FORT MYERS, FLA. — Home visits and follow-up telephone calls improved elderly depression in a program that used existing community services for seniors in Seattle, according to a presentation at the annual meeting of the Academy of Psychosomatic Medicine.
Rates of depression are higher in older adults who are socially isolated, have comorbid conditions, or are homebound. About one-fifth to one-sixth of elderly individuals in the United States have clinically significant depression. They are more likely to have minor depression or dysthymia, compared with their younger counterparts.
A 12-month, randomized, controlled trial showed the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) effectively improved depression among older adults at higher risk, specifically those who are physically impaired, socially isolated, and/or of lower socioeconomic status.
“It is home based, so in a way it is a systematized, stylized way to do house calls, but a postmodern version done by social workers, not doctors,” Paul Ciechanowski, M.D., explained.
“It's amazing how much extra information you get by observing and visiting patients in their own homes,” said Dr. Ciechanowski of the University of Washington, Seattle. The university runs PEARLS in collaboration with Senior Services Seattle/King County, Aging and Disability Services, and Public Health Seattle King County. The study was funded by the Centers for Disease Control and Prevention.
There were 138 participants, 99 referred from agencies and 39 who were self-referred. About half were diagnosed with dysthymia, the other half with minor depression. The mean age was 73 years, 79% were female, and the majority had a mean annual income of less than $10,000. At baseline, 35% were taking antidepressants. People were excluded if they had major depression or another psychiatric disorder, substance abuse, or a cognitive disorder.
After randomization, there were 66 patients in a routine care group and 72 in an intervention group. Routine care included referral and communication between the patient's primary care physician, the community agency social worker, and University of Washington researchers.
The intervention included a mean of 6.6 1-hour problem-solving treatment (PST) sessions in the home over 19 weeks. PST is effective, nonpsychiatric, and consistent with other modern self-management strategies in medical disease, Dr. Ciechanowski said. “We define and break down problems, establish realistic goals, and take small, incremental steps. They begin to feel empowered.”
The intervention also included one or more of the following: problem-solving counseling sessions, social activation, physical activity, and/or prescription of antidepressants.
If there was not a 50% improvement in depression scores, it was a red flag. The PEARLS staff would then consult with the patient's primary care physician about initiation or adjustment of medication. “I ended up calling 52 people, mostly providers, about drug therapy and other patient factors,” Dr. Ciechanowski said.