For sick seniors, at-home program eases depression

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For sick seniors, at-home program eases depression

Last Updated: 2004-04-06 16:00:31 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A home-based treatment program that

emphasizes problem-solving skills significantly reduces mild depression

experienced by elderly, socially isolated people coping with various

medical conditions, investigators report.

Dr. Ciechanowski, at the University of Washington School of

Medicine in Seattle, and associates created the Program to Encourage

Active, Rewarding Lives for Seniors (PEARLS) for use in low-income,

mostly homebound older adults.

Therapists for the program were drawn from participating community

agencies, the team explains in the April issue of the Journal of the

American Medical Association.

The intervention involved eight 50-minute in-home sessions scheduled

over 19 weeks, after which therapists made monthly telephone calls to

the patients.

During each session, participants selected from a list of 250 " pleasant

activities " to engage in before the next session. They were also

assisted in developing a regular physical activity program, and given

resources for group interactions.

The 138 community-dwelling individuals in the study were an average of

73 years old, and were diagnosed with minor depression as well as

several chronic medical conditions. They were randomly assigned to take

part in the PEARLS program or to a control group in which they received

their usual care.

Letters were also sent to the patients' health care providers reporting

their diagnosis of depression.

After 6 months, depression scores had improved significantly in the

PEARLS group compared with the control group, and remained significantly

better at 12 months.

According to responses on health-related quality-of-life questionnaires,

active intervention was also associated with significantly greater

improvements in functional and emotional well-being.

The authors estimate the total average cost of the PEARLS intervention

was $630 per patient.

" This is one of the first studies to show that by partnering with

community agencies, it is possible to target and effectively treat

depressed, frail, elderly adults using primarily nonpharmacological

treatments such as psychotherapy, " Ciechanowski's group concludes.

Although the PEARLS trial is " particularly intriguing, " multiple

barriers stand in the way of delivering innovative programs to older

adults, notes editorialist Dr. M. Lyness of the University of

Rochester Medical Center in New York. Obstacles include high costs and

disparities in insurance reimbursement for mental illnesses.

SOURCE: Journal of the American Medical Association, April 7, 2004

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org