Intervention Development for Geriatric Depression in Homebound Elderly

Purpose: This K01 study tests the feasibility and acceptability of Problem Solving Therapy (PST), a psychosocial intervention model designed to decrease depressive symptoms and increase quality of life and problem solving abilities in homebound medically ill depressed elderly. We present data from a K01 pilot research program initiated to develop, refine, and test the outcomes of PST-HC that targets the mental health needs of older adults in a community-based setting.

Research Methods: The study describes a pilot, randomized clinical trial comparing the impact of PST to an enhanced Treatment as Usual (TAU) condition in a sample of medically ill homebound older adults with severe depressive symptoms. Compared with 32 older homebound participants randomized to treatment as usual condition, 30 older homebound older adults in the intervention condition received six sessions of problem-solving therapy. All analyses conducted on follow-up data involved 2 (condition) × 2 (trial: posttreatment vs. 3-month follow-up and also vs. 6-month follow-up) repeated measures MANOVAs that used the same groupings as in the pre-posttreatment analyses.

Results: Outcome data suggested significant improvements in depression symptomatology as measured by the Hamilton Depression Rating Scale and the Geriatric Depression Scale, and significantly higher problem-solving ability scores on the SPSI-R but not significantly higher quality of life scores, relative to enhanced TAU. Patients in the enhanced TAU condition did not experience any significant changes on any measure from baseline to posttreatment. The experimental group was also more satisfied with treatment as compared to the control condition.

Conclusion: The findings are consistent with other studies demonstrating significant effects in decreasing severe depressive symptoms in later life. Authors discuss results in terms of the “real-world” applications in comunity-based settings and present lessons learned from the K-Award process.