positive for each condition will be refer to clinic for diagnosis. Among them only those cases confirmed as depression by psychiatrists will be enrolled in this study. Enrolled patients will be randomly assigned to either case management or usual care conditions. The objective of the study is to test whether a system of screening, assessment, and follow-up provided by case manager improves in recognizing the target geriatric conditions (depression, dementia, urinary incontinence, and sleep disorder) and healthcare outcomes.