Treatment of depression improves physical functioning in older adults.
OBJECTIVE
To determine the effect of collaborative care management for depression on physical functioning in older adults.


METHODS
Multisite randomized clinical trial.


METHODS
Eighteen primary care clinics from eight healthcare organizations.


METHODS
One thousand eight hundred one patients aged 60 and older with major depressive disorder.


METHODS
Patients were randomized to the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) intervention (n=906) or to a control group receiving usual care (n=895). Control patients had access to all health services available as part of usual care. Intervention patients had access for 12 months to a depression clinical specialist who coordinated depression care with their primary care physician.


METHODS
The 12-item short form Physical Component Summary (PCS) score (range 0-100) and instrumental activities of daily living (IADLs) (range 0-7).


RESULTS
The mean patient age was 71.2, 65% were women, and 77% were white. At baseline, the mean PCS was 40.2, and the mean number of IADL dependencies was 0.7; 45% of participants rated their health as fair or poor. Intervention patients experienced significantly better physical functioning at 1 year than usual-care patients as measured using between-group differences on the PCS of 1.71 (95% confidence interval (CI)=0.96-2.46) and IADLs of -0.15 (95% CI=-0.29 to -0.01). Intervention patients were also less likely to rate their health as fair or poor (37.3% vs 52.4%, P<.001). Combining both study groups, patients whose depression improved were more likely to experience improvement in physical functioning.


CONCLUSIONS
The IMPACT collaborative care model for late-life depression improves physical function more than usual care.
Callahan
Christopher M
CM
Indiana University Center for Aging Research, Indianapolis, Indiana, USA. ccallaha@iupui.edu
Kroenke
Kurt
K
Counsell
Steven R
SR
Hendrie
Hugh C
HC
Perkins
Anthony J
AJ
Katon
Wayne
W
Noel
Polly Hitchcock
PH
Harpole
Linda
L
Hunkeler
Enid M
EM
Unützer
Jürgen
J
D000203:Activities of Daily Living; D000368:Aged; D003865:Major Depressive Disorder / Q000145:classification / Q000628:therapy*; D005260:Female; D005853:Geriatrics; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D012720:Severity of Illness Index