The student will complete the following items and submit a Word doc to the assignment link.

Provide a title that conveys or describes the assignment.
Literature Review – Provide the key terms used to guide the search for the evidence and provide at least five (5) summaries of research studies to support the evidence.
Critical Appraisal of Literature – Discuss the strengths and weaknesses of the evidence, what is known from the evidence and any gaps in knowledge from the research evidence.
References – Cite a minimum of five scholarly references in APA 6th ed format.

PICOT formatted Clinical Project Questions
P: In the home health setting of patients aged range 60-75 with depression symptoms.
I: Does the PHQ-2 depression screen versus the GDS-15 assist in early identification of symptom severity and monitor symptom changes for clinical depression.
C: Using GDS-15 screening tool VS PHQ-2 SCREEN
O: to improve identification of the clinical depression in the elderly by 100%.
T: in the initial office visit and over a 6 month period?

For the purpose of this paper, the relevant and credible evidence-based research studies that will support the project proposal include:








Tsoi, K. K., Chan, J. Y., Hirai, H. W., & Wong, S. Y. (2017). Comparison of diagnostic performance of Two-Question Screen and 15 depression screening instruments for older adults: systematic review and meta-analysis. The British Journal of Psychiatry, 210(4), 255-260.

The study has compared the diagnostic performance of GDS-15 and PHQ-2 as screening instruments among older adults. The study is a meta-analysis and systematic review that aims at evaluating the diagnostic accuracy of PHQ-2 and GDS-15 while evaluating the specificity and sensitivity of the primary outcomes.

Manea, L., Gilbody, S., Hewitt, C., North, A., Plummer, F., Richardson, R., … & McMillan, D. (2016). Identifying depression with the PHQ-2: A diagnostic meta-analysis. Journal of Affective Disorders, 203, 382-395.

This study has focused on the use of PHQ-2 which is a very brief instrument to identify depression. The study is a systematic review that was carried out to evaluate the studies that had examined the diagnostic performance of PHQ-2 as a major depression detecting tool.

Balsamo, M., Cataldi, F., Carlucci, L., Padulo, C., & Fairfield, B. (2018). Assessment of late-life depression via self-report measures: a review. Clinical interventions in aging, 13, 2021.

The study has focused on psychometric performance of GDS-15 in assessing depression among cognitively intact patients over 65 years. The review includes self-report depression measures that are current and commonly being used for geropsychological practices. The study has indicated that GDS-15 is an effective instrument for rating the severity of depression and monitoring the patient progress.

Chen, I. P., Liu, S. I., Huang, H. C., Sun, F. J., Huang, C. R., Sung, M. R., & Huang, Y. P. (2016). Validation of the Patient Health Questionnaire for depression screening among the elderly patients in Taiwan. International Journal of Gerontology, 10(4), 193-197.

The study aimed to assess the validity, reliability and factor structure of the PHQ-2 for screening major depression among elderly. The study was carried among elderly in Taiwan. The results indicated that PHQ-2 is reliable and valid to screen depression among the elderly and is a better alternative to GDS-15 scale. The screening accuracy of PHQ-2 was acceptable since it demonstrated good specificity and sensitivity.

Durmaz, B., Soysal, P., Ellidokuz, H., & Isik, A. T. (2018). Validity and reliability of geriatric depression scale-15 (short form) in Turkish older adults. Northern clinics of Istanbul, 5(3), 216.

The study aimed at assessing the reliability and validity of GDS-15 among Turkish older adults. The results of the study have indicated that GDS-15 is a beneficial scale in evaluating depression among older adults. GDS-15 is brief, time-effective, and simple with an optimal balance of specific and sensitivity in determining patients with major depression.

Critical Appraisal of Literature
Critical appraisal of the literature is considered as the process of evaluating reliability, validity, and applicability as it links to the PICOT question. Supporting evidence from multiple evidence-based research articles has supported screening for major depression among older adults. Evidence from the results indicates that screening for depression should rely on highly specific screening tools such as GDS-15 and PHQ-2 rather than using clinical judgment to determine depressive symptoms among the elderly. GDS-15 has been considered reliable and valid tools for screening the elderly for major depression in homecare health settings. According to (Tsoi et al.,2017) the psychometric performance of both GDS-15 along with the relative brevity and ease of use has made more reliable and attractive in screening for depression among older adults. The supporting evidence from the literature has indicated that GDS-15 is essential in detecting major depression as well as monitoring the symptom changes.
Develop an EBP Standard
Evidence-based practice involves the integration of the most effective research evidence with patient values and clinical expertise. The EBP will involve the formulation of the question in order to recognize a problem and assess the need for change. The PICOT question in this case will be utilized to formulate a researchable clinical question with an evidence-based practice framework. The next step will be to gather evidence from both external and internal evidence. The external evidence will be gathered from scientific literature the internal evidence will be gathered from patients through a randomized control trial to determine the effectiveness of the intervention. The third step will be to critically analyze the gathered evidence. Ideally, analysis of the evidence will be conducted to determine the reliability and validity of GDS-15 and PHQ-2 in facilitating early identification of clinical depression as well as managing symptoms among the elderly. The fourth step is to develop the intervention plan which entails designing the most effective screening tool for the homecare settings to help in identifying clinical depression and managing symptoms among the elderly. The fifth step is to implement and assess the intervention plan. This will include evaluating the outcomes of the project and analyze how the process of identifying depression among the elderly in the homecare settings has improved. The last step is to integrate and maintain the intervention through shared recommendations among stakeholders to integrate the intervention plan into the homecare settings standard of practice.
EBP is an intervention with strong scientific proof that offers positive outcomes for varying disease disorders. EBP for the elderly with depression are essential since they can improve function and health as well as lower symptoms of major depression. The Evidence-based intervention plan will be completed in a homecare setting through a randomized selection of subjects to evaluate the effectiveness in improved identification of major depression among the elderly.
The outcome of the project is expected to offer intervention for depression screening among the elderly within home healthcare settings. The current method is utilized for the identification of major depression among the patients is clinical judgment. Therefore, the project aims to establish which of the two, PHQ-9 and GDS-15 is accurate and reliable identifying depression among the elderly. A potential randomized trial will offer meaningful evidence about the feasibility and effectiveness of PHQ-9 and GDS-15 screening tools in identifying clinical depression and managing symptoms among the elderly. Therefore, the research-based evidence is expected to offer improved interventions for routine screening protocol to assist in early identification of symptom severity and monitor symptoms changes for clinical depression.

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