Developing an intervention for depressed, chronically medically ill elders: a model from COPD.
BACKGROUND
Geriatric depression preferentially afflicts individuals with chronic medical illnesses. Disability, hopelessness, lack of acceptance of antidepressant treatment, and limited problem-solving skills contribute to poor treatment adherence, compromised outcomes, and chronically experienced adversity.


METHODS
This paper uses depression comorbid with chronic obstructive pulmonary disease (COPD) as a model entity to develop an approach for integrating treatment components essential for improving treatment adherence and outcomes.


RESULTS
The behavioral inertia of depression and its coexisting cognitive problems reduce adherence to the sustained and complex demands of the COPD rehabilitation regimen and antidepressant treatment. An intervention identifying reasons for poor treatment adherence and offering direct instructions for addressing them can be combined with problem-solving therapy to target treatment adherence, depressive symptoms, and disability.


CONCLUSIONS
An intervention focusing on treatment adherence and problem-solving skills development may serve as the platform for administering specific treatments to address the interacting problems of depressed medically ill patients.
Alexopoulos
George S
GS
Department of Psychiatry, Weill Cornell Medical College, NY 10605, USA. gsalexop@med.cornell.edu
Raue
Patrick J
PJ
Sirey
Jo Anne
JA
Arean
Patricia A
PA
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology; D016730:Program Development; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology*; D016896:Treatment Outcome
D000928:Antidepressive Agents