Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

AIMS: Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. METHODS: We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. RESULTS: The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95$3849; 95% CI 2520-5177 or a 176% increase) and the moderate group (US$1843; 95$691; 95% CI 444-939), then gradually fell to negative between scores of 12 (US$- 35; 95$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). CONCLUSIONS: The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services

Multilevel impacts of the Wofoo Asian Award for advancing family well-being: A multimethod qualitative study applying a socio-ecological model

Awards are ubiquitous but unique. Individual and organizational impacts of an award have been extensively discussed in the fields of business, manufacturing, education, and social work; little effort has been devoted to understanding the multilevel impacts of an award. This article seeks to propose an adapted socio-ecological model for the award program based on the Wofoo Asian Award for Advancing family well-being (3A Project), using a multimethod qualitative research design. Findings suggest that a multilevel perspective should be adopted in evaluating an award program; the 3A Project exhibited positive impacts at four levels. At the professional level, the 3A Project acted as a platform for multidisciplinary collaboration and knowledge transfer. At the organizational level, it encompassed six major impacts: being vision-driven, being growth-anchored, being leadership-sharing, being platform-sustaining, being knowledge-depositing, and being ecology-optimizing. At the community level, it cultivated positive values and beliefs about family well-being. At the regional and international level, it set a role model for promoting family well-being and achieved a special consultative status granted by the United Nations. The multilevel impacts made visible by the 3A Project provided insight into a social-ecological model of an award program that may help social workers and organizations strive for recognition