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Home-Delivered Problem Adaptation Therapy (PATH) for Depressed, Cognitively Impaired, Disabled Elders: A Preliminary Study

https://doi.org/10.1097/JGP.0b013e3181d6947dGet rights and content

Objectives

This preliminary study examines the efficacy of 12-week home-delivered problem adaptation therapy (PATH) versus home-delivered supportive therapy (ST) in reducing depression and disability in 30 depressed, cognitively impaired, disabled older adults.

Design

A 12-week randomized clinical trial. Research assistants were unaware of the participants' randomization status. Assessments were conducted at baseline, 6 weeks, and 12 weeks.

Setting

Weill-Cornell Advanced Center for Interventions and Services Research.

Participants

Thirty elders with major depression, cognitive impairment, and disability were recruited through advertisement and the Home-Delivered Meals Program of the Westchester County Department of Senior Programs and Services.

Intervention

PATH is a home-delivered intervention designed to reduce depression and disability in depressed, cognitively impaired, disabled elders. PATH is based on problem-solving therapy and integrates environmental adaptation and caregiver participation. PATH is consistent with Lawton's ecologic model of adaptive functioning in aging.

Measurements

Depression and disability were measured with Hamilton Depression Rating Scale—24 items and Sheehan Disability Scale, respectively. Client Satisfaction Questionnaire was used to assess patient satisfaction with treatment.

Results

Mixed-effects model analyses revealed that PATH was more efficacious than ST in reducing depression and disability at 12 weeks. Participants in both treatment groups were satisfied with treatment.

Conclusions

This preliminary study suggests that PATH is well accepted and efficacious in depressed elders with major depression, cognitive impairment, and disability. Because this population may not adequately respond to antidepressant medication treatment, PATH may provide relief to many patients who would otherwise remain depressed and continue to suffer.

Section snippets

Participants

Elderly participants (age ≥65 years) were recruited through the Community Network Unit of Weill-Cornell Advanced Center for Interventions and Services Research (ACISR) located at a University Hospital in Westchester County, NY. Participants were community elders responding to an advertisement for geriatric depression or receiving home-delivered meals through the Home-Delivered Meals Program of the Westchester County Department of Senior Programs and Services, a collaborating agency of the

RESULTS

A total of 37 potential participants were referred to the study; 30 agreed to participate and were randomized to PATH (N = 15) or ST (N = 15) (Fig. 1). The participants were of advanced age, and most had high-school or higher education (Table 1). Participants suffered from major depression of mild to moderate severity. Their cognitive impairment ranged from mild cognitive deficits to mild dementia. The participants' executive functioning was significantly impaired as indicated by their DRS IP

CONCLUSIONS

The principal finding of this study is that home-delivered PATH is more efficacious than home-delivered ST in reducing depression and disability in elders with major depression, cognitive impairment, and disability. Moreover, the comparable rates of treatment satisfaction between PATH and ST participants suggest that these effects were not a byproduct of patient enjoyment. Although the study is preliminary and results need to be confirmed with a large sample, this finding is encouraging because

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    This work was supported by NIMH grant K23 MH074659 and P30 MH085943, National Alliance for Research on Schizophrenia and Depression (NARSAD), and MINT Health Foundation.

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