title: Community-integrated home-based depression treatment in older adults: a randomized controlled trial.
abstract: BACKGROUND
  Older adults with social isolation, medical comorbidity, and physical impairment are more likely to be depressed but may be less able to seek appropriate care for depression compared with older adults without these characteristics.
  
  
  OBJECTIVE
  To determine the effectiveness of a home-based program of detecting and managing minor depression or dysthymia among older adults.
  
  
  METHODS
  Randomized controlled trial with recruitment through community senior service agencies in metropolitan Seattle, Wash, from January 2000 to May 2003.
  
  
  METHODS
  One hundred thirty-eight patients aged 60 years or older with minor depression (51.4%) or dysthymia (48.6%). Patients had a mean of 4.6 (SD, 2.1) chronic medical conditions; 42% of the sample belonged to a racial/ethnic minority, 72% lived alone, 58% had an annual income of less than 10 000 dollars, and 69% received a form of home assistance.
  
  
  METHODS
  Patients were randomly assigned to the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) intervention (n = 72) or usual care (n = 66). The PEARLS intervention consisted of problem-solving treatment, social and physical activation, and potential recommendations to patients' physicians regarding antidepressant medications.
  
  
  METHODS
  Assessments of depression and quality of life at 12 months compared with baseline.
  
  
  RESULTS
  At 12 months, compared with the usual care group, patients receiving the PEARLS intervention were more likely to have at least a 50% reduction in depressive symptoms (43% vs 15%; odds ratio [OR], 5.21; 95% confidence interval [CI], 2.01-13.49), to achieve complete remission from depression (36% vs 12%; OR, 4.96; 95% CI, 1.79-13.72), and to have greater health-related quality-of-life improvements in functional well-being (P =.001) and emotional well-being (P =.048).
  
  
  CONCLUSIONS
  The PEARLS program, a community-integrated, home-based treatment for depression, significantly reduced depressive symptoms and improved health status in chronically medically ill older adults with minor depression and dysthymia.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195-6560, USA. pavelcie@u.washington.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.forename: Edward
authors.initials: E
authors.lastname: Wagner
authors.forename: Karen
authors.initials: K
authors.lastname: Schmaling
authors.forename: Sheryl
authors.initials: S
authors.lastname: Schwartz
authors.forename: Barbara
authors.initials: B
authors.lastname: Williams
authors.forename: Paula
authors.initials: P
authors.lastname: Diehr
authors.forename: Jayne
authors.initials: J
authors.lastname: Kulzer
authors.forename: Shelly
authors.initials: S
authors.lastname: Gray
authors.forename: Cheza
authors.initials: C
authors.lastname: Collier
authors.forename: James
authors.initials: J
authors.lastname: LoGerfo
mesh_terms: D000368:Aged; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration; D006801:Humans; D008297:Male; D011788:Quality of Life; D014861:Washington