Session: Late-Life Depression in Community-Based Settings (Research that Promotes Sustainability and (re)Builds Strengths (January 15 - 18, 2009))

The incidence of depressive disorders among older adults has become a critical concern as epidemiological evidence mounts that the majority of older adults with depression remain undiagnosed and untreated across a range of health and mental health service delivery systems. Current rates of depression in medically ill older adults range from 10% to 43%. Established consequences of untreated late-life depression include higher rates of medical co-morbidity, disability, and mortality, poorer health outcomes and quality of life, and increased health care costs. The provision of mental health care to older adults poses a unique set of challenges to social work practitioners in diverse practice arenas. To inform evidence-based social work practice in aging and mental health, in this symposium, we report on four studies that address late-life depression in community settings. The first paper reports results of a survey aimed at identifying neighborhood factors associated with mental health in a random sample of 226 older adults in a naturally-occurring retirement community (NORC) in a metropolitan county. The study found that psychological distress was significantly higher in NORC residents who were younger and living alone, reported higher levels of loneliness, lower levels of mastery over their environment, worse general health, or a negative change in health over the last year. The second paper presents findings from a survey on the relationship between depressive symptoms, life regret and pride in a sample of 213 low-income older adults in urban and rural areas of a Southwestern state. Multivariate analysis showed that loss-and-grief related regrets were significantly positively, but pride in long and strong marriage was negatively associated with Geriatric Depression Scale scores. A third paper describes the results of a pilot evidence-based clinical intervention for assessing and treating depression in older adults in rural primary care clinics. This multi-site intervention, structured after Project IMPACT, used onsite geriatric depression specialists, clinical staff training, team collaboration and practice guidelines to improve depression care for rural elders. The majority of staff participants reported earlier identification of geriatric depression and improved communication with the primary care provider following the intervention. Finally, a fourth paper presents a study comparing the systems-oriented perspectives of aging services and mental health providers on geriatric mental health treatment barriers and facilitators in a suburban region. Employing concept mapping methodology, the study found aging and mental health groups ranked the severe shortage of geriatrics-trained professionals as the most important barrier to mental health treatment. This symposium underscores the conference theme by presenting applied research aimed at supporting the capacity of individuals, communities and agency-based systems to respond to the formidable challenges of treating late-life depression. The symposium addresses knowledge development in the provision of mental health care to older adults in community-based samples (e.g., naturally occurring retirement communities, low-income communities, primary care medicine, aging and mental health service systems) in distinct regions (e.g., urban, suburban, rural). The symposium will conclude with a synthesis and discussion of research implications across these community-based settings to inform evidence-based social work practice in aging and mental health.